Comparison of post-operative pain with topical glyceryl trinitrate cream versus lateral internal anal sphincterotomy after hemorrhoidectomy

Background: hemorrhoidectomy is the surgical treatment for grade III, IV hemorrhoids. Hemorrhoidectomy is notorious for postoperative pain which may be due to spasm of the internal anal sphincter

Objective: to compare mean post-operative pain with 0.2% topical Glyceryl Trinitrate cream versus lateral internal anal sphincterotomy after hemorrhoidectomy

Methodology: Setting: general Surgery ward, Sheikh Zayed Medical College/ Hospital Rahim Yar Khan. Duration: from 4[th] February to 4[th] August, 2015

Design: randomized Controlled Trials. A total of 60 patients with hemorrhoids were included in this study. Thirty patients were in group A and subjected to Milligan-Morgan open hemorrhoidectomy followed by post-operative application of 0.2% topical Glyceryl Trinitrate [GTN] using a measuring spoon, three times a day. 30 patients were included in group B and treated with Milligan-Morgan open hemorrhoidectomy along with lateral internal sphincterotomy. All the patients were followed up to one week for post-operative pain assessment and mean post-operative pain was noted for both groups at 7th day postoperatively. This all data was recorded on an especially designed Proforma. The data was entered in SPSS version 16 and analyzed

Results: mean post-operative pain score was significantly low in group B [2.07 +/- 0.9] as compared to group A [3.17 +/- 1.1] [p=0.0005]. Conclusion: Internal sphincterotomy with open hemorrhoidectomy is an effective method to reduce posthemorrhoidectomy pain as compared to 0.2% topical Glyceryl Trinitrate [GTN] cream

Diagnostic accuracy of surgeon-performed focused assessment sonography in trauma patients with blunt abdominal injury

Background: computerized tomography [CT] Scan is the gold standard for imaging in blunt abdominal trauma. Focused Assessment Sonography in Trauma [FAST] is a quickly performed screening technique aimed to detect collections of free fluid

Objective: to determine the diagnostic accuracy of surgeon-performed Focused Assessment Sonography in patients with blunt abdominal Trauma by taking operative findings as gold standard in detecting hemoperitoneum

Methodology: this cross sectional study was conducted in Department of Emergency and Trauma, Sheikh Zayed Hospital, Rahim Yar Khan from 1[st] January to 30[th] June 2015. A total of 167 patients with blunt abdominal trauma within 24 hours were included in this study. Surgeon performed Focused Assessment Sonography in Trauma[FAST] was done in all patients with Ultrasound Machine for detection of hemoperitoneum. All the patients were undergone through exploratory laparotomy and compared the findings of FAST. All this information was entered on Proforma. Data was entered and analyzed using SPSS version 16

Results: the sensitivity, specificity, positive and Negative predictive value as well as accuracy of surgeon performed FAST in detecting hemoperitoneum were 83.8%, 92%, 90.5%, 86% and 88% respectively

Conclusion: FAST has a high accuracy. It can be included in the initial evaluation of adult patients with Blunt abdominal trauma [BAT] and it will assist in rapidly identifying the need for laparotomy

Small bowel volvulus leading to gangrene and short bowel syndrome

A young man was operated for acute abdomen. Laparotomy revealed small bowel diverticulosis with very short mesentery leading to volvulus of near total small bowel. Resection and end to end anastomosis was performed. Patient ended up with short bowel syndrome

Surgical complications of abortions at periphery

Objectives: To study the patients presented with catastrophic abdominal misadventure due to abortion performed by untrained birth attendants to get rid of unwanted fetus by un-indicated procedures in unfavorable circumstances

Design: Observational case series

Place and Duration of Study: Surgical Unit I, Sh. Zayed Hospital, Rahim Yar Khan from July, 2001 to August, 2004

Patients and Methods: Forty patients from different age groups presented with this killer problem. Majority was concealing it. They were resuscitated, operated and managed postoperatively

Results: These patients presented late, suffered financial loss, morbidity and significant mortality

Conclusion: Unplanned abortions are catastrophic. Education of masses in regard to birth control is mandatory

Cutaneous metastasis in gastric cancer

This is a case report of newly born twins. The live twins were with two separate heads and a symmetrical body, conjoined in a sagittal plane. Their thorax and abdomen were broader then singleton normal. Spines were separate in cervical regions but gradually approached each other and completely fused at sacrum. Single perineum had an imperforate anus

Short bowel syndrome: an update review article

With the advent of anesthesia and better operative facilities, many patients suffering from dangerous gut diseases that were not likely to survive in near past are saved now. Non availability of parenteral nutrition was another factor in their early mortality. The advent of parenteral nutrition and its better availability has prolonged the misery of this killer disease. On the other hand development of rh-GH, IGF-I, short bowel lengthening, short bowel transplantation and better immunosuppressants have a ray of hope for the better survival of these patients. Some of the patients are saved and enjoying independent life, a lot are handicap of parenteral nutrition while majority is prey to this killer disease. Yet it is challenging era for the whole universe of medicine