ABSTRACT
Background: A varicocele is an abnormal dilatation of veins in the pampiniform plexus of the spermatic cord. Several methods have been used for its treatment including open surgical ligation of the spermatic vein as well as laparoscopic and microsurgical varicocelectomy
Objective: To compare laparoscopic varicocelectomy with open varicocelectomy techniques in patients of varicocele in terms of operative time, duration of hospital stay, recurrence rate and effect on semen parameters
Methodology: Study Design: Randomized clinical trial Setting: Punjab Medical College and affiliated hospitals. Duration: 27 September 2014 to 26 September 2016. A total of 129 patients of varicocele were included in the study. All patients were diagnosed clinically as having varicocele. 43 patients underwent laparoscopic varicocelectomy [group A], 43 open varicocelectomy using retroperitoneal approach [group B] and 43 underwent open inguinal approach[group C]. Outcome in terms of operative time, duration of hospital stay, recurrence rate and impact on semen parameters, was compared in three groups. The data was entered and analyzed by using SPSS version 20
Results The operative time and hospital stay in the laparoscopic group were significantly shorter than in retroperitoneal and inguinal groups [P < 0.01]. Recurrence rate was 18.6% in the open inguinal group, 16.27% in the retroperitoneal group, and 4.65% in the laparoscopic group. This lower rate of recurrence was statistically significant in the laparoscopic group [P < 0.05]. Among the three groups, comparisons between preoperative and postoperative semen parameters revealed improvements in sperm concentration and motility [P < 0.01]
Conclusion: Outcome of laparoscopic varicocelectomy is better than open varicocelectomy techniques in patients of varicocele
ABSTRACT
Background: Kala pathar is a chemical used as hair dye in the developing countries. Cases of trans dermal absorption are reported, but the main concerns are regarding its suicidal intake, as there is no specific antidote for this
Objective: To determine the frequency of acute renal failure in patients with kala pathar [paraphenylene diamine] poisoning
Methodology: This cross sectional study was carried out at Department of Medicine, Sheikh Zayed Hospital, Rahim Yar khan from the period of 1[st] January to 31[st] December 2016. The patients with age 15-50 years with history of kala pathar poisoning either by transdermal or oral ingestion [assessed by history] of any amount were included. The frequency of acute renal failure was labeled where the blood urea level was found more than 30 mg/dl and serum creatinine more than 2 mg/dl.The data was entered and analyzed by SPSS by version 21
Results: In this study there were 65 cases, out of which 47 [72.31%] were females and 18 [27.69%] males. The mean age was 24.35+/-9.8years. The mean duration of kala pathar taken before presenting to the hospital was 5.35+/-0.48 hours. Out of 65 cases 58 [89.23%] had oral intake as compared to 7 [10.77%], trans-dermal absorption. All 7 trans-dermal absorption suffered accidental exposure while out of 58 oral intakes, 54 [93%] took it for suicidal attempt. Acute renal failure was seen in 12 [18.46%] out of 65 cases. Renal failure was common in females affecting 9 [19%] out of 47 cases with p= 0.17. It was significantly higher [19%] in age group less than 30 years [ p= 0.04]. Renal failure was also significantly associated with cases that took it orally, with suicidal intent and their time to presentation to hospital was more than 4 hours with p values of 0.001, 0.02 and 0.03 respectively. There was no significant difference in terms of marital status, however, it was common in un-married with p= 0.08
Conclusion: Kala pathar poisoning is common in our population and acute renal failure is seen almost in every 5[th] cases. Young age, oral intake, suicidal intent and late reporting to hospitals were significantly associated with acute renal failure
ABSTRACT
Lymphangiomas are the benign cystic swellings, usually tend to occur in areas of major lymphatic channels, especially in cervical and axillary regions. The usual presentation is a cystic, painless mass which increases in size with age. lymphangioma of scrotal region is very rare. In our case infected lymphangioma of scrotumpresented as acute scrotum
ABSTRACT
Introduction: The aim of this study is to see the incidence of facial nerve injury in mastoid surgery for chronic suppurative Otitis media active epithelial type and how can we reduce this incidence
Methods: We operated upon 165 patients for chronic suppurative otitis media active epithelial type and saw the facial nerve palsy intraoperatively and postoperatively. A total of 165 mastoid explorations were performed out of which Modified radical mastoidectomy was done in 155 cases. Radical mastoidectomy was done in 7 patients and combined approach tympanoplasty done in 3 patients
Results: In our series, only three patients got facial weakness 24 hours postoperatively which was grade 3 according to HB [House Brackman].Complete facial nerve recovery was achieved in all three cases with conservative treatment alone. Two patients developed labyrinthine fistula which was managed conservatively. In ten patients, facial nerve was exposed in tympanic segment of the middle ear cavity
Conclusion: Mistake that most likely occurred during mastoid surgery were drilling towards the antrum and going inferiorly. Short process of incus is good landmark to avoid facial nerve injury
ABSTRACT
Objective: Objective of this study was to evaluate diagnostic accuracy of fine needle aspiration cytology in diagnosing solitary thyroid nodule keeping histopathology as gold standard
Study Design: Cross sectional study
Place and Duration of Study: Combined Military Hospital, Multan from 27 Aug 2010 to 26 Feb 2011
Material and Methods: Three hundred and forty nine patients were included in the study through non-probability convenient sampling. In outdoor visit, after taking detailed history, general physical examination was done. Patients fulfilling the inclusion criteria were admitted in ward. The procedure of FNA was explained in detail to the patient and Informed consent was taken
Results: Out of 349 patients, all underwent FNAC whereas 321 underwent surgery. FNAC showed 113/321 [35.20%] patients to have malignancy, however after surgery 109 / 321 [32.08%] patients were found to have malignancy on histopathology. Eighteen patients were diagnosed as papillary CA on FNAC all confirmed on histopathology. Follicular carcinoma was diagnosed in 35 patients on FNAC. However, only 32 were actually found to have the disease on histopathology
Conclusion: Role of FNAC is quite conclusive for the diagnosing malignancy and proposing surgery in most of cases of cold nodules due to its potential for malignancy. FNAC can be relied upon due to good sensitivity [92.56%], specificity [95.81%], Accuracy [94.49%], Positive predictive value 93.83% and Negative predictive value of 94.93%
ABSTRACT
Objectives: To determine damage of RLN with and without exposure during thyroidectomy. Study design: Randomized control study Sampling technique: Non-probability consecutive sampling. Sample size: 150 patients. Setting: Surgical units of Allied Hospital Faisalabad
Methodology: With informed consent, study was conducted on two groups[75 in each group].Patients were distributed on alternate basis into group A and group B for thyroidectomy with and without identification of RLN respectively
Results: In group A 30[40%] patients were between 31-40 Years and 18[24%] between 41-50 Years. In group B 32[42.7%] were between 31-40 Years,13[17.3%] between 41-50 Years and 15[20%] between 50-60 Years. Mean of age was 38.5 +/- 10.9[standard deviation].In group A,28[37.3%] were male and 47[62.7%] females while in group B 25[33.3%] were males and 50 [66.7%] females. In group A 38[50.7%] patients were of MNG, 10 [13.3%] diffuse goiter, 7[9.3] solitary nodules, 13 [17.3%] suspicion of malignancy and 7[9.3%] malignanacy. In group B 33[44%] patients were having MNG, 15[20%] diffuse goiter, 10[13.3%] solitary nodule, 6[8%] suspicion of malignancy and 11[14.7%] malignant disease. In group A 39[52%] patients underwent STT, 20[26.7%] NTT, 10[13.3%] TT and 6[8%] hemi-thyroidectomy. In group B 35[46.7%] patients underwent STT, 21[28%] NTT, 12[16%] TT and 7 [9.3%] hemi-thyroidectomy. In group A 3 [4%] patients developed transient paralysis and 1[1.3%] permanent paralysis of RLN. In group B 7[9.3%] patients developed transient paralysis and 3[4%] permanent paralysis of RLN
Conclusion: Preservation of RLN is more likely with exposure and identification of RLN post-operatively
ABSTRACT
Objective: to study the various causes and management of Pharyngocutaneous fistula in total laryngectomy
Material and Methods: 40 patients underwent total laryngectomy in service hospital Lahore from May 2003 to December 2014. The patients were prospectively studied regarding formation of Pharyngocutaneous fistula in the following aspects age, tumor site, and stage of disease, primary repair, infection and recurrence of tumor
Results: pharyngocutaneous fistula was diagnosed in 9 patients [22%] out of 40. Fistula developed in 2 patients [22%] on 3rd day due to rent in repair. 5 patients [55%] had fistulae due to infection on 8th day and 2 patients [23%] due to presence of residual tumor on 15th day. Pharyngocutaneous fistula is common complication which occurs after total laryngectomy. Three patients previously submitted to tracheostomy had fistula out of 5patients 6O %[ higher incidence] as compared to the 6 patients out of 35[17%] without tracheostomy. The reported incidence ofpharyngocutaneous fistula is extremely variable in literature ranging from 13% to 25% and in our series it is about 22 %
Conclusions: spontaneous closure is possible with proper wound care, good nutrition and antibiotics. 7 cases out of 9 in our series heeled with conservative treatment. Incidence of Pharyngocutaneous fistula formation is more in supraglottic, previously tracheostomised patients and also in advanced stage. In some patients surgical intervention is needed to close the fistula by flap. We used deltopectoral flapin two patients
ABSTRACT
Objective: to see the effectiveness of various treatment modalities in peritonsillar abscess
Material and Methods: 250 patients were admitted in ENT department services hospital Lahore through emergency and opd having symptoms of unilateral severe throat pain, trismus, drolling, earache, and change of voice [hot potato voice]. Patients having peritonsillitis can be differentiated from peritonsillar abscess by intraoral ultrasonography
Results: 50 Patients having peritonsillitis are treated by IV antibiotic, pain killer and IV fluids. In patients having peritonsillar abscess needdle aspiration done in 15 patients [6%] and incision and drainage done in 85 patients [34%]. In 100 patients having history of recurrent acute tonsillitis[fourto five attack per year] and sleep apnea interval tonsillectomy done
Conclusion: peritonsillitis can be mananged conservatively. Incision drainage is gold standard for peritonsillar abscess. In tonsillectomy when indicated early interval tonsillectomy is better option than delayed interval tonsillectomy
ABSTRACT
Background: Hemorrhoidectomy treatment has multiple options, depending on grade of disease
Objective: This study was conducted to compare the postoperative morbidity of rubber band ligation [RBL] and milligan morgan haemorrhoidectomy in terms of frequency of pain and bleeding in patients with third degree hemorrhoids
Material and Methods: This study was conducted in Department of Surgery, District Headquarter Hospital Faisalabad, affiliated with Punjab Medical College from 25[th] January, 2012 to 24[th] January, 2014. This study included 140 [70 in each group] patients of grade 3 hemorrhoids. Patients were randomly allocated into either the rubber band ligation [RBL] group or milligan morgan haemorrhoidectomy groups by using computer generated random number tables. Both groups were observed for the impact of these treatment modalities on post operative pain and bleeding
Results: In group A, 49 patients [70%] and in group B, 47 patients [67.2%] were male. Regarding postoperative pain, 2 patients [2.9%] of group A and 22 patients [31.4%] developed mild postoperative pain [p<0.001], 1 patient [1.4%] of group A and 31 patients [44.3%] of group B faced moderate postoperative pain [p<0.001], 1 patient [1.4%] of group A and 11 patients [15.7%] has severe postoperative pain [p=0.002]. In group A, 2 patients [2.9%] and in group B, 10 patients [14.3%] has mild postoperative bleeding, 1 patient [1.4%] in group A and 8 patients [11.4%] in group B developed severe postoperative bleeding
Conclusion: RBL is a reliable and safe procedure with minimum complications and morbidity after the procedure
ABSTRACT
Background: Tetanus is a disease with high mortality, and different treatment modalities are being tried
Objective: The objective of this study was to compare the impact of early tracheostomy on outcome in tetanus
Patients and Methods: This randomized clinical trial, was carried out in Surgical Unit-5, DHQ Hospital, Faisalabad, Pakistan from 1[st] January, 2012 to 31[st] December, 2013. Sixty patients of tetanus [grade-2] of any age and sex, diagnosed clinically were taken and divided into two groups, 30 patients in each. One group was given only medical treatment and second group was given medical and surgical treatment and both groups were observed for the impact of these treatment modalities on outcome. The data was entered and analyzed in SPSS version 17
Results: Out of 30 patients who underwent medical treatment, 10 [33.3%] were cured and 20 [66.7%] were expired. Among patients who underwent both medical and surgical treatment, 18[60%] were cured and 12 [40%] expired. 21[70%] developed tracheostomy complications and 9 [30%] did not develop any complication. [P-value < 0.05]
Conclusion: Tracheostomy in early stages of tetanus has mortality benefit and it is associated with less morbidity and mortality
ABSTRACT
<p><b>BACKGROUND</b>Drug eluting stents (DESs) made with biodegradable polymer have been developed in an attempt to improve clinical outcomes. However, the impact of biodegradable polymers on clinical events and stent thrombosis (ST) remains controversial.</p><p><b>METHODS</b>We searched Medline, the Cochrane Library and other internet sources, without language or date restrictions for articles comparing clinical outcomes between biodegradable polymer DES and durable polymer DES. Safety endpoints were ST (definite, definite/probable), mortality, and myocardial infarction (MI). Efficacy endpoints were major adverse cardiac event (MACE) and target lesion revascularization (TLR).</p><p><b>RESULTS</b>We identified 15 randomized controlled trials (n = 17 068) with a weighted mean follow-up of 20.6 months. There was no statistical difference in the incidence of definite/probable ST between durable polymer- and biodegradable polymer- DES; relative risk (RR) 0.83; 95% confidence interval (CI) 0.62-1.11; P = 0.22. Biodegradable polymer DES had similar rates of definite ST (RR 0.94, 95% CI 0.66-1.33, P = 0.72), mortality (RR 0.94, 95% CI 0.82-1.09, P = 0.43), MI (RR 1.08, 95% CI 0.92-1.26. P = 0.35), MACE (RR 0.99, 95% CI 0.91-1.09, P = 0.85), and TLR (RR, 0.94, 95% CI 0.83-1.06, P = 0.30) compared with durable polymer DES. Based on the stratified analysis of the included trials, the treatment effect on definite ST was different at different follow-up times: ≤ 1 year favoring durable polymer DES and >1 year favoring biodegradable polymer DES.</p><p><b>CONCLUSIONS</b>Biodegradable polymer DES has similar safety and efficacy for treating patients with coronary artery disease compared with durable polymer DES. Further data with longer term follow-up are warranted to confirm the potential benefits of biodegradable polymer DES.</p>
Subject(s)
Humans , Coronary Artery Disease , Drug Therapy , General Surgery , Drug-Eluting Stents , Polymers , ThrombosisABSTRACT
Splenic Lymphoma is a marginal zone lymphoma [MZL's] that is a type of Non-Hodgkin's Lymphoma. It is characterized by a lymphocytic tumor of marginal zone of spleen that may involve splenic hilar lymph nodes and may spill the abnormal BLymphocytes in the blood. A38 years old male, known HCV, presented with pain in left hypochondrium and an abdominal mass in left hypochondriac region. He was diagnosed clinically as a case of splenic hematoma which turned to be splenic lymphoma after investigations and was treated
ABSTRACT
Splenic Lymphoma is a marginal zone lymphoma [MZL's] that is a type of Non-Hodgkirf s Lymphoma. It is characterized by a lymphocytic tumor of marginal zone of spleen that may involve splenic hilar lymph nodes and may spill the abnormal B-Lymphocytes in the blood. A 3 8 years old male, known HCV, presented with pain in left hypochondrium and an abdominal mass in left hypochondriac region
He was diagnosed clinically as a case of splenic hematoma which turned to be splenic lymphoma after investigations and was treated
ABSTRACT
Background: With increasing number of motor vehicles and population, trauma patients are increasing day by day. Motorcycle accidents are one of the major causes of disabilities and deaths in young males
Objectives: To determine the pattern of orthopaedic injuries and outcome of its treatment in patients presented to Allied Hospital Faisalabad after motorcycle accidents and to provide the baseline data to policy makers and other stakeholders who want to undertake necessary measures to improve road safety in the country
Study design: Descriptive cross sectional
Setting: Accident and Emergency [A and E] and orthopaedic department of Allied Hospital Faisalabad
Duration of study: January 2012 to December 2012
Method: All patients were admitted through Accident and Emergency department. The data was collected in retrospective way and was analyzed using SPSS version 17
Results: Total 1003 patients were included in this study. 859 were male [85.6%] and 144 were female [14.4%]. The patient ages ranged from 3 to 90 years with peak frequency of 21-30 years 318 [31.7%]. Businessmen290 [28.9%], employee/public workers 224 [22.3%] and students 216 [21.5%] were the majority of victims. Collision of motorcycle with vehicles was the most common mechanism of injury 31.4% and Motorcycle riders 613 [61.1%] were the usual victims. Frequency of non-helmet use was 93.4% and of head injuries along with orthopaedic injuries were 33.1%. Most common orthopaedic injury pattern in motorcycle accidents was fracture of tibia and fibula 43.4%. Mean duration of hospitalization was 9.1days
Conclusion: Road traffic accidents constitute one of most important public health problem in our society. Disabilities and deaths in motorcycle crash are increasing day by day. Preventive programs must be launched by policy makers of concerned departments and stakeholder at national level as solely a medical approach is insufficient to save precious lives of many people
ABSTRACT
Bilateral vocal cord paralysis refers to the neurologic causes of bilateral vocal cord immobility and specifically refers to the reduced or absent function of vague nerve or its distal branch recurrent laryngeal nerve. Various etiologies for vocal cord paralysis are neck surgery [predominantly thyroid], trauma, neurological disorders and laryngeal malignancies. Bilateral immobile vocal cords due to bilateral abductor palsy leads to respiratory distress that can become life threatening ldiopathic causes are the second most common cause of child hood BVCP. Diode laser cordectomy is an alternative option to CO2 laser cordectomy
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Carpal dislocations are wrist injuries and Lunate dislocation is its severe form. Lunate and perilunate dislocations are uncommon. These injuries have significant clinical impact on the patient but are easily missed and lead to potentially devastating effect if mismanaged. This case report outlines the important clinical aspects and management of Lunate dislocation
Subject(s)
Humans , Male , Joint DislocationsABSTRACT
To document the peroperative and postoperative complications of functional endoscopic sinus surgery. 113 patients diagnosed as having sinonasal polyposis who underwent FESS at ENT unit 1 SIMS/SHLfrom September 2010 to June 2012, were registered in this study. Out of 113 patients 15 developed complications out of which only 2 had major ones. Extreme care is required in FESS because of paranasal sinuses proximity to vital structures. Complications if identified early can be managed adequately
ABSTRACT
Background: There has been a trend toward operative management of pediatric Diaphyseal Forearm Fractures [DFFx]. We studied our experience with surgical management of these injuries to assess outcome and complications
Objective: The purpose of this study was to assess outcome and complications associated with open reduction and intramedullaryKirschner-wire fixation for fracture shaft radius ulna in children
Design: Prospective study
Setting: Orthopedic surgery departments of Independent Medical College, Punjab Medical College and University Medical College Faisalabad
Study Period: Between March 2009 and February 2011
Method: The study group included 32 boys and 12 girls aged 6-15 years with unstable displaced fractures shaft radius, ulna or both. Relevant history and x-rays of the forearm were taken. We followed the inclusion and exclusion criteria. All the cases were treated with open reduction and retrograde Kirchner wire fixation. The cases were followed for at least 6 months. Patients were assessed functionally and radiologically and results were graded according to the system described by Price et al as excellent, good, fair and poor
Results: This prospective study was completed on 44 patients 32 were male and 12 were female. All fractures were united in acceptable alignment. At final assessment there were 30 [68.18%] excellent, 8 [18.18%] good, 3 [06.82%] fair and 3 [06.82%] poor results. The fair or poor clinical outcome was higher in children above 10 years of age. Delayed union after IM intramedullary fixation occurred in 3 children over 10 years of age
Conclusion: This technique can provide precise fracture reduction, maintains stabilization for fracture healing, results in minimal cosmetic deformity, cost effective and facilitates easy removal of implants after treatment
ABSTRACT
Background: Well-reduced unstable distal radius fractures have the potential to undergo late displacement and/or collapse due to musculotendinous forces. To over come this there is controversy as to which is the preferred treatment - minimally invasive like external fixation or invasive like open reduction and plating
Objective: To determine the outcome of augmented external fixation of unstable distal radius fractures
Design: Prospective study
Setting: Orthopedic surgery department of Independent Medical College, Punjab Medical College and University Medical College Faisalabad
Period: Between January 2009 and December 2010
Methods: In this case series study 46 patients with unstable distal radius fractures were followed for 1 year after operation using the technique of application of common 3.5mm AO external fixator using principle of ligamentotaxis for reduction and restoring length with addition of k-wires plus bone graft if needed. All patients were evaluated according to the sum of demerit points system [Saito, 1983]
Results: There were 20 male [43.48%] and 26 females [56.52%] with mean age 48.54+16.36. According to the sum of demerit points [Saito, 1983], the latest follow-up functional end results were 'Excellent' in 45.66%, Good in 34.78%, Fair in 10.87% and Poor in 08.69%. As for the anatomical results at follow-up, the radial shortening <2mm in 37 [70.44%], from 2- 4mm in 5 patients [10.87%] and >4mm in 4[08.69%]. The average radial tilt was 22°and palmar tilt was 6°
Conclusions: The application of common 3.5mm AO external fixator with addition of k-wires is simple, cost effective, quick, minimally invasive and prevents redisplacement of fracture fragments adequately. The risk of infection is small and there is little damage to the surrounding tissues
ABSTRACT
Background: Perforation of peptic ulcer is a life-threatening emergency and associated with marked post surgical morbidity
Objective: To enlist the predictors of the postoperative morbidity in surgically treated patients of perforated peptic ulcer
Methods: A cross sectional study was conducted at Surgical Departments of Allied and DHQ Hospital Faisalabad. Clinically and radiologically suggestive but surgically proven, 60 cases of the perforated peptic ulcer were included in the study. Possible predictors were recorded on admission as well as during surgery. Postoperatively, patients were taken care of and followed up for the development of complication till the time of discharge. Depending upon the presence/ absence of the post operative complications, patients were divided into two groups. Data was entered and analyzed by using SPSS version 11
Results: In our study, age ranged from 24-80 years. 26.7 percent of the cases had clinical features of shock at presentation. Smoking was noted in 47 percent of the cases. In 97% of the cases, the size of perforation was less than 1 cm while more than half of the cases had amount of peritoneal spillage more than 1 Litre. The most common complication was wound infection. Most of the patients were discharged home between the 7[th] and 10[th] postoperative days. Age more than 40 and male sex [p-value < 0.147] were not found to be associated with increased risk of development of the post operative complication. Complication rate was found to be quite high for the patients presenting after 72 hours of the development of the pain [p=0.006, OR=9.3]. Other factors which showed significant difference between the two groups for the development of complication included shock at presentation [p-value= 0.032], history of smoking [p-value= 0.002] and the presence of associated medical illness [p-value= 0.01]
Conclusions: Late presentation, history of smoking, presence of shock at the time of presentation and presence of the associated medical illness significantly influence the rate of development of post operative complications