Intralesional bleomycin sclerotherapy: an effective treatment of cystic hygroma in children

To study the outcome of intralesional sclerotherapy with injection Bleomycin in cystic hygroma in children. A case series. The department of Pediatric Surgery at Military Hospital, Rawalpindi, Pakistan from Jan 2011 to Dec 2012. All patients with peripheral cystic hygroma [CH] presenting to us, were enrolled in the study. The cyst was aspirated in the operation theater under sedation. Injection bleomycin 0.5 mg /kg diluted in 10-15 cc of distilled water was injected in the cyst at multiple sites. Injection was repeated after every month depending upon the response. A total of 30 patients reported to the department with superficial cystic hygroma, 12 were males [40%] and 18 were females [60%], age ranged from 15 days to 8 years. Cervico-facial was the most common site. Results were assessed in terms of excellent [complete resolution], good [> 50% reduction in size] and poor [< 50% reduction in size]. In 2 patients, complete resolution was achieved after maximum seven shots of intra-lesional bleomycin injections [IBI], while 18/30 [60%] resolved after single dose. Twenty seven patients [90%] resolved completely, 2 [6.6%] had good response, 1 [3.3%] showed poor response. Minor complications were noted which were treated by symptomatic treatment. No major side effects or recurrence were noted in maximum 2 years follow up. Intralesional bleomycin sclerotherapy is safe and effective as primary treatment in cystic hygroma

Single scrotal incision orchidopexy for palpable undescended testis

To retrospectively asses the results of single scrotal incision orchidopexy [SSIO] performed at our centre with ligation of the patent processus vaginalis in children having palpable undescended testes [UDT]. Quasi-experimental with retrospective data. Department of Paediatric surgery Military Hospital Rawalpindi, from April 2007 to December 2011. After making a single transverse incision at superior scrotal border, the testis was identified; gubernaculum and the sac were dissected to the highest level and divided. The testis was places into the scrotum and fixed to the scrotal fascia/skin. All patients were assessed at 2 weeks, 2 months and 6 months post operatively, and then yearly. A total of 38 orchidopexies were performed in 33 patients. The patients' age ranged from 14 months to 7 years [mean: 2.1 years]. Bilateral UDT were found in 5 patients [15.1%]. Operative time ranged from 20 to 45 minutes [mean: 36 minutes]. The single scrotal incision technique was successful in all 38 cases [100%]. All testes were easily fixed in the scrotum. Two patients [5.2%] developed scrotal haematoma and one patient [2.6%] developed stitch abscess. All showed good anatomical and cosmetic results up to a minimum of six months of follow-up. Single scrotal incision orchidopexy for palpable undescended testis is a simple and safe technique. It has shown to consume shorter time and give good cosmetic results

Vacuum assisted closure [VAC] therapy for difficult wound management

To show the usefulness of vacuum assisted closure [VAC] therapy for management of difficult wounds. Descriptive type of study. The study was conducted in the surgical dept of Combined Military Hospital Rawalpindi from September 2002 to February 2003. Fifty two patients were selected through non-probability convenient sampling. Age ranged from 12 years to 61 years. Out of 52 patients 22% were females while 78% were males. The commonest wound type was traumatic in 68%, diabetic ulcer in 15%, pressure ulcer in 8%, venous ulcer in 7% and radiation ulcers in 2%. The commonest location of wound was lower limb in 42%, foot in 30%, hand in 12%, abdomen in 9% and chest in 7%. Muscle and soft tissues comprised the largest group of wound bed 71%, tendon in 16%, bone in 7% and orthopedic implant in 6%. Out of 52 patients in the study 18% were smokers while 21% had diabetes mellitus. The reduction in wound size at the end of VAC therapy was 68.1%. Granulation tissue formed in 88% of wounds. Duration of VAC therapy ranged from 2 weeks to 5 weeks. The dressing changes ranged from 2 to 12 and mean was 5 dressing changes. Foam odour, pain in-growth of granulation tissue in foam and infection. Vacuum-assisted closure therapy promotes healing and the formation of healthy granulation tissue

Circumcision - a comparative study

This quasi-experimental study was conducted in department of surgery in Military Hospital Rawalpindi from September 2003 to January 2004 with the aim to compare the results of one of the most commonly performed surgical procedure, circumcision, by open and bone-cutter method in terms of complications such as trauma to glans, bleeding and infection alongwith cosmetic outcome. Total 200 patients were selected from Out Patients Department on the basis of non-probability convenient sampling. After careful history taking and physical examination, patients fulfilling the criteria were identified into two equal groups, one underwent open method circumcision and the other bone cutter circumcision. Parents were instructed to follow up in the surgical OPD after seven days for assessment and earlier in case of any complication. There was insignificant different in terms of bleeding, superficial infection, cosmetic appearance and trauma to glans [P-value > 0.05]. Both methods proved to be safe and effective techniques with reproducible results but it is important to emphasize that trauma to glans; a well known and catastrophic complication is more common with bone cutter circumcision especially in the hands of an inexperienced operator

Early complications of laparoscopic cholecystectomy for calculous cholecystitis

Gallstones are the most common cause of hospitalization and most common elective procedure being carried out in hospitals. Although laparoscopic cholecystectomy is not as popular in Pakistan as in the west, because people have misconception of its complications. Therefore the present study was conducted to assess the early complications of laparoscopic cholecystectomy for calculus cholecystitis. This study was conducted at CMH Rawalpindi from January 2003 to July 2003. A total 100 patients with calculus disease were admitted. This comprised of 88 [88%] females, 12 [12%] males, age ranges from 21 to 60 yrs with mean age of 45 yrs. Patients were assessed per-operatively and post-operatively followed at 01 week, 01 month and 03 months for complications. The overall incidence of complications was 12% with major complication seen in only 4% cases. There was no mortality in our series. It is concluded that Laparoscopic cholecystectomy is safe with less post-operative morbidity and mortality