Amniotic membrane in burn wounds: does vascularization from bed really occur?

To establish whether role of amniotic membrane as biological dressing is because of blood vessel growth into it. Design: Prospective study of 22 cases of indoor burn patients. Setting; Plastic, Reconstructive Surgery and Burns Unit, Dow Medical College and Civil Hospital, Karachi. Subjects: Twenty two cases of indoor burn patients were studied. In nine cases freeze dried amniotic membrane and in thirteen cases fresh amniotic membrane was applied. Main outcome measures: Histopathological examination of biopsy specimen to see capillary budding and vascular ingrowth into membrane. Result: In none of the 22 cases studied capillary budding and any blood vessel growth into the membrane was found. The role of amniotic membrane in the management of burn wound stands the test of time and failure of documentation of vascular ingrowth into it does not alter its clinical utility

Typhoid bowel perforation: Lessons learnt at shaikh zayed hospital, Lahore

This study comprises of 41 patients with typhoid perforation managed over a 4 years period at Department of Surgery, Shaikh Zayed Hospital Lahore. Peritonitis due to typhoid bowel perforation was the commonest cause observed in 33.5% cases. The disease is prevalent in rainy season commoner in males [2.1:1] and in the younger age group [mean age 27.8 years]. Twenty four% patients were resistant to chloramphenicol and presentation to the hospital after perforation was late [mean lag 3.5 days]. Quinolone derivatives have changed the management scenario in perforated typhoid enteritis. Defunctioning procedures [loop ileostomy, tube ileostomy, or end ileostomy] in patients with advanced sepsis and toxemia in typhoid enteric perforation are found safe with low morbidity [p < 0.05] and zero mortality. Inspite of late presentation, the overall mortality is low [9.7%] on account of better perioperative management of the patients

Percutaneous drainage of amoebic liver abscess

This prospective study of 12 patients of amoebic liver abscess presenting to the department of Surgery, Shaikh Zayed Hospital, Lahore, over a one year period evaluates the results of ultrasound-guided percutaneous drainage of large amoebic liver abscesses. The results indicate short hospital stay, no mortality and minimal morbidity. This procedure may be safely recommended as the preferred primary method of managing ameobic abcesses larger than 6cm in diameter

Ketamine in burn wound management

Modern day treatment of burns often involves early tangential excision of the wound, followed by autografting or coverage with biological dressings. These procedures are painful and frightening for patients. Most general anesthetic agents cause immunosuppression in already metabolically stressed patient and may cause liver damage. They also require full time attention of anesthesiologist. To counter these difficulties a short acting anaesthetic agent Ketamine, was tried in burn patients. Ketamine was given intravenously in a dose of 2mg / kg body weight. Thirty-two cases were studied and total dose of Ketamine administered ranged between 50 mg and 200 mg. Duration of the procedures ranged between 20 minutes and 50 minutes. Untoward reactions included only increased salivation, vomiting and unpleasant dreams in two cases. We conclude that Ketamine is a useful agent for minor intervention of the burn wound

Comparison of ringer lactate with low molecular weight dextran in ringer lactate [Saviosol] in early burn resuscitation: a prospective study of 10 cases

This prospective study tests one brand of low molecular weight dextran [LMWD] in ringer lactate [SAVIOSOL] against Ringer Lactate [RL] alone in burn resuscitation. Ten cases of fresh burns, split into two random groups of five cases each were studied over a period of forty-eight hours and their response to the two types of intravenous [I/V] fluid administration was observed. Average age in the RL group [Group-I] was 22.6 years and burn extent 44.6% total body surface area [TBSA]. LMWD group [Group-II] was aged 18.6 years with 41.2% TBSA burns. Sex ratio was similar in both groups. Total I/V fluid received by Group-I was 7.6 L on day one and 5.141 L on day two. Corresponding figures for Group-II were 7.02 L and 5.03 L respectively. Composition of fluids was similar except that Group-II received SAVIOSOL [mean: 1.86 L] on day one while Group-I received no colloid. Resuscitation was evaluated by clinical and laboratory observations. Statistically significant differences between groups were noted in one clinical and one laboratory parameter. Pulse rate during the last 12 hours of study [36-48 hours postadmission] at 111/minute in Group-II, as against 121/minute in Group-I, indicated full volume restoration in the former but continued hypovolemia in Group-I. Platelet count lowered much more in Group-II, suggesting platelet disaggregation and improved microcirculation. Parameters that fell short of statistical significance but were nevertheless suggestive of improved performance by LMWD group included 24-hour urine output, Base deficit and Plasma protein values. It is concluded that addition of LMWD to ringer lactate in early resuscitation of acute burns in helpful in correcting hypovolemia and improving urinary output thus reducing chances of renal shutdown

race factors in surgical scars part I: recognition of ethnicity through facial anthropometry

Many factors participate in the determination of the final appearance of a surgical scar. Of these, race has been quoted as an important factor although no controlled studies seem to be available to substantiate such a claim. Our study, conducted in Karachi, was planned in two parts: first to identify objective characters that would distinguish the two major ethnic groups of Karachi, viz. the caucasoid and the negroid and in the second phase to observe long term scar characteristics in elective surgical wounds. This paper deals with the first part of the study. Forty-eight male volunteers between the ages of 10 and 50 years were enrolled and their genealogy for three generations ascertained through interview. Skin color, hair color and hair form were recorded through inspection. Six craniofacial indices were then measured and designated, respectively, facial, orbital, intercanthal, nasal, soft tissue nose and upper lip indices. Data were integrated and submitted to statistical analysis. Age between the two groups differed significantly in the numerical but not in a practical sense. Of the observed and measured parameters there was a considerable overlap between the two groups. Skin complexion and hair color were not significantly different. Of the craniofacial indices, nasal index, relating nasal width to its length, and upper lip index, relating lip height to its width were both significantly larger in the negroid group. The remaining four indices did not differ significantly between the two groups. We conclude that it is possible to distinguish the two ethnic groups through interview, supported by observation of the hair form and measurement of nose and upper lip dimensions