experience with mesh versus darn repair in inguinal hernias

Background and Objective: The inguinal hernia accounts for 50 percent in old age males. A Lichtenstein type of operation has now become the method of choice in most developed countries but in the developing world traditional simple suture repair is still in common practice in resource limited hospitals due to the scarcity and expensive nature of the commercial prosthetic mesh. Our objective was to compare the rates of complications in Lichtenstein repair to tension free Darn repair

Methods: Ninety two male patients from 20-60 years of age reported for direct or indirect inguinal hernia with open Mesh/Lichtenstein or darn repair in emergency or electively from January 2014 to December 2015 were enrolled in this prospective randomized control trial [RCT]. The primary end point was to compare the surgical site infection, length of hospital stay and hernia recurrence with different techniques

Results: The hospital stay was higher in patients who had Lichtenstein repair, Superficial surgical site infections in cohort A [6.5%] and cohort B [4.36%] were noted. Complications of recurrence in Group-A were [1.5%] as compared to Group-B which had a recurrence of 6.52%

Conclusion: Lichtenstein is more promising in comparison to Darn repair in terms of recurrence in inguinal hernia

Assessment of outcome of reverse sural fasciocutaneous flap for coverage of soft tissue defect of distal limb

Background: Distal limb soft tissue injuries are problematic defects of distal limb

Objective: To assess the success rate of reverse sural fascio-cutaneous flap for the coverage of soft tissue defect of distal limb

Methodology: This cross sectional study was conducted at Department of Plastic surgery, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1[st] May to 31[st] December, 2016. Total 40 patients having defects of soft tissues involving lower 3rd of leg were selected for this study. Reverse sural fasciocutaneous flap was designed on posterior aspect of affected leg based upon septocutaneous perforator vessels and placed over defect, anchored with vicryl 4/0 and half buried mattress suture. Success of flap survival was assessed after 4 months

Results: Age range in our study was from 5-60 years and mean age was 34+/- 17 years. Success [in term of flap survival] of treatment was noted among 36 [90%] patients. Male patients were 30 [75%] and female patients were 10 [25%]. Cause of defect was road traffic accidents in 24 [60%] cases, followed by wheel spoke injury in 9 [22%] and gun shot in 7 [18%] patients

Conclusion: This study found that perforator based sural flap has high success rate and may be used as a first line therapy for the coverage of defects of soft tissues of distal limb

Pattern of maxilofacial trauma in patients reporting at Liaquat University Hospital Hyderabad

Objective: The aim of present study was to evaluate the pattern of maxillofacial trauma in patients reporting at Liaquat University Hospital Hyderabad

Study Design: Observational / descriptive / cross sectional study

Place and Duration of Study: This study was conducted at the Oral and Maxillofacial Surgery Outpatient Department of Liaquat University Hospital from 01-01-2014 to 31-12-2015

Materials and Methods: This study was to analyze the age, gender and site of facial fracture of patients due to road traffic accidents, assault, falls, gunshot and sports injuries. Data relating to 136 patients was collected. The diagnosis of the maxillofacial trauma was done on the basis of history, clinical features and appropriate radiographs. All the relevant information was recorded on proforma

Results: Most prevalent age of trauma was 21-30 years teenagers, male 104 [76%] outnumbered the female 32 [24%] with ratio of 4:1. The most common fractured bone of midface was zygomatic bone n=52 [38.3%] and the most common region of mandibular fracture was parasymphysis n=34[25.0%]

Conclusion: Trauma is a main cause of fracture of facial bones especially in the young male population of Pakistan. Zygomatic bone fracture and parasymphseal regions are most common fracture site

Efficacy and safety of transepithelial collagen cross linking for progressive keratoconus

Objective: To evaluate the efficacy and safety of transepithelial [TE] collagen cross-linking [CXL] in patients with progressive keratoconus [KC]

Methods:This Quasi Experimental Study was conducted at PNS Shifa Naval Hospital, Karachi from June 2015 to June 2016. Sixty eyes of 32 patients who underwent TE CXL for progressive KC from June 2015 to June 2016 were analysed to ascertain efficacy and safety of TE CXL procedure. Statistical analysis of the data was done using SPSS version 17.0

Results:Twenty eight [87.5%] patients underwent TE CXL bilaterally, while 4 [12.5%] underwent unilateral CXL. Mean change in astigmatism, Maximum simulated Keratometry value [Kmax], Spherical equivalent [SE] and Central Corneal Thickness [CCT] were -0.67+/-0.35D, 1.28+/-0.64D, -0.58+/-0.17D and 0.40+/-7.58micro m respectively, from baseline. Mean gain in lines on Snellen's visual acuity chart was 1.13+/-0.83 lines. Changes in astigmatism, Kmax and SE were statistically significant [p<0.001], while change in CCT was not statistically significant. The procedure had excellent safety profile, with no major complication till 6 months follow up period

Conclusion:TE CXL is a safe and effective procedure with statistically significant reduction in corneal astigmatism, Kmax and SE with reasonable gain in Snellen's visual acuity

Frontalis brow suspension for congenital ptosis using silicon dacrocystorhinostomy tube with three months follow up

Primary congenital ptosis usually presents at the time of birth and is due to poor development of levator muscles.The frontalis brow suspension technique is being used for patients with severe congenital ptosis and a levator function of 4 mm or less. Oculoplastic surgeons have been using different artificial materials not only to avoid an accessory wound and bleeding, but also to shorten the surgical time. Several artificial materials [e.g., nylon suture, silicone rods] have been used for congenital ptosis surgery. In this case report we have used silicon dacrocystorhinostomy [DCR] tube for frontalis brow suspension. This synthetic tube is readily available as well as cost effective with promising results post operatively for congenital ptosis correction with Frontalis Brow Suspension Technique

Comparison of intraocular pressure measurement by goldmann applanation tonometry and pneumotonometry in healthy subjects and patients with primary open angle glaucoma

Objective:To evaluate the role of non-contact Pneumo-tonometry [PT] by comparing intraocular pressure [IOP] measurements with Goldmann Applanation Tonometry [GAT] and PT in healthy subjects, and patients with Primary Open Angle Glaucoma [POAG]

Materials and Methods: This prospective comparative study was conducted at PNS Shifa Naval Hospital, Karachi from January 2016 to June 2016. A total of 360 eyes of 180 patients were included, and IOP measurement was done using GAT and PT methods. The difference in readings between the two methods was calculated and analysed using SPSS version 17

Results: A total of 360 eyes were analysed. 90 healthy subjects [180 eyes] and 90 patients with diagnosed POAG [180 eyes] were included. Mean IOP measured in all eyes using GAT and PT was 16.32 +/- 5.31 mm of Hg and 18.16 +/- 6.76 mm of Hg respectively. Mean difference in IOP was 2.31 +/- 1.89 mmHg between two methods, with 278 [77.22%] eyes showing higher IOP reading than those measured using GAT. The difference of readings between two methods was statistically significant. The patients with POAG were divided into three groups. Group 1 had IOP less than 15 mm Hg, Group 2 had IOP between 15-25 mm Hg and Group 3 had IOP greater than 25 mm Hg. Mean difference in IOP between two methods was 1.38 +/- 1.85, 2.29 +/- 2.72 and 3.05 +/- 2.68 mm Hg in Group 1,2 and 3 respectively. The mean difference of IOP measurement using GAT and PT in these groups was statistically significant [P<0.001]

Conclusion: IOP measurement using PT overestimates the recorded IOP as compared to GAT, and the difference is more pronounced in eyes with higher than normal IOP

Ophthalmic injuries in orbito-zygomatic fractures

To assess the frequency and severity of ophthalmic injuries in patients with orbito-zygomatic fractures. A case series. Oral and Maxillofacial Department, KEMU/Mayo Hospital Lahore, from January 2009 to December 2011. Patients with orbito-zygomatic fractures were divided into three groups. Group-1 patients had fracture of floor/medial wall of the orbit [orbital-blow out fracture]. Group-2 had comminuted orbito-zygomatic fractures. Group-3 had simple zygomatic bone fractures. Frequency and types of ocular injuries were determined on each group. There were 296 [260 male, 36 female] patients with mean age of 31.7 years. Group-1 [n = 20] had 28 ocular findings in 12 [60%] patients including diplopia [n = 10, 36%], enophthalmos [n = 6, 14%], and hyphema, vitreous hemorrhage, retinal hemorrhage, choroidal rupture, traumatic mydriasis, and commotio retinae in 2 cases, 7% each. In Group-2 [n = 106], 44 ocular findings were identified in 30 [28%] patients including diplopia [n = 10, 23%], enophthalmos [n = 4, 9%], commotio retinae [n = 10, 23%], reduced visual acuity [n = 6, 14%], retinal hemorrhage [n = 4, 9%] and corneal laceration, corneal abrasion, retinal detachment, traumatic mydriasis, and canthal laceration in 2 cases, 4.5%. In Group-3 [n = 170], 22 ocular findings were seen in 16 [9%] patients included diplopia [n = 10, 45%], enophthalmos [n = 4, 18%], and retinal tear, hyphema, angle recession, and traumatic mydriasis in 2 cases, [9%] each. Ophthalmic injuries are a common complication of orbitozygomatic fractures occurring in about 20% of patients in this study, most frequent in the orbital blow fractures subgroup. Ophthalmology consultation is recommended for patients presenting with midface fractures

Prevention of alveolar osteitis in surgical removal of lower third molar

The purpose of this study was to evaluate and compare the efficacy of chlorhexidine [CHX] and amoxicillin plus clavulanic acid combination with control and Chlorhexidine CHX rinse alone for prevention of alveolar ostitis following the extraction of mandibular third molar. This clinical double blind randomized control trial was carried out in the Department of Oral and Maxillofacial Surgery at Liaquat University Hospital, Hyderabad for a period of two years from February 2008 to December 2009. A total of 214 patients were included in the study using non- probability purposive sampling technique. Informed consent was taken for participation in study and all treatment options, risks, benefits and complications were discussed before any intervention. The study was approved by university ethical review committee. All the patients were randomly divided into three groups by using random number table. After written informed consent extraction of 3[rd] mandibular molar was performed. Group 1 rinsed with 15 ml of 0.2% Chlorhexidine solution for 30 seconds twice daily for seven days. Group 2 patients in addition to 0.2% Chlorhexidine solution were prescribed Augmentin [amoxicillin trihydrate 500 mg plus, clavulanic acid [125 mg]] twice daily for 7 days. The patients of Group 3 used normal saline solution [0.09% NaCl]. Patients were scheduled on third and seventh day postoperatively for postoperative follow-up and were evaluated for the presence or absence of alveolar osteitis. The diagnosis of alveolar osteitis was made on the basis of collaborative clinical and subjective findings. The results of this study showed significant reduction in the incidence of alveolar osteitis in patients who received 0.2% CHX rinse in combination with oral amoxicillin and clavulanic acid

Crown fractures: frequency and associated causative factors among school children in district Khairpur-Sindh

In dentistry, crown fracture [CF] is a constant source of concern, hence in order to recommend suitable preventive measures it is essential to recognize its etiological factors beside its frequency and characteristics. The purpose of this study is to identify causative factors and treatment needs of Crown Fracture among school going children. This study was conducted from October 2010 to December 2010 to record the cause of dental trauma in relation to age and gender of school going children in rural areas of Sind province. The population in this study was 9-18 years old attending primary and higher secondary school students studying in 9 public and 4 private schools in district Khairpur. Crown Fracture ranging from normal crown to fractured crown involving pulp was observed. Root fracture was not recorded as no radiographs were taken, trauma reasons were asked and treatment taken or not was recorded. SPSS version 16 was used to analyze the available qualitative variables for results. Chi square test was used for testing the statistical differences between cause of crown fractures in relation to gender and age. Most common cause of coronal trauma was recorded as fall followed by road traffic accident, assault and sports related injury 51.3%, 15.7%, 13.1% and 6.5% respectively. Risk factors of CF almost identical as cited in dental literature by majority of authors

comparative study of gap and interpositional arthroplasty with temporalis myofacial flap for TMJ ankylosis treatment

The objects of this study were to evaluate the effectiveness of gap and interpositional arthroplasty with temporalis myofascial flap in the treatment of the temporomandibular joint [TMJ] ankylosis. This descriptive case series study consisted of twenty five patients. It was carried out at Oral and Maxillofacial Surgical Department, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh from January 2010 to December 2012. Orthopantomogram [OPG] and 3-D Scan was the standard radiograph and was taken in every case. Nineteen had unilateral and six bilateral TMJ ankylosis. Most patients were in 2nd decade of life age group [16]; followed by 3rd decade [05] and 1st decade of life [04]. 18 were female and 7 were male; Major etiological factor was fall [21] followed by forceps delivery [03] and ear infection [01]. Inter-incisal distance [IID]/mouth opening were noted preoperatively, immediately after completion of operation that was 35mm and postoperatively at follow-up. The incidence of TMJ ankylosis varies from country to country and closely related to the social and financial issues of the patients. TMJ ankylosis is challenging problem for the patient, as for the surgeon. Over the years many modifications were made in TMJ surgery for better results and Gap arthoplasty with temporalis myofascial flap as the interpositional graft is one of common treatment modality which is done at our center

Risk factors in spreading odontogenic infection

Spreading odontogenic infection is the extension of infection from its original site and can create potential life threatening situations. There are several risk factor reported for spreading odontogenic infection in literature including systemic health, virulence of organism and anatomical site. Apart from these factors odentogenic infection also observed in normal individuals. The objective of this study is to identify Risk factors in spreading odontogenic infection. Descriptive Case Series Study. This study was conducted in Department of Oral and Maxillofacial Surgery, Institute of Dentistry, LUMHS from January 2011 to February 2012. A descriptive case series study on 60 patients of spreading odontogenic infection was conducted. Male female ratio was 2.3:1, 2[nd] and 3[rd] decade was common presentation. The most frequent clinical findings were pain, swelling, trimus. The Buccal space was the most frequent location for a single space infection [53.3%], followed by Submandibular space [35%], Canine space [5%]. Three patients presented with multi space involvement [6.6%]. The most common involved tooth was mandibular third molar 26 [43.3%].The most common cause of the infection was periapical infection followed by pericronitis. 83.3% patient were healthy patients with no co morbid, only 16.7% patients were with co morbid like DM, hypertension and pregnancy. There was also no difference for mean WBC count. This study shows that lower molars were the most common involved teeth and buccal space was frequent space to be involved. The site of infection is important risk factors. We observed Odentognic infection in common in healthy individual than non-healthy individuals

In vitro comparison of the apical microleakage of mineral trioxide aggregate [MTA] with amalgam as a retrograde filling material

The objective of this study was to compare apical microleakage of MTA with Amalgam following retrograde root filling. Experimental study. This study was conducted at the Department of Operative Dentistry, Fatima Jinnah Dental College and Hospital, Karachi March 2006-March 2007. One hundred twenty extracted human single rooted teeth were randomly assigned into four groups of 30 teeth each. The root canal filling carried out and retropreparations were cut in each root using round bur to a depth of 2-3 mm. Cavity varnish applied prior to retrofillings. Group I retrofilled with amalgam. In group II MTA was used, Group III served as negative control and group IV as a positive control. Roots were suspended in 2% methylene blue and placed into incubator at 37°C for 7 days. Teeth were split and chosen halve evaluated using a dissecting microscope at 10[x] magnification. The roots were evaluated and scored as either acceptable or unacceptable. The results showed that MTA displayed significantly less dye leakage than Amalgam. 24 samples [83%] out of 29 samples of MTA scored as acceptable, where as 4 specimens [16%] out of 28 samples of Amalgam showed acceptable score. MTA was found to be superior to Amalgam in providing apical seal when used as a root-end filling material. Favorable results were obtained with MTA in leakage study and it was concluded that MTA provided a better apical seal than Amalgam

Freeway space measurement by Willis gauge and sprung divider

To compare the accuracy of Willis gauge and Sprung divider in determination of freeway space in dentate subjects. Cross-sectional comparative study. This study was carried out at Department of Prosthodontics, Lahore Medical and Dental College, Lahore from March 2010 to August 2010. Three hundred dentate subjects were included in this study. Both Willis gauge and Sprung divider methods were performed on same subject to measure the freeway space. Subjects were seated in comfortable upright position with unsupported head. Freeway space was measured by both Willis gauge and Sprung divider. The difference between the two measurements of rest position and maximum intercuspation was taken as freeway space. The collected data was entered in proforma. SPSS version 17 was used to analyze the data. Mean and SD was taken for age and gender. The measurement of both methods were compared through chi square test p value < 0.05 was considered significant. Out of 300 subjects, freeway space was achieved 217 [72.33%] with Willis Gauge and in 247 [82.33%] subjects freeway space was achieved with Sprung Divider. Although the achievement rate was slightly high with Sprig Divider as compare to Willis gauge method but it was non-significant [p-value = 0.078]. Sprung Divider measurement of freeway space is somewhat superior to Willis gauge

guide for bucco-lingual position of posterior teeth arrangement in complete dentures

To see the relationship between intercondylar distance and the maxillary and mandibular intermolar distances in dental students. Cross-sectional comparative study. This study was conducted at Institute of Dentistry, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad, from August 2009 to January 2010. One hundred fully dentate BDS students with age ranging from 21 to 25 years, free from facial and dental deformities were examined. Upper and lower arch impressions were taken using stock trays. Dental cast were made using dental stone type IV. Vernier Caliper was used to measure the linear distances between mesiobuccal cusp tips of the maxillary and mandibular 1[st] molars on the cast. Intercondylar distance was measured using arbitrary face bow [Hanau-H2] at rest position. Fork was attached to the teeth with silicone impression material. Hing axis marks were made 13 mm anterior to the upper border on the tragus canthus lines on both sides of the face. The mark was confirmed by placing the middle fingers of both hands over the marks and students were advised to open and close the jaw by 20 mm, the tactile sensation of rotating condyle confirmed the hinge axis location. The face bow was assembled by inserting the fork intraorally and placing the condylar rods over the hinge axis marks. Thereafter, face bow is removed from the face without changing the position of condylar rods and the distance between the two condylar rods was measured in millimeters with the help of Vernier Caliper. Every distance was measured three times to ensure the accuracy and mean taken. The statistically significant result of this study proved that the highest correlation was found between the intercondylar distance and Maxillary Intermolar Distance [r = 0.261, p = 0.009], while the lowest correlation was found between Intercondylar Distance and Mandibular Intermolar Distance [r = 0.202, P=0.04]. The observed relationship between the intercondylar and Maxillary Intermolar Distance could prove a useful guide for the buccolingual position of aritificial posterior teeth in edentulous patients

assessment of maxillofacial gunshot injuries and emergency management

Firearm injuries constitute a major challenging problem in maxillofacial surgery, causing major deformities of human body, and financial Burden to our society. Violent crimes are the major cause. Unemployed youth and socioeconomic deprivations are factors which contribute towards violence. There are few important steps in management of head and neck gunshot injuries, obtaining an airway, control hemorrhage, recognizing additional injuries and finally definitive repair facial deformities. The objective of this study was to report the causes, and patterns of maxillofacial gunshot injuries. A retrospective assessment of patients treated for gunshot injuries at Mayo hospital Lahore from May 2007 to July 2009 and February 2010 to January 2011 at Liaquat University Hospital Hyderabad was conducted, and data was collected with special emphasis on the patient's demographics, mode of injury, initial airway management, and bone injuries The sample consisted of 120 patients. [78.3%] males, in third and fourth decade of age were the most common group, violent crime [62.5%] was the predominant cause, and mandible [58.3%] was the most common site of injury. From this Available information provided in this study, is concluded that violent crime was major cause of facial gunshot injuries. Male gender and young adults were the most commonly victimized patients

Efficacy of pre-operative injection Mitomycin-C in prevention of pterygium recurrence

To determine the recurrence rate of pterygium with four weeks preoperative injection mitomycin-C using bare sclera technique. An interventional case series. This ongoing study was started in November 2005 at eye department of combined military hospital Kharian, Pakistan. Ninety one eyes of 87 patients have been so far enrolled in the study. Cases between 20 to 50 years of age, of either sex, with primary and recurrent pterygia were included. The subjects were first given 0.1 ml injection mitomycin-C 0.15 mg/ml into the body of pterygium. Four weeks later, pterygium surgery was performed using bare-sclera technique. The subjects are being followed up for at least one year to detect any recurrence. Out of 91 cases, 16 [17.58%] cases have been followed up for 12 months, 19 [20.87%] for 9 months, 21 [23.07%] for 6 months, 17 [18.68%] for 3 months and 18 [19.78%] for less than 3 months. Recurrence has not been encountered in any of these cases so far. Initial results show that pterygium surgery with pre-operative injection mitomycin-C appears to be an effective form of treatment for prevention of pterygium recurrence. Further follow up and multi-centric studies are required for final conclusion

Choroidal metastasis from renal cell carcinoma presenting with cataract

We report a case of rare involvement of the eye with choroidal metastasis from renal cell carcinoma presenting 08 years after the primary tumor was removed. The patient initially presented with cataract most probably induced by the tumor. After cataract extraction, tumor was detected when it induced vitreous involvement and retinal detachment. Enucleation was performed and an extraocular mass was also excised. Histopathology confirmed the diagnosis of metastasis from renal cell carcinoma in the ocular tumor, extraocular mass and the vitreous

Incidence of malignancy in prostatic enlargement: a prospective study conducted at Sheikh Zayed hospital and medical college, Rahim Yar Khan

The problem of enlarged prostate due to benign prostate hypertrophy and carcinoma prostate is becoming a great concern all over the world. Prostate cancer is a serious disease because it is a malignant condition. Early detection of carcinoma prostate at curable stage so with appropriate treatment, morbidity and mortality can be reduced. This present prospective and descriptive study was carried out from January 1999 to June 2001 to find out the incidence of malignancy in patients presented with prostatic enlargement at Sheikh Zayed Hospital, Rahim Yar Khan. Most of the patients who were diagnosed on histopathological repots were between 60 to 80 years of age. Patients got relieved their symptoms of prostatism for short period of time but ultimately they went into surgery either transvesical prostatectomy or transuretheral prostatectomy and reteropubic prostatectomy. Digital rectal examination [DRE] was performed in all these patients as a preliminary examination. The normal size of adult prostate is considered as chestnut, the enlarged lobes were rounded with palpable lateral margins with median groove in all of them. Out of 12 patients 8 patients had stony hard nodular with irregular surface, margins, palpable on digital rectal examination while other 4 patients were later on diagnosed on histopathalogical report to be carcinoma prostate. So the accuracy of DRE in this study is 66%. In 8 patients who had stony hard nodular prostate rectal mucosa was fixed on it and non-tender with irregular surface and in 3 patients finger was blood stained with ill defined lateral marsin. It is concluded that incidence of malignancy in patients presented with prostate enlargement in present study is compared and equal to study conducted in various centers