Outcomes of Primary Unilateral Cheiloplasty in Same-Day Surgical Settings

BACKGROUND: Financial, clinical, and psychological considerations have made same-day surgery an attractive option for a variety of procedures. This article aimed to analyse the postoperative results of same-day primary unilateral cleft nasolabial repair. METHODS: This study was performed from 2011 to 2014. Unilateral cleft lip patients fulfilling the inclusion criteria were preoperatively classified as mild, moderate, and severe. All patients underwent same-day surgery and were discharged after satisfying the appropriate clinical criteria, receiving thorough counselling, and the establishment of a means of communication by phone. Postoperative outcomes were assessed and stratified according to preoperative severity and the type of repair. RESULTS: A total of 423 primary unilateral cleft lip patients were included. Fisher's anatomical subunit approximation technique was the most common procedure, followed by Noordhoff's technique. The postoperative outcome was good in 89.8% of cases, fair in 9.9% of cases, and poor in 0.2% of cases. The complication rate was 1.18% (n=5), and no instances of mortality were observed. The average hospital stay was 7.5 hours, leading to a cost reduction of 19% in comparison with patients who stayed overnight for observation. CONCLUSIONS: Mild unilateral cleft lip was the most common deformity for which Fisher's anatomical subunit approximation technique was performed in most of the cases, with satisfactory postoperative outcomes. Refinements in the cleft rhinoplasty techniques over the course of the study improved the results regarding cleft nasal symmetry. Single-day primary unilateral cleft cheiloplasty was found to be a cost-effective procedure that did not pose an additional risk of complications.

Comparison of conventional pyodine dressing with honey dressing for the treatment of diabetes ulcers

To compare the conventional pyodine dressing with honey dressing in terms of recovery time and outcome [healed or ended up with amputation] in diabetic foot ulcers. This quasi-experimental study was performed in surgical "C" ward, Lady Reading Hospital Peshawar from November 2007 to November 2008. All Wegner's grade I-IV, unilateral diabetic foot ulcer patients were admitted and their blood sugar profile, cardiac and renal status were investigated. Patients were assigned to group A and B with simple convenience method. After ample wound debridement group A and B were treated with daily conventional Pyodine dressing and Honey dressing respectively and their recovery time, outcome were recorded during the 10 weeks follow up period. A total of 100 patients with 50 patients in each group A and B were enrolled in the study with mean age 56 +/- 8.0 years and male to female ratio of 1.7:1. Recovery time was significantly quicker in the Group B [Honey Dressing] as compared with the group A [conventional Pyodine dressing] with a p-valve of <0.0001. Healing rate was 69% and amputation rate was 31% as a whole. Healing rate was 66% in the Group A in comparison with 72% in the group B while amputation rates were 34% and 28% in the group A and B respectively with no statistical significance with a p-value of 0.6658. Honey dressing is more effective than conventional Pyodine dressing in terms of recovery time in the treatment of diabetic foot ulcer

Recent ethical and technical issues of cadaveric human bodies and tissues for educational purposes in pakistan: initiation of a discussion for making a policy

OBJECTIVE: To initiate a discussion, for devising a standardized nationwide policy for procurement and use of Cadaveric human bodies and tissues for educational purposes and then respectful disposition of the remains

DESIGN: Cohort design

PLACE: A Public Medical College

DURATION: 2006 through 2011

METHODS: Available data was grouped into two chronological equal halves, Group-A 2006 to 2008, Group-B 2009 to 2011. The data was analyzed for age, sex, Known identity, Unknown Identity, later identified-claimed and remaining unidentified-unclaimed dead bodies. Studies related to policies for cadaveric procurement, transport, handling, utilization and disposal are presented

RESULTS: A total of 1605 records were analyzed. 54.9 % Cadavers were from 2 and 3 decade of life. The males in Group-A were 86.32% and in Group-B were 81.82%

DISCUSSION: About 41.55 % cadavers brought to Anatomy department were with Unknown Identity. But 34.93 % were later identified and claimed. Hence the police department of the region and the Anatomy Department of the institution with the help of print media are providing a great service to the society

The remaining unclaimed bodies are also utilized for dissection or in case of putrefied bodies bones were used for medical education. Even after exhaustive search no published data was available for cadavers brought to a public mortuary in Pakistan, as is presented here

CONCLUSION: Pakistan, being a developing nation, is quite vulnerable to many hazards of the increasing demands of cadavers in the medical education business. This is high time to start a discussion for making a comprehensive policy for caring and utilizing dead bodies for medical education. In this respect the anatomist, Islamic scholars and legal experts can collaborate with 'organ transplant' legislation bodies for devising policies

Treatment of acute apical abscess by single visit endodontics - 2 case reports

The purpose to publish these case reports is to show the effectiveness of single visit endodontics in teeth with acute apical abscess. Infected non-vital teeth in two patients were treated with single visit RCT along with incision and drainage of the abscess in the same appointment. Follow up of both the patients showed relief of symptoms to remarkable extent in the evening of treatment day. Radiographs showed significant periapical bone healing after 3 months in both patients

Laparoscopic versus open appendectomy: a comparison of primary outcome measures

The aim of the study was to compare laparoscopic and open appendectomy [OA] in terms of primary outcome measures. Study design: A randomized controlled trial. Place and duration of the study: Khyber Teaching Hospital, Peshawar, Pakistan, February 2008 to December 2009. A total of 160 patients were divided into two groups, A and B. Group A patients were subjected to laparoscopic appendectomy [LA], whereas Group B patients were subjected to OA. Data regarding age, gender, and primary outcome measures, such as hospital stay, operative duration, and postoperative complication, were recorded and analyzed. Percentages were calculated for categorical data, whereas numerical data were represented as mean +/- SD. Chi-square test and t test were used to compare categorical and numerical variables, respectively. Probability

Rate and risk factors for surgical site infection at a tertiary care facility in Peshawar, Pakistan

Surgical site infections [SSI] are among the most common complications in surgical patients and have serious consequences for outcomes and costs. This study aimed to determine the rates and risk factors affecting surgical site infections and their incidence at Surgical 'C' Unit, Khyber Teaching Hospital, Peshawar, Pakistan. The study was conducted to compare with rates obtained by large international multi-centre studies. A review of all general surgical interventions involving an incision, excluding anal procedures, performed between December 2008 and March 2009 [n=269] was undertaken. Various clinical parameters were recorded. Infection rates were calculated. Data were analysed using the Fisher's exact test. The overall SSI rate was 9.294%, 4.88% in clean cases [C], 8.39% in clean contaminated cases [CC], and 20.45% in contaminated or dirty cases [D]. There were significantly higher surgical site infection rates among patients with combined American Society of Anaesthesiologists scores II and III than those with ASA score I in clean contaminated [p=0.0007], and dirty cases [p=0.0212]. There were also significantly higher surgical site infection rates among patients with combined Co-morbidity Scale score 1-6 than those with no comorbid factors in clean contaminated [p=0.0002]. Surgical site infection rate was highest in gastrointestinal system surgeries. The Surgical site infections can be minimised by adopting international protocols for surveillance

Laparoscopic cholecystectomy: an audit of cases done at a tertiary care hospital

The study aims to describe the complications and hospital stay associated with laparoscopic cholecystectomy. During the period from 01 August 2007 to 31 July 2009, all patients who were operated with laparoscopic cholecystectomy were included. The age, gender and other related data including the outcome and complications in 245 laparoscopic cholecystectomy cases were recorded. The findings documented in numbers and percentages were compared and discussed with those of other studies. 194[78.79%] were females and 51[21.21%] were males. Ages of female patients ranged from 25-51 years and of males from 28-54 years. Most of the patients were discharged on the 1[st] post-operative day. There were 13 cases converted to open surgery [5.3%]. Laparoscopic cholecystectomy was successfully completed in the remaining 232 patients with an average operating time of 93.74 +/- 21.7. Twenty four patients experienced morbidity. These included infections [n=10], bleeding [n=4], biliary peritonitis [n=5], visceral injury [n=1], pneumonia [n=2] and partial small bowel tear [n=2]. No bile duct injury or mortality was seen. Laparoscopic cholecystectomy is being performed in this setting with acceptable morbidity, mortality and conversion rates. A concerted effort to increase the performance of laparoscopic cholecystectomy may increase cost effectiveness in this setting

Influence of ASA score and charlson comorbidity index on the surgical site infection rates

To compare the frequencies of surgical site infections [SSI] in ASA class-I [American Society of Anaesthesiologists-I] with ASA class II-III and CCI-0 [Charlson Co-morbidity Index-0] with CCI 1-6 in clean [C] and clean contaminated [CC] surgeries. Analytical study. This study was conducted in a General Surgical Unit of Khyber Teaching Hospital, Peshawar, from December 2008 to April 2009. A total of 310 clean and clean contaminated general surgical interventions with pre-operative ASA score of I-III, were included in the study, excluding anal and cystoscopic procedures. On the basis of past medical record, patients were grouped into ASA-I [patients without any co-morbidity] and ASA II-III [patients with co-morbidities] on the basis of their ASA score pre-operatively. In the same way patients were divided into CCI-0 [patients without co-morbidities] and CC 1-6 [patients with co-morbidities] according to CCI score. All the patients were operated in the same environment by the same set of surgeons. Postoperatively the surgical wounds were observed for SSI by using ASEPSIS daily scoring system for one month prospectively. SSI rates in ASA-I was compared with SSI rates in ASA II-III. Similar comparison of SSI rates was performed in CCI-0 and CCI 1-6. Data was tested by using the Fisher's exact test with confidence interval of 95%. The overall SSI rate was 6.1% [n=19] with 4.23% [n=5] in clean cases [C] and 7.29% [n=14] in clean contaminated cases [CC]. There were significantly higher surgical site infection rates among patients in ASA II-III than those with ASA-I in clean contaminated surgeries [p=0.003]. There were also significantly higher surgical site infection rates among patients with CCI score 1-6 than those with CCI-0 in clean [p=0.024] and clean contaminated [p=0.002]. American Society of Anaesthesiologists [ASA] score and Charlson comorbidity index [CCI] has strong influence on SSI rates in clean and clean contaminated cases. Patients' with co-morbidities undergoing clean and clean contaminated general surgical procedures have greater SSI rates than those without any co-morbidity

Transabdominal repair of vesicovaginal fistula: an experience of 27 cases

To review the causes of vesicovaginal fistula and outcome of its repair through transabdominal approach. This is a descriptive cross sectional study which was conducted in Surgical "D" unit, Khyber Teaching Hospital Peshawar from January 2004 to December 2009. The record of all cases of vesicovaginal fistula that had undergone transabdominal repair was reviewed. Complex vesicovaginal fistula cases were excluded. Operative findings and procedure's details were obtained from operation notes. Post-operative follow up findings after one week, three weeks, forty days and three months were noted for every case. A total of 27 cases had undergone transabdominal repair for vesicovaginal fistula with age ranging from 26 to 63 years. Twenty two cases developed vesicovaginal fistula as a result of obstructed labour and five as a result of Gynaecological surgery [post-hysterectomy]. Mean post-operative hospital stay was seven days. Failure of repair was seen in one case only. Five cases were lost during follow up. Eight [29.63%] cases developed urinary tract infection, and two [7.40%] cases developed transient urinary stress incontinence. This study suggests that obstetrical trauma is the commonest cause for developing vesicovaginal fistula and the transabdominal approach gives satisfactory results in its repair

Experience of laparoscopic appendecectomies versus open appendecectomies

To compare the outcome of laparoscopic and open appendecectomies in terms of operative time and post-operative morbidity. This prospective study was done from March, 2008 to March, 2009, at Surgical "C" Unit of Khyber Teaching Hospital, Peshawar. All consecutive appendectomies [open and laparoscopic] performed over this time were included. Demographic details, operative time, conversion, infective post-operative complications and delay in discharge were recorded. The patients were divided into two groups, laparoscopic appendectomies [LA] and open appendectomies [OA]. A total of 165 appendectomies were performed, 72 in the LA group and 93 in OA group. Eighteen appendectomies were perforated at the time of operation. The patients' ages ranged from 12-65 years [median 24 years]. Eighty were males and eighty five were females. Operative time in LA group was longer with mean duration of 45 minutes [range 35-75 minutes] compared with 35 minutes [range 30-55 minutes] in OA group. A glove finger was used as extraction bag in 59 [83%] in LA group. LA patients' wound infection was recorded in12 patients, two out of 72 in LA and 10 out of 93 in OA group. The site of infection was the port of specimen extraction in LA group. Intra-abdominal abscesses complication was observed in one case in the OA group. LA group had shorter hospital stay [mean 1.5 days] than [OA] [mean 3.5 days], and early return to normal activity, 8-15 [mean 10.5] days in LA and15-25 [mean18.5] days in OA. Laparoscopic Appendectomy [LA] is safe and has major benefits like less post-operative pain, decreased wound infection, early hospital discharge and earlier return to work than Open Appendectomy [OA]. LA is recommended in all patients with acute appendicitis if laparoscopy is not contraindicated

Total versus sub-total thyroidectomy for multinodular goiter

The aim of the study was to compare total and subtotal thyroidectomy [STT] for benign bilateral multinodular goiter [BBMNG] in terms of the proportion of hypoparathy-roidism and recurrent laryngeal nerve paralysis [RLNP]. Quasi experimental Place and duration of study: Department of Surgery, Khyber Teaching Hospital Peshawar, from 1st October 2007 to 30th September 2008. A total of 60 patients with bilateral multinodular goiter, were divided in to two groups A and B [30 patients in each group]. Group A patients were subjected to IT while group patients to STT. Sample technique used was non-probability purposive. Demographic details, biochemical findings, indications for operation, operating time and complications under study were noted for either group. There was no significant difference in the age, gender, hormonal status or duration of goiter between the two groups [P=0.123, P=0.74, P=0.509 and P=0.6, respectively]. The mean operating time was longer [138 +/- 30 min versus 112 +/- 33 min, P=0.046] for TT vs STT. Either temporary RLNP or HPT occurred in 3 [9.9%] or 6 [20%] of the patients undergoing total compared with 2 [6.6%] or 3 [9.9%] of the patients undergoing SIT [P=0.64 and P=0.278, respectively]. Permanent RLNP was observed in none and HPT in one patient only in TT group compared with none of either complication in STT group [P=0.313 for permanent HPT]. The present study shows that TT can be performed without increasing risk of complications, and it is an acceptable alternative for benign MNG, especially in endemic regions, where patients present with a huge multinodular goiter

Situs inversus totalis with liver abscess

A case of multiple liver abscesses in a patient with situs inversus totalis is presented. Initially the patient was treated conservatively and remained symptom free for 4 days of hospital stay. On a follow up visit after 1 week the patient had high grade spiking fever and ultrasonography showed expanding multiple abscesses. The patient was restarted on intravenous antibiotics which resolved the disease

Venoarterial PCO[2] difference: a marker of postoperative cardiac output in children with congenital heart disease

To determine the relationship between venoarterial carbon dioxide gradient [delta pCO[2]] and central venous oxygen saturation [ScvO[2]] in children after cardiac surgery. A cohort study. The Paediatric cardiac intensive care unit of the Aga Khan University Hospital, Karachi, from June 2006 to May 2007. All children admitted in the paediatric cardiac intensive care after complete repair of congenital heart defect using cardiopulmonary bypass were included in the study. Simultaneous arterial and central venous blood gas samples were obtained from a catheter placed in the artery [either radial or femoral] and superior vena cava respectively. Linear regression analysis was performed between ScvO[2] and delta pCO[2]. Fifty seven children aged from 5 days to 14 years were included and 272-paired simultaneous arterial and central venous samples were analyzed. Mean venous pCO2 was 47.82 +/- 9.03 mmHg and mean arterial pCO[2] was 40.50 +/- 9.06 mmHg. One hundred seventy four samples had ScvO[2] > 70% with mean delta pCO[2] of 5.44 +/- 2.55 mmHg and 98 samples had ScvO2 < 70% with mean delta pCO2 of 9.07 +/- 3.90 mmHg. With ScvO[2] < 70%, 77 samples had delta pCO[2] of > 6 mmHg while only 21 samples had delta pCO2 of < 6 mmHg [p < 0.001]. On the contrary with ScvO[2] > 70%, 71 samples had delta pCO[2] of > 6 mmHg and 103 samples had delta pCO[2] of < 6 mmHg. Coefficient of correlation [R[2]] between 0.340 was ScvO[2] and delta pCO[2]. Elevated delta pCO[2] is practical and can be utilized as a useful adjunct to low ScvO[2] in the assessment of low cardiac output syndrome in children after cardiac surgery