ABSTRACT
Objective: To compare the efficacy of terlipressin versus octreotide after endoscopic variceal band ligation [EVL] in prevention of early variceal rebleed. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Gastroenterology, Military Hospital, Rawalpindi, from Jan 2011 to Jun 2011
Material and Method: All patients fulfilling the inclusion criteria were selected through consecutive sampling. Both male and female patients between ages of 30 and 60 years were included in study. All patients received same intravenous antibiotics, intravenous vitamin K, syrup lactulose and underwent upper GI endoscopy with band ligation was done by gastroenterologist. After the procedure, all patients were placed randomly in two groups based on lottery method. Group-A received octreotide and group-B received terlipressin. The group-A received intravenous octreotide at the rate of 50ugm/hour and group-B received terlipressin 1 mg/4 hourly for 5 days after band ligation. Both groups were observed daily for evidence of early rebleed i.e. hematemesis, melena or both. For efficacy to be labelled, both must be absent. End point of the study was the prevention of early rebleed efficiently. Symptoms of hematemesis, melena or both were also recorded in proforma by close monitoring of patient
Results: Efficacy of terlipressin versus octreotide after EVL in prevention of early variceal rebleed was recorded as 87.69% [n=57] in group-A and 96.92% [n=63] in group-B while remaining 12.31% [n=8] in group-A and 3.08% [n=2] in group-B were not effectively treated, p-value was calculated as 0.04 which shows a significant difference in both groups
Conclusion: Terlipressin was significantly more effective than octreotide once combined with EVL in preventing early variceal rebleed in our study
ABSTRACT
Objective: To find out the frequency of gastric varices in patients with portal hypertension based on endoscopic findings
Study Design: Descriptive Study
Place and Duration of Study: Department of Gastroenterology, Military Hospital, Rawalpindi from Jan to Jun 2011
Material and Methods: All patients fulfilling the inclusion criteria were selected through consecutive sampling. The patients presenting with hematemesis, melena or ascites with portal hypertension on ultrasound abdomen were admitted in the hospital. The patients were first stabilized hemodynamically and then kept empty stomach for at least four hours before endoscopy. The patients were sedated with intravenous midazolam and endoscopic findings obtained were entered on the patient proforma
Results: The overall frequency of gastric varices was 11%, whereas 89% had no gastric varices
Conclusion: A large number of patients with portal hypertension have gastric varices. It is recommended that endoscopy be carried out in all patients with identified portal hypertension
ABSTRACT
Objective: The objective of the study is to compare circumcision by plastibell and open method in terms of bleeding, infection and cosmesis
Study Design: Randomized clinical trial
Place and Duration of Study: Surgical ward, Combined Military Hospital, Kharian from Aug 2011 to Sep 2012
Material and Methods: All individuals fulfilling inclusion criteria underwent circumcision in the operation theatre of CMH Kharian as indoor patients, under local anaesthesia and aseptic measures. In group 1, circumcision was done using plastibell where as in group 2, circumcision was done by open method
Results: Mean age in plastibell group was 3.37 months [SD=1.77] and in open group was 3.12 months [SD=1.33] [p=0.100]
In plastibell group 18% had bleeding however in open group 4% had bleeding [p<0.001]. In plastibell group 4% patients had infection. However in open group 15% had infection [p<0.001]
In plastibell group 82% parents were satisfied whereas 18% had extra skin, whereas in open group 96% parents were satisfied, 1% had extra skin and 3% had less skin [p<0.001]
Conclusion: Circumcision being a commonest surgical procedure demands careful selection of the operative procedure because plastibell method is superior in terms of post-operative infection whereas open method is better in terms of cosmesis and post-operative bleeding
ABSTRACT
To compare polypropylene suture and skin staples for securing mesh in Lichtenstein inguinal hernioplasty in terms of mean operating time and postoperative pain. Randomized clinical trial. Surgical Ward, Combined Military Hospital, Kharian, from August 2011 to February 2012. All individuals fulfilling inclusion criteria underwent elective Lichtenstein inguinal hernioplasty as admitted patients, under spinal anaesthesia and with aseptic measures. In group 1, during the operation, mesh fixation was done with 2/0 polypropylene suture and skin was closed with subcuticular 2/0 polypropylene suture whereas in group 2, the anchorage of mesh was done with skin staples and skin was closed with staples from the same stapler. Mean operative time and postoperative pain, assessed on a visual analog score, were compared between the groups. The overall postoperative pain was lower [p = 0.026] when staples were used to anchor mesh. Moreover, operative time was also lower [37.42 +/- 2.69 minutes] in staple group versus [42.44 +/- 2.55 minutes in polypropylene group]. Mean operating time and postoperative pain is less in securing mesh with skin staples as compared to polypropylene suture in Lichtenstein inguinal hernioplasty