Roux-en Y duodenojejunostomy for larger duodenal defects

Objective: To find the outcome of lateral duodenojejunostomy for larger duodenal defects due to different surgical conditions

Study design: Case series

Methodology: The clinical records were traced from the unit and hospital clinical record room. The data was collected and analyzed for the outcome of the procedure

Results: A total of six patients were managed with the surgical technique. All patients were allowed oral sips on 3[rd] postoperative day. One patient out of six needed ICU care of 42 days. Patient stay in ICU was of 42 days. Postoperative complications including anastomosis leak occurred in one patient. Nausea and vomiting was reported in two and wound infection in two patients. Mean hospital stay of the patients was 16.67 days

Conclusion: Roux-en Y duodenojejunostomy is a safe technique for the reconstruction of larger duodenal defects involving >50% [2/3[rd]] of the duodenal circumference

Comparison of the efficacy of partial inferior turbinectomy and submucosal diathermy on nasal obstruction in allergic rhinitis

The purpose of this study was to compare the effects of bilateral partial inferior turbinectomy and submucosal diathermy of inferior turbinates on nasal obstruction in patients with allergic rhinitis. Prospective comparative study. This study was conducted at Departments of ENT, Mufti Mehmood Memorial [MMM] Teaching Hospital and District Headquarter Teaching Hospital [DHQ], Lakki Marwat from January 2009 to June 2013. Subjects of either sex, aging more than 10 years with symptomatic bilateral enlarged inferior turbinates due to allergic rhinitis attending ENT OPD were included. They were divided into two groups. An alternate sequential entry was made to group A and group B. Patients in group A were offered bilateral partial inferior turbinectomy [PIT] while those in group B underwent mono-polar sub-mucosal diathermy [SMD] of inferior turbinates. Data was collected at first visit prior to intervention, second at 1 month and third at 3 months after surgery. Anterior rhinoscopy and visual analogue scale were used to assess treatment outcomes. Out of 96 patients with 48 patients in each group, males [58%.3] out-numbered the females [41.7%] in both groups. Mean age of the patients in group 1 was 21.88 +/- 7.528 range [10-35] years and in group 2 was a 19.75 +/- 6.525 range [10-33] year. The mean nasal obstruction score was lower in group 1 than in group 2 at 1 month, and 3 months after surgery suggesting a good outcome, although statistically non-significant [p=value 0.177, 0.198 respectively]. Both bilateral PIT as well as SMD are effective in improving nasal obstruction in patients with hypertrophied inferior turbinates due to allergic rhinitis

Outcome of silver nitrate cauterization in controlling anterior epistaxis in children

To assess the outcome of silver nitrate cauterization in controlling unilateral spontaneous anterior epistaxis in children in terms of success on initial attempt and complications like recurrence of bleeding, pain, infection, exposure of septal cartilage, septal perforation and stenosis of the nostrils. Cross-Sectional Descriptive This study was conducted at Department of ENT, Mufti Mehmood Memorial Teaching Hospital, D.I.Khan, from October 2010 to September 2012. All patients having ages between 6-16 years with spontaneous unilateral anterior epistaxis were included in the study. Patients with bilateral anterior epistaxis, posterior epistaxis, post-traumatic epistaxis, and epistaxis due to bleeding diathesis or neoplastic lesions were excluded. Patients were managed by silver nitrate cauterization after packing the nose with ribbon gauze soaked in 4% lidocaine and adrenaline 1:1,000 in equal amounts for 5-10 minutes. Furacin antibiotic ointment was applied to the cauterized area and was continued two times daily for two weeks. All patients were reviewed fortnightly for six weeks. Mean age of the patients was 10.43 +/- 3.23 years with 49 [65.35%] males and 26 [34.65%] females. Silver nitrate cauterization was successful on initial attempt in 69 [92%] patients. Recurrence of bleeding, infection and exposure of septal cartilage were noted in 7 [9.35%], 2 [2.65%] and 1 [1.33%] cases respectively. The increased success rate and decreased post procedure morbidity associated with silver nitrate cauterization make it an effective and safe procedure for managing spontaneous unilateral anterior epistaxis in children

Causes and management of epistaxis at a district hospital

To determine causes, types, laterality, need for hospital admission and success rate of treatment modalities of epistaxis. This study was conducted at Department of ENT, Mufti Mehmood Memorial Teaching Hospital, D.I. Khan, Pakistan from September 2010 to June 2012. All patients of acute epistaxis due to any cause were included. Those in whom bleeding stopped spontaneously were excluded. The data for the following nine variables was collected; gender, age in years, age group, cause, type and laterality of epistaxis, need for hospital admission and success rate of treatment modalities. Out of 275 patients. 199 [64%] were male and 76 [36%] female. Mean age of the patients was 38.30 +/- 23.69 years. Trauma was the commonest [46.9%] cause followed by hypertension [26.9%]. Anterior epistaxis was commoner [61.45%] than posterior [20.75%]. Silver Nitrate Cautry was the commonest [57.80%] treatment modality followed by anterior nasal packing [31.3%]. The success rate was 91.80% for Silver Nitrate Cautry. Carrying good success rate, Silver Nitrate Cautry is a preferred choice for treatment of anterior epistaxsis

Frequency of hepatitis B and C in patients visiting outpatient department of District Head quarters Hospital Lakki

To find out the frequency of hepatitis B and C among the patients visiting out patient department. A total of 1443 subjects were screened for HBs Ag and anti-HCV in this descriptive study conducted from 1[st] January 2008 to 31 December 2008 in out patient department [OPD] District Headquarter Hospital Lakki. Patients of either sex and more that 15 years of age were screened for both hepatitis B and C. Patients with evidence of hepatitis B or C in the past were excluded. The HBs Ag and Anti-HCV screening was performed through Immunochromatographic [ICT] method. All sera showing reactivity were then confirmed with Enzyme Linked Immunosorbent Assay [ELISA]. The information of the patients was recorded on a proforma and analyzed. The frequency of hepatitis B was found to be 175 [12.12%] with a male predominance of 138 [14.97%]. Prevalence of hepatitis C was 58 [4.0%] with a male predominance 39 [4.22%], whereas in 5 [0.35%] cases both hepatitis B and c were present. Highest frequency of HBs Ag was detected in the settled area of the district while anti HCV was positive in high proportions in the frontier region [FR]. Overall prevalence of hepatitis was more common in rural population than the urban population. Hepatitis B is more common than hepatitis C in District Lakki. The high frequency of hepatitis needs to launch a major public awareness program and preventive measures to prevent its further spread

Nasal involvement in cutaneous leishmaniasis

To determine the frequency of nasal involvement in cutaneous Ieishmaniasis and to study demographic and clinical pattern of disease involving nose as well as nasal mucosa. Patients with cutaneous leishmaniasis presented to leishmaniasis clinic situated in the Basic Health Unit for Afghan refugees at Sarai Gambeela, District Lakki Marwat from January 1, 2009 to December 31, 2009 were registered. The patients were diagnosed clinically and confirmed by laboratory demonstration of parasite in a giemsa stained smear prepared from the lesion. Those having lesions primarily on nose, irrespective of age and gender were included in the study. All those cases with primary lesion elsewhere over face and secondarily involving nose [creeping lesion] were excluded. All important clinical details were recorded on a specially designed proforma and patients were given a registration card for the purpose of treatment and follow up visits. Sixty seven out of' 682 [9.82%] cases of nasal leishmanisis were encountered. Male to female ratio was 2:1. Forty nine [73.13%] had solitary lesions and among these fourty four [65.67%] had lesions limited to their nose. Wet type cutaneous leishmnaniasis was seen in 19 [28.36] cases. Seventy three percent of sufferers were less than 30 years of age. Cutaneous leishmaniasis is endemic in Distt. Lakki Marwat. Nose was a common site of involvement. In endemic areas, it should be included in the differential diagnosis of nasal lesions