Outcome of distal femoral locking plate in supracondylar fracture of femur mullar type-a by mipo technique

Background: Supra condylar femoral fracture has to multiple treatment options and may have different complications including wound infection, delayed or nonunion and loss of knee motion. Distal femoral locking plate is a recent advance method of treatment as minimal invasive technique

Objective: To determine the outcome of locking plate in supracondylar fracture of distal femur by minimal invasive plate osteosynthesis, regarding union and range of motion at knee and hip joint

Methodology: This descriptive study was carried out in Orthopedics Department of Lahore General Hospital, Lahore on 35 patients from 1[st] January 2013 to December 2014. All the patients suffering from closed supra-condylar fractures of distal femur Muller Type-A presenting within 24 to 48 hours of injury between 20-50 years of age were included in the study. MIPO technique was used for surgical treatment in these cases. Union was assessed at follow up. Data was entered and analyzed by using SPSS version 20

Results: There were total 35 patients in this study; the mean age of the patients was 32.37 +/- 7.86 years. There were 26[74%] male and 9[26%] female. The mean hip flexion for operated limb was 124.91[degree] +/- 7.03 and the mean knee flexion for operated limb was 125.43[degree] +/- 10.56. At 36[th] week follow up all 35[100%] patients presented with grade-I radiological union i.e. formation of homogenous bone structure

Conclusion: Distal femoral locking plates resulted in favorable outcomes on short-term basis for treating supra-condoyle fractures of distal femur Muller A in terms of union and range of motion at knee and hip joint

Complications of post septoplasty nasal packing and trans-septal suturing

Objective: To find out complications of nasal packing and trans-septal suturing during septoplasty procedure for deviated nasal septum [D.N.S.]

Study design: Descriptive case series

Place and Duration of study: Department of E.N.T. and Head and Neck Surgery, Liaquat University Hospital Jamshoro /Hyderabad, from June 2014 to May 2016

Methodology: Patients of either gender of 17 year or more of age with symptomatic deviated nasal septum and needing septoplasty, were included in the study. They were randomly divided into groups A and B representing the nasal packing group and trans-septal suturing group respectively. Complications were noted in both the groups following surgery

Conclusion: A total of 316 patients were included in the study. There were 207 [65.5%] males and 109 [34.5%] females. The age range was from 17 year to 52 year with the mean age of 27.83 year. In this study most common complications noted were nasal pain, headache, postnasal dribbling, sleep disturbance and epiphora. All these complications were more commonly observed in nasal packing group

Results: Trans-septal suturing addressed the purpose of nasal packing effectively and safely with fewer postoperative complications

Otomycosis - a clinico-pathological study

Objective: To determine the frequency of different fungal isolates involved in otomycosis along with their mode of presentation and outcome of treatment modalities

Study design: Descriptive Study

Place and Duration of study: Departments of E.N.T, Head and Neck Surgery and Department of Pathology, Liaquat University Hospital Hyderabad, from August 2014 to July 2016

Methodology: All patients of either age and gender who attended the E.N.T. outpatient department with the clinical diagnosis of otomycosis were included in the study

Results: A total of 164 patients were managed. There were 93 [56.7%] males and 71 [43.39%] females. Age ranged from 4-73 year with mean age of 35.33 year. Considering each ear as a separate entity, 125 [60.38%] sample ears were right sided and 82 [39.61%] left sided, with a total of 207 sample ears. The most common clinical feature in this study was blockage of the ear which was noted in 136 [65.70%] sample ears. The most common fungal specie isolated was Aspergillus niger [n= 56 - 27.05%]. Clotimazole 1% solution proved to be very effective to achieve clinical cure in 191[92.27%] sample ears within a short span of time

Conclusions: Otomycosis a disease of inner portion of external auditory canal was more common in males. The common predisposing factors were ear poking and use of antibiotics / steroid otic drops. Aspergillus Niger was the commonest specie isolated. Clotrimazole 1% solution proved to be effective for clinical cure followed by 2% salicylic acid in rectified spirit

Flexible fiberoptic naso-pharyngo-laryngoscopy: indications and outcome

Objective: To find the indications and outcome of flexible fiberoptic naso-pharyngo-laryngoscopy in ENT practice

Study design: Case series

Place and Duration of study: Department of E.N.T. and Head Neck surgery, Liaquat University Hospital Hyderabad, from February 2013 to January 2015

Methodology: All patients with upper airway problems in whom flexible fiberoptic naso-pharyngolaryngoscopy [FFONPL] performed were included

Results: A total of 437 patients were included in this study. There were 228 [52.2%] males and 209 [47.8%] females. The age range was from 8 year to 80 year with mean age of 45.87 year. It was performed for diagnostic purpose in 351[80.3%] patients having voice and swallowing problems. It was possible to identify structural etiology in all cases. It was used in follow up of 73 patients for residual disease who had chemo radiotherapy for different tumors. Of these, in 54 [73.97%] patients the airway was patent to allow the removal of tracheostomy tubes. In 13 cases it was used to facilitate passage of nasotracheal tube in patients with ankylosis of temporomandibular joint. It was successful in 12 cases

Conclusion: FFONPL is an effective and safe tool for various ENT related pathologies

Role of proton pump inhibitors in chronic cough

To see the effectiveness of Proton Pump Inhibitors in patients with chronic cough at Liaquat UniversityHospital. Observational study. This study was conducted at ENT Department, Liaquat University Hospital, Jamshoro/Hyderabad from November 2010 to October 2011. Irrespective of age and gender 109 cases were recorded with history of chronic cough. After getting a detailed History all the cases were examined thoroughly for any pathology in Nose, Nasopharynx,Sinuses, Throat and Larynx in ENT department and then Sent to Physician to find or exclude the pathology in chest and Gastro intestinal tract. Required investigations were carried out in selected cases. All the cases after diagnosis were selected for PPI treatment for 30 days. Patient's response to the treatment was recorded. All the data regarding sign symptoms, clinical diagnosis, duration of cough and response of the cases to PPI treatment was entered on Performa for analysis. 109 cases were chosen in present study with chronic cough, majority of the cases 55 [50.45%] were found with age group of 41-60 years. Female were found in the big percentage 63 [57.79%], as compare to male 46 [42.20%], mostly 86[78.89%] cases had duration of cough under VIII weeks. 39 [35.77%] cases were noted with feeling of lump in throat and this was commonest symptom. 57 [52.29%] patients were found with complete response, 35 [32.11%] patients were noted with partial response and continued for some more days, while 17 [15.59%] patients had not respond to PPI treatment and those were advised some other investigations and treatment. PPI having prime role in cases of chronic cough. PPI can easily be given on Clinical ground even without more investigations

To detect the fungal infection in the patients with nasal polyps

To determine the prevalence of fungal infection in the patients having nasal polyps at Liaquat University Hospital, Hyderabad. Observational and prospective study. This study was conducted in the Department of the ENT of Liaquat University Hospital, Jamshoro/Hyderabad from March 2012 to August 2012. Total 50 had selected. All the cases with nasal polyp, both genders and above 18 years of the age were integrated. Routine lab investigations had completed. Radiological examination including the X-ray of paranasal sinuses and CT scan had done to diagnosis sinuses, bony erosion, orbital and intracranial extension. Surgical procedure had done according to the need of the patient. After surgery all the samples separated in 2 places under sterile process. One for histopathology and 2[nd] in the normal saline had sent for fungal Culture of specimen. Total 50 cases were selected in the study after diagnosis of nasal polyp, mean age of the cases was mean +SD=36.05+7.21 years, male had found in the majority 31[62.0%]. Nasal obstruction was the most common 42 [84.0%] in the clinical presentation. Majority of the cases 26.0% were under went surgical procedure of nasal polypectomy. After done histopathology frequently diagnosis found as Inflammatory polyp 43 [86.0%], while08 [16.0%] cases were found with fungal infection and 42 [84.0%] were without fungal infection after culture test. In conclusion fungal infection is found most common in the cases having nasal polyps

Complications of modified radical neck dissection type III in oral squamous cell carcinoma

Modified radical neck dissection type III is considered as relatively safe procedure for management of metastatic cervical lymphadenopathy, with low complication rate. This Descriptive study was conducted to evaluate complications of modified radial neck dissection type III from April 2007 to March 2010 at Department of ENT-Head and Neck Surgery Civil Hospital, Karachi. The surgical record of 115 patients of oral squamous cell carcinoma who underwent Modified Radical Neck Dissection type III was evaluated for frequencies and pattern of complications. Out of 115 patients, age of the patients was ranging from 26 to 66 years [std Dev: +/- 10.62]. 80% of patients were male and 20% of patients were female and male and female ratio was 4:1. The overall complications were 48.7%. Marginal mandibular nerve palsy [15.7%] and seroma [12.2%] were frequent complications. Although complications may occur despite the best efforts to prevent them, proper preoperative planning, early recognition of perioperative complications, and prompt, effective management can minimize the impact of complications that may occur

Presence of multiple antimicrobial resistant strains and frequency of pseudomonas aeruginosa in bronchiectasis patients in balochistan

Objective: To discover the frequency and presence of multiple antimicrobial resistant strains of Pseudomonas aeruginosa [P.aeruginosa] in patients with Post tuberculosis bronchiectasis in Baluchistan

Design: A prospective descriptive study

Place and duration: this study was done in Pulmonology and tuberculosis outpatient department [OPD] of Fatimah Jinnah Chest Hospital and Rehan Hospital Quetta Pakistan from 1st October 2011 to 1st April 2012

Methodology: The samples were obtained from post tuberculosis patients [n=60, Age = 40+ years] suspected of bronchiectasis who were subjected to spirometry test, Mueller Hinton sensitivity testing, oxidase test and disk-diffusion method to find out frequency and multiple drug resistance of P. aeruginosa

Results: Our results confirmed the association of chronic P. aeruginosa infection with poor lung function. It is not clear whether P. aeruginosa caused the accelerated decline in lung function or it was just a marker of those whose lung function was already declining rapidly. The antibiotic susceptibility testing confirmed the presence of resistant strains of the P. aeruginosa most of which were mucoid strains. It proved that a single antibiotic therapy is not a good treatment for patients with P. aeruginosa infection in airways

Conclusion: Bronchiectasis is more frequently encountered in middle-aged and elderly persons and resistant strains of P. aeruginosa are highly prevalent in these patients

Epistaxis - a study of etiologies and management at a tertiary care hospital of urban sindh

OBJECTIVE: To highlight different etiologies of epistaxis and their management at the setup of a tertiary care level hospital of urban Sindh

STUDY DESIGN: Descriptive Study

SETTING: Department of E.N.T. and Head and Neck Surgery, Liaquat University Hospital Hyderabad from June 2011 to May 2013

METHODOLOGY: A prospective study of 437 patients presented with epistaxis due to different etiologies and its management at the department of E.N.T. and Head and Neck Surgery, Liaquat University Hospital Hyderabad. The patients of all age groups of both the genders were enrolled. All the data was collected on a pre-designed Performa equipped with all the relevant details. Finally all the collected data was then fed into SPSS VER. 16 to have statistical assistance and to construct different graphs and tables

RESULTS: Spanning over two years period, this study comprised 437 cases. 263[60.2%] were male and 174[39.8%] were female. The age range was 3-77 years with mean age to be 31.66 years. The commonest cause in this study was trauma which affected 155[35.6%] patients. Most of the patients i.e. 324[74.1%] reached us through emergency department. Site of bleeding was anterior in most of the patients, accounting 229[52.4%] patients. Maximum numbers of patients i.e. 163 [37.3%] were managed successfully by anterior nasal packing

CONCLUSION: Epistaxis constitutes the main bulk of emergency cases attending the E.N.T. department. This study observed trauma to be the commonest cause of epistaxis in our set up. Maximum number of cases required anterior nasal packing as the only measure to be effective and successful from management point of view

Psuedoaneurysm of the right hepatic artery: a rare cause of obscure GI bleeding

A 63 years old female with 1 month history of hematemesis and malena, severe weakness and lethargy, for which she had upper GI endoscopies multiple times, but the source of bleeding could not be identified. Base line investigations revealed Hb of 6.0g/dl. CT scan abdomen showed cholelithiasis with air inside the gallbladder. The selective celiac axis / Hepatic artery angiogram revealed a right hepatic artery aneurysm [pseudoaneurysm]. After resuscitation with blood transfusion and fluids, the patient under went surgical exploration, revealing an aberrant right hepatic artery aneurysm bleeding inside the gall bladder with a cholecystodeudenal fistula [Mirrizi type III] into the 1st part of the deudenum form where the blood was leaking into the gastrointestinal tract and causing severe hematemesis and malena. A cholecystectomy, dissection of sleeve of liver bed, ligation of the aneurysmal bleeding vessel, repair of the cholecystodendenal fistula and placement of the T-Tube done. Post operative the patient remained stable and was discharged on 7th post operative day. Biopsy revealed acute on chronic cholecystitis and cholelithiasis. Biopsy of the aneurysmal wall revealed inflamed granulation tissue

Mesh versus non-mesh repair, eleven years experience at Shaikh Zayed Hospital, Lahore

Ventral Incisional Hernias are a well known complication after abdominal surgery with a reported incidence of 10% - 20% and a recurrence rate of 30% - 50% after open suture repair and less than 10% after open mesh repair. To compare the outcome of two different methods of open repair of VIH [i.e. Mesh versus Non-mesh or Suture Repair in terms of morbidity, complications and recurrence. 11 years period [January 2000 - December 2010]. Shaikh Zayed Hospital, Lahore. The total number of patients who underwent surgery for repair of VIH during the study period was 321.There were only 33 patients in Group A [simple suture/Keel repair] while Group B had 288 patients. The most common early postoperative complications seen in both the groups were wound seroma and infection. Post-operative respiratory insufficiency was more common in the obese. Chronic pain and feeling of foreign body was more frequently seen in the mesh group. On the other hand, recurrence rates were far greater in the suture repair group. The overall mortality in the whole series was 3 patients [0.93%]. The rates of ventral incisional hernia recurrence and complications are significantly lower after open onlay mesh repair as compared to the open suture repair. However, these results require confirmation by prospective randomized clinical trials which should also include the results of laparoscopic ventral incisional hernia repair which is a new and emerging technique in Pakistan

Foreign bodies in external auditory canals: experience of 653 cases over 8 years

Objective: To analyse the spectrum of presentation and management of foreign bodies in external auditory canal

Study Design: Retrospective analysis of data

Place and Duration: District Government Hospital Paretabad Hyderabad [Sindh] Pakistan over a period of 8 years, i.e. from July 1999 to June 2007

Methods: A pre designed proforma was used to collect the data regarding patients' demographics, frequency and type of foreign body, management and outcome

Results: Total 653 patients with foreign bodies in external auditory canals were dealt with over a period of about eight years. The age variance was from 1-65 years. Most of the foreign bodies i.e. 163 [25%] were retrieved in the children up to two years of age. A wide variety of foreign bodies totally numbering 41 were retrieved from external auditory canals. Stone/concretion were the single most frequently removed foreign body constituting 32.6%. Jobson Horne Probe was the single most frequently used tools which was utilized in 37% of the cases to remove different types of foreign bodies. General anesthesia was employed in only 11.79% of the cases. Operating loupe was used in 53.13% of the cases. Morbidity occurred in 11% of the cases with tympanic membrane perforation occurring in 0.6% of the case

Conclusion: Different types of foreign bodies are prevalent in different parts of the world. Similarly different methods of removal are adopted dictated by the nature, location and state of the foreign body at the particular instant

Multiple angiosarcomas of the gut (duodenum, appendix and cecum) - a case report

Angiosarcoma is a rare soft-tissue neoplasm that occurs most often in the skin and the subcutaneous tissues but very rarely in the gastrointestinal tract. We present a case of angiosarcoma involving small and large intestine

Anatomic level of biliary obstruction and outcome of pre-operative biliary stenting in malignant obstructive jaundice -A Shaikh Zayed hospital experience

Abstract: Malignant Obstructive Jaundice can be due to proximal hilar obstruction [Cholangiocarcinoma] and carcinoma [CA]. gall bladder. Distal biliary obstruction can result from distal cholangiocarcinoma or tumors of pancreatic head, periampullary region, duodenum and rarely from tumors of stomach and retroperitoneum. The study was under taken to see prevalence of various malignant causes of biliary tract obstruction and evaluate the role of preoperative biliary drainage on post operative outcome

Patients and Methods: Retrospective study of 109 patients conducted between July, 2001 to July, 2008. Preoperative workup included history, physical examination and routine investigations. Ultrasound, computerized tomography [CT scan], Magnetic Resonance Cholangiopancreaticography [MRCP] were used to diagnose level of obstruction. Endoscopic retrograde cholangiopancreaticography [ERCP] was done to diagnose, take biopsies and to do therapeutic stenting to achieve biliary decompression after coagulation profile has been corrected by vitamin K and Fresh Frozen Plasma [FFP]. Treatment of proximal obstruction aimed at resection of tumor and CBD and gall bladder and internal drainage by Roux-en-Y hepaticojejunostomy if operable if not operable external drainage was done. Malignant distal obstruction was relieved by Kaush and Whipple's procedure, if operable, Bypass surgery was done if not operable

Results: There were 61 male patients and 48 female M:F ratio is 1.7: 1. and mean age 53 years. Main presenting symptoms were jaundice 100%, weight loss 58%, pruritis 53%, abdominal pain 41 %, fever 29% palpable mass 21 % respectively. Mean bilirubin was 18.1 mg/di. Mean Alkaline Phosphatase was 1119 IU/dl. The predominant pathology causing proximal malignant obstruction was hilar cholangiocarcinoma n=33 [30%], CA gall bladder n= l3 [12%] malignant distal obstruction was mainly caused by pancreatic head cancer in 44 patients [40%], pancreatic body tumor 2 [1.8%]. Periampullary tumors 13 patients [12%] and duodenal cancers 2 patients [1.8%] and retroperitoneal lymphoma in 2 patients [1.8%]. Preoperative biliary stenting was done in 24 patients 22% 18 by ERCP and six by percutaneous route. The main complications were wound infection 21 %, abdominal collection 21 % cholangitis 15% and respiratory complications 13%. 13 patients died due to various reasons. [12%]

Conclusions: Commonest malignancy causing proximal biliary obstruction is hilar cholangiocarcinoma. Pancreatic head cancer is the most common distal malignancy. Preoperative Biliary stenting endoscopic/percutaneous is associated with increased operative difficulty and post op. problems we don't recommend it, except in the very sick and inoperable patients

Hepatoprotective effects of berberis lycium, galium aparine and pistacia integerrima in carbon tetrachloride [CCL4]-treated rats

The aim of this study was to evaluate the hepatoprotective effects of mixture of berberis lycium, galium aparine and pistacia integerrima in carbon tetrachloride [CCL4]-treated rats. This study was conducted in the animal house of the Quaid-i-Azam University, Islamabad in the year 2000. A total of 20 rats were divided in 4 groups of 5 rats each. 1. Normal Control Group: with no medication given 2. CCl4 Treated Group: only CCl4 was given 3. Hepatopreventive group: Initially treated with medicinal plants mixture followed by CCl4 4. Hepatoprotective group: Initially treated with CCl4 followed by medicinal plants mixture Then blood sample from each rate was collected and analysed for ALT, AST and ALP. The rates included in the study were male Sprague Dawley rats [albino] weighing 150-300g received from the animal house of the NIH, Islamabad. ALT, AST and ALP activities were significantly raised [P<0.001] in hepatocurative groups as comparative to the normal control, and decreased [P<0.001] as compared to the CCl4-treated rated and the hepatopreventive group. While the hepatocurative group treated with aqueous extract of the mixture of medicinal plants decrease more than treated with suspension of medicinal plants mixture and alcoholic extract. The results this study indicates that a mixture of Berberis lycium, Galium aparine and Pistacia integerrima have hepatoprotective effects. These medicinal plants have more effect as curative agents rather than preventive agents

Supracondylar fractures; comparison of medial and lateral approach for fixation of humerus in children

To determine the surgical approach most suited in our setup and evaluate the results based on the functional and cosmetic outcome especially in the range of motion, the subsequent deformity, if any, and the carrying angle. Setting Orthopaedic surgery, Nishtar Hospital, Multan. Duration Two years. Study design Quasi experimental type of study. Thirty patients. Sampling technique Non-probability technique. Results The age of the patients included in our study ranged from 4-10 years with a mean age of 5.93 years in group A and 6.66 years in group B. Out of 30 patients in group-A, 3 [20%] males and 4[26.6%] in group-B had fracture on right side where as 12[80%] females in group-A and 11[73.3%] in group-B had fracture on left side. Majority of the patients i.e. 12[80%] in group-A and 11[73.3%] in group-B got injured due to fall from height. One [6.66%] patients from group-A and B had superficial wound infection. Pin tract infection was found in 1[6.66%] in group A and 2[13.33%] patients in group-B. This technique was easy to perform and proved to be safe, although hospitalization time was minimum in both groups. So we recommend medial approach for open reduction and internal fixation of all displaced supra-condylar fractures of humerus in children with appropriate indications

Transduodenal Sphincteroplasty - still an effective biliary drainage procedure in the Laparoscopic era

With the advent of interventional endoscopic procedures and with growing experience with laparoscopic surgery, the indications for open biliary procedures have become limited. This prospective study reviews the changing trends in the indications of transduodenal sphincteroplasty and presents the short-term and long-term outcomes of this procedure in the present minimally invasive surgical era. Transduodenal sphincteroplasty was performed for various benign obstructive biliary pathologies. Various parameters recorded were the demographic data, indications for surgery, early and late complications and long-term outcome of the procedure. The changing trend in the current indications of the procedure was reviewed. Results of transduodenal sphincteroplasty on 49 consecutive patients over 9 years period are presented. Mean age was 48.4 years with male to female ratio of 1:3.4. Twenty-six [53.0%] patients presented with obstructive jaundice and 36.7% had cholangitis. Common indications of surgery included multiple common duct calculi [44.8%], impacted ampullary stones [36.6%] and ampullary stenosis [10.2%]. Overall hospital morbidity was 12.2% with zero mortality. After a mean follow up of 9.3 years, 95.9% patients had "good" or "fair" and 4.1% reported "poor" results. Most of the biliary pathologies may be dealt with laparoscopic and endoscopic procedures; open drainage procedures may still be indicated in selected patients. Transduodenal sphincteroplasty remains an effective biliary drainage procedure with acceptable morbidity and mortality. The procedure should be regarded as an essential in the general surgical knowledge and training

Fine needle aspiration cytology

Fine Needle Aspiration Cytology [FNAC] is a diagnostic modality, which over the years has proved itself to be quick and virtually without complications. Since its popularization in late 1920's by Martin and Ellis, it has undergone a tortuous course, comprising popularity, ignorance and again a period of well-acceptance. This time, however, its use has also initiated exploration into new vistas in the form of study of biological behaviour of tumour cells and detection of different receptors and tumour markers etc. Initially employed cautiously and limitedly, FNAC, now-a-days is being applied to almost all the superficial and deep structures of the body, both in children as well as in the adults. Also synergistic [additional] advantage is being gained with C.T. scan, MRI, Ultrasound, endoscopy and various immunological techniques to broaden the utility of this modality in different diagnostic and prognostic horizons