Comparison of circumcision by plastibell versus open method

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

Polypropylene suture versus skin staples for securing mesh in lichtenstein inguinal hernioplasty

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

Tracheal resection and end-to-end anastomosis for tracheal stenosis: etiology and outcome

To know the etiology of tracheal stenosis and asses outcome of tracheal resection and end-to-end anastomosis for tracheal stenosis. Descriptive prospective case series. Department of Thoracic Surgery, Combined Military Hospital, Rawalpindi and Quetta from May 2005 to March 2010. Twenty two patients were included in the study who underwent tracheal resection followed by primary tracheal reconstruction by same surgical team. Etiology was ascertained on the basis of available history and per-operative findings. End-to-end tracheal anastomosis was done using vicryl 3/0. Outcome of surgical technique was assessed using peak expiratory flow rate [PEFR] and flexible bronchoscopy. Twenty two patients were managed over a period of five years, of which 17 [77.3%] were male and 5[22.7%] female. Mean patient age was 27.31 +/- 9.61 years. Seven [31.8%] patients had New York Heart Association grade [NYHA]-III and 15 [68.2%] had NYHA grade-IV dyspnoea. Seventeen [77.3%] had stridor. All patients were already being managed by pulmonologists, ENT specialists or intensivists. Twelve [54.5%] had grade-V stenosis [91-100% luminal obstruction] and 9 [40.9%] had cervical tracheal stenosis and 3[13.6%] had mediastinal tracheal stenosis. Six [27.3%] patients had partial cricoid resection followed by thyrotracheal anastomosis, 13[59.1%] patients underwent cervical tracheal anastomosis and 3 [13.6%] patients required mediastinal tracheal anastomosis. Patients were followed up post-operatively for the development of immediate and delayed complications. The follow up was carried out for a minimum period of 6 months to a maximum period of 2 years. Postoperative complications included neck pain, lung collapse, and superficial skin infection. Tracheal resection with end-to-end anastomosis is a safe, reliable and permanent procedure for the treatment of tracheal stenosis

Yield of cervical mediastinoscopy in diagnosis of indeterminate mediastinal lymphadenopathy/masses and staging of lung cancer

To determine the yield of cervical mediastinoscopy in indeterminate antero-superior mediastinal lymphadenopathy or masses and in staging of non small cell carcinoma lung. Descriptive prospective study. Thoracic Surgical unit of Combined Military Hospital Rawalpindi from Jan 2007 to June 2009. Patients were placed in group I for diagnostically indeterminate antero superior mediastinal lymphadenopathy/masses and in group II for staging of non small cell lung cancer [NSCLC] with enlarged mediastinal lymph nodes on CT scan [greater than 10 mm on short axis]. All patients underwent the procedure under general anaesthesia. A plane anterior to trachea was developed using blunt finger dissection until carina. Biopsies of the mass or lymph nodes were taken and sent for histopathology. In case of staging for Carcinoma lung, lymph node stations 2L, 2R, 4L, 4R and 7 were searched and biopsied and sent in appropriately labelled containers for histopathology. Patients were usually discharged on the same day. Forty eight cases were included in this study during the course of 2 1/2 years of period. Twenty nine cases were included in group I and nineteen in group II. In group I chronic caseating granulomas due to tuberculosis were the most cause in 45% of cases followed by 24% cases of lymphoma. In group II, 4 [21%] cases revealed no evidence of malignancy in any lymph nodes and in 11 [57.9%] cases only ipsilateral mediastinal lymph nodes were involved by tumor making it N2 disease. In 4 [21%] cases contra lateral mediastinal lymph nodes were involved by tumor making it N3 disease. Mortality in this study was only one case [3 4%] Mediastinoscopy is minimally invasive cost effective and simple procedure in trained hands for both diagnosis and staging purpose

Tracheal schwannoma: a rare tracheal tumour

Primary tracheal tumours are histologically similar but 100 times less common than main stem tumours. We report a case of primary tracheal schwannoma in a middle aged man. He had chronic cough for 2 years, and developed hemoptysis and stridor in the days preceding to presentation. He was treated by resection of the tumour and primary anatomosis of the trachea. The patient recovered well after surgery and had a near normal PEFR after one and a half year of follow-up and bronchoscopic examination excluded any recurrence

Gastropleural fistula: an unusual sequel of blunt chest trauma

In the October 2005 Earthquake in mountainous Azad Kashmir and adjacent areas in Pakistan, a young female sustained crush injury chest and upper abdomen. She remained hospitalized with lower chest pain. All initial investigations were normal and she was discharged symptom-free on conservative management. Six months later, she developed acute left sided chest pain and dyspnoea. Provisional diagnosis of empyema was made on X-ray, and tube thoracostomy was done. Diagnostic VATS revealed gastropleural fistula secondary to necrosis of herniated stomach. Resection of necrosed stomach, repair of diaphragm and decortication and transthoracic repair with lower thoracoplasty two months later was performed but both were unsuccessful. After another 02 months, a Roux-en-Y gastrojejunostomy at fistula site was fashioned which proved curative

Pilomatrixoma breast mimicking carcinoma

A 50-year-old male with a painless progressively increasing lump of right breast, misdiagnosed on fine needle aspiration cytology as carcinoma breast, operated for modified radical mastectomy, is presented here. Histopathology of the resected specimen revealed pilomatrixoma

Threaded - alive on a wooden picket

A case of 4-year-old girl is presented, brought threaded-alive on wooden picket due to head-on fall from roof with wooden picket entering through left subcostal region and exiting from right buttock. Midline laparotomy was performed. Wooden picket was removed after enlarging the entry and exit wounds