Burr hole aspiration of brain abscess in children with cyanotic heart disease

Objective: To determine the efficacy of burr hole aspiration of brain abscess in children with cyanotic heart disease in terms of number of aspirations and residual abscess

Study Design: Experimental study

Place and Duration of Study: Department of Pediatric Neurosurgery at The Children's Hospital and The Institute of Child Health, Multan, from July 2010 to June 2014

Methodology: Pediatric patients of cyanotic heart disease with brain abscess were admitted. After taking history, clinical examination and necessary investigation, aspiration of abscess through a burr hole was performed. Data was collected through pre-designed proforma. Analysis of results was performed and comparison was made through statistical package for social sciences [SPSS-20]

Results: Total number of patients were 50 with 31 [62%] male and 19 [38%] female children. Patients' age ranged from 5-10 years with mean age of 7.44 +/-1.11 years. Single abscess in supra tentorial was commonly found in 44 [88%] patients. Multiple abscesses were present in 4 [8%] patients. Cerebellum was involved in 2 [4%] patients. Abscess was completely aspirated in single attempt in 37 [74%] patients, two attempts in 9 [18%] patients, and three attempts in 4 [8%] patients. No bacterial growth on culture was reported in 32 [64%] patients. Culture was positive in 18 [36%] patients. Postoperative hematoma developed in 2 [4%] patients. No mortality was reported in early postoperative period

Conclusion: Aspiration of brain abscess in children with cyanotic heart disease through a burr hole is safe and successful

Surgical outcome of spelenectomy in Thalassemia major in children

Objective: To determine the surgical outcome of splenectomy in children with thalassemia major

Methods: It is an observational and descriptive study conducted in Department of Paediatric Surgery in collaboration with hematology, radiology, anesthesia and paediatric intensive care department at The Children's Hospital and the Institute of Child Health, Multan during the period of September 2007 to September 2013. A total of 50 patients suffering from thalassemia major already diagnosed and under management reffered from haematology department for splenectomy were included in this study. After admission, patients were assessed on the basis of history, clinical examination, and necessary investigations before surgery and later on follow-up. Investigations carried were CBC, PT, APTT, Viral markers, ECG, X-ray Chest, abdominal ultrasonography and ECHO if necessary. Splenectomy was performed after prophylactic vaccination against post splenectomy infections. Follow up was performed for at least two years. Blood transfusion requirements and number of hospital visits per annum before and after splenectomy were calculated and results analyzed statistically using SPSS-20

Results: Fifty patients were included in this study. Out of these fifty, 43 [86%] male and 7[14%] were female with a mean age of 9 years. Average blood transfusion requirement was 250 ml/kg/year, interval of blood transfusion was two weeks and twenty five visits per year before splenectomy. After splenectomy, requirement of blood transfusion reduced to 125ml/kg/year, interval between transfusion increased to one month and hospital visits reduced up to twelve per year

Conclusion: Blood transfusion requirement and number of hospital visits per year are decreased and interval between transfusions is increased after splenectomy. Splenectomy should not be delayed when indicated. Preoperative vaccination decreases the chance of post splenectomy infection

Management of posterior urethral valves in public sector hospital: challenges faced

To adjudge the mode of presentation, upshot of treatment and complications of posterior urethral valve in our habitat. Descriptive study. This study was conducted at Department of Pediatric Urology, The Children's Hospital and ICH Multan from 1[st] October 2012 to October 2014. All the information were entered on a structured sheet, like presenting features with their duration, treatment done and its outcome, complications of the disease. The data was later analyzed with the help of software. Two hundred thirty patients were included in the study. Median age ranges from 3 days-10 years [median age2.5 years]. Mean time tenure before clinical presentation was 2.5 years. Obstructive symptoms were present in all patients while UTI was second most common and present in two hundred and ten patients [91%], Vesicoureteral reflux was seen in eighty patients [35%]], Neurogenic bladder was present in thirty five [15%], and forty patients [17%] presented with significant renal parenchymal damage. Micturating cystourethrogram confirmed the findings of posterior urethral valve. Cystoscopy and fulguration of valves was done in all patients and supra vesical diversion was done later in selected cases. Study results concluded that delayed presentation of the disease is customary in our society. This is linked with lofty morbidity and mortality rates. Efforts should be made in improving awareness among healthcare professionals at primary and secondary care centre for early diagnosis and treatment

Incidence of generalized oedema in random population attending the Moalejat and Modern Medicine OPD of Ajmal Khan Tibbiya College Hospital, Aligarh Muslim university, Aligarh, India

Oedema is defined as clinically apparent increase in the interstitial fluid volume which may expand by several liters before it becomes clinically apparent. Depending upon its cause and mechanism, oedema may be localized or generalized. In generalized form it is recognized by puffiness of face and by persistence of an indentation of the skin following pressure, which is known as pitting oedema. The patients may complain of fitting of ring on a finger snugly or difficulty on putting of shoes particularly towards evening. It has been our observation in the recent past that there is an appreciable increase in number of patients suffering from generalized swelling without any known cause. This prompted us to find out the cause of such a sudden rise in its incidence. The present study is a demographic study of 126 patients suffering from oedema due to different causes. In idiopathic type oedema, we have tried to discuss its possible causes

Tetanus in children- An exclusive study

To document the causes, mode of presentation and establish the morbidity and mortality of tetanus in childhood age group. Descriptive study. Department of Paediatric Surgery, Nishtar Medical College and Hospital, Multan. It was carried out for three years from January 2002 to December 2004. All paediatric patients presenting with tetanus during these three years were inducted in the study. However neonatal cases were excluded from study. All but two cases were admitted through emergency. The remaining two arise in the ward, one being treated for burns and other for long bone fracture in orthopaedic ward. Complete history and clinical findings were noted in a predesigned proforma and a treatment protocol was started. There is four bedded tetanus bay with basic treatment facilities in our ward. However our tetanus bay lacks ventilators and cardiopulmonary monitors. Complications arising 4 during the treatment were noted. A total of 96 patients were included in the study. There were 66 male and 30 female children. The youngest child was of 15 months of age and elder one of 12 years of age. Almost 2/3[rd] [65.62%] of 5 patients belonged to rural background. Wounds supposedly responsible for tetanus were present in 60 patients. Chronic SOM in 10 patients and idiopathic in 26 patients. Abdominal rigidity was present in 90.62% and lock jaw in 85% cases. Lock fit time was <2 days in 25[26.4%] cases. Seven patients required tarcheostomy. Respiratory and anemic complications were amongst the common. Overall mortality was 21.95%. Children make almost1/3[rd] of the total cases of tetanus. The disease pattern remains the same. However survival is better than adults and neonatal tetanus

One stage repair of anterior hypospadias and its results

This prospective study was carried out over a period of 18 months i.e. from January 1995 to June 1996. Twenty eight cases of anterior hypospadias with an age range of 6 months to 12 years were treated in the department of Paediatric Surgery Nishtar Hospital Multan. Twenty one cases of glandular coronal and distal subcoronal hypospadias were submitted to meatal advancement and glanuloplasty [MAGPI] and in 7 cases mainly of proximal subcoronal type Mathieu's repair was performed. Stent was used in all cases. Suprapubic urinary diversion was done in 4 cases following Mathieu's rapair. Urethrocutaneous fistulae were seen in two [7.14%] meatal stenosis in one [3.57%] and wound infection in one [3.57%] case that resulted in disruption of repair. In over 85.72% cases good results were obtained both functionally and cosmetically