Rubber band ligation of symptomatic internal haemorrhoids; result of 450 cases

To assess the outcome of rubber band ligation of 2[nd] and 3[rd] degree haemorrhoids in terms of relief of symptoms. Case series. Colorectal clinic, Department of General Surgery, Jinnah Post Graduate Medical Center Karachi, from January 2001 to May 2008. All Patients with 2nd and 3rd degree haemorrhoids were included in this study. Data related to the age, gender etc, were recorded. Patients were counseled regarding prospects of success of the procedure. Short and long term outcome data were recorded for success of treatment. A total of 450 patients underwent rubber band ligation. There were 337 males [74.88%] and 113 females [25.11%] with male to female ratio of 3:1. Age of the patients ranged from 20-80 years. Male with 2nd degree haemorrhoids were 297 [66%] and females were 203 [22.88%]. Successful results were achieved in 86.22%. Rubber band ligation is a safe, effective and economical procedure for treating 2nd and 3rd degree haemorrhoids on out patient basis

Nitroglycerine ointment for anal fissure

To determine long term effectiveness of glyceryl trinitrate [GTN] for treatment of anal fissure and to find out its side effects. This study was done on patients who presented with symptoms of anal fissure in colorectal clinic surgical ward 2 JPMC. Total 498 patients were included out of which 237 had acute anal fissure while 261 patients had chronic fissure. All patients received 8 weeks treatment with 0.2% GTN ointment three times daily applied over perianal area. Those patients who developed side effects i.e. headache were offered treatment with 2% diltiazem. After 8 weeks treatment 228 patients of acute anal fissure had complete healing and 9 patients had partial response. In chronic anal fissure, 229 patients completely healed after 8 weeks of treatment while 32 patients were advised further 4 weeks treatment of GTN due to partial healing and out of them 22 patients had complete healing. Thirteen patients had to undergo lateral sphincterotomy. Five patients complained of headache that settled after shifting to treatment with diltiazem ointment. Ten patients developed recurrence of symptoms. GTN proved to be good first line treatment for most of patients with anal fissure. Small group of patients experience recurrence of symptoms and most of them respond to prolong duration of treatment

audit of the management of acute pancreatitis in a general surgical ward

To assess the results of the management of Acute Pancreatitis. Retrospective descriptive study from Jan. 2003 to Dec. 2005. Setting: Surgical Ward-2, Jinnah Postgraduate Medical Centre, Karachi. 62 patients with the diagnosis of Acute Pancreatitis. The demographic variables, cause and outcome of the cases were observed and recorded. Out of the total 62 patients, 37 had cholelithiasis; other causes were alcoholism, abdominal trauma, worms, instrumentation [ERCP] and drugs. All patients were classified according to APACHE-II scoring system into acute oedematous pancreatitis, severe acute pancreatitis and acute necrotizing pancreatitis. Forty eight patients developed complications including ARDS, anuria, hypotension, paralytic ileus and pseudocyst formation. Four cases died due to multiorgan failure. Current recommended principles in the management of Acute Pancreatitis are based on identification of patients having severe disease and the group at risk for the development of complications. APACHE-II is a helpful scoring system and CT scan is an effective diagnostic tool in difficult cases