Injection sclerotherapy versus rubber band ligation for second degree hemorrhoids

Objective: To compare the efficacy of injections Sclerotherapy [IST] and rubber band ligation [RBL] for the treatment of 2nd degree haemorrhoids in terms of improvement in symptoms severity score [SS score] in OPD patients

Study Design: Randomized controlled trial

Place and Duration of Study: It was conducted in surgical OPD of CMH Kohat, from 15th October 2010 to 10th April 2011

Material and Methods: A total of 116 patients with symptomatic 2nd degree haemorrhoids were randomly divided into two groups, RBL and IST [58 patients each] respectively and a baseline symptoms severity score was noted for each patient. Patients in RBL group were treated with RBL while in IST group were treated with IST. The outcome measures were relief of symptoms and improvement in SS score

Results: In RBL group, baseline SS score was 4.67 +/- 2.01 which reduced to final mean SS score of 1.34 +/- 0.96 whereas in IST group the baseline SS score was of 4.31 +/- 2.13 which reduced to a final mean SS score of 1.6 +/- 0.97. 44 [75.95%] patients had complete recovery and control of bleeding in RBL group; whereas in IST group 32 [55.1%] of the patients had this response by the end of two weeks

Conclusion: Rubber band ligation was found to have better patient outcomes as compared to injections sclerotherapy in treatment of 2nd degree hemorrhoids

Diagnostic accuracy of saline hysterosonography in cases of abnormal uterine bleeding

To evaluate diagnostic accuracy of saline hysterosonography in diagnosing endometrial hyperplasia taking histopathology as gold standard. Validation study. Radiology Department MH/CMH Rawalpindi form 10th July 2006 to 10th January 2007. Fifty cases of Abnormal Uterine Bleeding comprising both pre and post menopausal patients were included. They were selected on non probability convenience sampling technique. Saline hysterosonography was conducted in the Radiology Department and results compared with histopathological findings. Among 50 patients who underwent saline hysterosonography, 40 patients were diagnosed to have positive findings while 10 did not show any abnormality on saline hysterosonography. Of the 10 patients whose endometrium did not show any abnormality on saline hysterosonography, 8 were found to be normal on histopathology and 2 cases showed abnormality. One case was of endometrial hyperplasia and the other showed a benign endocervical polyp which was missed on saline hysterosonography. This showed that Saline hysterosonography has a sensitivity of 94.7%, specificity of 66.7%, and an overall diagnostic accuracy of 88%. Saline hysterosonography is highly accurate in the diagnosis of endometrial pathologies. It is cost effective, well tolerated by patients and can be performed as an outpatient procedure

Frequency of placenta accreta on doppler studies in patients with previous caesarian section

To determine frequency of placenta accreta in patients with previous Caesarian section on Doppler ultrasound examination. A descriptive study. The study was conducted in Radiology Department CMH / MH Rawalpindi which is a tertiary care hospital from April 2006 to February 2007. All patients who were pregnant and had previous LSCS were included in our study. The patients were included on the basis of Non-probability convenience sampling. Patients who had all previous normal deliveries were not included in our study. The method adopted on Doppler ultrasound studies placenta accreta in patients with previous caesarian section was confirmed in the first trimester if sac was low lying and attached to anterior wall of uterus with little or no myometrium between sac and bladder. In the second and third trimester visualization of multiple irregular vascular spaces/ sinuses within placenta and visualized vascular bundles leaving the placenta and reaching lower part of bladder was diagnostic of accreta. We found the frequency of placenta accreta in patients with previous caesarian deliveries to be 3% [3/100] in CMH / MH Rawalpindi which is almost consistent with other studied performed in Pakistan and abroad. Out of 100 selected patients 3 were given suspicion of accreta on Doppler studies and confirmed to have accreta by our obstetrician and hysterectomy was done. Placenta accreta is a life threatening condition with increase risk to mother morbidity and mortality. Doppler ultrasound is a reliable radiological technique to diagnose placenta accreta

Validity of colour doppler ultrasonography with d-dimers in clinically suspected deep venous thrombosis of the lower LIMB

This study was designed to evaluate the validity of colour Doppler ultrasonography with D-dimers in clinically suspected deep venous thrombosis of the lower limb. Validation study Place and Duration of study: Radiology Department CMH/MH Rawalpindi Six months from 15 June 2006 to 31 December 2006. Subjects and Thirty cases of clinically suspected deep venous thrombosis of the lower limb were included in the study selected on non probability convenience sampling technique. Colour Doppler ultrasonography examination of the affected lower limb was carried out and results compared with D-dimers assays results. Among 30 patients who underwent colour Doppler ultrasonography examination of the affected limb for diagnosis of deep venous thrombosis, 27 [90%] were diagnosed to have deep venous thrombosis, 3 [10%] were diagnosed not to have deep venous thrombosis. Amongst them 2 patients had raised D-dimers levels and repeat Doppler ultrasound advised. On revised ultrasound deep venous thrombosis in these patients was confirmed. This showed that colour Doppler ultrasonography examination has sensitivity of 93.1%, specificity 100%, positive predictive value 100%, negative predictive value 33.33% and overall accuracy of 93.33%. Colour Doppler ultrasonography has a high diagnostic yield in cases of deep venous thrombosis of lower limb when used in conjunction with D-dimers assays