Comparative study of non-contrast-enhanced spirat CT scan to ultrasonography in the diagnosis of acute renal colic

To evaluate the sensitivity and specificity of noncontrast spiral CT scan in ureteric colic with comparative evaluation of ultrasonography. Prospective comparative study. This study was conducted at the Dept. of Radiology, Nishtar Medical College and Hospital, Multan from June, 2010 to June 2011. 62 patients with flank pain were examined with both ultrasonography and non contrast enhanced 16 slice spiral CT scan over a period of one year. Both techniques were used to determine the presence, size, and location of ureteric stone, and the presence or absence of secondary signs like ureteral and calyceal dilatation, stranding of perinephric, periureteric fat and soft tissue rim sign. 43 of the 62 patients were confirmed as having ureteric calculi based on stoned recovery or urological intervention. Ultrasound showed 93% sensitivity and 95% specificity in the diagnosis of ureterolithiasis. CT scan showed 91% sensitivity and 95% specificity respectively. hydronephrosis was seen in all patients that were positive for ureteric calculi. Most common site of calculus was distal ureter. Perinephric fluid was demonstrated in three patients. Perinephric stranding was seen in 26 cases, and periureteric stranding in three patients on CT scan. Pathology unrelated to urinary stone disease was demonstrated in six patients. Although both modalities were excellent for detecting ureteric stones, consideration of cost and radiation lead us to suggest that ultrasound be employed first and CT scan be reserved for when ultrasound is unavailable or non-diagnostic

Insertion of intrauterine contraceptive device [IUCD] at caesarean section after the delivery of placenta: an experience with 60 cases

To access the safety of Intrauterine Contraceptive Device [IUCD] insertion at Caesarean section after placental delivery. Observational analytical study of cohort type. Department of Obstetrics and Gynecology, Bolan Medical Complex Hospital, Quetta, from September 2009 to August 2010. This prospective study was conducted in the department of Obstetrics and Gynecology Quetta from September 2009 to August 2010. Sixty patients who had IUCD inserted at cesarean section were studied and followed for six months. The age ranges from 20-45years. Detailed history of each patient was recorded and thorough physical examination was performed. Patients with findings of any medical disorder were excluded. All analysis and computation including data base were done by SPSS 10. During the study period, a total of sixty women who had IUCD inserted at cesarean section were observed. All the cases were within age group ranging from 20-45 years of age. Out of them 53.3% were between 20 - 30 years, 28% between 31 -40 years, 18.3% belongs to 41-45 years of age. The events that were analyzed during the puerperium were pain, bleeding, infection and expulsion. Considering the postoperative complications, pain was the main complication during the puerperium and it occured in 54% of patients. Endometritis were occurring in 25% of cases and heavy lochia in 21% of cases. The expulsion rate was 8.3%. Women undergoing Cesarean section, who are suitable for using this method, should be given the option of IUCD insertion at the same time

Clinical presentation of dilated cardiomyopathy in children

To describe the presenting symptoms of dilated cardiomyopathy in children. Descriptive case series. This Study was conducted at the Department of Pediatrics, Bolan Medical complex Hospital, Quetta during a period of 1 year. Following patients were included in this study; that had tachycardia, respiratory distress, and heart failure. Following patients were excluded from this study; hypertrophic cardiomyopathy, restrictive cardiomyopathy, coronary artery anomalies, congenital heart disease, Rheumatic carditis and RHD. 50 Patients were included and their clinical variables, laboratory parameters and echocardiograms were analyzed. Out of 50 patients, 5 died, all these were 10 years or older. The following symptoms were found to be clinically significant. respiratory distress p<0.05, poor feeding p<0.05. The signs were clinically significant. Arrhythmia p<0.05, Fever p<0.05, Tachycardia p<0.05, Tachypnea p<0.05, Hepatosplenomegaly p<0.05, gallop rhythm p<0.05. Other significant findings were: X-ray chest, increased cardio thoracic ratio p<0.05. On echocardiography increased dimension >115 and ejection fraction <20% p<0.05, ST segment changes and T wave abnormality p<0.05. High index of suspicion followed by appropriate investigation can lead to correct diagnosis

Audit of five years of burn ICU in BMC hospital Quetta

Burns are series form of trauma with grave consequences for the patient and Family, with high morbidity and mortality. Since the establishment of burns ward at Bolan Medical College and Complex Hospital Quetta in 2002, we have been Receiving and managing a great variety of patients with burns from Kerosene oil, Petrol, gas, fire, scalds, chemical and Electric bums, Patients were received from With in [balochistan and sindh] and outside Afghnistan and Iran [Irani Balochistan] and as victims of war on terror from the region as a results on going war. An audit of our patients received from 2004 to 2008 has been presented which Consists of patients out of which 58% were male and 42% were female, Major Pathogens isolated were staphylococcus aurous [MRSA] and pseudomonas. Indicates of infection was high in patients with longer stay and extensive burns out Come of admit patients is also mentioned

Hybrid external fixation in treatment of metaphyseal fractures of long bones of the lower extremity

This study was conducted to evaluate the clinical results of metaphyseal fractures of tibia and distal femur after operative treatment by Hybrid External Fixators. A prospective descriptive study from 2004 to2008, conducted in Orthopaedic unit I, Bolan Medical Complex Hospital, Quetta. We have prospectively analyzed the results of Hybrid external fixation in the management of metaphyseal fractures tibia and femur in 21 patients [17 open and 4 closed fractures]. The mean age of the patient was 36.5 years. Age range was 14 yeas to 60 years. Eighteen patients were males and 3 were females. In 19 patients hybrid fixation was the primary procedures while 2 patients were initially dealt by local bone setters. Four patients subsequently required surgeries such as bone grafting and soft tissue cover. The mean follow up our patients was 14.8 months [5-24 months]. We achieved excellent results in 10 fractures, good results in 4 fractures, fair in 4 fractures and poor results in 3 fractures. Bony union was achieved in 18 of the fractures. Hybrid external fixation is an effective and useful treatment modality in the management of fractures close to joints in case of tibia, providing excellent to good results. In ease of distal femur it proved to be less effective. It combines the advantage of both Ilizarov and A.O. external fixators. It is minimally invasive, safe, modular and yet efficient in promoting massive new proliferative callus formation at the fracture site

Plate augmentation for femoral non-union after intramedullary nailing

This study was conducted to evaluate the clinical results of femoral non-union after intramedullary nailing treated by plate augmentation with or without autogenous bone grafting. a prospective descriptive study from 2004 to 2007, conducted in Orthopaedic unit I, Bolan Medical Complex Hospital, Quetta. We have prospectively analyzed the results of augmentation plate fixation in the treatment of femoral non-union after Intramedullary nailing in 36 patients. The mean age of the patient was3 1.4 years, 34 patients were males' and 2 were females. Age range of the patients was 22 years to 58 years. In 7 patients showing atrophic non-unions, autogenous bone grafting was done. The mean follow up of our patients was 1 year [4-18 months] post-operatively. Solid union was achieved in 34 femoral non-unions, [94.4% union rate]. Two cases showed non-union, requiring further surgery. Plate augmentation is a useful treatment option in the management of non-union of femoral shaft fractures after intramedullary nailing

Orthopedic implant failure a retrospective review of 100 cases

Internal fiuxation with various devices for the repair of fractures is widely used in orthopedic surgery. A stable osteo synthesis obtained which allows early mobilization and promotes fracture healing. however these are not free from complication; many of them are due to poor surgical technique and/or inadequate monitoring. Breakage due to fatigue of the material is riot un common in our setup, where there is no any quality control system. A review of too cases was made who reported to OPD section of department of orthopedic surgery Bolan Medical College Quetta, Initially operated in this department or elsewhere, during the period Jan. 1998 to Dec. 2008. This study shows Plate failure more common than nail failure in long bone fracture of lower limb. In most of failure cases there was significant retrauma during the healing phase. In significant number of case there was inadequate post operative immobilization, in adequate fixation and poor surgical technique

Wide resection and arthrodesis of knee using fibular graft in aggressive giant cell tumor of distal femur

This prospective study was conducted to evaluate the outcome of resection and massive allograft arthodesis in the management of aggressive giant cell tumor of distal femur. 10 Patients with mean age 37.8 years [30-46] with Giant cell tumor, Enneking stage-Ill of distal femur were treated by wide resection and reconstruction allograft arthodesis using free fibular graft and fixed with suitable hardware from July 1999 to 2008. There were 6 female patients and 4 male. Follow up period ranged from 30 to 65 months with an average of 45.3 months. At the final follow up, functional score ranged from 18-27 out of a total of 30. Average was 80.4%, range 66-90%. At the end of follow up all the patients were alive and disease free. All the patients achieved union. The mean union time was 16.4, ranged 14-20 weeks. Two patients had fall and fractured the graft. We had to do revision and additional cancellous grafting. Later on healed full union was achieved. One patient developed superficial wound infection which was treated with systemic antibiotics. In selected patients of giant cell tumor of distal femur, resection arthodesis of knee using fibular graft is an effective reconstructive method. It offers biological reconstruction alternative to amputation in selected patients where mobile joint reconstruction can not be carried out

Wide subtalar release in congenital talipes Equino Varus deformity of foot

There is controversy regarding preferred operative procedure for correction of Congenital Talipes Equino Varus [CTEV]. Objective of this study was to determine the efficacy of wide subtalar release as described by Mackay in 1983 in children having CTEV. Twenty patients up to the ages of 3 with grade-Il, Ill congenital club foot were treated with this procedure; those having deformity secondary to diseases like CP, arthrogryposis multiplex congenital were excluded. Patients were followed for a minimum of one year after operation. Results were graded as per Frank and Hem criteria. Clinical and radiological evaluations were done and compared with other soft tissue procedures. 72.41% patients had satisfactory, 17.24% moderate and 10.34% poor results. Club foot surgery is instituted when well planned cast correction fails. Children up to the age of 3 years can be successfully treated with this method under skilled hands