Comparison of different modalities of treatment of hypertrophic scars and keloids

Hypertrophic scars and keloids are extreme overgrowth of scar tissue. To improve the cosmesis and symptomatology, to compare the results of different treatment modalities and to find out the most workable treatment option. Prospective randomized clinical trial. This study was conducted at the Allied Hospital, Faisalabad from April 2009 to September 2011. In this study 72 patients were studied. Most of them were treated on outdoor basis while others in wards. Detailed history and physical examination were carried out and applied different treatment options and followed them up. In our study of patients of hypertrophic scars and keloids, 29 were males and 43 were females. There was 20% recurrence rate in intralesional injections of steroid, 255 in silicone gel sheeting, 25% in surgery and postoperative intralesional injection, 50% in case of surgery and postoperative irradiation and 20% in surgery alone. In case of intralesional injections of triamcinolone acetonide 62.5% patients had excellent results. In both combined surgery with radiotherapy 1 patient improved while the other got recurrence. After surgical excision of hypertrophic scars 40% patients had excellent results. Intralesional injections of triamcinolone acetonide had good results. In early lesions silicone gel sheeting was useful option while recurrent scars can be treated by combined modalities of treatment

Etiology and diagnosis of obstructive jaundice, our experience

Obstructive jaundice is a common problem faced by surgeons. To ascertain various etiologies of obstructive jaundice in our set up and to evaluate the usefulness of available diagnostic modalities. Descriptive study. This study was conducted at Allied and District Head Quarter Hospital, Faisalabad from April 2010 to Sep. 2010. Eighty-five patients with obstructive jaundice were included in the study. They were evaluated on the basis of history, clinical examination, biochemical tests and ultrasonography. CT scan abdomen was done in suspected malignant cases only. Operative findings were compared with preoperative ultrasound and CT scan findings. The results were then prepared and analyzed. In our study. 56.5% patients were of benign etiology and 34.5% were of malignant etiology. Female to male ratio was 2:1. Serum bilirubin was raised more in malignant diseases than in benign diseases. and accuracy of 80% of ultrasound and 86% of CT scan abdomen was found out after performing different surgical procedures in our patients. In benign group of patients the most common cause was choledocholithiasis, 47.1% while in malignant group the most common cause was carcinoma of head of pancreas, 34.1%. Common causes of obstructive jaundice in our study were choledocholithiasis and carcinoma head of pancreas. Ultrasound is a reliable tool for diagnosis of obstructive jaundice and CT scan is helpful in evaluation of malignancy scan is helpful in evaluation of malignancy

Coverage of exposed tibia; comparison of various methods

The alarming rise in road traffic accident has resulted in increased incidence of degloving lower limb injuries requiring some sort of cover for exposed bones e.g tibia. To study and compare the rate of wound infection and decreased morbidity in degloving injuries of lower limb following early bone coverage by various surgical methods of bone coverage. Comparative, prospective study, Allied Hospital SU II Faisalabad. From January 2002 to October 2004. Thirty [30] patients divided into four groups, muscle and musculocutaneous flaps for 15 patients, local rotational flaps for 05 patients, cross leg flaps and decortication for 05 patients. The patients in each group were divided unequally because of unavailability of patients. Patients were also examined postoperatively for 06 weeks. The patients underwent surgery for degloving injury of leg. Most of them were young males between 5-45 years of age resulting mainly from different types of accidents. 2 out of 15 [13.3%] patients having, musculocutaneous flaps developed wound infection. 1 out of 5 [20%] with local rotational flaps, 2 out of 5 [40%] with cross leg flaps and 3 out of 5 [60%] with decortication developed wound infection. 14 out of 15 [93.3%] patients with muscle and musculocutaneous flaps while 4 out of 5 [80%] with local rotational flaps recovered within 3 weeks. Patients with cross leg flaps recovered after one month while patients with decortication recovered after forty five days. 13 out of 15 regained full function [86%] with muscle and musculocutaneous flaps while patients having local rotational flaps regained 100% full function. 4 out of 5 [80%] regained full function with cross leg flaps and 1 out of 5 [20%] regained full function with decortication. Muscle and musculocutaneous flaps for exposed tibia is safe and effective method of treatment having low rate of wound infection with wider coverage and decreased morbidity

Inguinal hernia; lichtenstein and darn repair a comparative study

To compare the rate of wound infection, recurrence and haematoma formation following Darn and Lichtenstein repair. Prospective, comparative study. Surgical Unit-ll, Allied Hospital, Faisalabad. One year study from 15-01-2003 to 15-01-2004. Total of 50 male patients between 16-60 years of age having right sided, left sided and bilateral inguinal hernias were divided by odd and even numbers into two groups, each group consisting of 25 patients. In 1[st] group of patients, Lichtenstein repair was done. While in 2[nd] group, Darn repair of posterior inguinal wall was performed. Patients were examined postoperatively for wound infection, haematoma formation and recurrence. Most of them presented with reducible inguinal hernias [84%] while others with irreducible inguinal hernias [16%]. Wound infection and hematoma formation were not observed in any patient in case of Lichtenstein repair. Wound infection was not observed in any patient and hematoma formation in two patients in case of Darn repair. Recurrence occurred in one patient with Darn repair while non was observed in case of Lichtenstein repair. Lichtenstein repair [mesh repair] of inguinal hernia is safe and has less rate of recurrence and haematoma formation

Hydrocele; surgery vs. sclerotherapy

A hydrocele is an abnormal collection of serous fluid within the tunica or processes vaginalis. It is treated by surgery and sclerotherapy. To compare the results of surgery and sclerotherapy in the treatment of scrotal hydrocele. Randomized control trial. Department of Surgery, Allied Hospital, Faisalabad; Period: April 2001 to March 2002. 50 consecutive male patients with provisional diagnosis of hydrocele. Patients stratified into three age groups and each stratum equally and randomly divided into two groups for sclerotherapy [A] or surgery [B]. 1% Sodium tetradecyle sulphate [STD] was used as sclerosant after aspiration of hydrocele. Surgical procedures used were Jaboulay's, Lord's and subtotal excision. Follow up done for three months. Age range was from 15 to 75 years. Hydrocele was right, left and bilateral in 56%, 42% and 2% patients. Postoperative complications included pain [24% and 20%], hematoma [8% and 12%], infection [8% and 12%], recurrence [40% and 12%] and complications related to anesthesia [0% and 36%] in group A and B respectively. Results of sclerotherapy and surgery for hydrocele are comparable with advantage of economy and convenience for sclerotherapy. However, larger study is recommended with comparison between different sclerosants to find the best one with high success rate and minimum complications