Effect of Helicobacter Pylori eradication in treatment of Gastroesophageal Reflux Disease [GERD]

Objective: To determine the outcome of helicobacter pylori eradication in the treatment of GERD

Methods: A total of 200 patients fulfilling the inclusion and exclusion criteria were enrolled for study. Informed consent was taken from patients for inclusion in the study. Demographic data was collected. Endoscopy for evidence of GERD was done in Medical Unit-1 of Services Hospital, Lahore for evidence of GERD. Outcome of H. pylori eradication on GERD was assessed according to the symptom improvement defined in material and methods of study

Results: A total of 200 patients fulfilling the inclusion and exclusion criteria were enrolled for study. Informed consent was taken from patients for inclusion in the study. Demographic data was collected. Endoscopy for evidence of GERD was done in Medical Unit-1 of Services Hospital, Lahore for evidence of GERD. Outcome of H. pylori eradication on GERD was assessed according to the symptom improvement defined in material and methods of study

Conclusion: The results of the study showed that there was no statistically significant improvement in the symptoms of GERD after H.pylori eradication

Pseudoaneurysms in intravenous drug abusers

lntravenous drug abuse can lead to vascular complications, most frequent of which is pseudoaneurysm. These pseudoaneurysms [false aneurysms] are prone to rupture, leading to profuse hemorrhage and death. To evaluate pseudoaneurysms in intravenous drug addicts for the site, mode of presentation, management and outcome. Descriptive study. Surgical unit I, Combined Military Hospital, Rawalpindi. Surgical unit 2, Combined Military Hospital, Lahore. January 2006 to September 2010. All cases of pseudoaneurysms in intravenous drug addicts who presented to a single vascular surgeon, between 1st January 2006 and 30 th September 2010, were evaluated for site, mode of presentation, treatment and the outcome. Surgical procedures included excision of pseudoaneurysm with interpositioning of graft, repair of vascular rent, ligation of vessel and debridement. All cases were referred to psychiatrist for management of drug addiction. Total 12 cases of pseudoaneurysms due to IV drug abuse were included in our study. Arteries affected included 9[75%] common femoral arteries [CFA]. ln 3[25%] cases, both common femoral artery and vein were involved with arteriovenous fistula between them. There was 1[8.3%] pseudoaneurysm each of external iliac artery, superficial femoral artery and brachial artery. Nine cases [75%] presented with recurrent hemorrhage from a swelling while in 3[25%] cases there was swelling with no history of hemorrhage. ln 7[58.3%] cases, repair/grafting, while in 5[41.6%] cases ligation and debridement was done. There was seroma formation in 1[8.3%] case after excision and grafting. ln none of the cases, in which artery was ligated, critical limb ischaemia occurred. Common femoral artery is the most frequent site of pseudoaneurysms in lV drug abuse. ln those cases where vascular reconstruction is not possible due to extensive skin necrosis or infection, ligation of affected vessel is not only a life saving procedure but a safe option also.

Failure to thrive, can this be Bartter's syndrome?

A case series of four children, of different age groups, having complaints of polyuria and failure to thrive. These cases include two infants, a toddler and a child and investigations revealed that they had hyponatremia, hypokalemia, hyperchloremia and metabolic alkalosis, leading to a diagnosis of Bartters syndrome. Two of the patients also had hypomagnesemia. All the children were put on treatment for Bartter's Syndrome, and they responded well but unfortunately one of them was lost to follow-up

Quality of life assessment in patients with locally advanced head and neck malignancy after ablative surgery and reconstruction with microvascular free flaps

To assess the improvement in Quality Of Life [QOL] after ablative surgery in locally advanced head and neck malignancies by microvascular free flaps reconstruction. Quasi-experimental. Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from September 2005 to February 2007 A total of 44 patients with locally advanced stage III and IV malignancy of head and neck were included in the study. All patients were treated with ablative surgery and reconstruction with microvascular free flaps. QOL was assessed by using a scoring questionnaire [including 5 parameters for extra oral cancers including physical and role function, body image, weight loss score and pain donor site morbidity; and an additional 5 parameters for intraoral tumours that included swallowing, speech, drooling of saliva and mouth opening]. A high score indicated a poor QOL. Patients were assessed pre-operatively and then at 2, 4 and 6 months postoperatively. Mean accumulative score and mean individual parameter scores for both extra- and intraoral tumours were significantly improved [p < 0.05]. Microvascular free flap reconstruction after ablative surgery in locally advanced head and neck malignancy had a profound impact on the improvement of QOL. There was an initial deterioration of physical scores postoperatively and postradiotherapy, followed by gradual improvement. By the end of 6 months, it surpassed the pre-operative QOL scores

Tuberculous tenosynovitis: a cause of carpal tunnel syndrome

To highlight the presentation of tuberculous tenosynovitis as Carpal Tunnel Syndrome [CTS]. A descriptive study conducted with purposive sampling on the patients presenting between April 2004 to January 2005 to the department of Plastic Surgery, CMH Rawalpindi, with the clinical picture of CTS. Symptoms and signs were recorded. The carpal tunnels were explored under nerve blocks. Where tenosynovitis was observed per-operatively, specimen of excised synovium were sent for histo-pathological examination, acid fast stains and bacterial cultures, to ascertain or rule out the presence of tuberculosis. A total of 53 patients predominantly males were included in the study. The median age was 43 years and average duration of symptoms was 9 months. Tenosynovitis was observed in three patients [6%] per-operatively, with histopathology suggestive of Tuberculous tenosynovitis. Point Prevalence of tuberculous tenosynovitis as a cause of CTS was 6%. These patients reported clinical improvement with anti-tuberculosis treatment. NCS/EMG co-related well with clinical relief. Tuberculous tenosynovitis is an uncommon cause of median nerve compression at the wrist. As symptoms are usually typical of CTS, diagnosis is frequently missed. Consideration of the possibility, examination of the opened canal at surgery and proper treatment can result in a successful outcome

Skin sparing mastectomy and immediate breast reconstruction

To evaluate skin sparing mastectomy[SSM] and immediate breast reconstruction[IBR] in terms of the survival, chances of recurrence, aesthetic restoration and prevention of psychosocial problems. An interventional study. The Department of Plastic and Reconstructive Surgery, CMH, Rawalpindi from November 1998 to November 2003. Twenty-eight patients of breast cancer, included in the study, were discussed in a Multidisciplinary Breast Clinic. Detailed metastatic work-up was performed. In all patients SSM with en-bloc level II axillary clearance and IBR was done. The patients' age ranged between 25-46 years. Two patients [7%] were nullipara. Tumor size was T1 in 10 [36%] and T2 in 18 patients [64%]. In all the patients a circum-areolar incision was used. A contralateral uni-pedicled TRAM flap was used in 24 [86%] and latissimus dorsi flap in 4 patients [14%]. All the flaps survived completely. There was marginal necrosis of native skin flaps in 03 [10.5%], infection in 03 [10.5%], axillary seroma in 03 [10.5%] and abdominal seroma in 01 patient [3.5%]. As late complication 5 patients [19%] developed fat necrosis. Adjuvant chemotherapy was given in 6 [21%] and adjuvant radiotherapy in 4 patients [14%]. No recurrence encountered in maximum follow-up. We found an excellent aesthetic restoration in 23 [82%], good in 1 [3.5%] and fair in 4 patients [14%]. SSM for patients with early breast cancer is an oncologically safe procedure. IBR can greatly reduce the psychological trauma associated with breast loss including diminished feelings of feminity, decreased libido, social behavior, sense of mutilation and depression