Evaluating anatomical subunit approximation technique for unilateral cleft lip repair

To evaluate the outcome of anatomical subunit approximation in unilateral cleft lip of different severity. Seventy four consecutive patients with cleft lip were seen in the outpatient department of Plastic and Reconstructive Surgery at Hayatabad Medical Complex, Peshawar and Plastic Surgery unit at Said Anwar Medical Centre, Peshawar, from 1[st] June 2007 to 31[st] December 2008. The severity was assessed and all of them were operated using David Fisher's anatomical subunit approximation technique. Postoperatively the vertical height of the lip was compared on the cleft and non cleft side along with symmetry of Cupid's bow and philtral column, the alignment of white roll, quality of the cutaneous lip scar, vermilion fullness and vermilion notching. The nose was evaluated by noting the nasal tip symmetry; alar rim level; alar base height and width; and nostril sill size, both pre and post operatively. Seventy two patients showed adequate vertical height and good nostril size, alar base height. Two patients showed 1.0 mm discrepancy of the vertical height as compared to the non cleft side. These belonged to the severe complete cleft lip category. This technique has shown good results in achieving vertical height and nostril size symmetry especially in incomplete and mild to moderate severity of complete cleft lip

Distally based sural fasciocutaneous flap for soft tissue reconstruction of the distal leg, ankle and foot defects

Soft tissue management around the lower third of the leg and foot presents a considerable challenge to the reconstructive plastic surgeon. The options in this region are limited. A durable flap is the preferred option for coverage of such defects. This descriptive study was conducted at Hayatabad Medical Complex and Said Anwar Medical Centre Peshawar over a period of 4 years to evaluate the efficacy of distally based Sural flap in coverage of the lower third of leg, ankle and foot defects, in 25 patients. A descriptive study was conducted at the department of Plastic and Reconstructive Surgery at Hayatabad Medical Complex and Said Anwar Medical centre Peshawar. 25 patients with soft tissue defects over the distal leg and foot were included in this study. Distally based sural fasciocutaneous flap was used for coverage in all cases and its survival, successful coverage of the defect and donor site morbidity studied. Out of 25 flaps, 20 showed complete survival [80%]. Partial flap loss was found in 2 patients [8%], marginal flap necrosis in 2 patients [8%] and complete loss in 1 patient [4%]. The distally based sural flap is a versatile and reliable flap for the coverage of soft tissue defects of the distal lower extremity. The procedure is done as a single stage; the dissection is easy with short operating time and minimal morbidity

Dehiscence of laparatomy wounds in children

To assess the various causes or factors leading to dehiscence of incised surgical wounds of the abdomen in children. The record and charts of all patients who developed dehiscence of the abdominal wounds after operation for various diseases were reviewed and data was collected. The age, sex, timing of surgery, reason for surgery, place of primary surgery, operating experience of surgeon, type of suture material, surgical technique, associated medical conditions, nutritional status and the use of per operative antibiotics were the variables which were analyzed. Different causes of wound dehiscence were assessed and analyzed. During the period of 12 months 22 patients developed wound dehiscence. Age ranged from 3 days to 10 years. There were 13 male and 9 female patients. The reason for primary surgery was: intussusceptions in 2 patients; worm obstruction: 2; colostomy for recto vaginal fistula: 3; colostomy closure: 3; posterior saggital anorectoplasty combined with abdominal approach: 1; abdominal injuries [blunt and penetrating]: 5; enteric perforation: 3; mass abdomen: 2 ; band obstruction and subsequent anastomotic leak: 1. Two patients died during the treatment. 17 patients developed complete burst which was repaired while 5 patients were treated conservatively and developed incisional hernia. Wound dehiscence was commonly seen in patients with abdominal wound infection, peritonitis and malnutrition. Control of infection, correction of anemia and malnutrition along with strict adherence to surgical principles plays a vital role in preventing the dreaded complication of abdominal wound dehiscence

Surgical management of hepatic hydatid cyst in children

To know the effectiveness of removal of hydatid cyst of liver along with pericyst [pericystectomy] as operative treatment, in terms of intra-operative and post-operative complications in the pediatric age group. This study was conducted on paediatric patients with liver hydatid cysts at Department of Paediatric Surgery, Lady Reading Hospital, Peshawar from January 2000 to December 2006. All patients with ultrasound findings for hydatid cyst disease of the liver were included in the study. They were evaluated according to age, clinical presentation, ultrasound and CT scan findings for operative management. After Laparatomy through right transverse incision, half of the contents of the cyst were aspirated, refilled with hypertonic saline solution of the aspirated volume and after waiting for five minutes Pericystectomy was carried out, followed by careful examination and stoppage of any leakage of blood or bile from the residual cavity. In infected cases the cavity was drained. Out of 21 paediatric patients operated for liver hydatid cysts during the study period, 11[52.4%] were girls and 10 [47.6%] were boys, with age ranging from 4 to 15 years. Cystectomy with tube drainage was performed in 20 patients while in one patient de-roofing was performed because of rupture. Hypertonic saline was used as a scoliocidal agent. There was no operative mortality. The mean hospital stay was 6.5+3.8 days. Recurrence after operation was seen in one [4.8%] patient. Hepatic hydatid cysts in children can be treated successfully by peri-cystectomy

Efficacy of combination of ezetimibe and simvastatin versus atorvastatin in reducing low density lipoprotein-cholesterol in male patients of hypercholesterolemia, at Bahawalpur

To see the efficacy of reducing Low-Density Lipoprotein cholesterol [LDL-C] with the combination of Ezetimibe/Simvastatin compared with Atorvastatin monotherapy in the local patients of hypercholesterolemia. This was a single-blind, randomized, uncontrolled, study [6 weeks of active treatment with Step 1 dietary advice and a 3 week wash out period]. Patients with hypercholesterolemia were randomized by an equal allocation to 2 treatment groups: Ezetimibe/Simvastatin [10/10 mg] and Atorvastatin [20mg]. Two hundred and nineteen [219] men came for follow up after 6 week treatment when their lipid levels were compared to those at the start of treatment to calculate the efficacy measures; the percent change from baseline to the end of the 6-week treatment period in LDL-C levels and the percentage of patients who achieved the treatment goals for LDL-C levels after 6 weeks of treatment. LDL-C concentrations [in milligram per deciliter] were calculated by using Friedewald equation. The subjects having Coronary Heart Disease [CHD], Diabetes Mellitus [DM], metabolic syndrome, thyroid disease, chronic renal disease and hepatic disease were excluded from the sample. Mean percentage change from baseline in LDL-cholesterol levels after 6 week treatment with the combination therapy was found significantly superior to that with the monotherapy. There is significant [P<0.01] advantage of the combination therapy over the monotherapy for the achievement of LDL-C levels reductions below the clinical cut off value of 100mg/dl. Combining Ezetimibe with statins looks to be advantageous to the statins alone for LDL-C lowering in patients of hypercholesterolemia

Management protocol of mandibular fractures at Pakistan Institute of Medical Sciences, Islamabad, Pakistan

Maxillofacial trauma is very frequent and associated with a high incidence of mandibular fractures. Although there is universal agreement as to the treatment goals and basic therapeutic principles of reduction and stabilization, a variety of currently accepted treatment modalities indicate a lack of consensus. The authors evaluate the incidence, etiology, management and complications of 344 mandibular fractures in 228 patients treated in the Department of Plastic and Reconstructive Surgery at Pakistan Institute of Medical Sciences [PIMS], Islamabad, Pakistan, during a three year period. Indications and techniques for closed and open treatment of mandibular fractures are reviewed along with any complications of these fractures or their management. A total of 344 mandibular fractures in 228 patients were included in this study. The sex, age, etiology, presentation, fracture characteristics, associated injuries, various methods of management and any pre or postoperative complications were evaluated. Although various devices and techniques have been used to treat these fractures, modern plate and screw fixation systems have proved to provide the best rigid stabilization, early mobility and associated with least complications. There was a satisfactory bone healing in all the patients and a minimal complication rate associated with open reduction and internal fixation [ORIF]. Mandibular fractures occur with high frequency in road traffic accidents and interpersonal violence. They are among the most common types of facial fractures treated by the plastic surgeons. They must be managed carefully to maintain the function of the mandible, reestablish proper occlusion, and minimize secondary complications. Open reduction and internal fixation has proven to be the most effective method for treatment of mandibular fractures

Retrospective analysis of clinical presentation of children with diagnosed intussusception

To know the presenting clinical features of intussusception in children up-to the age of twelve years. The study was conducted at the Department of Paediatric Surgery, Post-Graduate Medical Institute, Lady Reading Hospital, Peshawar, over a period of 18 months. A total of 71 patients with diagnosed intussusception were included. The relevant data, both pre-operative and postoperative, of children who were operated for intestinal obstruction and finally turned out to be suffering from intussusception, was fed into a pre-designed proforma and the information so obtained was analyzed according to objectives of the study. The common presenting features were colicky abdominal pain in 70 [98:59%] cases, vomiting in 67 [94.36%] cases, abdominal distension in 67 [94.36%] cases, constipation in 63 [88.73%] cases, bleeding per rectum in 61 [85.91%] cases, palpable mass per abdomen in 56 [78.87%] cases and fever in 18 [25.35%] cases. In 11 [15.49%] cases there was a mass palpable per digital rectal examination and 05 [07.04%] patients had diarrhoea on presentation. Colicky abdominal pain, vomiting, abdominal distention, constipation, bleeding per rectum, palpable mass per abdomen are the commonest presenting clinical features of intussusception in children

Prevalence of HBV, HCV and HIV in blood donors at Liaquetpur

To know the prevalence of hepatitis B, hepatitis C and HIV. Observational cross sectional study. Blood Transfusion Center Tehsil Headquarter Hospital Liaquetpur. The data of blood donors from 2001 to 2003. Total blood donors studied were 1426. The prevalence for hepatitis B was 5.96% [CL 4.84%-7.32%] It was 0.07% [CL <0.01% - 0.44%] for HCV and zero for HIV. The prevalence of HBV in males was 6.03% [CL 4.87%-7.45%] while 5.05% [CL 1.91%-11.63%] in females [p=0.6917]. The prevalence in 17-20 years age group was 6.4% [CL 3.92%-10.23%], 5.81% [CL 4.6%-7.33%] in 21-40 years age group and in 41-60 years age group it was 4.35% [CL 1.33%-28.19%] [p=0.9029]. Hepatitis B is common, hepatitis C is an uncommon health problem while HIV is not present in this area

Role of distant flaps in soft tissue defects of the hand

To evaluate the role of different distant [groin, hypogastric] flaps in soft tissue defects of the hand. Design and Observational case series from Jan. 2002 to Jan. 2005.Bahawal Victoria Hospital, Bahawalpur.32 patients, 28 males and four females with large skin defects on hand due to agricultural machine injury 16], road traffic accidents [8], blast injuries [6] and electric burns [2].In 18 cases groin flap while in 14 cases hypogastric flaps were employed to cover the defects. Results: Two flaps were lost completely, partial flap loss occured in one, marginal necrosis in three, while infection was noted in one case.Distal flaps are useful for the coverage of the soft tissue defects of the hand when applied with proper. indications

Small babies; relationship of maternal serum zinc levels to the birth weight of the infants

Zinc is an essential trace mineral. It is considered a growth factor as it is the metallic component of enzymes DNA polymerase, DNA dependent RNA polymerase and thymidine kinase. To find out the relationship of maternal serum zinc levels with birth weight of the babies. January 1989 to May, 1991. Lady Wellingdon Hospital Lahore, King Edward College, Lahore and Metallurgy Department PCSIR Laboratories, Lahore. Prospective study. Among the 216 registered pregnant women 46 subjects had no feto-maternal complications during pregnancy and they delivered babies having birth weight adequate for Gestational Age [AGA]. Thirteen women gave birth to babies Small for Gestational Age [SGA]. Blood samples were taken at the end of each trimester and serum zinc was measured by atomic absorption spectrophotometer. Serum zinc levels were significantly low [P<0.001] throughout pregnancy in women giving birth to SGA babies. Serum zinc levels throughout the course of pregnancy are associated with intrauterine growth of the babies

Comparison of Magpi and Mathieu repair in distal hypospadias

To compare the outcome of MAGPI and Mathieu Procedures in the treatment of distal penile hypospadias in children. Material and This prospective comparative study was conducted in the Department of Paediatric surgery Lady Reading Hospital, Peshawar from Jan 2002 to Dec 2002. A total of 40 children with distal hypospadias without chordae were selected. They were divided into two groups. Group one consisted of 20 children with glandular, coronal and subcoronal hypospadias without a groove in the glans penis. For this group MAGPI procedure was performed. Group two consisted of 20 children with coronal and subcoronal hypospadias with a groove in the glans penis. This group was managed with Mathieu procedure. of the two procedures were compared. Age of these boys ranged from one to 10 years. 32 children had coronal and subcoronal hypospadias while 8 had glandular hypospadias. Functional and cosmetic were good in Mathieu procedure but the fistula rate was more as compared to MAGPI procedure. Meatal stenosis was more commonly observed in MAGPI procedure. Observed P valve of 0.02 between two procedure is significant statistically. The MAGPI procedure was found to have better as the fistula rate was significantly less in spite of the frequent meatal stenosis