Comparison of scar with polypropylene and polyglactin 910 in thyroid incisions

To compare quality of scar after subcuticular stitches between Polypropylene [Prolene], a non-absorbable suture, with Polyglactin 910 [Vicryl], an absorbable suture after thyroid surgery. Randomized controlled trail [RCT]. Department of Surgery Combined Military Hospital and Military Hospital Rawalpindi from 1 Jan 2007 to 31 Dec 2007. Sixty patients undergoing elective thyroid surgery were included and randomly divided into two groups using random number tables. Informed written consent was obtained from each patient. The neck wound was closed by subcuticular suturing technique and the suture material was used according to the sampling technique. The patients were followed up in OPD on 10[th] post operative day and twelve weeks after surgery for the quality of scar. After 10 days, 1 patient in each of the Polypropylene group [3.3%] and Polyglactin 910 group [3.3%] had a bad scar [p = 1.000]. After twelve weeks of surgery, 2 patients in the Polypropylene group [6.7%] and 3 patients in the Polyglactin 910 group [10.0%] had bad scars [p = 1.000]. There is no significant difference between the frequency of bad scar formation in the Polypropylene and Polyglactin 910 group. It is thus recommended that absorbable Polyglactin 910 sutures should be used for wound closure after thyroid surgery as it does not require suture removal and thus prevents patient anxiety and discomfort and also saves surgeon and staff's time

Cervical lymphadenopathy: a common diagnostic dilemma

To determine the diagnostic accuracy of fine needle aspiration cytology [FNAC] in cervical lymphadenopathy using histopathologic examination of the excised lymph node as gold standard. Cross sectional study. Combined Military Hospital Rawalpindi in collaboration with Armed Forces Institute of Pathology [AFIP] Rawalpindi, from January 2007 to January 2008. A total of 70 patients suffering from cervical lymphadenopathy were selected. After obtaining informed consent FNAC was obtained from the lymph node. Afterwards same lymph node was removed under local anesthesia for histopathology. All specimens were sent to AFIP for histopathology reporting. Sensitivity, specificity, positive and negative predictive values and diagnostic efficacy for both the modalities were calculated. Data was analyzed using SPSS version 10. Mean and standard deviation for age and gender were calculated. Mean age of the patients was 38.14 +/- 16.88 year. FNAC findings showed a sensitivity of 79.5%, specificity 47.61%, positive predictive value 78%, negative predictive value 50% and diagnostic efficacy 70%. FNAC appears well established method of diagnosis, as its results compared favorably in many respects with those obtained from traditional surgical biopsy.

Comparison of tramadol with bupivacaine as local anaesthetic in postoperative pain control

To determine the effectiveness and duration of postoperative pain relief after local infiltration of tramadol in comparison with bupivacaine, in adult hernia surgery. Quasi experimental study. Department of Surgery, Combined Military Hospital Rawalpindi. Study was conducted on 60 patients aged between 20-60 years with elective mesh repair of inguinal hernia. Patients were divided into two groups of 30 patients for 0.25% bupivacaine [group A] and tramadol [group B]. Patients were assessed for pain at 1, 6, 12, 18 and 24 hours following surgery using visual analogue pain score [VAPS]. Patients with score =5 were given rescue analgesia in the form of 75 mg intramuscular diclofenac sodium. Comparison of first analgesia requirement time and the VAPS between the two groups was done using "t" test taking a p-value of <0.05 as significant. Patients in group A had a mean age of 46 +/- 11.03 years whereas in group B the mean age was 46 +/- 11.39 years. Mean visual analogue pain score after 1 and 6 hours of operation was 2.73 and 4.7 respectively in group A while it was 1.43 and 3.43 in group B. VAPS after 24 hours of operation was 3.47 in group A and 2.53 in group B. Mean time when 1st dose of rescue analgesic used was 8.20 hours in group A and 11.60 hours in group B. independent sample t-test for VAPS between the 2 groups revealed a highly significant difference [p-value <0.05] at 1, 6, 12 and 24 hours but no significant difference was seen at 18 hours. Independent sample t-test for time required for rescue analgesia and total number of doses required was also highly significant [p-value <0.05] between the two groups. Locally infiltrated tramadol provided an improved postoperative analgesia in comparison to bupivacaine and decreased the requirement of postoperative analgesics with early patient mobility and discharge