Scierotherapy versus rubber band libation. comparative study of efficacy and compliance in the treatment of uncomplicated second degree haemorrhoids

To compare the outcome of two different procedures of non operative treatment of uncomplicated second degree hemorrhoids in terms of efficacy and patients compliance. Prospective interventional. Controlled Phase II clinical trial. Surgical Unit DHQ [Teaching] Hospital Rawalpindi from 10th September 2004 to 20th May 2006. Regardless of age and sex, first hundred patients attending the out patients department of surgical unit, DHQ [Teaching] Hospital, Rawalpindi with uncomplicated second degree hemorrhoids after informed consent were enrolled in the trial. Patients were divided into two treatment groups A and B with 50 patients in each by random draw sampling. Patients in Group A were subjected to injection sclerotherapy [SCL] whereas of Group B, Rubber band ligation [RBL]was performed. One hundred patients of mean age of 42.24 years with uncomplicated second degree hemorrhoids with standard deviation of +13.63 years were enrolled in this study. Out of total one hundred patients, 62 were male and 38 were female. The major indications of treatment were bleeding per rectum and prolapse. Patients in Group A were subjected to Injection sclerotherapy [SCL] and of Group B, Rubber band ligation [RBL] was performed. In Group A, 28 patients [56%] were symptoms free after 4-6 weeks with single session of SCL, 16 patients [32%] required additional second session at eight week and 6 patients [12%] required third session at 12 weeks respectively due to persistence of symptoms. In Group B, 44 patients [88%] were symptom free after four weeks with single session of RBL, while 6 patients [12%] required second session at 10 weeks to become symptom free. At 12 month follow-up 46 patients [92%] remain symptomfree and 4 patients [8%] had recurrence of symptoms in Group A and rubber band ligation was performed. All the patients of Group B [RBL] remained symptom free. [P value=0.041]. Rubber band ligation is a safe, effective, economical non operative treatment option for second degree uncomplicated hemorrhoids with good patients compliance

Acute pancreatitis; management, morbidity and mortality experience in a surgical unit

Acute pancreatitis represents a spectrum of disease ranging from a mild, self-limited course to a rapidly progressive, severe illness. The mortality rate of severe acute pancreatitis exceeds 20%, and some patients diagnosed as mild to moderate acute pancreatitis at the onset of the disease may progress to a severe, life-threatening illness within 2-3 days1. A study was conducted in RGH [Now BBH]. January, 1997 to January, 2001. All patients with abdominal pain and having a serum amylase level of five times the normal range, were included in the study. 72 patients were admitted. 29 [40.2%] were males and 42 [59.7%] were females. Male to female ratio was 2:3. The age of the patients ranged from 7 years to 85 years [average age 40 years]. Disease severity was assessed according to Ranson's criteria. They were managed in a general surgical ward or intensive care unit when indicated. Development of complications and their management done were recorded. Patients stayed in the hospital from 1-21 days with an average period of 8.59 days. 32 [44.44%] recovered uneventfully without any complication while 40 [55.55%] patients developed either local or systemic complications. Overall 10 [13.88%] patients died early in the course of disease i.e. within one week. All of them were above 55 years of age, 6 of them were females and 4 of them were males, mortality ratio for female to male was 3:2. [1] To study the morbidity and mortality in patients of acute pancreatitis. [2] To evaluate the management of acute pancreatitis in a general surgical unit. Management of mild acute pancreatitis is simple, it needs only supportive treatment. However, the management of severe acute pancreatitis is complex. Mortality is high and the treatment requires individualized approach regarding timing of surgery and choice of technique

Selective management of typhoid perforation of bowel

To evaluate the selective management of enteric typhoid perforation, according to the time of presentation, in terms of morbidity and mortality. Descriptive case series. Surgical unit of DHQ teaching hospital, Rawalpindi, from April 2004 to April 2011. A total of 84 patients were included, and divided into two groups. Forty patients, who presented early [within 48 hours] constituted group A, were managed by primary closure. of perforation while patients who presented late were put in group B and stoma was made. The age range was 10 to 40 years. Seventy five patients were males and 9 females. Forty four patients presented with features of systemic toxicity. All group A patients were managed by primary closure of perforation. In group B, ileostomy was performed in 20 patients after bowel resection, and the perforation was exteriorized in 22 patients with single perforation. Two patients had primary anastomosis. Overall mortality was 11.9%. Primary closure should be reserved for selective patients who present early, without gross peritoneal contamination. Patients who present late, or are severely ill, should be managed by ileostomy

Post thyroidectomy hypocalcemia - does arterial ligation play a significant role?

The aim of this study was to determine if bilateral inferior thyroid artery [ITA] ligation is a causal factor for the occurrence of postoperative hypocalcaemia after subtotal thyroidectomy. Quasi experimental trial. One year study from Jan 2005 to Dec 2005 conducted at surgical department of Rawalpindi General Hospital [UNIT-I]. One hundred patients were included in the study who underwent subtotal thyroidectomy with and without truncal ligation of inferior thyroid artery and were prospectively analyzed comparing postoperative and late serum calcium levels A significant incidence of postoperative hypocalcaemia occurred: more in Group A [48%] as compared to Group B [22%]. This difference was statistically significant shown by the P value < 0.5 on the 1st postoperative day in patients with ligation of inferior thyroid artery. The ligation of the ITA tends to produce hypocalcaemia in patients undergoing subtotal Thyroidectomy

Cirrhosis of liver in asymptomatic patients

Autopsy experience shows that cirrhosis may be entirely asymptomatic and in life it may be found incidentally at surgery. [1] A study was carried out on 100 patients, selected at random, who underwent laparotomy. Purpose of study was to find the incidence of liver cirrhosis in asymtomatic patients, diagnosed on laparotomy and identify the risk factors [i. Viral hepatitis B and C, ii. Alcohol, iii. Toxins and drugs e.g., methotrexate.] Out of 100 patients, 54 patients were females and 46 males, with a mean age of 33.8 years. Seven patients had asymtomatic cirrhosis, 2 were hepatitis B positive, 4 were hepatitis C positive and one was alcoholic. Main cause of asymtomatic cirrhosis was Hepatitis B and C

Penetrating chest injuries

Penetrating wounds to the chest in civilian practice result mainly from stabbing or gun shot wounds. A study was carried out in surgical department of Rawalpindi General Hospital from October 1996 to October 1998, to know the cause of increasing incidence of penetrating chest injuries, its clinical presentation, treatment options, morbidity and mortality. Patients of all ages and either sex were included. 45 patients with penetrating injuries were hospitalized. The age range was between 17-57 years. There were 42 males and 3 females. 29 patients had Gunshots, 16 had Stab wounds. Patients with cardiac injuries were excluded from the study. 28 patients got isolated chest injuries and 17 patients had associated injuries. 55.55% patients required chest intubation only, 13.33% required laparotomy and chest intubation and 6.66% had thoracocentesis. Ten patients were treated by observation alone. 2 patients died [mortality = 4.4%]. The major complications occurred in 26.6%. Surgical emphysema developed in 4 patients. Wound infections in 4.4%. Thoracic empyema developed in two patients and were treated with tube thoracostomy and ribs resection. The duration of stay ranged from 2 to 54 days. The mean hospital stay was 3 days in patients with penetrating chest injuries alone and 24 days who had associated abdominal injuries. Two patients with stab wound and one patient with gunshot wound developed haemothorax after 16 hours of admission. In two patients chest intubation was done and thoracocentesis done in other patient and 250 ml blood aspirated with 14 G intravenous cannula. First aid training to public and mass education can prevent early deaths. Tube thorocostomy is the most common method of treating penetrating chest injuries

comparative study of the efficacy and cost -effectiveness of occlusive versus conventional dressing in the treatment of open wounds and ulvers

The choice of wound dressing was limited until recently and dressing application, decided empirically and often left to the most junior member of the team. Many wound dressings are now available and others are under development. A study was carried out on 60 patients at Surgical Unit-I, Rawalpindi General Hospital, Rawalpindi from January 1996 to April 1997. Patients were divided into two groups and treated with pyodine gauze or hydrocolloid type of dressing. Twentythree [76.7 percent] were males and 7 [23.3 percent] were females in the pyodine gauze dressing group and 20 [66.7 percent] were males and 10 [33.3 percent] were female in the hydrocolloid dressing group. The major causes of the wounds in our study were road traffic accidents [50 percent hydrocolloid group, 60 percent Pyodine gauze group] incision and drainage of abscesses [23 percent hydrocolloid group, 27 percent pyodine gauze group] and post-operative appendicectomy wounds, intentionally left unstitched. Twentyfour patients [80 percent] in the pyodine gauze group and 25 patients [83.3 percent] in the hydrocolloid group completely healed and 3 patients in each group required secondary suturing. Skin grafting was done in 3[10 percent] patients in the pyodine gauze group and 2[6.7 percent] patients in the hydrocolloid group. Wound infection occurred in 4 patients [13.3 percent] in pyodine gauze group and one patient [3.3 percent] in hydrocolloid group. Incidence of positive growth with no clinical evidence of infection occurred in 6 patients [20 percent] in pyodine gauze group compared to one patient [3.3 percent] in hydrocolloid group. In the hydrocolloid group, 27 patients [90 percent] experienced marked reduction in pain compared with none in the pyodine group. Removal of dressing was easy in all the 30 [100 percent] patients in the hydrocolloid group compared with only 6 [20 percent] patients in the pyodine gauze group. Also removal of dressing was painless in all the patients in the hydrocolloid group, compared with painful dressing removal in 27 [90 percent] patients in the pyodine gauze group. Necrotic tissue in wound was softened in 24 [89 percent] patients in the hydrocolloid group compared with 2 [6.7 percent] patients in the pyodine gauze group. No exudate was found in wounds in 21 [70 percent] patients in the hydrocolloid group compared with 6 [20 percent] patients in the pyodine gauze group. The appearance of granulation tissue was good in 27 [90 percent] patients in the hydrocolloid group compared with 18 [60 percent] patients in the pyodine gauze group. The total number of dressings required to heal a wound completely ranged from 2 to 8 dressings for the hydrocolloid type [average 4.4 dressings], compared with the pyodine gauze requiring 7 to 29 dressings to heal a wound [average 16.1 dressings]. Total days to heal a wound under hydrocolloid dressing ranged from 14 to 49 days [average 26.7 days], compared with 11 to 74 days for pyodine gauze group [average 29.1 days]. Frequency of change of dressing was 4 to 7 days for hydrocolloid [average 6.14 days], compared with 1 to 3 days for pyodine gauze [average 1.84 days]

Role of helicobacter pylori in perforated peptic ulcer disease and its persistence

The present study investigated H. pylori infection in patients with perforated peptic ulcer and attempted to determine whether continuing infection is related to persistence of peptic ulcer and leading to perforation. A prospective study of 35 patients was carried out, who presented to the emergency department with perforated peptic ulcer during 1995 and 1996. There were 34 male and one female patient. Ages ranged from 25-85 years. Eleven patients presented during the month of Ramdan. Twenty six patients had history of dyspepsia, eight had taken two to three doses of NSAIDs, 12 had history of medication from hakeems while 28 [80%] were smokers. Anti H. pylori antibody was positive in 12 out of 30 patients. Biopsies from ulcer was positive for urease test in nine patients. On histopathology, 10 patients had evidence of H. pylori infection and one had adenocarcinoma. Over all incidence of H. pylori infection was 40%. In patients with H. pylori infection, 10 out of 12 patients had persistent duodenal ucler on follow up endoscopy, which were treated subsequently by eradication therapy. The study suggests that H. pylori is responsible for persistence of chronic peptic ulcer, but has no role in acute peptic ulcer perforations, where NSAIDs and medications from hakeems appear to be responsible for its causation

Frequency of hepatitic b and c; surgical patients in rawalpindi general hospital

Viral Hepatitis is the most common liver disease today and constitutes a world wide problem [Cuschieri A. et aI, 1995. Surgeons and Health Care Workders are exposed to an increased risk with all types but especially Hepatitis "B" Virus [HBV] and Hepatitis "C" Virus [HCV]. A randomised crossectional study was carried out on 300 surgical patients irrespective of their age, sex or diagnosis. 1: To know the frequency of HBV and HCV. 2: To identify risk factors which are associated with higher incidence in surgical hospitalised patients and 3: To identify the asymptomatic carriers. 154 patients were females and 146 were males, with mean age of 42.5 years. 18.66% [27M-29F] patients were Hepatitis B antigen +ve and 16.33% [26M-23F] patients were Anti HCV +ve. Mean age for HBV and HCV positive patients was 44 years and 41 years respectively. History of operation with or without transfusion was present in 101 patients. Out of which 51 patients were positive for either HBV or HCV. 70 patients had dental treatment, 32 patients were positive. Only 35 patients had history of jaundice with positive results in 21 patients. 190 patients received multiple injections but positive results were present in 28 patients. 76 [12+ve] patients has no significant history of risk factors. One patient acquired HBV from sexual intercourse and one patient had HCV from vaccination. There is high prevalence of Hepatitis B and C in surgical hospitalised patients. So all patients under going surgery should be screened for Hepatitis B antigen and Anti Hepatitis C antibody. All risk factors should be avoided. History of Jaundice only, should not be relied upon, as less than 25% patients had the history

Reflux oesophagitis: a comparison of treatment with normal and slow release metoclopramide preparations

Twenty four patients with reflux oesophagitis were recruited into a crossover study of normal release metocloparmide [Maxolon tablets 10 mg three times a day] and slow release metocloparmide [Digestine capsules 40 mg equivalent to 16 mg metoclopramide HCI-once daily]. Both treatment regimens were found to be effective in the relief of reflux symptoms. The incidence of side effects was similar in both groups. Slow release was preferred by more patients. It is concluded that normal release metoclopramide given 10 mg three daily and slow release metoclopramide given 16 mg once daily are equally effective and both are well tolerated; however the slow release preparation has the advantage of smaller dose and once daily administration