Intraperitoneal mesh plasty

Incisional hernia is a common surgical condition with a reported incidence of 2-11% following laparotomy. Various modalities of repair have been advocated but the overall results still remain disappointing. To evaluate in incisional hernias the efficacy and safety of intraperitoneal mesh repair with conventional Polypropylene mesh. In CMH Muzaffarabad, CMH Sialkot and PAC Hospital Kamra. From January 2000 to January 2007. 90 cases of incisional hernia with a minimal defect size of 4 inches were included; there was no limitation to age and sex. Patients with comorbid conditions like Diabetes Mellitus, Hypertension, Bronchial Asthma, and lschemic Heart Disease etc: were also included if there was no other contraindications for surgery. Observations were made with regard to duration and ease of the operation, wound complications, hospital stay, recurrence and delayed complications. In our series of 90 patients, females [92.22%, n=83] outnumbered males [7.77%, n=7] and the highest incidence was in the 4[th] decade of life in females and the 3[rd] decade of life in males. Gynecological operations accounted for 61.44% [n=51] of the index operations. 77.7% [n=70] of patients had a BMI >30. Comorbid conditions were present in 36.66% [n=33] of patients. The polypropylene mesh placed intraperitoneal varied from 15x7.5 cm to 30x20 cm. The mean operating time was 60 +/- 20 minutes; operating time was extended when the procedure was accompanied by Dermolipectomy 80 +/- 10 minutes. 85.55% patients [n=77] attended our follow-up, ranging from 12 months to five years. Method of follow-up in outpatients department [OPD]/Clinics: 71.11% [n=64], by telephonic conversation: 12.22% [n=11]. 14.44% [n=13] were lost in follow up. All patients in follow up had serial abdominal sonograms at 3, 6, 9 and 12 months postoperatively respectively to evaluate bowel motility, adhesion formation and any locally associated complication. No recurrence was noted in the follow-up group. Historically intraperitoneal mesh placement of conventional polypropylene has been avoided as it was associated with significant postoperative complications. Based on our analysis, we believe that intraperitoneal mesh repair is still an effective option for incisional hernias, especially in difficult cases and with patients having comorbid conditions. The associated high incidence of complications associated with intraperitoneal mesh placement in the literature were not seen in our experience

Role of radiology in pancreatic disorders

To find out mode of presentation and role of image modalities in pancreatic lesions in patients referred to radiology department. Prospective study. Radiology departments of CMH Muzaffarabad and CMH Sialkot from Jan 2003 to Jan 2006. This study was conducted at CMH Muzaffarabad in collaboration with Kashmir CT Scan installed at CMH Muzaffarabad and CMH Sialkot in collaboration with PVT-CT Scans. Radiology departments of CMH Muzaffarabad and CMH Sialkot are equipped with ultrasound and fluoroscopic facilities. We evaluated 50 patients of different pancreatic lesions referred to our radiology department. Pancreatic lesions were more common in men [70%] than women [30%]. Large group of patients [90%] belong to old age group. Out of 50 cases, 60% patients presented with jaundice, 20% with acute abdomen, 10% with mass abdomen and 10% with mixed symptoms. Ultrasonograph [USG] has been the main imaging modality in our study. All patients initially scanned with USG, patients diagnosed as mass pancreas on USG were advised CT scan, percutaneous transhepatic cholangiogram [PTC]/endoscopic retrograde cholangiopancreatogram [ERCP], and USG guided FNAC. In 15 [30%] cases ultrasound was inconclusive, in 10 patients pancreas was not clearly visualized and in 05 cases pancreas was normal looking. CT scan is more sensitive in picking up pancreatic lesions. CT scan was done in 24 [48%] patients. The results are shows in table. In our study 26 [52%] patients were of pancreatitis [Acute/chronic] and 20 [40%] of growth pancreas, 04 [8%] misc. cases [Divisum pancreas 02, annular pancreas 01, retropancreatic haemangioma 01]. It is concluded that pancreatic lesions present as acute abdomen, mass epigastrium and jaundice. In our set up USG is the main imaging modality to diagnose the pancreatic lesions. CT scan, PTC and ultrasound guided FNAC used as complementary tool

Bicycle passenger injuries in children

To find out types of traumatic injuries in bicycle passenger children. At PAC hospital Kamra. Period: From October 2005 to October 2007. The children between the ages of 03 to 10 years were included in this study. They were divided into two groups. First group[Gp-I] sustained injuries due to ankle or foot entrapment in rear running wheel while the second group [Gp-II] sustained injuries due to fall of bicycle, while child sitting alone either at front bar or rear luggage carrier unattended. Gp-I sustained mostly frictional injuries ranging from simple abrasion to deep lacerated wounds of lower leg, ankle and foot. While in Gp-II severe injuries like fractures of upper and lower limbs, visceral abdominal injuries and head injuries were observed. Bicycle passenger injuries are common injuries of the children in less developed countries. These injuries range from simple "road rash" to serious head injuries

Neonatal resuscitation; the use of laryngeal mask airway

The key to success in newborn resuscitation is the knowledge about the neonatal physiology and adequate preparation of the staff involved in the resuscitation process. The pulmonary part of the resuscitation can be accomplished with either Endotracheal Tube [ETT] or Face Mask [FM], both of these techniques require expertise and are associated with high rates of failure. Hence a third potential option has been suggested to overcome these problems. To evaluate the efficacy of Laryngeal Mask Airway [LMA] in neonatal resuscitation and artificial ventilation and to compare it with that of ETT and FM. To evaluate LMA's efficiency in situation where endotracheal intubation and facemask ventilation is difficult or not possible. A Non interventional, analytical/ comparative study. Combined Military Hospital Rawalpindi. 20 weeks [1st] January 2002 to 31 May 2002]. A group of 75 neonates born with C-Section were selected on the basis of non-probability convenience sampling. They were subdivided into three sub gps with 25 neonates in each sub gp. 75 neonates born after C-Section, were divided into sub gps i.e. A, B, and C containing a no of 25 neonates in each gp. They were ventilated with ETT, FM and LMA respectively. These newborn babies had an Apgar score < 4. They were resuscitated using a fix protocol. The efficacy of ventilation with either technique was evaluated in terms of placement and ventilation. The LMA emerged, as a valuable and better option in newborn resuscitation. Moreover, it was a successful tool in situations where endotracheal intubation and facemask ventilation was difficult or impossible. The LMA is a potential valuable adjunct for the management of neonatal airway

Per-cutaneous transhepatic cholangiography in obstructive jaundice by using lumbar puncture needle

To assess the effectiveness of per-cutaneous transhepatic cholangiography [PTC] with 22G lumbar puncture [LP] needle in obstructive Jaundice. The study was carried out at CMH Muzaffarabad and CMH Sialkot from January 2003 to March 2006. Twenty two patients were included in our study who underwent PTC for evaluation of obstructive Jaundice. PTC was done in these patients using ordinary LP needles [22 G] instead of Chiba needle under fluoroscopic guidance. Preliminary ultrasound scan and coagulation profile were done in all patients. Of 22 patients 12 were males, and 10 females, their mean age being 55+ 10 years. Intra hepatic and extra hepatic channels were opacified with 100% accuracy. Growth / masses and stones were commonest causes of obstructive jaundice. Out of growth and masses, cholangiocarcinomas [including Klatskin tumor] and carcinoma head of pancreas were more common. PTC related complications were nil. PTC can be successfully performed in cases of obstructive jaundice with ordinary LP needle [22 G]. This is cost effective, simple and less time consuming