Evaluation of modified Alvarado score for frequency of negative appendicectomies

Appendicitis being the commonest surgical emergency is primarily diagnosed clinically but posses diagnostic difficulty usually, especially to junior surgeons, demanding the need for tool/scoring system that can be easily applicable, accurate and reproducible in the diagnosis of appendicitis, with low negative Appendicectomy rate. This study is designed to assess one such scoring system, i.e., Modified Alvarado Score. A total of 100 consecutive male and female patients with age 10 year and above presenting with symptoms suggestive of acute appendicitis were included in study, assessed according to eight variables of Modified Alvarado scoring system and were accordingly placed into 3 groups. Group-I patients having score 1-4 were discharged, Group-II patients having score 5-7 were observed while Group-III patients having score 8-10 were operated. Status of appendix of operated patients was assessed histo-pathologically. Out of 100 patients included in study, 58 patients were operated on the basis of said scoring system. Of the operated patients 52 [89.65%] had acute appendicitis, thus yielding a positive predictive value of 89.66% while negative appendectomy rate of 10.34%. Frequency of negative appendicectomy was 7.69% [3/39] amongst males and 15.79% [3/19] in females. Post-operative complication rate including wound infection, pelvic abscess, chest and urinary tract infection was 22.41% [13/58]. Frequency of the negative appendicectomies can be reduced through standardization of the diagnostic procedure, by applying Modified Alvarado score in the diagnosis of suspected appendicitis cases as compared to simple clinical assessment

Frequency of renal stone disease in patients with urinary tract infection

To determine incidence of renal stone disease in patients with urinary tract infection, this cross sectional study was conducted at Surgical Unit of District Head Quarters Hospital, Charsadda over a period of one year from January to December 2005. One hundred consecutive patients were enrolled in this study. All those patients who presented with urinary symptoms were included. While patients with lower urinary tract stones, upper urinary tract stones with renal failure, renal tumours and previous history of renal stones disease were excluded. The data was obtained and analyzed by filling a specially designed proforma for each patient. All 100 patients were between age ranges of 15-60 years [Mean age 37.5 years]. Infection was present in 79% of cases. The commonest organisms isolated according to culture report were E. Coli [30%], Proteus [19%], Klebsiella [11%], Pseudomonas [7%], Staphylococcus aureus [3%] etc. The frequency of renal stone disease in patients with urinary tract infection was 18.98%. [12.6% in male and 6.3% in female]. Mean age of patients with renal stones was 31.26 years and male to female ratio was 1.5:1. Renal stone disease makes an important group among urinary stone diseases. Urinary tract infection with certain bacteria plays an important role in the synthesis of renal stones. A high incidence can be prevented by adopting a variety of simple conservative measures

Role of total leukocyte count in diagnosis of acute appendicitis

Acute appendicitis is a common surgical emergency. Diagnosis may be difficult with little help from radiological and laboratory investigations. Total leukocyte count is one of the helpful investigations, being evaluated in this study. The patients presenting with right ower quadrant abdominal pain whom were diagnosed as having acute appendicitis and later underwent appendicectomy were included in the study. The preoperative leukocyte count was compared with histo-pathology findings of removed appendix. Sensitivity and specificity of TLC was calculated by standard formulas. The sensitivity and specificity of TLC as calculated in this study is 76.5% and 73.7% respectively while positive predictive value is 92.5%. TLC although not a diagnostic criteria for acute appendicitis but still is helpful investigation in decision making

Outcome of modified open surgery in tennis elbow

Tennis elbow is a common disorder of upper extremity. It can be treated conservatively in majority of the patients but some resistant cases eventually need surgery. This descriptive study was conducted at Department of Orthopaedics, Ayub Teaching Hospital, Abbottabad, from January 2002 to June 2006. Sixteen patients had surgical release of the extensor tendon origin along with excision of the lateral epicondyle ridge. These patients did not respond to conservative treatment i.e. rest, non- steroidal anti inflammatory drugs [NSAIDS], local steroid injections and physiotherapy. Patients were followed up to six months. Outcome was graded as excellent, good and poor according to pain relief and function of the hand. Sixteen patients [17 elbows] were studied, Thirteen were female [81.25%] and three were male [18.75%]. Fifteen patients [93.75%] had unilateral Tennis Elbow, while one had bilateral involvement [6.25%]. In unilateral disease, right side was affected in eleven patients [68.75%] and left side in four [25%]. Excellent outcome was noticed in eleven patients [68.75%] and good result in five patient [31.25%]. Open surgical technique of releasing extensor tendon origin along with excision of lateral condylar ridge of the humerus is new and simple procedure and yields excellent and good result in patients with resistant Tennis Elbow

surgical intervention an ideal treatment of De-Quervain's disease?

To evaluate the outcome of surgical treatment of DeQuervain s disease. Prospective study conducted from January 2004 to February 2005. Khyber Teaching Hospital, Peshawar. Clinically diagnosed cases of DeQuervain s disease who failed to respond to conservative treatment i.e. analgesics, splinatge and local steroid injections. The above mentioned patients were operated under local anesthesia and the tendons of extensor pollieis brevis and abductor pollicis longus were released. The patients were followed up for a minimum of four months to assess the clinical outcome of the procedure. There were 23 females and two male patients. Their ages ranged from 35 to 55 years with a mean age of 40 years. The two male patients were exposed to repetitive friction in terms of profession while all female patients were manual workers. Five out of 23 female patients had rheumatoid arthritis. The results of surgery showed that 22 patients had complete resolution of symptoms; in two patients the procedure ended up with failure as symptoms did not resolve and in one patient there was temporary skin paresthesia over the anatomical snuff box. Surgical intervention has promising results in DeQuervain s disease, when medical treatment fails

Outcome of closed reduction and casting in displaced supracondylar fracture of humerus in children

Supracondylar fracture of humerus in children is most common in first decade of life and needs proper management to prevent complications like cubitus varus, elbow stiffness and compartment syndrome. There are various treatment modalities i.e. traction, closed reduction and casting, open reduction and internal fixation and percutaneous pinning. Purpose of the study was to know the outcome of closed reduction and casting in displaced supracondylar fracture of humerus in children while comparing the results with published literature. Study was conducted at the Orthopaedics unit of Lady Reading Hospital Peshawar from January 2002 to December 2002 and 25 patients at random, with age range of 04 ' 12 years with displaced supracondylar fracture of humerus were treated with closed reduction and casting. Based on assessment through Flynn's criteria, results were excellent in 04 patients [16%], good in 11 [44%], fair in 03 [12%] and poor in 07 patients [28%]. Good results can be obtained in displaced supracondylar fracture Gartland type II of humerus in children with closed reduction and casting while the results with Gartland type III fracture were not satisfactory