Perinatal testicular torsion: some facts and figures

Perinatal testicular torsion is a different entity from testicular torsion in the general paediatric population. Delay in management may result in testicular loss and grave consequences like anorchia. To determine the effectiveness of immediate surgical exploration in salvaging perinatal testicular torsion. A retrospective analysis was carried out between July 2003 to June 2008 on 11 surgically proved neonates with testicular torsion. All neonates underwent immediate surgical exploration irrespective of duration of symptoms. If a nonviable testis was determined intraoperatively, it was removed, otherwise detorsion and orchiopexy was done and at the same time contralateral orchiopexy was performed. Eleven patients underwent immediate surgical exploration. In 4 [36%], testis could be salvaged. In these patients duration of symptoms was less than 12 hours. Seven [64%] underwent orchiectomy due to trank necrosis, later on proved by histopathology. Neonates younger than 30 days of age presenting with clinical findings suggestive of extravaginal testicular torsion who are expeditiously explored surgically may have a high salvage rate. Time should not be wasted in undue investigations. Urgent bilateral exploration is strongly advised in all newborns presenting with either unilateral or bilateral torsion. Such policy carries diagnostic, potential therapeutic and prognostic implications

Management of empyema thoraces in our setup

To find out the proper method of management of empyema thoraces to be adopted according to the stage of disease. Prospective study. This study was carried out at Children Hospital Complex, Multan in department of Paediatric Surgery from January 2003 to December 2005 for a period of three years. Fifty patients of post pneumonic empyema thoraces were managed from January 2003 to December 2005. All of them were included in the study. On basis of history, examination and investigations disease was staged as I, II and III. In addition to antibiotics according to culture and sensitivity, intercostals chest tube drainage was performed in all the patients of Stage-I and II. Out of fifty patients thirty four [68%] were male and sixteen [32%] female. Thirty nine [78%] were under 5 years and eleven [22%] of 6-12 years of age. Right side was involved in thirty two [64%] and left side in eighteen [36%]. Twenty nine [58%] were suffering from Stage-I, thirteen [26%] Stage-II and eight [16%] from Stage-Ill. Intercostals chest tube drainage was performed in Stage-I and II. All of the twenty nine [100%] of Stage-I and five out of thirteen [38%] of Stage-II recovered successfully. Thoracotomy was performed in all eight patients of Stage-III straight forward and eight out of thirteen of Stage-II who did not recovered after chest tube drainage. Fifteen out of these sixteen [94%] recovered, one [6%] developed sepsis and expired on 6[th] day after thoracotomy. Tube drainage is very much successful in Stage-I. Early thoracotomy is an excellent option to treat Stage-II and III. Pus drainage facilitative measures are helpful in evacuation of the pus and expansion of lungs

Comparative study between early and delayed grafting in burn patients

To evaluate the relationship between the mortality and morbidity in both early and delayed types of grafting. From September 1998 to September 2000, forty seven patients with full thickness burns were admitted to the Department of Paediatric Surgery, Nishtar Hospital, Multan, Out of these forty seven, twenty eight patients with full thickness burns were prospectively studied. Nearly all of the patients were admitted through casualty. Male to female ratio was 1.3:1. Pertaining to the type of burn, flame burns are 50% and scalds 39.2% in our study. Average number of dressing in early grafting was 7-10 whereas in delayed grafting it was 25.30. Hospital stay in early grafting was 10-15 days while it was 25-30 days in delayed grafting and return to school/work in early grafting was within 2 weeks but in delayed grafting it was 4-5 weeks. Mortality rate in early grafting was 1 [7.1%] but in delayed grafting it was 4 [28.5%]