Early stage ingrown toe nail and role of conservative treatment- an experience at Sukkur

To find out the frequency, causes and role of conservative treatment in early stage ingrown toe nail. Descriptive, observational, case series study. This study was conducted at the Department of Surgery, Ghulam Muhammad Mahar Medical College [GMC] ,Teaching Hospital, Sukkur from March 2011 to February 2012. Detailed history and physical examination especially local examination of the affected toe was made in OPD, to stage the disease. Only patients with early stage [Stage-I] ingrown toe nail were included in this study. Patients in advanced stages [stages-II and III], with history of diabetes, trauma, vascular diseases and all recurrent cases, which were operated upon in past excluded from this study. The patients were treated conservatively by advising for good foot hygiene and cutting the nails properly. Selected patients required wicking technique. This procedure was taught to patients so that they could do it once or twice daily at their homes. Patients were kept on antibiotics where required and simple pain killers. The patients were advised to visit the OPD regularly at defined time. 86 patients participated in this study, 54 [62.7%] were males and 32 [37.2%] were females with male: female ratio of 1.68: 1. Age ranged from 17-66 years, majority of patients were in between 21 to 40 years of age [44.1%] with mean age of 36 years. In majority of patients the right big toe was affected [n=56, 65.1%], in 22 [25.5%] left big toe and in 08 patients [09.3%] there was bilateral involvement of both big toes. Lateral nail fold was affected more [n=38, 44.1%] than medial fold [n=12, 13.9%]. In 36 [41.8%] patients both nail folds were affected. Various causative factors were identified with most important was improper nail trimming [n= 17, 19.7%] followed by tight fitting shoes [n=14, 16.2%] and idiopathic [n=02, 2.3%]. Majority of the patients [n=52, 60.4%] were only required antibiotic, pain killer and advice on foot care while 34 [39.5%] patients were advised for wicking. In our study, the success rate of conservative treatment remained 92.85% [n=65] at one year follow up. Ingrown toe nail is quite common condition. In early stage, it can be safely treated by conservative methods, if applied properly, which avoid disfigurement and train the patients to care for their own toes

Etiological factors and treatment outcome of genital and perineal necrotizing fascitis [Fournier's gangrene]

To analyze clinical and laboratory parameters in patients with Fournier's gangrene [FG] and to assess factors that determine mortality. A retrospective review of 82 patients with FG from January 2007 to December 2011 was made. They were divided into two groups: those who survived [survivors] and those who did not [non survivors]. We analyzed clinical and laboratory data. The mortality rate remained 36.6% [30/82 patients]. Increased heart and respiratory rates, elevated serum creatinine, pre-existing kidney disease, and higher extent of affected body surface were associated with higher mortality. Severe sepsis on admission and hypotension < 90 mm Hg] were also predictive for higher mortality. The median FG severity index [FGSI] score was higher in non survivors [22 vs 12, p < 0.0001]. Besides standard clinical and laboratory parameters included in the FGSI calculation, higher extent of affected body surface area and presence of hypotension on admission were positively associated with mortality. Early clinical identification and prompt aggressive treatment are essential for reducing mortality and morbidity in patients

When to operate and abdominal gunshot wounds

Violence has become part and parcel of the daily routine of living, the prospective study of 86 patients, sustaining abdominal gunshot wounds was designed to evaluate the pattern, presentation and treatment outcome. Descriptive study. This study was conducted at the department of Surgery, Ghulam Muhammad Mahar Medical College Sukkur from January 2011 to January 2012. patients presenting with abdominal firearm wounds at accident and emergency department were included in this study, clinically all were evaluated, resuscitated and their findings were recorded on proforma. Patients with signs of acute abdomen [peritonitis]/ shock underwent midline emergency laparotomy, others having minimal or equivocal abdominal signs were selected for observation [non-operative management] group. Total number of patients included was 86, all were males, they belonged to age varying from 15-70 years. 54 [62.8%] were below the 40 years of age, in 44 [51.1%] cases instrument of attack used by assailant was pistol/shotgun, 45[52.3%] cases were victims of armed robbery, in 75 [87.2%] entrance wounds were present in anterior abdominal wall where as in 11[12.1%] were present posterirly, 67 [77.9%] underwent emergency laparotomy and 19 [22%] were observed initially. Two patients belonging to observation group showed failure, needed delayed laparotomy and both had positive laparotomy. Gunshot wounds of abdomen can be safely managed non-operatively, in the absence of abdominal tenderness haemodynamic instability or inevaluable factors as head injury and heavy intoxication. Success of non operative management depends upon continuous monitoring and frequent clinical examination

Laparoscopic cholecystectomy: an experience of 550 cases at Sukkur

To see the results and complication rate of Laparoscopic cholecystectomy at Sukkur. Prospective Study. This study was conducted at Ghulam Mohammad Mahar medical College Hospital Sukkur and Sukkur Blood Bank Hospital from December 2004 to December 2009. The study comprises of 550 case. All were admitted from OPD of both hospitals. All patients had routine investigations, Liver function tests and ultrasound abdomen. The patients who underwent laparoscopic cholecystectomy whether successful or converted were included in study. The procedure was carried out by standard four port technique. Clinical examination, investigations, operative time, postoperative complications, reasons for conversion and hospital stay were recorded on proforma and results were drawn. The male patients were 100 and female patients were 450, male to female ratio was 1:4.5. Mean age of patients were 47.63 years ranging from 25 years to 75 years there were 127 [23.09%] obese, 72 [13.90] controlled hypertensive. Anatomical obstacle noted in 40 [7.27%] patients. Adhesions in 52 [9.45%] and acute cholecystitis in 22 [3.75%] patients. Overall conversion rate was 4%. In total of 22 patients which were converted, causes were slipped clip, 2 hemorrhage from falciform ligament 1, severe hemorrhage 3, unclear anatomy 6, common bile duct injury 4, intra abdominal adhesions 4, gangrene gall bladder 1, and advance carcinoma 1. mean hospital stay was 1.8, ranges from 1 day to 10 days. Laparoscopic cholecystectomy has a gold standard procedure. It is safe and effective and becoming cost effective day by day. Incidence of complication is low, morbidity and mortality are low. The pain free postoperative period and early ambulation lead to saving of value able working hours

How early is early laparoscopic cholecystectomy in acute cholecystitis?

The efficacy and timing of early laparoscopic cholecystectomy for acute cholecystitis has been a subject of debate for years. Prospective comparative study, done at Ghulam Muhammad Mahar Medical College and Hira Medical Center, Sukkur, from July 2007 to June 2010. All patients undergoing Laparoscopic cholecystectomy for acute cholecystitis were included in the study. They were admitted through emergency with acute cholecystitis. Patients were divided into two groups according to the timing of surgery from the onset of symptoms. Group I included 205 patients who presented with acute cholecystitis within 48-72 hours of onset of symptoms and their surgery was done within 48-72 hours of presentation. Group II included 95 patients who presented after 72 hours of onset of symptoms and their surgery was done after 72 hours to one week of presentation. Clinical data was recorded and routine investigations along with ultrasound abdomen were carried out. The procedure performed, and its complications and success rate noted and compared between the two groups. The study included 300 patients with acute cholecystitis who underwent early laparoscopic cholecystectomy within 48 to 72 hours of onset of symptoms in Group I and after 72 hours to 1 week in Group II. Among 300 patients there were 90[30%] males and 210[70%] females. The age of patients ranged from 20 to 70 years with a mean of 45 years. There were no open conversion in group I while 4.2% had to be opened in group II, the median operative time was 65 minutes in group I and 90 minutes in group II, postoperative hospitalization was 1 day in group I and 3.5 days in group II and total hospital stay was 2 days in group I and 4.5 days in group II. Intra-operative and postoperative complications were less in group I as compared to group II. Early laparoscopic cholecystectomy within 48-72 hours of onset of symptoms results in lower conversion rate, shorter operative time and reduced hospitalization. All patients with acute cholecystitis should be operated within 48-72 hours of the symptoms