Acute scrotal pain: a two year prospective cohort study

Objective: To determine the cause of acute scrotal pain and its subsequent treatment

Study Design: Prospective cohort study

Place and Duration of Study: This was carried out in Armed Forces Institute of Urology Rawalpindi and Combined Military Hospital Abbotabad from 1[st] Jan 2014 to 31[st] Dec 2015

Materials and Methods: A total of 116 patients who presented with acute scrotal pain were included in the study

Those presenting within six hrs and a history consistent with testicular torsion underwent urgent exploration. Those presenting with a history of more than six hours or within six hrs but clinically suggestive of testicular torsion underwent emergency Doppler ultrasonography before surgery

Results: The occurance of different conditions were as follows: testicular torsion 10, torsion of appendix testis 02, Epididymo-orchitis 4, orchitis 10, trauma 12, infected hydrocelei 12 ,strangulated inguinal hernia 3, and idiopathic scrotal pain 18. Mean age [in years] for testicular torsion was 13 +/- 5 for Torsion of appendix testis 16 +/- 8, and for epididymo-orchitis 50 +/- 22. Mean duration of symptoms [in hours] for testicular torsion was 10+/-4, torsion of appendix testis was 11 +/- 3 and epididymo-orchitis 18 +/- 14. During surgery for testicular torsion ,detorsion of the affected testis was done and bilateral orchidopexy was performed in 04 patients. Orchidectomy with orchidopexy of the contralateral side was done in 06 patients who had nonviable testis

Conclusion: Acute scrotal pain is a common presentation. Our study concluded that in such cases colour Doppler ultrasonography is important to reach a definitive diagnosis

The occurance of testicular torsion is very high in patients less than 18 years of age .Moreover if there is a clinically strong suspicion of testicular torsion then yield of immediate surgery is high, because delay in exploration proves detrimental to the efforts of salvaging the testis. Patients with epididymo-orchitis respond well to ciprofloxacin prescribed for two weeks

Comparison of lateral anal sphincterotomy [closed method] versus anal dilatation

To compare lateral anal sphincterotomy [closed method] with anal dilatation in the management of primary chronic anal fissure. A prospective, comparative, interventional study. Department of Surgery Combined Military Hospital Kohat from Jan 2001 to Mar 2002. During the period, all patients with primary type of chronic anal fissure, who were above 12 years of age and were fit for surgery, were selected for study. They were divided into two groups for both surgical procedures in a randomized manner. After their respective surgical procedures patients were followed up for four weeks on weekly basis. The changes in signs and symptoms were thoroughly reassessed and noted in a separate proforma maintained for each patient for the purpose of comparison. The total number of patients was 49 with an average age of 40 years. Male to female ratio was 7:1. In 44 [89.79%] patients the fissure was located posteriorly while in 5 [10.20%] patients it was located anteriorly. Closed lateral anal sphincterotomy [LAS] was done in 28 [57.14%] patients, of which 25 [51.02%] were males and 3 [6.12%] females. While anal dilatation [AD] was done in 21 [42.85%] patients, 18 [36.73%] males and 3 [6.12%] females. In all the patients in whom LAS was done, there was disappearance of all the symptoms and complete healing of ulcer. Those operated by AD, there was disappearance of all the symptoms and complete healing of ulcer in only 8 [38%] patients. Incontinence was present in 9 [18.36%] patients. Three [14.2%] patients had persistence of ulcer while one [4.76%] was having recurrence of ulcer. Lateral anal sphincterotomy, especially close method gives excellent results as compared to anal dilatation in terms of ulcer healing, disappearance of symptoms and lower rate of ulcer recurrence or incontinence

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

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

Monkey bite

Monkey bites have been reported less frequently in medical literature as compared to other animal bites. An animal keeper of a zoo was bitten by a monkey resulting in multiple would all over body more so on genital area. They were in form of lacerations and crushing with puncturing patterns. Wounds were irrigated and debridement done. Antibiotics cover with tetanus and rabies prophylaxis were given Secondary suturing was done later. The recovery was smooth without any residual defect