Efficacy Of Local Anaesthesia In Repair Of Inguinal Hernia.

BACKGROUND: Local anaesthesia has been identified as the most favourable anaesthesia for elective inguinal hernia repair with respect to complication rate, cost effectiveness and overall patients' satisfaction. This study was conducted to determine the efficacy of local anaesthesia in inguinal hernia in terms of pain relief, wound infection and hospital stay. METHODS: In this randomized controlled trial (RCT), 60 patients with inguinal hernia were included at the General Surgical 'B' Unit, Ayub Teaching Hospital Abbottabad. RESULTS: The day-case rates were significantly higher when patients underwent surgery under LA compared to GA (82.6% versus 42.6%). The incidence of urinary retention was higher in the GA group (p<0.05). There were 17 (2.9%) re-admissions overall. The reasons for readmission included haematoma (n=6), severe pain (n=4), infection (n=3), fainting (n=2) and urinary retention (n=2). CONCLUSIONS: This study demonstrates that local anaesthesia for inguinal hernia repair has better efficacy as compared to general anaesthesia.

Frequency of external hernias in Ayub Teaching Hospital Abbottabad.

BACKGROUND: Hernia is a protrusion of a viscous or a part of a viscous through an abnormal opening in wall of its containing cavity. Different external hernias present differently and ultimate treatment is surgical, which is most commonly performed elective operation in the world. The objectives were to know the age and gender wise frequency of external hernias in Ayub Teaching Hospital, Abbottabad. This retrospective study was conducted at the surgical units of Ayub Teaching Hospital from June 2004 to June 2005. METHODS: Records of all cases of hernias operated in Ayub Teaching Hospital during June 2004 to June 2005 were retrieved from the operation registers of the entire three surgical units available at the operation theatres. The data was collected on a proforma and was analysed by SPSS-16. RESULTS: Of the 1063 cases, 982 (92.38%) were male and 81 (7.62%) were female. Right Inguinal Hernia (RIH) was the most frequent as expected, i.e., 44.12%, followed by Left Inguinal Hernias (LIH) 18.72%. Least common hernias were femoral hernias with a frequency of 0.85%. CONCLUSION: It is concluded that 85% hernias occur in the groin, with 12% incisional and only 3% hernias occur elsewhere. To reduce the rate of complications, health education is the most important intervention. For future health planning maintenance of disease register can not be over emphasised.

Morphological changes in human placenta of wet snuff users.

BACKGROUND: Wet snuff is commonly used by both males and females in different parts of Pakistan. Apart from other ingredients, tobacco is the major component of snuff. Adverse effects of smoking on morphology of human placenta have been shown by some previous studies. But snuff is not considered as dangerous as smoking during pregnancy. This study was designed to see the effects of snuff on morphology of human placenta. METHODS: In present study total 80 human placentae, 40 from normal and 40 from snuff users were used. This study was carried out in the Department of Anatomy Basic Medical Sciences Institution (BSMI) Karachi. Duration of study was six months. Samples were obtained from Gynaecology and Obstetric unit-I JPMC. Placentae washed well with running tap water to remove blood clots. Umbilical cord and other membranes were removed and placenta gently squeezed to expel the foetal blood. Gross features like weight, diameters, central thickness and attachment of umbilical cord were noted in normal and snuff users' placentae. Then placentae were preserved in 10% formalin for at least five days before the sectioning for micromorphology. Placentae divided in two groups-A & B. 4 microm thick sections of the tissue were taken on rotary microtome and stained with H & E, Mallorys trichrome and methanamine silver for different histological observations. RESULTS: Micromorpholgical changes have been observed in placentae of snuff users leading to loss of functional components of placentae. This loss of functional component may have deleterious effects on outcome of pregnancy. No significant gross morphological changes were found in snuff user placentae. CONCLUSION: Wet snuff effect the micromorphology of placenta leading to loss of functional component and in turn effects the exchange of materials between mother and foetus which may leads to intrauterine growth retardation. Loss of trophoblasts may lead to hormonal imbalance necessary for normal pregnancy and this imbalance can cause premature labour. Nocotine can cross the placental barrier, which may produce foetal tachycardia.

Penile fracture: experience at Ayub Teaching Hospital.

BACKGROUND: Penile fracture is a relatively rare traumatic rupture of the tunica albuginea of one or both corpora cavernosa of an erect penis. It is a real urological emergency which needs early assessment and surgical management. METHODS: Twelve (12) cases of penile fracture were reviewed from July, 1997 to July, 2007 in the Department of Urology, Ayub Teaching Hospital Abbottabad. All cases presented with classical history of penile fracture and the diagnosis was made on the basis of history and clinical examination only. RESULTS: All the patients underwent immediate surgical repair with well preserved potency and excellent overall results. CONCLUSION: Penile fracture has typical signs. Standard treatment consists of immediate surgical repair of penile fracture with a low incidence of late complications. Post op complications including urethral strictures and erectile dysfunction should be ruled out by regular follow-up.