Objective: To find and analyse the associated determinants of mortality in admitted patients in cirrhotic patients with MELD score >18 presenting in emergency department with variceal bleeding.
Objective: To assess the effectiveness of different modes of treatment of chronic anal fissure as regards improvement of symptoms and complications. Methods: This prospective study included 129 consecutive patients with chronic anal fissures presented to the Surgical Outpatients’ Department of Islam Teaching Hospital Sialkot, Pakistan; from September 2010 to November 2012. Patients were distributed in three groups. In “OBG group”, patients had attended Gynae/Obs OPD and got treated and were then referred to surgical OPD for failure of treatment or recurrence. Patients who presented with history of treatment by GPs were included in “GP Group” “SGR Group” included those who directly reported to surgical OPD for treatment. Patients were managed both pharmacologically as OPD patients and surgically as admitted patients. Patients were instructed to apply small amounts of 0.2% GTN paste in soft white paraffin, to the anoderm with finger tips three times a day. Patients were evaluated at two-week intervals and at each visit the symptoms control, adverse effects and fissure status were recorded. If there was symptomatic relief or the fissure healing was in progress, the treatment was continued for a total duration of eight weeks. Operated patients were nursed in wards after surgery i.e Internal Anal Sphicterotomy. They were advised to report to OPD weekly for one month or earlier if they experienced any symptoms suggestive of complications. Patients were declared cured in case of complete symptomatic relief with fissure healing. Success, failure and associated problems were recorded and analysed to get results. Results:This study included 129 patients who could be followed up for a minimum of three months. These patients were referred by gynaecologist i.e. 22 (17%) for treatment failure while 5 patients with wrong diagnosis were not included in statistical analysis; similarly 41 (32%) patients were referred by general practitioners and 9 patients with wrong diagnosis were excluded. Sixty six patients i.e. 51% were those who directly reported to surgical OPD and had no previous treatment. With surgical treatment, pain, bleeding per rectum and constipation showed significant improvement as compared to GTN ointment application. Fissure healing was 100% in surgical group as compared to 74% in medical group. Complications were recorded and were found to be headache with medical treatment; while the most feared complication with surgical treatment i.e. permanent incontinence was not encountered in our study. Conclusion: Topical glyceryl trinitrate is economical, has a good healing rate, and faecal incontinence has not been reported. Its effectiveness, however, depends on patients’ compliance which may be poor in view of associated headaches and a local burning sensation. It is first line of treatment for anal fissure but lateral internal sphincterotomy is superior, more effective and curative than the chemical sphincterotomy. Surgery is reserved for people with anal fissure who have tried medical therapy for at least one to t...
Background: Cranioplasty (CP) is a neurosurgical procedure performed after decompressive craniectomy using autologous bone graft or various artificial materials. Aim: To find differences in complications between patients who underwent CP using an autologous bone flap versus a titanium mesh as well as to identify significant risk factors for post-CP complications Study Design: Comparative cross-sectional study. Methodology: A total of 46 patients were included in this study, out of which 37 were males (80.4%) and 9 were females (19.6%). All patients underwent cranioplasty using titanium mesh or autologous bone graft. Results: Comparison of outcome between autologous graft and titanium implant was done. In 45.7% patients, autologous bone graft was used while titanium implant was used in 54.7%. 23.9% patients had developed different types of complications in both groups, out of which 81.9% were from autologous group and 18.1% belonged to titanium graft group. Surgical site infection was noted in 18.1% of patients (equally) in both groups. Craniopalsty infection was noted in 45.4% patients who underwent autologous graft. Hematoma was encountered in 2 patients; both with autologous bone graft and none in patients who had titanium mesh cranioplasty. Removal of autologous bone graft was done in one patient whileremoval was not done in the other arm of study. Bone resorption was seen in five patients, all of which had autologous bone graft. Learning curve is that this technique be followed by neurosurgeons for better outcome. Practical implicatio Titanium mesh cranioplasty is a technique to be followed by junior neurosurgeons for learning and good outcome, decrease duration of hospital stay and preservation of precious resources of hospital. Conclusion: Cranioplasty in which titanium mesh is used is superior to autologous bone grafting as it has lessercomplications. Keywords: Autologous graft, bone resorption, cranioplasty, hematoma, infection, titanium mesh.
Aim: To compare improvised loop traction dissection with simple dissection technique for lymph node excisional biopsy of cervical region Study design: Cohort study. Place: Combined Military Hospital Rawalpindi, Abbottabad, Multan & Peshawar. Duration: September 2013 – January 2022. Methodology: cervical region Lymph nodes with intact architecture more than 1 centimeter were considered for this study while lymph nodes of the cervical region with distorted architecture and size <1cm were not included in this study. Among 530 patients, two dissection techniques (simple and improvised loop) were adopted. The lymph nodes to be removed were detected with palpation or through ultrasound and imaging such as computed tomography (CT). An open biopsy surgical procedure with or without modification was adopted. In the first group-I (n=206), Lymph node dissection was continued with the conventional technique, and in the group (n=324) lymph node was inserted with a silk suture for traction as the loop is adopted. The post-procedural assessment was for the difficulty level of dissection was done. Results: Among 530 Patients (Male=76.03%: Female=23.96%), the mean age in years of the patient was simple dissection technique n=206(range=20-69 mean 39) and loop techniques n=324(mean 41 and range 21-66). On average, 19.30 minutes for loop improvised and structural preservation was 69.75% (226), while rupture with the simple technique was observed in about 18(8.7%). The dissection time was less among patients with improvised loop technique and architectural preservation. Conclusions: Inserting silk suture as a double loop reduces duration and facilitates dissection in preserving architecture of lymph node sample Keywords: improvised loop technique, griping& holding, preserved architecture
Objectives: To evaluate the efficacy of different modalities for the prevention of post-operative edema in patients undergoing hair transplant. Study Design: Prospective study. Place and Duration of Study: Department of Plastic Surgery, Bashir Hospital (private), Sialkot from March 2016 to April 2018. Patients and Methods: Male patients with typical male baldness patterns were serially included in the study. Informed consent was taken both for the surgery and purpose of research. Patients were followed up daily for one week to assess the post-operative edema. However patients were also called for follow up after three months to see the late complications. Patients not giving consent for the study were excluded from the data. Data was entered and analysis done by SPSS v 22. Results: Total 97 patients were operated. Two groups A&B each of 45 and 57 patients were selected randomly. Group A which was administered tumescent solution including steroid showed maximum prevention of edema, success rate (93.3%). Group B having oral steroid course postoperatively for 5 days showed less promising results with success rate of (57.8%). Conclusion: The results of this study revealed that addition of steroid (Triamcinolone) to the tumescent solution had more promising results regarding the prevention of post-operative edema.
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