Objective: To share our experience regarding the management of arterial injuries in children with pulseless hand secondary to supracondylar fracture of the humerus (SFH).Patients and Methods: All consecutive children with pulseless hands after SFH who were being treated in the vascular surgery units of the Combined Military Hospital, Lahore and Peshawar between September 2011 and September 2016 were included. The type of fracture, mode and pattern of injury, time from injury to definitive treatment, operative treatment, and complications were recorded.Results: There were 55 [82% (n=45) male and 18% (n=10) female] patients with pulseless hand and SFH [Gartland type III: 18% (n=10) and IV: 82% (n=45)]. The hand was cold in 38.1% (n=21) patients and warm in 61.8% (n=34). The most common mode of injury was accidental fall [45% (n=25)], and the mean time from injury to presentation was 4±2.5 hours (mean±standard deviation). Overall, 71% (n=39) patients underwent vascular reconstruction: autologous interposition venous grafting was performed in 49% (n=19) and segmental resection and primary anastomosis in 25% (n=10) of the cases. There were no cases with amputation, fasciotomy, re-exploration, or long-term ischemic sequel.Conclusion: Immediate vascular exploration is the treatment of choice for cold, pulseless hand. A similar approach should be adopted for warm, pulseless hand if there is no immediate return of pulse.
Objective: To find the efficacy of diagnostic laparoscopy and its role in patients with chronic abdominal pain. Study Design: Observational study Place and Duration of Study: Department of General Surgery, Ali Fatima Hospital/Abu Umara Medical & Dental College Lahore from 1st July 2021 to 31st March 2022. Methodology: Seventy patients suffering from chronic abdominal pain were enrolled. An informed written consent was taken from each of them as an approval of participation. The age of the patients was between 20-65 years. Mostly the left side of the abdomen upper-quadrant was opted. Post creation of pneumo-peritoneum a 3 trocar technique which is standardized procedure was applied and a 10mm port through umbilical while two lateral trocars of 5 mm were used. The completed abdominal-cavity was investigated in detail initializing from the liver then gall bladder as well as anterior-surface of stomach and also the spleen. In women uterus as well as Douglas pouch was examined in context to fluid consistency, colour in addition to its site. The specimens were collected and sent to the histopathological lab for analysis. Results: The mean age of the patients was 36±15.3 years with majority were males with 55.71%. Around 45.71% patient’s pain site was at the right lower quadrant while 21.42% had left lower quadrant. The outcomes of laparoscopic investigation showed 27.10% patients to have appendix related pathology, while 19% had bands of adhesion. Conclusion: Laparoscopic proved to be an effective surgical technique in evaluating exact causes of chronic abdominal pain especially in cases where traditional methods have failed to explain the particular cause. Keywords: Bowel movement, Laparoscopy, Recurrent, Prolonged, Well-being
Objective: Effectiveness of aspiration under ultrasound guidance in breast abscess in terms of early resumption of breast feeding. Study Design: Randomized controlled trial Place and Duration: Mardan Medical Complex and Teaching Hospital and Jinnah International Hospital, Abbottabad, from November, 2021 to April, 2022. Methods: There were a total of 140 female participants. The patients ranged in age from 16 to 50. After obtaining the patient's written consent, demographic information including age, weight, height, and body mass index were collected. Breast abscess diagnosed on clinical examination and ultrasound breast were included. Seventy patients were assigned to Group I and treated with percutaneous aspiration, whereas the same number were assigned to Group II and underwent incision drainage. Early breast feeding was restored in both groups and compared for their respective outcomes. The entire dataset was analyzed using SPSS 20.0. Results: We observed that the percentage of patients in group I who were able to resume breast feeding was 61 (87.1%), and in group II was found in 42 (60%) patients. The level of comfort experienced by patients in group I 60 (85.7%), as compared to group II 35 (50%), was significantly greater. Conclusion: In this study, we came to the conclusion that percutaneous aspiration in breast abscess was successful and effective in comparison to incision drainage, with less problems and a high percentage of satisfaction among the women. Keywords: Incision drainage, Breast abscess, Percutaneous aspiration
Objective: To evaluate the safety outcome of staple hemorrhoidectomy in grade III and IV hemorrhoids. Study Design: Descriptive study Place and Duration of Study: Department of Surgery, Shahida Islam Medical Complex, Lodhran from 1st July 2020 to 30th June 2021. Methodology: Seventy patients were selected who were suffering from third or fourth grade hemorrhoids. The age of the patients was between 21-56 years with both gender been presented. Longos method was opted with spinal analgesic been delivered in lithotomy positioning. The complete surgical protocol was maintained with preoperative antibiotic deliverance. The procedure took 30-50 minutes. Patient was then kept in recovery room for three hours post operation and all postoperative antibiotics were timely administered. Results: Mean age of study participants was 41.2±3.2. Men appeared to be higher in number as compared to women. Grade III patients were more in number as compared to grade IV. Most common complication which was observed in present study is postoperative pain. Majority of the patients (70%) showed no associated complications. Conclusion: Staple hemorrhidectomy is appeared to be a safe and reliable surgical procedure for the treatment of grade III and grade IV hemorrhoids. Keywords: Hemorrhoids, Surgical procedure, Stenosis, Efficacy, Conventional
Objective: To compare short term post-operative complication of laparoscopic transabdominal preperitoneal (TAPP) and Lichtenstein’s tension free hernia repair. Study Design: Randomized clinical trial. Place & Duration of Study: Surgical Unit of Khyber Teaching Hospital (KTH) Peshawar during the period of 6 months from 1st January, 2020 to 30 June, 2021. Material and Methods: In this study 492 cases of inguinal Hernia with 246 in each group. For group A, laparoscopic TAPP repair were performed with 10cmx 15cm polyprophlene mesh (prolene-Ethicon) and were fixed with tackers (Protack 5mm fixation device - covidien). For Group B Lichtenstein’s repair were performed through supra inguinal incision, using 10cmx 15 cm polypropylene mesh (prolene- ethicon). Then the patients were monitored for short term post-operation complication post-operatively. Results: Our study shows that in Group A(Laparoscopic TAPP) mean age was 42 years with SD ± 8.13 and in Group (Lichtenstein repair) mean age was 45 years with SD ± 8.13. In Group A (Laparoscopic TAPP) 99% patients were male and 1% patients were female while in Group B (Lichtenstein repair) 99% patients were male and 1% patients were female. In Group A(Laparoscopic TAPP), urinary retention was 5(2%), hematoma was 5(2%), surgical site infection was 10(00%), Ischemic orchitis was 2(1%), seroma was 20(8%) While in Group B (Lichtenstein repair). urinary retention was 25(10%), hematoma was 39(16%), surgical site infection was 66(27%), Ischemic orchitis was 5(2%), seroma was 54(22%). Conclusion: Frequency of short term post operative complication are higher in Lichtenstein’s tension free hernia repair as compare to laparoscopic transabdominal preperitoneal (TAPP) group. Keywords: Short Term, Post-Operative Complication, Laparoscopic Transabdominal Preperitoneal (TAPP), Lichtenstein’s Tension Free, Hernia Repair.
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