ObjectiveDescription of surgical technique, complications and outcome of radius/ulna fractures in toy and miniature breed dogs treated with the paraosseous clamp-cerclage stabilisation (PCCS) method.Study designRetrospective study.MethodsClinical records of small breed dogs with fractures of the radius and ulna were reviewed between January 2011 and January 2016. Inclusion criteria were bodyweight of ≤3.5 kg, fracture of the radius and ulna of one or two limbs without previous repair attempts, available follow-up information, and the use of PCCS for repair of the fracture as the sole method of fixation.ResultsSeventeen fractures in 17 dogs were included in the study. Radiographic union was documented in 13/17 cases. Median time to radiographic union was 13 weeks (range: 5–53 weeks). Major complications occurred in 24 per cent (4/17) due to implant failure, and for revision surgery the PCCS method was chosen in all four cases. Three of four revised fractures healed radiographically. One of the four dogs was lost for radiographic follow-up, but the owner could be contacted for a telephone questionnaire. Eleven of 17 dogs achieved an excellent return to function without any lameness during clinical examination, but 5/17 dogs showed an intermittent mild lameness despite full radiographic union. Routine implant removal was performed in 9/17 dogs. The owners of 15/17 dogs could be contacted for a telephone questionnaire for a long-term follow-up. No further complications were reported.ConclusionsPCCS is a feasible low-cost internal fixation technique for repairing radial and ulnar fractures in toy breed dogs. Further biomechanical and clinical studies are needed for better evaluation of the PCCS method.

An 8-year-old male Jack Russell crossbreed dog was admitted to our hospital with dyspnea and shock following a dog-bite injury on the ventral neck. Radiographs revealed subcutaneous emphysema and bilateral thyrohyoid bone fractures. Intraoperatively, rupture of both sternohyoid muscles, both hyoepiglotticus muscles, both thyrohyoid muscles, and a partial cranial rupture of the superficial sphincter colli muscle were detected. Part of the epiglottis was detached from the thyroid cartilage. The patient’s severed muscles and torn epiglottis were reattached using a simple interrupted suture pattern. Hyoepiglotticus muscles could not be identified. The bilateral thyrohyoid bone fractures were repaired with intraosseous wire suture. A temporary tracheostomy tube and an esophageal feeding tube were placed postoperatively. The dog was discharged after 8 days, re-examined at 2 and 6 months and laryngeal and pharyngeal function were evaluated as normal. To the authors’ knowledge, this is the first report of a dog that presented with laryngeal trauma with hyoid bone fracture and acute dyspnea that underwent surgical treatment resulting in an acceptable outcome.

Background: Majority of the patients presenting for coronary artery bypass surgery are preoperatively on clopidogrel and aspirin i.e., Dual antiplatelets therapy (DAPT) because of high incidence of left main stem disease, acute coronary syndrome and diffuse coronary artery disease. Preceding coronary stenting and coming from far flung areas even from other countries with poor socioeconomic status contributes to continuation of DAPT till surgery. The main objective of the study was to evaluate hospital complications like chest tube output, re-explorations, blood, and blood product administration and in-hospital mortality in patients who continued DAPT till 48 hours prior to surgery versus those who continued DAPT until 48 to 120 hours before surgery. Methods: Preoperative history, perioperative and postoperative data of patients was gathered retrospectively from 1st July to 31st December 2019 in a tertiary care hospital of Peshawar. Total patients undergoing CABG Surgery were 223. From those 223 patients 192 patients were on DAPT. We than divided the 192 patients into two groups, Group A and Group B. 102 patients (Group A) received clopidogrel plus aspirin until 48 hours before surgery, and 89 patients (Group B) continued clopidogrel 48 to 120 hours prior to surgery. Chest tube output, need for exploration, in-hospital mortality, and blood or products transfusions among both groups were compared. Results: In terms of bleeding complications no significant difference between the both groups with similar chest drainage in the first 24 hours (602 ml and 609ml). In group A 33 patients received blood transfusion compared to 25 patients from group B. There was no significant difference in the amount of platelets given to group A (0.63 L) and to group B was (0.60 L). On the other hand, Group, A received 1.08 L fresh frozen plasma (FFPs) transfusion and group B 1.10 L respectively. Re-exploration was observed in Group A and B as (3 vs 2). Mortality was observed in 7 patients from group A and 2 from Group B. Conclusions: Usage of Dual antiplatelets therapy (DAPT) before surgery was an effective treatment method for postoperative complication of bleeding. It was suggested that with proper management with DAPT before surgery was planned is an effective and safe treatment method.. Keywords: Cardiopulmonary surgery, Coronary bypass grafting, hemoglobin, platelets, bleeding.

Objective: To evaluate the success rate of Transcanalicular Diode laser assisted Dacryocystorhinostomy (TC-DCR) in cases of acquired nasolacrimal duct obstruction (NLDO). Methods: This Quasi-Experimental study was conducted in Armed Forces Institute of Ophthalmology (AFIO) Rawalpindi, from July 2018 to April 2019. In this study, 73 patients of chronic dacryocystitis secondary to acquired NLDO were treated by TC-DCR under general anaesthesia. Follow up examination was done after one day, one week and three months. Silicone tubes were removed three months after surgery and syringing of lacrimal system done to confirm patency of lacrimal passages. Success of the procedure was documented as absence of epiphora and patent nasolacrimal duct on syringing. Results: Seventy three patients (males 27; females 46) were included in this study. Mean age of these patients was 51.6±21 years. On completion of this study which was three months after surgery, we found subjective improvement (absence of epiphora) in 86.3% patients and objective improvement (successful irrigation of lacrimal passages) in 93.2% patients. Conclusion: TC- DCR is a minimally invasive technique of doing Dacryocystorhinostomy and imparts more than 90% success rate. It has additional advantages of good cosmetic results, low complication rate and short surgery and convalescence time. doi: https://doi.org/10.12669/pjms.36.4.1906 How to cite this:Awais M, Naqvi SAH, Akram A, Shahid M. Transcanalicular diode laser assisted dacryocystorhinostomy: A breakthrough in the treatment of acquired nasolacrimal duct obstruction. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.1906 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: Varicoceles along with oligospermia as well as with asthenozoospermia lead to the male infertility. It can weaken the spermatogenesis via many different pathophysiological mechanisms. Many surgical and non-surgical methods are available for its treatment. Objective: To compare microscopic versus open sub-inguinal varicocelectomy in males with varicocele with oligospermia and asthenozoospermia. Study Design: Randomized controlled trail Place and Duration of Study: Department of Urology, Lahore General Hospital, Lahore from 1st May to 30th November 2017. Methodology: One hundred and fifty males with varicocele were recruited and divided in two equal groups. Group A patients underwent microsurgical sub-inguinal varicocelectomy and Group B patients underwent conventional/open sub-inguinal varicocelectomy. Semen analysis was done before surgery and after four months of surgery and 50% improvement in semen parameters were noted. Results: The mean age was 31.69±5.49 years. In group A and group-B ≥50% improvement was observed in 36 (48%) and 21 (28%) respectively. The improvement was significantly higher in group A than group B (p>0.012). Conclusion: The improvement in sperm count and motility was significantly higher in patients treated with microsurgical sub-inguinal varicocelectomy when treated with conventional/open sub-inguinal varicocelectomy. Keywords: Male infertility, Varicocele, Varicocelectomy, Seminal parameters, Microsurgical sub-inguinal, Conventional/open sub-inguinal

Background: The urethral strictures occurred due to narrowing of urethra. These may occur after an injury or ureteral or excretory system diseases, due to the injury to urothelium or corpus spongiosum that lead to the development of scar tissues. Mitomycin C can be used as chemotherapeutic agent because of its quality of being anti-tumour actions. Aim: To compare the recurrence rate of strictures after internal optical urethrotomy with intralesional injection of Mitomycin C versus without Mitomycin C injection in patients presenting with anterior urethral stricture. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Urology, Lahore General Hospital, Lahore from 5th September 2016 to 5th March 2017. Methodology: Sixty male patients age 18-70 years, diagnosed with anterior (penile and bulbar) urethral stricture up to 2.0cm were included. Patients were randomly divided into two groups; Group A patients were treated with internal optical urethrotomy alone and Group B patients treated with internal optical urethrotomy with intralesional injection of Mitomycin C. After the procedure, an 18F or 20F indwelling catheter left for 7 days. After 6 months, surgical site evaluated and if stricture again developed, then recurrence labeled. Results: The mean age was 39.32±11.38 years, mean duration of stricture was 6.85±3.32 months and the mean stricture size was 1.21±0.45 cm. The recurrence occurred in 18 (30%) patients. Significant difference was noted for recurrence in both groups (p-value<0.05). Conclusion: The recurrence rate with anterior urethral stricture is significantly lower in with Mitomycin C as compared to without Mitomycin C. Keywords: Recurrence, Urethral stricture, Mitomycin C

Purpose: To present our experience with emergency ureteroscopic lithotripsy (URSL) on ureteral stones related with acute kidney injury (AKI). Place and Duration: In the Department of Urology for three years duration from January 2019 to January 2020. Material and methods: We retrospectively analysed 27 patients consisting of 54 ureteral units (UU) undergoing URSL. There were 9 females and 18 males with M: F of 2:1 The anuria cause was bilateral obstruction with calculi in 21 cases, and unilateral obstruction with calculi in 33 cases with contralateral nephrectomy. In the same session, bilateral ureteroscopy was performed for bilateral synchronous ureteral stones. The anuria duration ranged from 12hours to 3-days. After the procedure, all patients ureteral stent were systematically removed. The operation was accomplished 6-12 hours afterward hospitalization. After surgery; all individuals were followed for minimum one-month. Results: A total of 27 urgent URSL were performed in 9 (33.3%) females and 18 (66.7%) males with an average age of 51 (range 32 to 73). Percutaneous nephrostomy was performed in 2 (7.4%) patients and in 2 (9.5%) patients with bilateral stones, the ureteral units (UU), severely wedged distal hard stones. These patients were candidates for open surgery, ureterolithotomy, 6 to 8 weeks afterward the initial intervention (PCN+ URSL). The improvements in renal function as demonstrated by post-obstruction diuresis and serum creatinine were compared in the two groups of patients using the Fisher's exact test. In 20 (71.1%) patients, URSL proved to be an effective therapeutic approach for obstruction removal and stone removal. Repeat surgery was required in 3 (11.1%). In 3 (11.1%) patients, URSL caused significant damage to the mucosa with a guide wire in the area of the damaged ureteral calculus. Ureteral stenting was sufficient to treat this complication. Stone or fragment migration was observed in 5 (18.5%) patients, all of which were in the upper stone position, and this procedure was the main reason of failure. In the first 24 hours, mild macroscopic haematuria was detected which did not require treatment. Postoperatively, 6 (22.2%) patients had high fever. Body temperature reversed back to usual within four days after getting the high dose and intravenous injection of a third-generation cephalosporin antibiotic (ureteral stent culture for Escherichia coli and positive urine culture). Conclusion: Calculus anuria is a therapeutic emergency that necessitates timely analysis and decompression management. URSL is the appropriate technique for designated patients and can be accomplished securely and has a high achievement rate with insignificant incidence of morbidity. Key words: Ureteral stones, ureteroscopy; surgery; kidneys, anuria, abnormalities; outcome and treatment.

Objective: To compare the effectiveness of nifedipine and tamsulosin for expulsion lower ureteral stones with size ranging from 4mm-11mm. Study Design: A Randomized controlled trial. Methods: The study was held over a 2-year duration from January 2018 to December 2019 in the Urology department of Islam Medical College/ Teaching hospital Sialkot and Govt. Kot Khawaja Saeed Teaching Hospital Lahore. 72 total patients, 37 patients in each group, were selected for the study. The patients in A group were treated with alpha-1-blocker alone (tamsulosin), patients in B group were treated with calcium channel blockers (nifedipine 30-mg). Data on stone size, transit time, stone removal rate and control of pain were analyzed and collected. The mean ± SD of continuous variables was used to determine the percentage and frequency of categorical variables. The student’s t-test and Chi-square test were applied to compare numerical and categorical variables, correspondingly. Results: 72 total patients were involved and 36 patients in each group were analyzed after randomization. The patients mean age in A group was 36.40 ± 6.98 years, and in B group it was 38.01 ± 9.40 years correspondingly (p 0.76). The mean size of stone was 6.40 ± 1.82 mm in group A and in group B it was 6.51 ± 1.69 mm (p 0.80). Mean time of expulsion in A group was 8.40 ± 2.41 days and for group B; it was 6.71 ± 2.33 days (p <0.001). Patients receiving tamsulosin endured suggestively fewer attacks of pain related with patients receiving nifedipine treatment (p 0.017). Conclusion: The tamsulosin is safe treatment for appropriately sized lower ureteral stones as compared to nifedipine. The tamsulosin monotherapy have clear advantage over nifedipine but more detailed school studies are needed for efficacy and safety. Keywords: Tamsulosin, ureter, nifedipine.