bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical experience in the management of Spontaneous Pneumothorax
Authors: Bilal Aamir , Nabi Muhammad Shoaib , Salim Muhammad
Published: June 2016

Objective: To determine the efficacy and evaluate the results in terms of recurrence of Bullectomy and parietal pleurectomy in patients with spontaneous pneumothorax. Design: A prospective observational study. Place and duration of study: This study was conducted at the department of cardiothoracic surgery, postgraduate Medical Institute Lady Reading Hospital Peshawar from March 1998 to April 2001. Patients and methods: This prospective study included 110 patients; 82 (75.5%) males and 28(25.4%) females. Male: female ratio was 2.5:1. The mean age of the patients was 38.5 years (range 10 to 50 years. Ninety percent of the patients complained of chest pain while 45% experienced dyspnea pain. (Best radiograph was obtained in all while CT thorax was obtained in 20(18.1%) patients. The magnitude of pneumothorax and associated pathology was determined radiologically. Thirty-nine (35.4%) patients presented with first episode; 99 (44.5%) had recurrent while 22(20%) had persistent pneumothorax. Tube thoracostomy was the initial line of management in 80 (72.7%) of patients who presented with first episode of pneumothorax. Indications for surgery included recurrent pneumothorax, persistent air leak (>7 days), non expansion of the lung, complicated pneumothorax and suspicion of bulls on CxR or C.T thorax. Out of 110 patients, 28(25.4%) required surgery. Result: The mean operative time was 45(+15) minutes. Surgical indications included recurrences 18(66.6%), persistent air leak 5(18.5%) non expansion of the lung 3(11.1 %) patients. Twenty-two (78.5%) patients under went bullectomy/wedge resection, over sewing and ligation was clone in 6 (21.4%) while pleurectomy was done in all these patients. There were no operative deaths. Over all 2(7.1%) patients had post operative air leak. The post operative hospital stay averaged 6.9 days. Our 18 months of follow up has show n no recurrence and no significant impairment of post operative pulmonary function tests. Conclusion: Pleurectomy with bullectomy or ligation of subpleural blebs is a safe and reliable procedure and gives excellent results.
Comparative study of postoperative complications of Lichtenstein Tension Free Repair and Pure Tissue Repairs like Modified Bassini or Shouldice at Nishtar Hospital Multan
Authors: Aziz Muzaffar , Ahmad Naveed , Anwar Fakhra , . Faizullah
Published: June 2016

The objective of this study is to compare the postoperative complications of Lichtenstein tension free repair and pure tissue repairs like modified Bassini or Shouldice. This was an interventional (quasi experimental) study. This study was carried out on 100 patients having primary inguinal hernia. After taking detail history, examination and necessary investigations, only tit patients were included in the study and rest were excluded. A separate file was maintained for each patient to note the complication rate of different hernia`s repairs. Patients in group I underwent modified Bassini (35%) and Shouldice repair (15%). Patients in group II underwent Lichtenstein repair (50%).30 (30%) complications were observed. Out of these 23(23%) were in group I and 7(7%) were in group II. All were managed conservatively. The main complications were wound hematoma (9%), Wound infection (3%), scrotal edema (1%), postoperative neuralgia (6%), retention of urine (8%) and recurrence (3%). Wound infection, wound hematoma and recurrence were seen more in group I. Post operative neuralgia was more common in group II. Although follow up was for a shorter period of time and complications like recurrence and post operative neuralgia could not be assessed accurately. It was concluded that Lichtenstein tension free repair is simple and effective method of repairing inguinal hernia, with low complication rates and low recurrence rate. The method is much easier and should be considered in majority of patients with inguinal hernia.
Primary chest wall neoplasms - an experience of 39 patients
Authors: Salim Muhammad , Bilal Aamir , Nabi Muhammad Shoaib
Published: June 2016

Objective: To evaluate treatment approaches, role of surgical resection and reconstruction and outcome of patients with primary chest wall tumor. Study Design A prospective observational study. Place and Duration. The study was conducted at the Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital from March 1996 to April 2000. Patient and Methods A total of 39 patients underwent resection for primary chest wall tumors. Male were 27 and female were 12. Age range was 15 years - 55 years with a mean age of 23±2 years. 75% of patients presented with a painless mass while 25% complained of pain. Twenty three were on right side, twelve were on the left side while 4 extended onto the sternum. Sizes were <3cm (7 patients), 3-5cm (24 patients), 5-10cm (6 patients) and > 10cm (2 patients). Chest radiograph in all and CT thorax was done in 20 cases. Out of 39 cases, 25 had previous biopsies attempted by other surgeons leading to ulceration and fungation in 18 cases. Chest wall resection and primary closure was done in 33 cases. In 4 cases marlex mesh alone was used while in 2 cases it was reinforced with Methyl Methacrylate. Results Mean operative time was 68 (+/-40) minutes. Postoperatively, 19 patients required ventilation. Out of these, 14 patients were extubated the same day, 3 the next day while 02 patients died despite prolonged ventilation. Post-operative flail was observed in 3 cases without respiratory compromise. Histopathology reporting were chondrosarcoma in 24, fibrosarcoma in 6 cases while the rest were not reported. Twenty one patients were followed-up for up to one year with no evidence of disease while the remaining were lost to follow up. Conclusion To conclude primary chest wall tumors can be safely managed by resection and primary closure or chest wall reconstruction and are associated with long term survival.
Acute Appendicitis in Children: Comparison of clinical diagnosis versus modified Alvarado score system
Authors: Hussain Mukhtar , Kashif Muhammad , Ahmad Shafiq , Pasha Haroon Khurshid
Published: June 2016

Objective: To compare the accuracy of clinical diagnosis of Acute Appendicitis with that of Alvarado Score System in Children. Design: A Prospective and Comparative Study. Patients and Duration of Study: Department of Pediatric Surgery, Nishtar Medical College & Hospital, Multan from January 200I to June 2002. All patients of pain abdomen with suspicion of acute appendicitis were included in study. Subjects and methods: 92 patients were admitted with pain abdomen, After preliminary history and examination sixty were suspected of acute appendicitis. A Detailed history, clinical examination and relevant investigations were done. These patients were divided in two equal groups of 30 each. In group-I all the findings were entered on Performa based on the indicants of modified Alvarado Score. Later on their Score was calculated according to the assigned weight-age of each indicant. Twenty-eight patients were submitted for Surgery having Alvarado Score of >7. In group-II patients were clinically evaluated by one of the consultant to declare the diagnosis of Acute Appendicitis or otherwise. Twenty-nine out of 30 were submitted for surgery in this group. Three cases turned out to be of mesenteric lymphadenitis confirmed on Ultrasonography. The diagnosis of Acute Appendicitis was further confirmed by Histopathology of appendix after removal. Hence the accuracy of both methods was compared. Results: The diagnostic accuracy of Alvarado Score was 85.71% with false positive or negative appendectomy rate of 14.29% while the accuracy of clinical diagnosis was 93.01% with false positive or negative appendectomy rate of 6.99%.
Sonographic diagnosis in intestinal Ascariasis
Authors: Sajjad Malik , Qureshi Muhammad Saleem , Zaidi Nasir Raza
Published: June 2016

Ascaris Lumbricoides belongs to Nemathelminthes group and is one of the largest human nematode, which entrenches in the small intestine. Abdominopelvic Sonographic evaluation of 350 patients was done at Medical Camp in "Skardu" Baltistan, Pakistan, with features of "RAP" recurrent abdominal pain, dyspepsia, urinary retention, dysmenorrhea, biliary and renal colic etc. In 15 patients apart from other findings, linear, curved, tramline like echogenic structures were seen in the small intestine and stomach without any acoustic enhancement or shadowing. Cases with similar findings were also detected at Jinnah Hospital, Lahore. Findings were confirmed on barium study. According to WHO estimate 1.3 billion population is having worm infestation, Hence stressing upon the efficacy and importance of ultrasonography in diagnosis of intestinal ascariasis due to its easy availability, inexpensive and being non invasive.
Controlled tissue expansion in reconstruction of post burn deformities of head and neck
Authors: Babar Abdul Hakim , Mirza Ali Rafique
Published: June 2016

Reconstruction of post burn scars and contractures in the region of head and neck is a difficult task. Introduction of controlled tissue expansion has provided a versatile and reliable technique in management of these cases by providing skin of excellent quality and minimal donor site deformity. A review of forty-five (45) procedures carried out for reconstruction with controlled tissue expansion, between January 1994 and December 2003 is presented. Expanders of various shapes and sizes were used to achieve a fill volume ranging from 140 c.c to 470 c.c over a period of 9 to 12 weeks. Expander was reused in eight (8) expansions and three (3) patients with large defects underwent two or more expansions of the same area to achieve desired results. In 32 cases the procedure was completed without any complications whereas in 10 cases minor or major complications hampered or delayed eventual reconstruction. Only in 4 cases (8.8%) the reconstruction was compromised as a result of early complications. Controlled tissue expansion provides a safe and predictable technique for reconstruction in the region of Head and neck with acceptable rate of complications and provides excellent results.
Initial experience of cataract surgery under surface anesthesia
Authors: Ashraf Maqbool
Published: June 2016

A prospective study was performed to see if the patients in our set up could safely and reliably be operated upon for cataract extraction under surface anaesthesia alone. This initial experience suggests that surface anaesthesia alone is suitable for carefully selected patients, while others tend to face undue anxiety, resulting in excessive ocular movements and eye lid squeezing during surgery.
An audit of indoor morbidity and mortality in a medical ward at a Tertiary Care Hospital
Authors: Qadir Abeer , Nadeem Muhammad Arif , Munir Atif , Khan Zafar Ullah
Published: June 2016

There is a great geographical variation in disease burden around the world, which is due primarily to environmental, genetic, social and economic factors. Similar variations exist in worldwide mortality figures from a particular disease that can be attributed almost entirely to the access and efficacy of healthcare facilities. We did this audit to identify the major causes of morbidity and mortality in patients admitted in a medical unit of a tertiary care hospital and to highlight the importance of primary prevention. The audit was carried out in West Medical Ward Mayo Hospital Lahore, Pakistan from 1st January 2004 to 31st December 2004. All patients admitted with medical problems from the Outpatient and Emergency Departments were included. During the year 2004, a total of 2045 patients were admitted, out of which maximum number of patients admitted in the ward were suffering from chronic liver disease (17%) followed by ischemic heart disease (14.4%) cerebrovascular accidents (10.4%) and renal diseases. Total number of deaths were 321 with male mortality was 167 (14.40%) and female mortality 154 (17.40%). Chronic liver disease also had the highest mortality (16.8%) followed by cerebrovascular accidents (14%), renal disease (11.5%) and ischemic heart disease (7.8%). Even the mortality due to chronic liver disease was significantly higher (p <0.01) than ischernic heart disease. The number of patients having the four common diseases having age 45 years or more (770) was significantly greater (p <0.0001) then the number of patients (279) in the age range of 15 to 44 years. It was observed that significantly greater number of male patients (595) had morbidity than females (462), (p <0.0001), while mortality has no difference. Chronic liver disease, ischemic heart disease and cerebrovascular accidents are the diseases putting maximum burden on our health resources and disabling our productive population. This audit highlights the fact that all these three groups of diseases can be prevented and thus obviates the need of primary prevention of these major killers.
Management of Post Traumatic Posterior Urethral Stricture; Internal Urethrotomy verses Perennial Urethroplasty
Authors: Nazir Muhammad , Ahmed Mumtaz , Chughtai Nawaz , Husain Sajjad
Published: June 2016

Objective: To compare the efficacy and cost effectiveness of cold knife optical internal urethrotomy with perineal urethroplasty (excision and end to end anastomosis) in the management of post traumatic short posterior urethral stricture. Design: an observational prospective study. Place and duration of study: the study was performed in the department of urology and kidney transplantation Services hospital/post graduate medical institute Lahore, from September 1997 to December 1999. Patients and methods: Forty male patients of post traumatic posterior urethral stricture revealed by their urethrogram were included in the study. Patients were divided in two groups randomly (group A & group B). After complete evaluation, patients of group A were managed by internal uretherotomy, while those of group B by perineal urethroplasty. Follow up was done at 1,3,6,9 & 12 months. Results: age range of the patients was 20 to 59 years with the mean age of 35.5 years. Road traffic accident was the main cause (82.5%). After facing the traumatic urethral injury, there was history of attempted Foley catheterization (47.5%), bouginage (15%) and intervention by rail road technique in 10% of the patients. All patients were with supra pubic catheter because of failure to void. The length of stricture varied from 0.5 to 2.0 cm (mean 1.4 cm). Clinical response at the end of the study in group A & B was "good" in 58.82% & 66.66%, "satisfactory" in 23.52% & 22.22% and "poor" in 17.64% &11.11% respectively. The mean cost of operation, hospital stay and loss of working hours were less in group A as compared to that of group B. Conclusion: The results of perineal urethroplasty are comparatively better than optical urethrotomy. The other differences of the two procedures lie in operative time cost of the operation and mean hospital stay. It is concluded that optical urethrotomy is an acceptable alternative to urethroplasty in patients with short post traumatic posterior urethral stricture.
Tuberculosis as an occupational hazard in ward workers
Authors: Khalid Ch Muhammad , Shaikh Muddassir Muhammad , Nasir Summiyah , Rasul Shamshad , Khan Saulat Ullah
Published: June 2016

The present study was designed to estimate the risk of tuberculosis in ward workers in a tertiary care hospital, Lahore. A total 53 ward workers who had been working in chest medicine and internal medicine wards for the last one year, were assessed. As regards demographics, 34 were male and 19 were female with mean age 34.3 years. Out of these workers, three (5.6%) were diagnosed as case of active tuberculosis and all these workers were male. Sputum AFB microscopy was positive in one case. Nosocomial transmission of tuberculosis is known to occur and this risk is much more common in ward workers than that of general population. So it is concluded that there is a significant increased (P<0.001) risk of tuberculosis in ward workers.
Comparison of Pregnancy outcome among Placenta Previa and Abruption
Authors: Humayun Shamsa , Nahid Fehmida
Published: June 2016

The objective of study was to compare the pregnancy outcome among placenta previa& placental abruption. Study Design: A retrospective analysis of pregnancies complicated by placenta previa or abruption, from January 2003 to December 2003. Results A poor fetal outcome was more frequent in cases of abruption (56.6%) than placenta previa (20%) Prematurity was significantly high in abruption (63.3)%than in placenta previa (40%).cesarean section rate was high in placenta previa(98%) compared to (20%) in abruption. Renal failure PPH and cesarean hysterectomy were the major complications in both groups. Conclusion: Women with abruption had poor pregnancy outcome than placenta previa They were more likely to deliver prematurely with high neonatal morbidity and mortality. Operative delivery was more common in placenta previa.
CT Scan in evaluation of cardiac masses
Authors: Sheikh Qamar Sardar , Shaukat Asim , Shaukat Aadil , Khan Tahir Qadeer , Batool Sadaf , Qureshi Afshan
Published: June 2016

Objective. To evaluate the usefulness of CT scan in Cardiac tumor Design. A descriptive study with convenient sampling Results. We studied seven cases referred to us for work up of cardiac masses, the contrast enhanced CT scan was able to identify and give the extent in five of these patients. Two patients were negative on CT scan but were confirmed to have a mass in the cardiac chamber by echocardiography. While CT was able to identify the thrombotic mass extending into the heart in two of the patients which remained inconclusive on echocardiography. Conclusion. CT is better modality for the extent of the lesion and echocardiography is better as an initial modality to screen the cardiac chambers.
Comparison between primary repair and exteriorization in cases of Typhoid perforation
Authors: Khan Asaad Akbar , Khan Intesarur Rashid , Najeeb Umer , Sheikh Asim Jameel
Published: June 2016

Objectives: This comparative study was conducted at Mayo Hospital, Lahore from April 2004 to May 2005 to compare the results of primary repair and exteriorization in cases of typhoid perforation Materials and methods: :80 patients were selected out of which 48 were males and 32 were females. Inclusion criteria: Consisted of a history of fever abdominal pain, constipation, sharp shooting pain superimposed over the colicky abdominal pain clinical finding included tense tender abdomen and absent bowel sounds, investigations including gas under diaphragm in abdominal x-ray and positive widal test. Exclusion criteria: Consisted of negative Widal test even if there was gas under diaphragm, per op findings suggestive of tuberculosis or histopathology reports suggestive of tuberculosis or any pathology other than typhoid. Primary repair was done in patients who presented within 36 hrs of experiencing sharp shooting pain and per op findings of minimal contamination. Exteriorization in the form of loop or double barrel ileostomy was done in other cases.
Seroprevalence of HbsAg and anti-HCV in Ghurki Teaching Hospital, Lahore
Authors: Waseem Rizwan , Kashif Muhammad Ali , Khan Muhammad , Qureshi Abdul Waheed
Published: June 2016

Objective: To find out the prevalence of hepatitis B and C in general population. Design: This is an analytical type of and non-interventional study. Setting: Data was collected from a two-day free screening camp for hepatitis B and C at Ghurki Trust Teaching Hospital, Lahore. Material and method: Normal people of any age and either sex were included in the study. Screening was performed for Hbs Ag and Anti HCV by Acu-check one step test (chromatographic immunoassay) in serum. Results: A total 1680 subjects were screened for both Hbs Ag and Anti HCV. Prevalence of Hbs Ag was 2.97% and Anti HCV was 11.96%. The mean age was 24.96 14.67 years. Females were 55.2% and males were 44.8%. seroprevalence in females and males of Hb Ag was 1.2% and 1.78% and that of Anti HCV 8.6% and 3.33% respectively. These gender differences are statistically significant (p value <0.05). Hbs Ag was more prevalent in younger population (up to 10 years). The majority of Anti HCV positive was in 31 to 40 years of age. Conclusion: Seroprevalence of Hbs Ag and Anti HCV is high in general population. Prevalence of HCV is very high in younger age group while Hbs Ag is very high in children up to 10 years of age. Larger population based studies are needed to confirm the results.
Amputations in general surgical practice
Authors: Khan Intesarur Rashid , Shafiq Mohammad Akmal , Irshad Khalid
Published: June 2016

Amputation is still often viewed as a failure of treatment. The responsibility for performing an amputation may even fall on the most junior member of the surgical team. Whatever the reason for extremity amputation, it should not be viewed as a failure of treatment. Amputation can be the treatment of choice for severe trauma, vascular disease, and tumors. In our setup amputations for vascular and diabetic complications fall under the domain of general surgeons Objective: The purpose of study was to determine the age and sex distribution, incidence of diseases that resulted in amputations, and the level of amputations done in them. Methods: A descriptive study on one hundred patients undergoing limb amputations in general surgical practice at department of Surgery, Mayo hospital Lahore. Inclusion Criteria: All the patients presented to general surgical emergency/OPD with limb pathology Exclusion Criteria: Patients with bone tumors and isolated limb trauma (referred to orthopedic unit). Conclusion: Most amputations in our study were performed in elderly persons for PVD, Diabetes mellitus being the leading cause
Comparison of Nalbuphine and Midazolam on the cardiovascular response to Laryngoscopy and intubation
Authors: Asad Naila , Ali Khawar , Iqbal Mazhar , Qayyum Abdul
Published: June 2016

Objective: To compare the effects of nalbuphine and midazolam on cardiovascular response to laryngoscopy and intubation -during induction of anaesthesia. Method: Ninety adult male patients of ASA I or II status were included and divided into three equal g roups. Group I was control in which 3ml of saline was given. Group II received nalbuphine 75 ug/kg and Group III received midazolam 30 ug/kg. The cardiovascular response was evaluated at laryngoscopy and every minute after intubation for three minutes.The results were analysed statistically by ANOVA.p<0.05 was taken significant. Results: A decrease in HR, SBP, DBP, MAP was seen after three minutes in Group II and III but the decrease was more pronounced in Group II.(p<0.05) Conclusion: Premedication with nalbuphine 75gg/kg is more effective than midazolam in blunting the haemodynamic response to laryngoscopy and intubation.
Serum folate levels in end stage renal disease patients
Authors: Sirhindi Ghazanfar Ali , Alam Saadia Shahzad , Riaz Shah Shahida Amjad , Asif Javed , Izhar Mateen , Khan Abdul Hameed , Hussain, Shahid , Farooq Muhammad , Farooq Muhammad
Published: June 2016

Objective: This study was aimed to measure serum folate levels in patients of end stage renal disease (ESRD) on regular haemodialysis and compared with normal healthy individuals. Study design: It is a comparative study. Setting: Department of Pathology, Shaikh Zayed Hospital, Lahore Patients and methods: One hundred subjects were selected and divided into two groups. Group A include fifty patients of end stage renal disease on regular haemodialysis and group B include fifty normal healthy individuals as control. Two ml of blood was drawn by venepuncture, one ml for complete blood examination and one ml for serum folate level. Results: A significant decrease in folate level was observed in end stage renal disease patients on regular haemodialysis as compared to control group. Conclusion: By measuring serum folate level in patients on regular haemodialysis we can manage anaemia due to folate deficiency.
Clinical manifestations of benign ovarian tumors
Authors: Zafar Al Fareed , Fazil Aqeela , Asifa Al , Karim Attiya , Akmal Noreen
Published: June 2016

Aims and objectives: To examine the cases of Benign Ovarian Tumours and their clinical manifestations. Design:- Prospective study of consecutive cases of Ovarian tumours, identified using gynaecological case records. Place: Tertiary care teaching hospital affiliated with Fatima Jinnah Medical College Lahore, managing more than 1500 gynaecological cases annually. Subjects: 50 cases of Ovarian tumours managed in Department of Gynaecology & Obstetrics Sir Ganga Ram Hospital, Lahore between 1st May 2004 to 1st May 2005. Results: The most common presenting complaints were abdominal pain or discomfort and palpable tumour causing abdominal distension. Abdominal pain was present in 70% of benign ovarian tumours. 20% of the patients had pain due to torsion of ovarian cyst. The complaint of a palpable tumour was found in 4 7% of cases. Vague abdominal and bowel complaints were present in 2 2.5% of cases. 6(15%) patients were asymptomatic. Of these 2 were diagnosed by ultrasound and 3 at the time of emergency Cesarean section and one on routine pelvic examination. Menstrual irregularity and urinary complaints were present in a small number of patients. None of the patient complaint of weight loss or post menopausal bleeding. Conclusion: Benign Ovarian Tumours are most common cause of ovarian enlargement and a very common cause of hospital admission. Symptoms and signs are non specific and presentation is a late stage.
Frequency of atrial fibrillation in Mitral Stenosis and its correlation with left atrial size
Authors: Razzaq Anjum , Niaz Zafar , Aziz Bilal , Saleem Asim , Nazar Tazeen , Ali Ahmed , Rehman Azizur , Abaidullah Sajid , Hasan Mumtaz
Published: June 2016

Introduction: Chronic rheumatic heart disease is much the commonest cause of mitral stenosis. Incidence of rheumatic MS parallels that of acute rheumatic fever. Atrial fibrillation usually develops in the presence of pre-existing ECG evidence of left atrial enlargement and is related to the size of the chamber, the extend of fibrosis of the left atrial myocardium, the duration of the atriomegaly and the age of the patient. Study Design: Descriptive Setting: Mayo Hospital, Lahore and Punjab Institute of Cardiology, Lahore Type of sampling: Convenient No. of cases: 129 consecutive cases of predominant mitral stenosis. 112 cases included in the final workup. Results: The frequency of AF in MS in this study was calculated as 25.9%. The correlation between AF and left atrial size was significant (p = 0.000). This was plotted on the scattergram (Figure No. 1), which shows a steep rise in the frequency of AF beyond a left atrial size of 70 mm. Conclusions: Frequency of AF in patients with MS is 25.9%. The correlation between AF in MS and left atrial size is significant (p = 0.000).
Restless Leg Syndrome
Authors: Chaudhary Asif , Malik Kifayat Ullah , Ahmed Jamil
Published: June 2016

Restless leg syndrome (RLS) is a very common medical condition that is under recognized and often misdiagnosed and maltreated in general practice in Pakistan. It is a very distressing condition for patients and often attributed to nutritional deficiencies or labeled as simple cramps. Its cure is rarely possible. In this article the authors intend to discuss the diagnosis and management of this condition.
Normal value of BMD (Bone Mineral Density) in Pakistani student nurses and its relation with age and other factors
Authors: Ahmad Mansoor , Ghazi Muhammad Ahmad , Ali Ahmed , Anwar Hooria , Mazhar Farah , Akram Javed
Published: June 2016

The aim of this study was to evaluate the BMD in younger age group. It was a cross-sectional observational study done in January 2003. 223 subjects were taken (all females) of age group 16-25 years. Heel Ultrasound procedure was done on all these subjects using a "Clinical Bone Sonometer" and their T-score was plotted against age. The results of the study showed that young female nurses gain bone minerals with increasing age in this group.
Childhood intussusception
Authors: Mansur, Syed Harood , Ahmed Sarfraz , Rafi Mazhar , Sheikh Afzal
Published: June 2016

In a retrospective study, 38 patients with intussusception presenting to paediatric surgical emergency were studied. The objective was to review the management of childhood intussusception and identify factors that require attention for improved outcome. Out of 38 children 26 were males and 12 were females. Age ranged from 2 months to 10 years. Presenting features were mainly vomiting, abdominal pain/excessive crying, abdominal distension, passage of blood and mucus in the stool and a palpable abdominal mass. Duration of symptoms i.e., time period lapsing between the onset of symptoms and seeking the treatment was < 24hours in 21.3% cases, 24-72 hours in 3l.5% > 72 hours in 39.4 % and > 1 week in 7.8% cases. Ileo-colic intussusception was found in 76% cases, colo- colic in 16 and ileo-ileal in 8% cases. Manual reduction was successful in 34% cases and resection of the gut had to be done in 66% cases. Delay in diagnosis was associated with increased morbidity and mortality. The authors recommend that prompt treatment is the key to reduce the morbidity and mortality.
Changes in electrolyte and blood urea in cirrhotic patients
Authors: F Khawaja Tariq , Jawed Samia , Sultan Asghar , Ahmad. Shahid
Published: June 2016

Patients suffering from liver cirrhosis, age between 18 to 60 years both male and female were studied from Biochemistry Deptt, PGMI and Medical I, Services Hospital, Lahore. Out of total 49 patients were found to be positive for hepatitis B virus and 23 percent for hepatitis C virus. Serum bilirubin and alkaline phosphatase was highly significant (p<0.001, while alanine transferase moderately and total protein was non-significantly reduced. Blood urea was normal for majority of patients. Serum electrolytes were normal for potassium but decrease in sodium was non significant. Increase in serum bilirubin and alkaline phosphatase, slight decrease in serum sodium and normal potassium were frequent findings in liver cirrhosis.
Management of refractory atonic post partum hemorrhage by upper segment compression suture
Authors: Toheed Rakhshanda , Tarique Naela , Siddique Saqib
Published: June 2016

Aims: The study was undertaken to test the efficacy of Upper Segment Compression Suture(USC Suture) for the control of atonic post partum hemorrhage unresponsive to medical treatment. Study Design: Observational study. Duration:: From March 1998 to March 2003. Setting: Department of Obstetrics & Gynaecology, Lahore General Hospital , Post Graduate Medical Institute, Lahore, Pakistan. Subjects: Fourteen women with atonic PPH refractory to medical treatment. Results:: Fourteen women with severe atonic PPH were managed using uterine massage and utero tonic drugs. Failing these measures, Upper Segment compression suture was used as first line conservative surgical technique. There was no relaparotomy for recurrent PPH. All cases were managed successfully avoiding hysterectomy or other complex surgical procedures. Recovery in all cases was uneventful.Long term follow up was available in four cases. All were having normal menstruation. Two o f them achieved spontaneous pregnancies. Conclusion:: Upper Segment Compression Suture is an effective technique for managing refractory PPH caused by uterine atony.
Spontaneous endobroncheal erosion of a bullet - an uncommon presentation of gunshot trauma in remote past
Authors: Nabi Muhammad Shoaib , Chima Kamran K , Cheema Saeed Ashraf
Published: June 2016

A case of unknown bullet trauma to the lung, in remote past, presented with hemoptysis which was mislabeled as hematemesis. Once labeled, a number of physicians, one after the other, kept on treating her for that symptom. She also consulted a number of specialties and was treated for reflux esophagitis, tuberculosis etc. Meanwhile her x-ray chest revealed a foreign body which was treated as an artifact first, and proved to be a bullet on CT scan. Thoracotomy had to be performed to remove the pathologic right lower lobe of lung.
Linitis Plastica (diffuse, infiltrating, poorly differentiated adenocarcinoma)
Authors: Khan Intesarur Rashid , Shafiq Mohammad Akmal , Azeem Khawaja Mohammad
Published: June 2016

A 50 years old female patient, presented with retrosternal pain early satiety and vomiting for last three months. Vomitus contained undigested food matter and was more for solids. No significant weight loss was noted by the patients or attendants. She consulted local doctors who gave her some medications and advised g astroscpoy which revealed non specific gastritis. Surgeon advised Barium meal which revealed shrunken stomach with irregular margins. Despite no true preoperative histological. Support, we decided to operate upon the patient and procedure planned was palliative gastrectomy and Rouxen-Y esphagojejunostomy. After opening abdomen via midline incision, operative findings noted, resectibility of tumor was assessed. Major vessels of stomach were tied. Spleen and stomach were taken out. Duodenal stump was closed. Continuity was restored by bringing the roux loop of jejunum and anastomosing it end to side with abdominal esophagus using nasogastric tube as stent. The specimen was sent for histopathology which revealed adenoicarcinoma. Result:The patient was referred to oncology ward for chemotherapy, where she received full course of chemotherapy. She visits us regularly and is satisfied with the treatment offered.
Vesico vaginal fistula after interval debulking in epithelial ovarian cancer
Authors: Shami Nabela , Anwar Shaila , Akmal Iram , Zafar Naheed , Asif Shaheena , . Shaharyar
Published: June 2016

Mrs. S.E, 45 years of age was diagnosed as a case of ovarian carcinoma and had interval debulking, following which she developed vesico-vaginal fistula. Continuous bladder drainage was done for 6 weeks and she was given post operative chemotherapy with cisplatin and gemcitabine. On her 6 weeks postoperative examination, the fistula had healed completely. She is receiving her chemotherapy cycles and is in satisfactory condition.
Vaginal Hysterectomy: study of 75 cases
Authors: Khan Ikramullah , . Shazia , Farooq Muhammad
Published: June 2016

Objectives: To evaluate the outcomes of vaginal hysterectomy in respect of operative, post operative complications. Study design: Lady Aitchison Hospital affliated with king Edward medical college Lahore, from January 2004 to December 2005. Patients and methods. Out of total 215 hysterectomies performed,75 were vaginal for different conditions. Results: The results showed, that at the age of 50 yrs prolapse [48%] was the main indication, while menorrhagia [36%] was the main indication at age of 40 - 50 yrs. Between 30 - 40 yrs Menorragia with prolapse [16%] and below 30 yrs complete prodencia was the indication. 8% intraoperative complications were, 4% operative haemorrage, 1.3% visceral injury, 2.7% return to theature. The post operative complications were maternal death 1.3%, fistula formation (1.3%), return to theature (6.7%), retention of urine (5.3%), pelvic heamatoma (4%), and granulation tissue (2.7%). In 80.1% of cases hospital stay was less than 72 hours Conclusion: Vaginal hysterectomy was the safest, low cost procedure in benign conditions with a few intra / post operative complications.
Complications and visual outcome of sclerally fixed posterior chamber intraocular lenses
Authors: Ali Shah Syed Raza , Ahmad Shakeel , Mahju Tahseen Mehmood , Inayat Nasira , Khan Asad Aslam
Published: June 2016

Hundred eyes of 97 patients were operated for determining complications and visual outcome of Sclerally Fixed Posterior Chamber Intraocular Lenses at Institute of Ophthalmology, Mayo Hospital, Lahore from January 2002 till December 2002. Those operated either had ICCE done previously, per-operated large rent in posterior capsules, dislocated lens and t raumatic subluxated cataractous Iens. Immediate complications were transient rise in IOP, corneal edema, striate keratopathy. Late complications noted had decentration of IOL ( 4%), Cystoid Macular edema 4%, suture erosion (2%) and lens tilt (1%). 80% patients had Post-operative V/A of 6/6-6/12 and 20% had V/A 6/18- 6/60 as compared to Pre-Operative V/A of 56% in 6/6-6/12, 10% in 6/18-6/60 and 34% in 3/60-PL+ ve. Encouraging results favour this procedure.
Effect of Placenta Previa on fetal & maternal morbidity / mortality
Authors: Zaman Bushra Sehr , Zubair Asma , Bhatti Sher Zaman , Malik Muhammad Zubair Saeed
Published: June 2016

Objective: To see the effect of placenta previa on fetal and maternal mortality/ morbidity. This was a case series study. Study was conducted in Gynecology unit BV Hospital Bahawalpur during year 2000 to 2003. All the patients presenting with or with out painless bleeding in antenatal clinic & proved to be due placenta previa were included in the study. Patients presenting with pain less bleeding in the antenatal clinic due to other reasons were excluded from the study. In all the patients` history along with the risk factors clinical and sonography finding, any intervention needed and final out come was recorded. SPSS was used for data collection & analysis. Results: Total 50 patients were studied Out of these 84% of patients were symptomatic a t admission the symptoms found were Bleeding, shock & Pain. Strong associations o f risk factors like Age, Parity, ERCP, Smoking and previous C. Section was found in our study. Severe hemorrhage, prematurity, stillbirths and ENND was associated with Placenta Previa. Conclusion: Placenta previa is not an uncommon but underestimated, under reported & preventable condition. Prevention is possible in case of Known risk factors. Early diagnosis is necessary as the delay in some cases may end up in disaster
Atrial Fibrillation in Mitral Stenosis and its correlation with age, sex & clinical symptoms
Authors: Niaz Zafar , Razzaq Anjum , Latif Muhammad , Aziz Bilal , Nazar Tazeen , Luqman Shoaib , Din Jalalud , Aman Nabeel A , Shah Zahid H , Rehman Azizur , Abaidullah Sajid , Hasan Mumtaz
Published: June 2016

Objective: The objective of the study was to calculate the frequency of atrial fibrillation of MS and its correlation with age, sex and clinical symptoms. Design: A prospective descriptive study. Place: Mayo Hospital & Punjab Institute of Cardiology, Lahore. Patients and methods: 112 patients of mitral stenosis were investigated with an ECG and an echocardiography to confirm mitral stenosis and to measure anteroposterior left atrial dimensions on M-mode. All patients who were suffering from AF due to causes other than mitral stenosis were excluded. The significance of findings were tested through standard "t"test. Results: Atrial fibrillation is more in female patient and has a linear correlation with age. More common symptoms of shortness of breath followed by palpitation.
Vaginal Prostaglandin E2 pessary versus gel in induction of labor at term
Authors: Akram Humaira , Khan Zohra , Rana Tabinad
Published: June 2016

Objective: To compare the prostaglandin E2 Vaginal pessary and gel with respect to cervical ripening, labour out come, side effects and cost effectiveness in induction of labour at term. Design: Experimental study. Place and duration of study: Lady Willingdon Hospital, Lahore February to July, 2005. Subjects and Methods: The trial was conducted on two group of patient for labour induction such that one group (n=30) received PGE2 vaginal pessary 6 hourly to maximum of 3 doses. Other group (n=30) received PGE2 gel at 6 hourly interval upto 2 doses. Labour induction, number of doses applied, need of augmentation, side effects, induction to delivery interval, mode of delivery, neonatal outcome and cost effectiveness were the main outcome measures. Results: Our results depicted that PGE2 gel produced favourable bishop score more rapidly and initiating uterine contraction simultaneously than PGE2 pessary. Few patients required oxytocin augmentation in gel group (P<0.05). There was no statistically significant d ifference in number of patients delivering vaginally with in 24 hours, the neonatal outcome and cost effectiveness in two groups (P>0.05). However, more side effects such as uterine contractions, abnormalities, and fetal distress observed in gel group (P<0.05). Conclusion: The PGE2 pessary was safe and easily applied, but PGE2 intracervical gel was more effective as it achieved greater changes in mean bishop score. However, more side effects encountered with gel category.
Neonatal mortality in a district hospital setup
Authors: Khurshid Asim , Rashid Junaid
Published: June 2016

Objective: To evaluate the causes and risk factors of neonatal mortality, in a non-tertiary district hospital nursery. Study Design: Descriptive study. Place and duration of study: This study was carried out in the Neonatal Unit of Social Security Hospital Muzuffar Garh, Pakistan from 1st May 2004 to 30th April 2005. Patients and methods: All newborns admitted in the nursery during study period were counted and the expired ones were evaluated in detail for the cause of death. Results: A total of 410 neonates were admitted during study period, 53.65% were male and 46.35 females. 47.22% were admitted within 1st 24 hours of their life, and 61.66% within 72 hours of birth. 56.66% of the expired neonates were low birth weight. Neonatal sepsis being the commonest cause of death (44%), 35% being of EOS and 65% cases of LOS. 2"d commonest cause of neonatal death was birth asphyxia (22%) and the third commonest cause was prematurity (19%) with its complications. Other causes of neonatal mortality were neonatal jau ndice (2.77%), meconium aspiration syndrome (1.66%), hyaline membrane `disease (6.66%), neural tube defects (1.11%) and congenital heart disease (1.66%). Many babies had more than one of the above said causes. Conclusion: Neonatal sepsis, birth asphyxia and prematurity are the major killers in nurseries.
The diagnosis and management of the urological complications of Renal Transplantation: a series of 1100 patients
Authors: Abbas Jafri Syed Saleem , Chughtai Nawaz Chughtai
Published: June 2016

Objective: To analyse the Urological Complications after Renal Transplantation and their management. Material and methods: -A retrospective analysis of 1150 consecutive live donor renal transplants was performed. The study period extended from December 1995 to December 2004. The surgical procedure for ureteral reimplantation was modified Lich anastomosis. Ultrasonography, renal scanning, antegrade pyelography, retrograde pyelography and cystography were the diagnostic tools. Results: -Overall, 68 primary urological complications (5.9%) were identified during the 15-year experience in 65 patients. The Urological Complications in our series included 35 ureteral obstruction (3.0%), 25 ureteral or bladder leaks (2.17%), 05 out flow obstruction, 02 cases of vesicoureteral reflux and 01 case of ureteral stone. Conclusion: The incidence of Urological Complications in our study is 5.9%. Early exploration of the ureteric leaks and timely intervention to obstructed kidney reduced the morbidity and improves graft su rvival. The causes of these complications and techniques for their prevention are discussed in this study.
Maternal mortality: A 10-year study at Nishtar Hospital Multan
Authors: Quddusi Huma , Masood Sajjad , Mazhar Sobia , Akhtar Samee
Published: June 2016

Objective: To analyse causes of maternal deaths and to identify preventable causes leading to this tragedy in our setup. Design: An analytical, hospital-based study. Place and duration of study: Department of Obstetric and Gynaecology, Nishter Hospital Multan from June-August 2005. Patients and methods: During the study period retrospective data was collected for period of 10 year from January 1995 to December 2004. This data was analyzed in order to determine the Maternal Mortality Rate (MMR), causes of death and characteristics of the mothers who died including her age, parity and whether they were booked or unbooked. Results: A total numbers of 30031 deliveries took place during the study period and there were 178 maternal deaths with maternal mortality rate of 593/100,000 LB (live births). 7(3.9%) patients were below the age of 20, 74(41.5%) were in the age group of 21-30 and 82(46%) in 31-40 years age range. 15(8.42%) were above the age of 40. Most of them (69%) were grand multiparas (Parity >5). The major causative factors were haemorrhage 63(35.4%), eclampsia 41(23.03%), sepsis 25(14.04%), anaemia 18(10.1%), hepatic encephalopathy 14(7.9%), abortion 11(6.2%). Majority of the patients were unbooked and presented in the hospital very late. Conclusion: A high proportion of potentially preventable maternal deaths indicate the need for improvements in education for both patient and health care provider. The provision of skilled care and timely management of complications can lower maternal mortality in our setup.
Mini Cholecystectomy: a comparison with Laparoscopic Cholecystectomy
Authors: Ahmad Ashfaq , Khan Hassan Muhammad , Gulshan Samina , Shah Tahir Ahmad
Published: June 2016

Laparoscopic cholecystectomy is the gold standard procedure for symptomatic gallstones but at a higher price. Recently a few studies comparing mini cholecystectomy to laparoscopic cholecystectomy have shown that mini cholecystectomy has comparable results to laparoscopic cholecystectomy at an affordable price. We compared these two techniques over a period of two years.224 patients were studied, 122 had laparoscopic and 102 had mini laparotomy cholecystectomies. Results showed that operation time and theatre cost were low in mini laparotomy cholecystectomies but these patients required more post operative analgesics. There was no significant difference in total hospital stay and resumption to routine activities. Total cost to hospital and patient was also similar for these two techniques. There were two common bile duct injuries in laparoscopic group and none in mini cholecystectomies and there was no mortality in either group. We conclude that results of mini laparotomy cholecystectomy are very much simi lar to laparoscopic cholecystectomy and it can be used as an alternative to laparoscopic technique.
Pharyngolaryngeal discomfort after use of LMA among patients receiving intermittent positive pressure ventilation and that breathing spontaneously
Authors: Asad Naila , Ali Khawar
Published: June 2016

Objective: To evaluate the occurrence of postoperative sore throat after the use of LMA among patients undergoing surgery on intermittent positive pressure ventilation and those on spontaneous mode. Methods: hundred adult patients of ASA I or II status were included and divided into two equal groups. Group I patients were randomly assigned for positive pressure ventilation and group II patients for spontaneous breathing. Anaesthesia was administered with propofol, oxygen nitrous oxide and halothane. The LMA of appropriate size was placed.After completion of surgery, LMA was removed when the patient regained deglutition reflex. Patient was questioned postoperatively for variables of sore throat for three days. Results: In group I, 12% patients complained of mild sore throat in comparison to group II where 6% suffered from mild sore throat (p>0.05). There was no difference in the discomfort levels among males and females. Conclusion: Pharyngolaryngeal discomfort is less after use of LMA under spontaneous ve ntilation in comparison to controlled ventilation.