Glans Anthropometry for Preputial Reconstruction in Hypospadias.

Background: Cases of hypospadias present for poor stream or cosmetic appearance. The main aim is to provide a visibly normal phallus. Preputial reconstruction is technical. A properly planned reconstruction based on anthropometry may improve the result. We are presenting our experience of reconstruction based on glans anthropometry. Aim: The aim of the study was to evaluate the importance of glans anthropometry in preputial reconstruction in cases of hypospadias. Materials and Methods: All cases of hypospadias operated between June 2014 and March 2022 were included. Glans width was measured at the base. The marking sutures for preputial reconstruction were taken at distance thrice the glans width at base. Those requiring religious circumcision along with repair, associated significant chordee, catheter came out before 2 weeks, or history of any previous penile surgery were excluded. All the cases were subjected to urethroplasty, meatoplasty, and preputioplasty. The results obtained were analyzed. Results: One hundred and forty-eight out of 159 cases formed the study group. There were 31 glanular, 42 distal penile, 58 mid-penile, and 17 proximal penile hypospadias. Mean glans width at base was 16 mm (range: 11-21 mm). Mean distance of marking suture at prepuce was 38 mm (range: 33-63 mm). Mean follow-up was 12 months (range: 1-36 months). Mean age at presentation was 23 months (range: 14-72 months). Mean operating time was 50 min (range: 45-60 min). Fistula at the base of preputioplasty was seen in four. Dehiscence of preputioplasty was seen in six. Meatal stenosis was seen in three cases. Conclusion: Preputial reconstruction improves the cosmetic appearance of the hypospadiac penis. Reconstruction based on glans anthropometry improves the result and avoids complications.

Wound closure after total knee replacement: Comparison between staples and sutures.

Background and Objective: Total Knee Arthroplasty is a commonly performed procedure for arthritic knees. Preventing complications is of utmost importance for good functional outcomes and preventing morbidity. Wound closure after the procedure is as important as the replacement aspect of surgery.The objective of this study was to provide subjective and objective evidence of better closure technique and material; we conducted the study so that the outcome of TKA can be further improved. Methods: We conducted a randomized trial at The Indus Hospital, Karachi, from December 2018 to June 2020. All patients from age 40 to 70 years who underwent total knee arthroplasty were included in the study. The wound of one knee was closed with Polypropylene (Prolene) sutures, and the other with staples. The wound was assessed independently by two assessors using Hollander's score; lower score means a worse outcome. All data was entered and analyzed using STATA version 16. Results: Thirty patients who underwent bilateral total knee replacement were included in the analysis, among which 71.8% were female. The average age of participants was 57.3 (± 7.5) years. The mean incision length on the right knee was 17.6 ± 1.1 cm, while on the left the incision length was 18.3 ± 1.2 cm. Overall, the mean Hollander score was significantly different among participants in the sutures and staples group in both the right (p-value=0.001) and left knees (p-value=0.001). The score was significantly higher in knees closed with sutures as compared to staples. Also, the mean Hollander score is significantly higher in females than males in both the right knee (B=0.56, p-value=0.049) and the left knee (B=0.38, p-value=0.044). Conclusion: The study has shown that Hollander's score was significantly higher in knees closed with sutures as compared to the patients in whom staples were used for wound closure.

Arthroscopic management of snapping scapula syndrome improves pain and functional outcomes, although a high rate of residual symptoms has been reported.

PURPOSE: To investigate the use of arthroscopy in the management of patients with snapping scapula syndrome, including aetiology, surgical decision-making, outcomes, complications, effectiveness of arthroscopy, and quality of evidence of the existing literature. METHODS: Three databases (PubMed, Ovid [MEDLINE], and EMBASE) were searched independently and in duplicate to systematically screen the literature. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist guided the reporting and data abstraction. Methodological quality of all included papers was assessed using the MINORS criteria. The results are presented in a narrative summary fashion using descriptive statistics including means, proportions, and ranges. RESULTS: Overall, 18 studies (5 case reports and 13 case series; all level IV evidence) were identified, including 201 patients (203 shoulders). The mean follow-up period was 32.7 months (range 1-154 months). Surgical decision-making for the use of arthroscopy was most commonly based on a failed trial of initial non-operative management in 17 studies (94%). Overall, 21% of cases achieved complete resolution of pre-operative symptoms, including pain, crepitus, and range of motion, while 68% of cases obtained some clinical improvement, but reported some residual symptoms (persistent crepitus [12%] and persistent scapulothoracic pain [4%]). Moreover, poor outcomes were reported 11% of cases and the most common complication was scapular oedema (6%). CONCLUSION: Arthroscopic management of snapping scapula syndrome yields improvement in pain, crepitus, and range of motion in a majority of patients; however, most patients experience residual symptoms. Further studies are needed to compare the outcomes of shoulder arthroscopy with other available treatment options for snapping scapula syndrome. Shoulder arthroscopy for snapping scapula can improve patients' symptoms; however, patients must be informed about the high likelihood of persistent symptoms post-operatively. LEVEL OF EVIDENCE: Systematic review of Level IV studies.

Arthroscopic management of suprascapular neuropathy of the shoulder improves pain and functional outcomes with minimal complication rates.

PURPOSE: The purpose of this study was to systematically assess the arthroscopic management of suprascapular neuropathy, including the aetiology, surgical decision-making, clinical outcomes, and complications associated with the procedure. METHODS: Three databases [PubMed, Ovid (Medline), and Embase] were searched. Systematic literature screening and data abstraction was performed in duplicate to present a review of studies reporting on arthroscopic management of suprascapular neuropathy. The quality of the included studies was assessed using level of evidence and the MINORS (Methodological Index for Nonrandomized Studies) checklist. RESULTS: In total, 40 studies (17 case reports, 20 case series, 2 retrospective comparative studies, and 1 prospective comparative study) were identified, including 259 patients (261 shoulders) treated arthroscopically for suprascapular neuropathy. The most common aetiology of suprascapular neuropathy was suprascapular nerve compression by a cyst at the spinoglenoid notch (42%), and the decision to pursue arthroscopic surgery was most commonly based on the results of clinical findings and investigations (47%). Overall, 97% of patients reported significant improvement in or complete resolution of their pre-operative symptoms (including pain, strength, and subjective function of the shoulder) over a mean follow-up period of 23.7 months. Further, there was a low overall complication rate (4%) associated with the arthroscopic procedures. CONCLUSION: While most studies evaluating arthroscopic management of suprascapular neuropathy are uncontrolled studies with lower levels of evidence, results indicate that such management provides patients with significant improvements in pain, strength, and subjective function of the shoulder, and has a low incidence of complications. Patients managed arthroscopically for suprascapular neuropathy may expect significant improvements in pain, strength, and subjective function of the shoulder. LEVEL OF EVIDENCE: Level IV, systematic review of level II to IV studies.

Reproductive Performance of Arabian and Thoroughbred Mares under Subtropical Conditions of Pakistan.

Breeding records of 57 Arabian and 66 Thoroughbred mares were analysed to assess their reproductive performance under the subtropical conditions of Pakistan. The Arabian mares showed significantly higher conception rates (p<0.05) in second mated oestrus and foal heat mated oestrus compared to Thoroughbred mares. However, conception rates for first lifetime mated oestrus were similar in both breeds of mares. Age at first mating (1,301±40 vs 1,500±32 days) was significantly (p<0.05) less in Arabian compared to Thoroughbred mares. Both breeds of mares showed significantly (p<0.05) higher frequencies of oestrous cycles and conception rates during the winter (October to March) compared to summer (June to August) months. Age of mares affected the conception rates, as mares at ages 3 to 7 and 8 to 12 years of ages had significantly higher conception rates (p<0.05) than those ≥18 years old in both breeds. This study demonstrates that i) reproductive performance in Arabians is better than Thoroughbred mares under the subtropical conditions of Pakistan, ii) mares remain cyclic throughout the year and iii) conception rates were higher in mares bred during winter compared to summer months.

A laminar forced convection via transport of water-copper-aluminum hybrid nanofluid through heated deep and shallow cavity with Corcione model.

The article explores how fluid flows and heat transfers in both deep and shallow cavities when using a nanofluid made of water, copper, and aluminum oxide. The study applies the Corcione model to hybrid nanofluids, which considers viscosity, conductivity, and the size of the nanoparticle, temperature, and Reynolds number. The cavity is connected to a rectangular channel, with the cavity's length being half the total length of the enclosure, and the aspect ratio (cavity height divided by height of the channel) is tested from 1 to 3. The study uses the Navier-Stokes equation and energy equation in two dimensions, along with finite element-based software, COMSOL 5.6, to simulate the combination of fluid flow and heat transmission. The results show a circular distribution of temperature in the cavity, and the average temperature drops as the volume fraction of copper upsurges. However, both the Reynolds number and volume fraction of copper improve the average Nusselt number, which shows how well the fluid transfers heat, along the cavity's middle line. The percentage change in the average Nusselt number decreases as the aspect ratio increases, indicating improved conduction.

Maximizing electrical output and reducing heat-related losses in photovoltaic thermal systems with a thorough examination of flow channel integration and nanofluid cooling.

In recent years, global energy demand has surged, emphasizing the need for nations to enhance energy resources. The photovoltaic thermal (PV/T) system, capable of generating electrical energy from sunlight, is a promising renewable energy solution. However, it faces the challenge of overheating, which reduces efficiency. To address this, we introduce a flow channel within the PV/T system, allowing coolant circulation to improve electrical efficiency. Within this study, we explore into the workings of a PV/T system configuration, featuring a polycrystalline silicon panel atop a copper absorber panel. This innovative setup incorporates a rectangular flow channel, enhanced with a centrally positioned rotating circular cylinder, designed to augment flow velocity. This arrangement presents a forced convection scenario, where heat transfer primarily occurs through conduction in the uppermost two layers, while the flow channel beneath experiences forced convection. To capture this complex phenomenon, we accurately address the two-dimensional Navier-Stokes and energy equations, employing simulations conducted via COMSOL 6.0 software, renowned for its utilization of the finite element method. To optimize heat dissipation and efficiency, we introduce a hybrid nanofluid comprised of titanium oxide and silver nanoparticles dispersed in water, circulating through the flow channel. Various critical parameters come under scrutiny, including the Reynolds number, explored across the range of 100-1000, the volume fractions of both nanoparticle types, systematically tested within the range of 0.001-0.05, and the controlled speed of the circular cylinder, maintained within the range of 0.1-0.25 m/s. It was found that incorporating silver nanoparticles as a suspended component is more effective in enhancing PV/T efficiency than the addition of titanium oxide. Additionally, maintaining the volume fraction of titanium oxide between 4 and 5% yields improved efficiency, provided that the cylinder rotates at a higher speed. It was observed that cell efficiency can be regulated by adjusting four parameters, such as the Reynolds number, cylinder rotation speed, and the volume fraction of both nanoparticles.

Viscoelastic fluid flow over a horizontal flat plate with various boundary slip conditions and suction effects.

This study examines the numerical representation of fluid flow on the Maxwell model in a double-diffusive boundary layer over a horizontal plate. The investigation incorporates slip conditions, encompassing momentum slip, thermal slip, and suction parameters. Moreover, the study includes the inspiration of thermal radiation, heat generation, and mass transfer. The governing partial differential equations (pertaining to momentum, continuity, energy transport, and mass transport) are transformed into ordinary differential equations (ODEs) using appropriate similarity transformations. To solve these equations in conjunction with suitable boundary conditions, the bvp4c inbuilt software is implemented. This is achieved through the shooting approach employed in MATLAB. A comprehensive agreement between the numerical technique and previously published findings demonstrates its efficacy. The outcomes are presented through graphical representations and tables, showcasing various parameters such as momentum slip, temperature slip, local Nusselt number, Sherwood number, and suction parameter. The primary motivation of this research lies in investigating the behaviour of Maxwell fluid flow in the absence of slip conditions. The study of Maxwell fluid flow over a flat plate with the combined effects of suction, thermal slip, and momentum slip conditions has a wide range of practical applications that span multiple industries, contributing to improved designs, efficiency, and understanding of fluid behaviour in various systems. The main aim of this study is to present streamlined results under varying conditions, explicitly investigating the influence of suction effects and slip conditions on the flow.

Investigation of a two-dimensional photovoltaic thermal system using hybrid nanofluids and a rotating cylinder.

This article focuses on a numerical investigation aimed at enhancing the electrical performance of a two-dimensional photovoltaic thermal system (PV/T) through the application of cooling using hybrid nanofluids. The hybrid nanofluids consist of titanium oxide and silver nanoparticles suspended in water, while the PV/T system is based on polycrystalline silicon, copper, and a flow channel with a rotating cylinder. PV/T devices generate electricity from sunlight, but their performance degrades over time due to the heat generated by solar radiation. Therefore, nanofluids can be circulated through the bottom flow channel to cool the device. This study utilizes 2D incompressible Navier-Stokes equations to control fluid flow and energy equations to manage energy distribution. The COMSOL 6.0 finite element software is employed for comprehensive modeling and simulation. To enhance the performance of the PV/T system, a parametric study is conducted by varying the Reynolds number (ranging from 100 to 1000), cylinder rotational speed (varying from 0.01 to 0.2 m s-1), and silver volume fraction (ranging from 0.01 to 0.2). The results show that increasing the Reynolds number and the volume fraction of silver leads to a reduction in the maximum temperature of the cell. The maximum temperature of the cell also decreases with the rotational speed of the cylinder but only for high Reynolds numbers. By applying the present model, the cell's efficiency is improved by 5.93%.

Enhancing heat transfer in solar-powered ships: a study on hybrid nanofluids with carbon nanotubes and their application in parabolic trough solar collectors with electromagnetic controls.

The aim of this research is to explore the use of solar-powered ships (SPS) as a means to reduce greenhouse gas emissions and fossil fuel dependency in the maritime industry. The study focuses on improving the heat transfer efficiency in SPS by employing hybrid nanofluids (HNF) containing carbon nanotubes (CNTs). Additionally, a novel approach utilizing renewable energy and electromagnetic control is proposed to enhance the performance of SPS. The research implements the non-Newtonian Maxwell type and Cattaneo-Christov heat flux model in parabolic trough solar collectors used for ships. The study conducts theoretical experiments and simulations to evaluate the thermal conductivity and viscosity of the CNT-based HNF. Various properties, including solar thermal radiation, viscous dissipation, slippery velocity, and porous media, are assessed to determine the effectiveness of thermal transport in SPS. The research employs similarity variables to simplify the complex partial differential equations into ordinary differential equations and solves them using the Chebyshev collocation spectral method. The results indicate that the MWCNT-SWCNT/EO hybrid nanofluid significantly improves the thermal conductivity, thereby enhancing heat transfer. The HNF exhibits an efficiency rate of approximately 1.78% with a minimum efficiency rate of 2.26%.

An innovative inertial extra-proximal gradient algorithm for solving convex optimization problems with application to image and signal processing.

This study introduces an innovative approach to address convex optimization problems, with a specific focus on applications in image and signal processing. The research aims to develop a self-adaptive extra proximal algorithm that incorporates an inertial term to effectively tackle challenges in convex optimization. The study's significance lies in its contribution to advancing optimization techniques in the realm of image deblurring and signal reconstruction. The proposed methodology involves creating a novel self-adaptive extra proximal algorithm, analyzing its convergence rigorously to ensure reliability and effectiveness. Numerical examples, including image deblurring and signal reconstruction tasks using only 10% of the original signal, illustrate the practical applicability and advantages of the algorithm. By introducing an inertial term within the extra proximal framework, the algorithm demonstrates potential for faster convergence and improved optimization outcomes, addressing real-world challenges of image enhancement and signal reconstruction. The algorithm's incorporation of an inertial term showcases its potential for faster convergence and improved optimization outcomes. This research significantly contributes to the field of optimization techniques, particularly in the context of image and signal processing applications.

Numerical investigation of heat transfer and fluid flow characteristics of ternary nanofluids through convergent and divergent channels.

The characteristics of nanomaterials have garnered significant attention in recent research on natural and forced convection. This study focuses on the forced convection characteristics of ternary nanofluids within convergent and divergent channels. The ternary nanofluid comprises titanium oxide (TiO2), zinc oxide (ZnO), and silver suspended in water, which serves as the base fluid. Using COMSOL Multiphysics 6.0, a reliable software for finite element analysis, numerical simulations were conducted for steady and incompressible two-dimensional flow. Reynolds numbers varying from 100 to 800 were employed to investigate forced convection. Additionally, we explored aspect ratios (channel height divided by the height of the convergent or divergent section) of -0.4, -0.2, 0, 0.2, and 0.4. Our findings revealed that only at aspect ratio a = 0.4 did the average outlet temperature increase as the Reynolds number rose, while other aspect ratios exhibited decreasing average temperatures with declining Reynolds numbers. Moreover, as the Reynolds number increased from 100 to 800 and the total volume fraction of the ternary nanofluids ranged from 0.003 to 0.15, there was a significant 100% enhancement in the average Nusselt number. For clarity, this article briefly presents essential information, such as the study's numerical nature, fluid properties (constant-property fluid), and the methodology (COMSOL Multiphysics 6.0, finite element analysis). Key conclusions are highlighted to enable readers to grasp the main outcomes at a glance. These details are also adequately covered in the manuscript to facilitate a comprehensive understanding of the research. The utilization of this emerging phenomenon holds immense potential in various applications, ranging from the development of highly efficient heat exchangers to the optimization of thermal energy systems. This phenomenon can be harnessed in scenarios in which effective cost management in thermal production is a critical consideration.

Squeezed Darcy-Forchheimer Casson nanofluid flow between horizontal plates under the effect of inclined magnetic field.

This article explores the properties of heat and mass transport for MHD Casson nanofluid flow between two horizontal plates by considering the Darcy-Forchheimer medium. The effects of a uniform inclined magnetic field are discussed numerically. A Darcy-Forchheimer medium is considered in the x-direction between two plates. The features of Brownian diffusive motion, porosity, friction, viscous dissipation, chemical reaction, and thermophoresis are also considered. The governing equations of the model are a system of partial differential equations. This system is converted into non-linear ordinary differential equations using suitable similarity functions. The numerical shooting technique is used to solve the attained boundary value problem. This numerical technique is endowed with the Runge-Kutta order four method and the Newton method. Graphs and tables depict different significant effects. It is observed that the effect of a magnetic field is inversely related to the fluid flow. Moreover, the porosity factor (λ) and the magnetic inclination (γ) are inversely related to the surface drag force (Cf) and the Nusselt number (Nu).

Thermal decomposition of propylene oxide with different activation energy and Reynolds number in a multicomponent tubular reactor containing a cooling jacket.

In this article, we are focusing on heat and mass transfer through a Multicomponent tubular reactor containing a cooling jacket by thermal decomposition of propylene oxide in water. The chemical reaction is an irreversible, 1st order reaction and an exothermic reaction that yields propylene glycol with enthalpy = -84,666 J/mol. The constant rate of the reaction is followed by the Arrhenius equation in which the activation energy is taken on a trial basis in the range from 75,000 to 80,000 J/mol with a fixed frequency factor. For the fluid to flow, the Reynolds number is kept in the range from 100 to 1000. The three partial differential equations of mass, momentum, and energy are coupled to study heat and mass transfer in a tubular reactor by using the chemistry interface in COMSOL Multiphysics 5.4. The initial concentration of propylene oxide is tested in the range from 2 to 3% and the thermal conductivity of the mixture is tested in the range 0.599-0.799. It was found that the amount deactivated of the compound decreases with an increase in Reynolds number. Propylene oxide is decomposed at about 99.8% at Re = 100 at lower activation energy and gives the total maximum enthalpy change in the tubular reactor. Observing the relationship between Sherwood numbers to Nusselt numbers, it was deducted that the convective heat transfer is opposite to convective mass transfer for high Reynolds numbers.

Emergency intraperitoneal onlay mesh repair of incarcerated spigelian hernia.

BACKGROUND AND OBJECTIVES: Spigelian hernia is a rare cause of incarcerated ventral abdominal hernia that may pose a diagnostic dilemma. However, with the increasing utilization of double contrast computed tomography (CT) for undiagnosed small bowel obstruction in a virgin abdomen, more such cases are being diagnosed with increasing confidence. Furthermore, with the rapid expansion of the indications for minimal access surgery in emergency situations, these rare emergencies are increasingly tackled using a laparoscopic approach leading to swift patient recovery and discharge. METHODS: We present the case of an emergency intraperitoneal onlay mesh (IPOM) repair of Spigelian hernia, causing acute small bowel obstruction in a 55-year-old man with liver disease and ascites that was diagnosed using a CT scan. We conducted a search of Medline, Embase, Science Citation Index, Current Contents, PubMed, and the Cochrane Database to review the history of laparoscopic repair of Spigelian hernia and its various advancements, which are briefly presented here. RESULTS: The hernia was successfully reduced using laparoscopy, revealing a moderate-size defect in the linea semilunaris. The hernial defect was repaired with a composite mesh that was tacked into position. The patient was discharged from the hospital on the second postoperative day. CONCLUSIONS: Spigelian hernia in an emergency setting can be easily and swiftly repaired using the IPOM method utilizing a composite mesh.

Prevalence of type-II diabetes mellitus and diabetic retinopathy: the Gaddap study.

OBJECTIVE: To determine the frequency of type-II Diabetes mellitus (DM) in the endogenous population of Gaddap town and also to evaluate the status of Diabetic retinopathy (DR) in this group. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Isra Postgraduate Institute of Ophthalmology, Al-Ibrahim Eye Hospital, Karachi, from January 2006 till December 2008. METHODOLOGY: This community based study of subjects of either gender was carried out in the Gaddap town. Three primary eye care centres were established in the existing primary health care (PHC) facilities, to screen the target Population aged 30 years and above, and who met other inclusion criteria for DM and DR respectively. Patients requiring intervention were managed accordingly. Data was entered and analyzed using Microsoft Visual Basic 6 and Microsoft Access. RESULTS: Out of the cohort of 19211 subjects, 1677 patients were found Diabetic, giving the prevalence of DM in Gaddap town at 8.73%, with 1258 (6.55%) known and 419 (2.18%) newly diagnosed cases. DR was seen in 460 (27.43%) of the Diabetic cases with 126 (7.51%) patients requiring urgent intervention for vision threatening complications. CONCLUSION: The result validates the importance of early screening of DR in people suffering from DM for possible management and prevention of sight threatening complications in the early stage of the disease and advocates the inclusion of primary eye care as a part of PHC system.

Landmark publications on Sudden Infant Death Syndrome: A bibliometrics analysis.

Sudden infant death syndrome (SIDS) is a poorly understood disorder, and its pathophysiology and risk factors remain unclear. Research in the area is the key to combating the pervasive prevalence of this fatal disorder. We sought to identify the top 50 articles concerning SIDS and study their bibliometric characteristics to gain an insight into the research trends in this area. Using the Scopus database, two independent reviewers conducted a literature search using a prespecified search string. Results were arranged according to the citation count, and the top 50 relevant articles were selected. No time restrictions were set, and all types of articles were included. A detailed analysis was carried out to identify the trends and characteristics of the top 50 articles. The top 50 articles were published between 1972 and 2011, with the most productive 5-year interval being 1991-1995. These 50 papers accumulated a total of 13,703 citations (median = 236 citations per paper). Among these, about 9% were self-citations. The citations received by these core papers seemed to decline post-2009. The top 50 articles were published in 21 different journals, with Pediatrics contributing the most (n = 15). US authors were listed for 60% of the articles (n = 30). None of the articles originated from Asian authors. Our manuscript highlights the characteristics of impactful articles on SIDS - and this can act as a directive for researchers aiming to publish on this topic. Bibliometric parameters suggest a decreasing research interest in the fi eld of SIDS, which is concerning, and efforts should be made to promote research. Furthermore, the lack of influential research from Asian authors is also troubling. Funding should preferably be directed toward Asian researchers to bridge the gap in knowledge.

Outcome of palliative esophageal stenting for malignant dysphagia: a retrospective analysis.

Greater than 50% of patients with esophageal carcinoma are found to be incurable at the time of diagnosis, leaving only palliative options. Self-expanding metal stents (SEMs) are effective for relieving symptoms and complications associated with esophageal carcinoma and improving quality of life. We undertook a retrospective analysis to evaluate the experience of palliative esophageal stenting for symptomatic malignant dysphagia in our institution over a period of 7 years. Between January 1999 and January 2006, 126 patients who received SEMs for malignant dysphagia were identified using an upper gastrointestinal specialist nurse clinician database. Data were obtained from patient case notes, endoscopy, histopathology, radiology, and external agency databases. Of the 126 identified, 36 patients were excluded from the analysis. A number of variables including age, sex, presenting complaints, type of stent, indications of stenting, success or failure of stent insertion, survival rate, and complication rate were analyzed. Of the 90 patients, 55 (61%) were male and 35 (39%) were female. The mean age of patients was 70.79 (range 40-97) years. The predominant presenting complaints were dysphagia (n = 81) and weight loss (n = 48). The indication for stenting was worsening dysphagia in all patients. Tumors were confined to the distal esophagus and esophagogastric junction in 73 patients (81%), and the mid-esophagus in 17 (19%). Adenocarcinoma was identified in 61 patients (67.8%) and squamous cell carcinoma in 29 (32.2%). Stenting numbers were comparable in endoscopic and radiologic groups (47 vs. 43), with successful stent deployment in 89 patients. The 7- and 30-day mortality was 9% (n = 8) and 28% (n = 25), respectively. Comparable numbers of early deaths were seen in both radiologic (n = 13) and endoscopic (n = 12) groups. Causes of early inpatient death included hemorrhage (n = 5), pneumonia (n = 7), exhaustion (n = 2), cardiac causes (n = 3), perforation (n = 1), and sepsis (n = 1). The number of patients with complications was 41 (45.6%), 25 in the surgical group and 15 in the radiologic group; the difference was not significant (P = 0.13). The mean survival time was 92.5 (0-638) days and median survival time was 61 days. A subgroup of patients with complete dysphagia (score 4) gained a mean survival of 59 days. Those patients receiving adjuvant chemotherapy or radiotherapy survived significantly longer than those receiving stenting alone (152.8 days vs. 71.8 days). There is no significant difference in complications or survival when using endoscopic or radiologic methods to deploy SEMs in patients with inoperable esophageal cancer. Mortality is low; however, the morbidity rate is significant. Patients receiving adjuvant chemotherapy or radiotherapy, in addition to stenting, survived significantly longer than those with a stent only.

Primary closure versus T-tube drainage after open choledochotomy.

BACKGROUND: Choledochotomy followed by T-tube has long been a standard surgical treatment for choledocholithiasis. It is still a preferred choice in many hospitals where minimal invasive procedures are not feasible. The use of T-tube is not without complications. To avoid the complications associated with T-tube, we have performed primary closure of the common bile duct (CBD) after exploration. This pilot study assesses the safety of primary closure of CBD, which would help form a basis for implementation on a wider scale. OBJECTIVE: To compare the clinical results of primary closure with T-tube drainage after open choledochotomy and assess the safety of primary closure for future application on a greater mass. PATIENTS AND METHODS: This comparative study was conducted at surgical unit IV Liaquat University of Medical and Health Sciences, Jamshoro, from January 2007 to December 2007. Thirty-five patients were included in the study of which 16 patients underwent primary closure. RESULTS: Thirty-five patients were included in the study. The mean age of patients who had primary closure done (n = 16) was 46.0 +/-16.8 and there were two (12.5%) males and 14 (87.5%) females. After primary closure of the CBD, bile leakage was noted in one patient (6.3%), which subsided without any biliary peritonitis as compared to the T-tube group in which two patients (10.5%) had bile leakage. Postoperative jaundice was seen in one patient (5.3%) who had a T-tube because of a blockage of CBD. Not a single patient had a retained stone in both groups as well as no recurrence of CBD stones. The postoperative hospital stay after primary closure was 5.56 +/-1.1 days as compared to after T-tube drainage which was 13.6 +/-2.3 days. The total cost of treatment in patients who underwent primary closure was USD194.5 +/-41.5 but after T-tube drainage it was USD548.6 +/-88.5. The median follow up duration for both groups was 6 months. CONCLUSION: Primary CBD closure is a safe and cost effective alternative to routine T-tube drainage after open choledochotomy.

Comparison of oral versus injectable vitamin-D for the treatment of nutritional vitamin-D deficiency rickets.

OBJECTIVE: To assess the safety and acceptability of a single dose of vitamin-D versus the efficacy of injectable Vitamin-D versus oral vitamin-D. STUDY DESIGN: Case control. PLACE AND DURATION OF STUDY: It was carried out at the Department of Paediatrics, Kharadar General Hospital, Karachi, from August 2003 to April 2004. METHODOLOGY: Children of the age of 6 months to 3 years with clinical, biochemical and radiological evidence of vitamin- D deficiency rickets were included. The history, clinical examination, complete blood picture, serum calcium. Phosphorus, alkaline phosphatase and X-ray of wrist joint were done. The children were divided into two groups A and B. Group A was given oral vitamin-D and group B was given intramuscular injection of vitamin-D on the first day and then they were followed for two more visits at 30 and 90 days with clinical, biochemical and radiological examinations to assess the outcome. RESULTS: There were 50 confirmed cases of rickets in each group. The mean age was 10.9+5.1 months and 14.7+8.1 months in group A and B respectively. In these children, clinical features were weakness, difficulty in walking, frontal bossing, ribcage deformity and widening of wrist were seen. After one dose of vitamin-D (cholecalciferol), there was appreciable gain of weight and height and raised levels of alkaline phosphatase became normal during follow-up. Radiological florid rickets and non-florid rickets in both groups healed clinically during follow-up period. Oral and injectable forms of vitamin-D (cholecalciferol) were effective but injectable form was shown to be statistically significant. There were no undesirable side effects and both forms of treatment were well-tolerated.