COMPARISON OF OPEN AND CLOSED TECHNIQUES OF HAEMORRHOIDECTOMY IN TERMS OF POST-OPERATIVE COMPLICATIONS.

BACKGROUND: Haemorrhoids have been diagnosed and treated since the dawn of civilization, yet their cause, nature, symptomatology and especially their treatment options, remain hotly debated. The general principle however is that treatment should be directed by symptoms and the degree of haemorrhoids. The objective of the study is to compare early and late complications and wound healing time in open versus closed methods of haemorrhoidectomy. METHODS: This was a Randomized control trial conducted at Department of Surgery CMH Kharian for a period of 3 years. During the period of study, patients presenting in Surgical OPD (Age Range 20-72 Years) with 3rd or 4th degree haemorrhoids requiring haemorrhoidectomy (n = 364) were divided in two groups:--Group-1 was subjected to haemorrhoidectomy by open (Milligan-Morgan) technique and Group-2 underwent closed (Ferguson) haemorrhoidectomy. All patients were followed up for 2 months post-operatively and assessed for duration of wound healing and post-operative complications. RESULTS: In group-1 (Open haemorrhoidectomy) patients' ages ranged from 21-70 years with a mean age of 43 years (SD ± 12.51). Duration of wound healing in this group was on the average 22 days (SD ± 5.76). Incidence of early post-operative complications including haemorrhage, infection and urinary retention was 4.94%, 8.24% and 7.14% respectively. The only late complication observed was anal stenosis in one patient (0.55%). No fissure or faecal incontinence was observed in this group. In group-2 (subjected to closed haemorrhoidectomy), patients' ages ranged from 20-72 years with a mean age of 42 years (SD ± 10.31). Duration of wound healing was on the average 14 days (SD ± 3.25). Incidence of early post- operative complications, i.e., haemorrhage, infection and urinary retention was 2.19%, 7.69% and 2.75% respectively. No late complications (stenosis, fissure or incontinence) were observed in this group. CONCLUSION: There is no statistical significant difference between open and closed haemorrhoidectomy for the treatment of 3rd and 4th degree haemorrhoids in terms of wound healing time and post-operative complications.

Attitudes and knowledge of anesthesiology trainees to radiation exposure in a Tertiary care hospital.

BACKGROUND AND AIMS: Ionizing radiation procedures are indispensable in medical clinical practice. Exposure to radiation at any dose could have serious adverse effects. Anesthesiologists working in interventional radiology suites are at a higher risk of radiation exposure than other personnel. The aim of this study was to assess the knowledge and attitude of anesthesiology trainees towards the radiation hazards and current safety practices. METHODS: This prospective cross-sectional survey was conducted at the department of anesthesiology at Aga Khan University. All anesthesiology trainees working in the department were given a 12-question paper-based survey after getting ethical review committee approval and informed consent. The questionnaire contained requests for personal demographic data and specific questions regarding radiation protection. RESULTS: A total of 54 participants were included in this survey. Thirty-two (59.3%) were male, and 22 (40.7%) were female. The average year of experience working in anesthesia of the participants was 2.8 ± 1.65 years (range, one to eight years). Frequency of radiation exposure of 32 (59.3%) participants was 1-5 times per week. Approximately 68.5% (37/54) of participants believed they took adequate precautions for protection against radiation. Only 20.4% (11/54) used both a lead apron and a thyroid shield for prevention of radiation exposure. Most participants using the radiation shield or clothing (70.4%; 38/54) cited concerns about cancer. CONCLUSIONS: A lack of knowledge persists among anesthesiology trainees in our institute regarding the risks associated with ionizing radiation. This study also serves to highlight the need for anesthesiology trainees to protect themselves properly. Radiation dose, hazards, and protection strategies must be included in the basic curriculum of medical colleges.

Maternal blood loss by expansion of uterine incision at caesarean section--a comparison between sharp and blunt techniques.

BACKGROUND: In order to minimize intra operative blood loss during caesarean section, two techniques of expansion of uterine incision (sharp versus blunt) while performing lower segment transverse caesareans deliveries and their effect upon intraoperative blood loss were studied. Moreover, each method was also compared for its inadvertent extension of uterine incision laterally or into the broad ligament, into the cervix or vagina. METHOD: A quasi-experimental study with convenient sampling, involving two groups of women who underwent lower transverse segment Cesarean section. Both groups were studied for their demographic characteristics and clinical data. Standard surgical techniques were used in both groups except the expansion of uterine incision, either by sharp or blunt methods. Finally a comparison of two groups was made regarding blood loss, change in haematocrit, blood transfusion and uterine tears. The study was conducted at Combined Military Hospital Rawalpindi during May 2002 to April 2003. RESULTS: No significant difference was found between the two groups regarding their demographic characteristics and clinical data. Intraoperative blood loss and post-operative hematocrit drop were more significant in the patient group in which a blunt uterine incision was made. Besides, more patients in this group received blood transfusions. Unintended extension of uterine (tears) was also significantly higher in this group. CONCLUSION: Sharp expansion of uterine incision during low segment caesarean section is safer and precise based on these results.