Analysis of 3794 civilian craniocerebral missile injuries - Results from 20 years of Kashmir conflict

An analysis of 3794 craniocerebral missile injuries managed, monitored and treated by the Sher-i-Kashmir Institute of Medical Sciences [SKIMS], India, over a period of 20 years from September 1988 - December 2008 was analyzed. It revealed an overall mortality of 88% [3327 out of 3794] and a good survival of 5% [176 out of 3794]. Most of the deaths occurred within 30 minutes of the patient's arrival to the hospital and only 694 patients lived beyond one hour of arrival. All patients with an admission Glasgow Coma Scale [GCS] of 3 and the majority of those with 4 died. No deaths occurred in the group of patients with GCS score 9-15. Poor and delayed mode of transportation accounted for up to 90% of deaths. Predictors of poor outcome were low admission GCS score, fixed and dilated pupils, poor and delayed mode of transportation, haemodynamic instability, abnormal breathing at admission, coagulopathy and disseminated intravascular coagulation, CT visualisation of subarachnoid haemorrhage, ventricular haemorrhage, midline shift, bihemispheric and multilobar injuries and scalp wounds at occipital, temporal and frontal areas. However, retained missile and bone fragments were less harmful than retained wooden [pulped mulberry stem] and cardboard wads and pneumocephalus in causing infections, cortical atrophy and seizures in the long run

Haemorrhoidectomy

Haemorrhoids are among the commonest surgical problems of anorectal region. Chronic constipation, straining, at defecation or micturation is the main predisposing factors but exact aetiopathogenesis remain unclear. Most patients in the initial stages are treated with conservative or minimally invasive approaches. However haemorrhoidectomy has proven long-term efficacy in the treatment of third degree haemorrhoids. There is still controversy whether open or closed haemorrhoidectomy is treatment of choice. Haemorrhoidectomy whether open or closed is associated with postoperative complications. This study was carried out to compare postoperative complications of both procedures to improve the management of haemorrhoids. To compare postoperative complications in open and closed haemorrhodectomy. Quasi- experimental. Surgical unit-1, Allied Hospital Faisalabad. One year [20/06/o6 to 20/06/07]. 100 cases [50 cases in each]. Convenience sampling. Patients with 3[rd] degree haemorrhoids. * Complicated third degree haemorrhoids. * Patients with other causes of bleeding per rectum. * Patients having associated medical problems. * Patients not willing for surgery. Out of 100 patients 7 had severe postoperative pain, 5 from open and 2 from close group.50 patients had moderate pain, 30 from open and 20 from closed group.8 patients, 5 from open and 3 from closed group got urinary retention. 2 patients both from open group had anal stricture. Closed haemorrhoidectomy is more advantageous with respect to less postoperative pain

role of drainage after thyroid surgery. Is it mandatory?

To assess the comparative analysis of usefulness of drains after thyroid surgery. A prospective randomized experimental study conducted over a period of one year, from April 2006 to April 2007. Surgical Unit-I, Allied Hospital Faisalabad. A total of 60 patients presented with Goiter randomly allocated equally to drain and non drain groups. The surgeon was informed of the group just before the closure of wound. Ultrasonography of the neck was done post operatively on Day-1 and Day-4 by same sonologist, each time to assess the fluid collection in thyroid bed. Any change in voice, wound infection or respiratory distress was also recorded. The data was analyzed by descriptive and inferential statistics. Both groups were evenly balanced according to age, gender, size of thyroid gland, volume of resected thyroid gland, type of procedure and time of operation. Overall fluid collection is more in drain group assessed by USG on Day-1 [P=.00] and day Day-4 [P=.04] as compare to nondrain group. Regarding post-operative complications three patients [10%] in drain group and two [6.7%] in non-drain group had change in voice. Three patients [10%] in drain group had prolonged hospital stay as compare to non-drain group in which no patient recorded. Two patients [6.7%]in none drain group developed seroma. putting of drains after thyroid surgery do not show any advantage to non drain group regarding peri-operative complications, rather hospital stay is more in patients of drain group