Pattern of dynamic intestinal obstruction in adults

Background: Pericardial effusion in clinical practice is commonly under diagnosed or missed especially minimal to moderate effusion. Aim and objectives: To study the clinical and etiological profile of pericardial effusion and to recognize radiological, electrocardiographic and echocardiographic features that are characteristic of pericardial effusion and to analyze pericardial fluid in various etiologies. Materials and methods: It was prospective study in patients presenting with pericardial effusion in department of Medicine and Cardiology. Total of 30 patients who presented with pericardial effusion based on clinical criteria and confirmed by echocardiography were included in the study. Results: The causes of pericardial effusion in this study were Tuberculosis (33.33%), Uremia (20%), Viral /Idiopathic (16.67%), Bacterial (10%), Malignancy (10%), Hypothyroidism (3.33%), and post MI with ischemic cardiomyopathy (3.33%), SLE (3.33%). 3 cases (10%) were HIV positive among viral causes,1 patient had tuberculous pericarditis. ECG findings of low voltage complexes were present in 90% of patients and electrical alternans was seen mainly in tamponade cases. Chest X-ray finding of cardiomegaly was present in 90% patients with pleural effusion in 13.3% patients. ADA levels elevated in all 10 patients of tuberculous effusion with 100% sensitivity and among them smear for AFB was positive in 3 patients. Increased levels of ADA>60U/L was associated with increased incidence of effusive constrictive pericarditis in TB effusion. Pericardial fluid IFN-ᵞ increased greater than 200 pg/L, tuberculous etiology showed 100% sensitivity and specificity. In all 10 patients of M Manjusha, B. Manoj Kumar, N. Venkat Rajaiah, P. Narayana. Study of characteristic of pericardial effusion and to analyze pericardial fluid in various etiologies. IAIM, 2017; 4(10): 221-229. Page 222 2Dimensional echocardiographic findings of right atrial, right ventricular collapse and left atrial collapse was seen predominantly in tamponade cases. Pericardiocentesis showed hemorrhagic effusion in malignancy and uremia, serous and serofibrinous in tuberculosis and purulent in pyogenic effusion. In 3 cases of pyogenic effusion, culture revealed Staphylococcus aureus in 2 patients and Klebsiella pneumonia in 1 patient. Among 3 cases of HIV, one patient had ADA >40 and smear for AFB positive suggesting tuberculous etiology and other 2 cases were directly due to HIV. In HIV with tubercular effusion the patient presented with cardiac tamponade. Conclusions: ADA>40U/L is diagnostic of tuberculous effusion which showed 100% sensitivity and specificity. Increase of ADA>60 U/L is associated with effusive constrictive pericarditis which has poor prognosis. IFN-ᵞ is increased >200pg/l in all patients of tuberculous etiology showing 100% sensitivity and specificity

Frequency of fistula formation after two stage repair of cleft palate

To estimate the frequency of fistula formation after two stage repair of cleft palate. A total of 50 patients having completed cleft palate repair with or without lip repair were recruited from December 2007 to February 2009. Patients were diagnosed on history and oral examination. Informed consent was taken from parents. Width of the cleft measured preoperatively. Two stage repairs were done by a single surgeon with a time lapse of six months. Five patients developed clinically significant oronasal fistula. All these fistulas occurred at the junction of hard palate and soft palate within 3 weeks time. The overall rate of true fistula development was 12% over a mean follow up period of 6 months. The incidence of true fistulas that were symptomatic and subsequently required surgical repair was 10%. Fistula rates were higher for more wide clefts but were not affected by gender or age

Our experience of pectoralis major myocutaneous pedicled flap

The pectoralis major myocutaneous pedicle flap [PMMPF] has been considered to be the "workhorse" of pedicled flaps in head and neck reconstruction. Despite the use of free flaps, this flap is still considered the mainstay of head and neck reconstruction. The flap is usually associated with a high incidence of complications compared with the free fasciocutaneous flaps yet its size, viability, and versatility make it a valuable tool for extending the limits of resectability and reconstruction. It is type V muscle flap with the dominant vascular supply from the pectoral branch of thoracoacromial artery. To share our experience of pectoralis major myocutaneous pedicle flap in selected cases of head and neck reconstruction. The indications, type of reconstruction and complications of the flap utilization were evaluated. Between March 2005 and August 2010, a 37 head and neck reconstructive procedures using the PMMPF were carried out. The indications for the flap use were defects due to resection of stage II-IV cancer in the head and neck region. The site, stage of the disease and the postoperative complications were all documented. Pectoralis major myocutaneous pedicled flap reconstructions were used to reconstruct defects in the following sites: oral cavity [25 patients]; oropharynx/ hypopharynx, [7 patients]; and neck or face [5 patients]. Of the 37 PMMPF reconstructions, 30 flaps were carried out as primary reconstructive procedures, whereas 7 flaps were "salvage" procedures. Twentyfive patients [67.59%] had complications. A higher complication rates were associated with the utilization of the flap as a salvage procedure, number of co- morbidities, and in oral cavity reconstructions. The pectoralis major myocutaneous pedicled flap is still an acceptable method of head and neck reconstruction. It is fast, reliable, provides safe repair and is indicated especially where bulk is needed

Our experience with macrodactyly: a rare congenital anomaly

To present our experience with [Macrodactyly] a rare congenital anomaly and its associated anomalies. Macrodactyly is an increase in the size of one or several fingers or toes. The overgrowth is limited to or predominantly affects the digits. It is characterized by an increase in all mesenchymal elements particularly fibro-adipose tissue. It does not appear to be an inherited condition and is thought to be caused by abnormal nerve supply, abnormal blood supply or abnormal humeral mechanisms. Pathologically, they are benign, soft tissue growths. Macrodactyly is commonly an isolated condition but other congenital anomalies are associated with it. It can be static or a progressive disorder. Soft tissue debulking, phalangectomies, ray resection, ostetomies and arthrodesis of interphalangeal joints are different modes of treatment. Descriptive case series. This study was conducted in Plastic Surgery Unit of Hayatabad Medical Complex Peshawar and Orthopaedic unit of Khyber Teaching Hospital, Peshawar from April 2007 to December 2009. A total of 32 patients were registered during the study period. Patients were admitted through out patient department, written informed consent was obtained from all individuals. Detailed history was taken, every patients was assessed clinically and radiologically. All patients were followed for recurrence. 2 patients were lost in follow up and the study was completed on 30 patients. Mean age of the patients was 13.7 years. Out of 30 patients, 19 were male and 11 were female. Hands were involved in 20 patients and feet in 10 patients. There was no bilateral hands or feet involvement. Eighteen patients had progressive and 12 patients have static macrodactyly. Seventeen patients had isolated macrodactyly while in 13 patients macrodactyly was associated with other congenital anomalies most commonly syndactyly. Most commonly involved digit was index finger in hand and big toe in foot. Macrodactyly is a rare congenital anomaly but cosmetic and functional disability of the patient is significant. Although it is mostly isolated but a significant number of cases were associated with other congenital anomalies which necessitate further research in this field

Functional outcomes of single follicular hair graft technique

To assess the percentage survival of follicular hair graft technique and the factors influencing it. A non-interventional descriptive study. Plastic Surgery Unit, Hayatabad Medical Complex from November 2003 to April 2004. A total of 30 patients were included in the study with pattern of baldness ranging from type II to type VII. Age ranged from 24 years to 50. Hair bearing skin strips were harvested from occipital area and sliced under magnification into grafts of various sizes. Either punch or slit knife was used for making holes in recipient area and grafting follicles. Patients were followed at 2 weeks, 3 months and 6 months. Graft survival was measured at 6 months postoperative interval. In 7 patients graft survival was above 90%; in 12 patients above 80% but less than 90%; in 7 patients between 70 and 80%; in 2 patients above 60% but less than 70%; in 2 patients less than 20% which was considered as failure. Survival was greater with punch method than use of slit knife. Chances of failure increased with the large size session, larger grafts and unknown factors that need further investigations