Arshad Zafar

Gastrointestinal perforation in children due to blunt abdominal trauma in Hazara, Northern Pakistan.

A retrospective study of 25 children with gastrointestinal perforation due to blunt abdominal trauma in a single region of Pakistan is presented. The age, sex, aetiology, site of perforation, abdominal and X-ray findings, associated injuries, surgical procedures and outcome were analysed. There were 20 boys and 5 girls: mean age was 10 years. The injuries were the result of road traffic accidents 12 (48%), falls 11 (44%) and ‘struck by animals’ two (8%). Associated injuries occurred in 19 (76%). On admission 20 (80%) patients had peritonitis while 18 (72%) had pneumoperitoneum. Mean time from trauma to admission was 10 hours and admission to operation was 5 hours. Ileum was the most common site of perforation. Simple closure was the most common surgical procedure. Complications occurred in nine (36%) patients — six (24%) died. Delay in presentation and operation was associated with increased morbidity and mortality. Frequent evaluation of the child and abdominal X-rays are still the important tools for early diagnosis of gastrointestinal perforation following blunt abdominal trauma.

Office haemorrhoidectomy with local anaesthesia: a feasible day-case procedure.

We report on 100 patients (88 men and 12 women) who underwent ligation-excision haemorrhoidectomy for prolapsing haemorrhoids in an outpatient office setting under local anaesthesia. Operating time, complications during procedure, postoperative complications and patient satisfaction with the procedure were analysed. The mean operating time was 55 (40–90) minutes. Ninety-seven were discharged three to five hours after surgery. Three patients were directly admitted to the hospital after surgery. One patient was readmitted after discharge. Severe postoperative pain occurred in eight; three suffered urinary retention; 88% were satisfied with the surgery but 12% were not. This study shows that, in selected patients, performing ligation-excision haemorrhoidectomy under local anaesthesia in the outpatient office setting is safe and viable.

Modified stripper for varicose vein surgery.

In this method. a drop of LPCB was put on a clean microscope glass slide. Then a strip of clean cellophane tape about 10cm long and 10-20 mm width was cut and held between the thumb and forefinger with the sticky side facing outwards.The sticky side was pressed against skin acrossthe anal opening of the child with even thorough pressure. The tape was removed and the sticky sidewasgently placed against surface of a glass slide containing a drop of LPCB. The slide was properly labelled.