Outcome Comparison of Endoscopic (Endonasal Trans-Sphenoidal) Repairs of CSF Leak vs. Transcranial Approach

OBJECTIVES: To compare the effectiveness of Endoscopic (endonasal transsphenoidal) repair of CSF leak with transcranial approach in terms of post-operative complications. METHODOLOGY: This study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar. Total of 40 patients diagnosed according to inclusion criteria were enrolled and were divided into two groups. One group was treated with endonasal trans-sphenoidal repair, and another was treated with a trans-cranial approach. All patients were followed for 1 year. RESULTS: The mean age of enrolled patients was 35.4±11.6 years. There were 62.5% male and 37.5% female. In the endoscopic group the recurrence rate was observed in 3 (15%) of the patients while in the trans-cranial group the recurrence rate was observed in 2 (10%) of the patients. The overall recurrence and success rate was 8% and 92% respectively. About 4 patients developed an infection, which was treated successfully. CONCLUSION: It is concluded that the endoscopic approach is safe and effective. The endoscopic approach should be considered as standard procedure for treatment.

Outcome Comparison of KTP laser and CO2 laser excision for Laryngeal papillomatosis -- A Systematic Review

Background: CO2 laser and the 532-nm potassium titanyl phosphate laser (KTP) were developed to treat Laryngeal papillomatosis (LP); however, the difference in their outcomes remains unclear. Methods: A systematic review was conducted through a comprehensive search of three databases. Results: Overall, the cure rates were 87.25% in the KTP group and 75.98% in the CO2 group (p＜0.05). The complications rates were significantly different between the two groups (p<0.0001). In addition, there was no significant difference between the recurrence rates of the CO2 group and the KTP group (10% vs 9.8%). The risks of bias were 13.1±1.45 and 13.6±1.52 for CO2 group and KTP group respectively, which indicated the fair quality of evidence. Conclusions: The available fair-quality evidence suggested that KTP laser excision may be a better choice for LP. Following evaluations on the benefits of the two surgical techniques with more high-quality randomized controlled studies are needed.

The Outcome Comparison of two Groups of total Extraperitoneal and Mesh Repair of Inguinal Hernia

Aim: The outcome comparison of total extraperitoneal versus mesh repair for inguinal hernia. Study design: Quasi experimental study. Place and duration of study: Department of Surgery, M. Islam Teaching Hospital, Gujranwala from March 2018 to March 2019. Methodology: After the approval of hospital ethical committee, a total of 50 patients were included and randomly divided into two groups equally. Group A (Total extraperitoneal), Group B (Mesh repair). An informed consent was taken from every patient about operative procedure and the outcome. A detailed history of the patient i.e. clinical examination, routine investigations (CBC, Urine R/E, urea, creatinine) and some specific investigations (chest X-ray, ECG and ultrasound abdomen and prostate) was done for surgery. All data of patients was collected on proforma and was analyzed with the help of a computer SPSS programme 20. Results: The mean age of patients was 34.22±11.54 years in group A and 35.63±11.25 years in group B. All male and female patients included in this study in both groups. Twelve (48%) of patients were direct inguinal hernia in group A 13(22%) were in group B and 14(56%) patients were in group A and 11(44%) patients were in group B. The mean±SD postoperative hospital stay was 24.48±4.62 in group A and 34.65±12.26 hours in group B (p 0.001). The mean±SD postoperative recovery time in weeks was 2.18±0.43 in group A and 2.90±0.46 weeks in group B (p 0.001). Only 2 (4%) patient had postoperative infection on first week and 4 (8%) patients had infection respectively. No recurrence was seen in group A and only 3% recurrence was in group B. Conclusion: It is concluded that group A had shorter hospital stay, recovery time, postoperative time and less infection rate as compared to group B. In group A 13% patients had severe pain and in group B 25% patients. Keywords: Inguinal Hernia, Total extraperitoneal, Mesh repair.

Clinical, radiological and patient-rated outcome comparison between total and partial ulnar head implants

This study aimed to analyse the clinical and radiological outcomes after ulnar head replacement and to compare partial and total ulnar head implants. Twenty-two patients with 23 implants were available with a mean follow-up time of 7 years (range 1.3 to 17) after distal radioulnar joint arthroplasty. At the final follow-up, patients had a low level of pain at rest and during effort, a median Disabilities of the Arm, Shoulder, and Hand (DASH) score of 12 and Patient-Rated Wrist Evaluation score of 12 with partial ulnar head implants, and scores of 20 and 22 in total ulnar head implants, respectively. While the range of motion in patients with partial ulnar head implants was slightly reduced in comparison with the preoperative condition and to the patients with total ulnar head implants, there was a tendency to a higher grip strength and rotational torque. Both types of prosthesis showed sigmoid notch resorptions and resorptions around the neck. We conclude that the results after partial ulnar head replacement do not significantly differ from the total ulnar head implants in many aspects. Level of evidence: III