Hip resurfacing arthroplasty has conventionally been undertaken through the posterior approach. There has been evidence in the recently published literature to suggest that the posterior approach may compromise the blood supply to the femoral head, by disruption of the posterolateral hip capsule. Ganz et al have proposed the trochanteric 'flip' osteotomy through a lateral approach, to permit surgical dislocation of the hip without damaging the blood supply. The disadvantages, however, are that early full weight bearing is not permitted and there is an incidence of trochanteric delayed or non-union, which may require further treatment. We describe a technique of hip resurfacing through a modified anterolateral approach preserving the posterolateral capsular blood supply. We describe our experience using this approach, and compare the results with our previously used Ganz trochanteric osteotomy. At a mean follow-up of two years, the outcome scores were not significantly different, and both groups had similar abductor strength. There were two cases of delayed union in the Ganz group, one of which required revision; there were no complications in the modified anterolateral group.

BACKGROUND: Type 2 Diabetes mellitus has reached epidemic proportions worldwide and Pakistan is no exception. This study was done to see the glycaemic control of our diabetic patients by estimating Glycosylated haemoglobin & Fasting blood glucose as poor control leads to significant complications causing enormous human suffering & socioeconomic burden. METHOD: This Cross-sectional study was conducted on Type 2 diabetic patients coming to medical OPD and medical B ward of Ayub Teaching Hospital between March-September 2007 fulfilling the inclusion criteria. RESULTS: Among 100 patients with type 2 diabetes forty two had HbA1c more than 7.5%, while seventy had fasting blood glucose more than 120 mg/dl. All patients with HbA1c more than 7.5% had increased fasting blood glucose. While thirty out of seventy patients with fasting blood glucose more than 120 mg/dl had HbA1c less than 7.5%. None of the patients with fasting blood glucose less than 120 mg/dl had HbA1c more than 7.5%. CONCLUSIONS: Significant number of patients (42%) had poor control of diabetes as revealed by HbA1c, with FBG showing poor control in even more patients, i.e., 70%. However their blood glucose estimation was not frequent enough as required. Blood glucose results can be spuriously high and may lead to frequent change/increase in the dose of hypoglycaemic medications. This can lead to poor compliance as well as psychological trauma to patients. HbA1c on the other hand is easy to interpret, reflects long term glycaemic control and cost effective. We recommend its more frequent use along with blood glucose for better glycaemic control and decreased chances of complications.

BACKGROUND: Penile fracture is a relatively rare traumatic rupture of the tunica albuginea of one or both corpora cavernosa of an erect penis. It is a real urological emergency which needs early assessment and surgical management. METHODS: Twelve (12) cases of penile fracture were reviewed from July, 1997 to July, 2007 in the Department of Urology, Ayub Teaching Hospital Abbottabad. All cases presented with classical history of penile fracture and the diagnosis was made on the basis of history and clinical examination only. RESULTS: All the patients underwent immediate surgical repair with well preserved potency and excellent overall results. CONCLUSION: Penile fracture has typical signs. Standard treatment consists of immediate surgical repair of penile fracture with a low incidence of late complications. Post op complications including urethral strictures and erectile dysfunction should be ruled out by regular follow-up.

BACKGROUND: Peptic ulcers were believed to be caused by stress, dietary factors, and gastric acid, but the link between H. pylori and peptic ulcers was identified in 1983. To see the frequency of Helicobacter pylori infection in patients with perforated duodenal ulcer and advise eradication therapy in these patients. This cross sectional study was conducted in Surgical Unit Hayatabad Medical Complex, Peshawar, during January 2007-June 2008. METHODS: A total of 50 cases were included in the study. All cases presenting to our unit with acute perforated duodenal ulcer were recruited. After resuscitation and baseline investigations, all underwent emergency laparotomy via upper midline incision, after thorough peritoneal lavage, the perforation margins were freshened and closed over an omental patch. Serum from every patient was tested for H. pylori and accordingly managed. RESULTS: Out of the 50 cases, 45 were males, and 5 were females. Age ranged from 20- 80 years old. All patients underwent emergency laparotomy. Postoperatively, all were started on PPI treatment and serum testing for H. pylori was done. Thirty-four (68%) turned out positive and 16 (32%) were found to be negative for H. pylori. CONCLUSION: There is still a high frequency of H. pylori infection in patients with perforated duodenal ulcer. But comparing these results with the various data available, there is a significant decline in H. pylori positive perforated duodenal ulcer patients.

There do not appear to be any reports or guidelines in the published literature regarding the outcomes of operative or conservative management of fractures in patients with known prion disease. This case report may be helpful in the clinical management of fractures in such patients.

The conventional technique of insertion and fixation of the Esophageal Tracheal Combitube(trade mark)(ETC) is occasionally associated with engorgement of the tongue. This study sought to evaluate the efficacy of an alternative placement technique in reducing the incidence of this complication. Methods: Thirty ASA I and II adult patients posted for elective surgery under general anaesthesia lasting from 30 to 120 min were randomly divided into two groups (n=15, each). In Group A, the ETC was inserted and fixed in the midline. In Group B, the ETC was inserted along the angle of the mouth and was fixed at this lateral position. Intra-operative occurrence of engorgement of the tongue, the time of such an occurrence and any complaints of post-operative discomfort were recorded. Results: The overall incidence of engorgement of the tongue in Group A patients (67%) was significantly more (P<0.01) as compared with Group B (17%). The incidence significantly increased (P<0.01) with an increase in the duration of surgery in both the groups. The engorgement persisted into the post-operative period in three patients in Group A and resolved spontaneously in <15 min in each case. Conclusion: Lateral insertion and fixation of the ETC is an easy, safe and effective method of preventing engorgement of the tongue associated with the use of this device without compromising a leak-proof oropharyngeal cavity.

A PAXpress (Vital Signs Inc., Barnham, UK) airway device was placed in 50 adult ASA grade I and II patients undergoing elective surgery under general anaesthesia. The alignment of the PAXpress to the larynx was scored fibreoptically. The patients were then intubated blindly through the PAXpress and the adjusting manoeuvres required for successful intubation and complications of intubation observed. Insertion of the PAXpress was successful in all patients, and intubation was successful in 42 (84%) patients. Eleven patients were intubated in the neutral position, seven with a flexion manoeuvre and 24 with an extension manoeuvre. Intubation was successful in 17/20, 18/20, 6/8 and 1/2 of patients with a fibreoptic alignment score of 1, 2, 3 and 4, respectively. When the fibreoptic alignment score was between 2 and 4 intubation was achieved predominantly with the extension manoeuvre (20/30, 66%) rather than the flexion manoeuvre (1/30, 3%) or the neutral position (5/30, 16%). Blood staining was observed in 20 patients. We conclude that blind tracheal intubation through PAXpress has a moderately good success rate and a high incidence of mucosal trauma.'Extension' is the predominant adjusting manoeuvre required for blind tracheal intubation, especially when the alignment of the PAXpress to the larynx is poor.

Whereas it is known that visual imagery is accompanied by activity in visual cortical areas, including primary visual cortex, whether olfactory imagery exists remains controversial. Here we asked whether cue-dependent olfactory imagery was similarly accompanied by activity in olfactory cortex, and in particular whether hedonic-specific patterns of activity evident in olfactory perception would also be present during olfactory imagery. We used functional magnetic resonance imaging to measure activity in subjects who alternated between smelling and imagining pleasant and unpleasant odors. Activity induced by imagining odors mimicked that induced by perceiving real odorants, not only in the particular brain regions activated, but also in its hedonic-specific pattern. For both real and imagined odors, unpleasant stimuli induced greater activity than pleasant stimuli in the left frontal portion of piriform cortex and left insula. These findings combine with findings from other modalities to suggest activation of primary sensory cortical structures during mental imagery of sensory events.