Methodology: A total of 300 children with 174 female, 126 males were studied, who came in OPD in Children Hospital Faisalabad for the evaluation of their short stature, excluding familial short stature and other causes of short stature (endocrinal, renal & other chronic illnesses). IgA, TTG & IgG antibodies were evaluated. These antibodies were measured by ELISA method and patients whose TTG antibodies were 10 times greater than normal were spared form duodenal biopsy, however patients having antibodies less than 10 times but greater than normal or having equivocal results were under gone for intestinal biopsy for confirmation of celiac disease. Results: We detected out of 300 patients 88 patients were having TTG titer > 10% of the normal value. 29 patients were having increase titer but less than 10 time of the normal value and 7 patients were found to have equivocal results. So, 36 patients were sent for biopsy out of them 32 were found positive for celiac disease. Hence, we detected 40% (n=120) children were having celiac disease. All 78 females, 42 males having celiac disease were at 2SD except 4 patients who were at 3SD. Conclusion: We conclude that prevalence of celiac disease is high in patients with idiopathic short stature and it is important to investigate all children with ISS for celiac disease by measuring TTG antibodies.

Objective: To demonstrate an outpatient vaginoscopic technique for treating multiple vaginal polyps. Design: Demonstration of surgical technique using slides, pictures, and video. Setting: Private hospital. Patient(s): Thirty-two-year-old nulligravid woman presenting to the gynecology clinic with one episode of intermenstrual bleeding, regular menstrual cycles with normal flow, and no history of dysmenorrhoea or dyspareunia. The genital local examination was normal, and speculum examination showed multiple vaginal lesions like polyps in the proximal posterior two-thirds and right lateral vaginal walls. Her transvaginal ultrasound read a normal uterus with a right ovarian simple cyst. Intervention(s): The surgeon performed an outpatient operative vaginoscopy using a 5-mm continuous flow office hysteroscope with a 2.9-mm rod lens optical system and a 5F working channel. Distension of the vagina was achieved with a normal saline solution, and an intrauterine pressure of 50 to 60 mm Hg was maintained by an irrigation and aspiration electronic pump. An inspection of the vaginal walls, fornices, and the external cervical os (Fig. 1) revealed 10 vaginal lesions like polyps in the proximal two-thirds of the posterior and right lateral vaginal wall. The vaginal lesions (Fig. 2) varied in size from 0.5 cm to 4 cm. An excisional biopsy was performed and the sample sent for histopathologic evaluation. The vaginal lesions <2 cm in length were excised by cutting the base with scissors or using a bipolar vaporization electrode, which was connected to an electrocautery unit by a bipolar high-frequency cord. Vaginal lesions >2 cm were excised with the TruClear 5C Hysteroscopic Tissue Removal System (HTRS) with a zero-degree scope using the 2.9-mm incisor with a 5-mm cutting window at one end attached to a reusable handpiece with two connectors-one to the motor unit and second to the suction bottle with a collection bag. The overall diameter of TruClear 5C is 5.7 mm, and the optic size is 0.8 mm. The same irrigation pump is compatible with HTRS, and the pressure was increased to 150 mm Hg to maintain vaginal distension. Three factors influenced our decision to use the HTRS intraoperatively: the number and size of the vaginal lesions and the surgical time in the outpatient setting. A mechanical system that works on the principle of excising and aspirating tissue, the HTRS incisor has a rotatory action with the excising window placed against the most distal part of the vaginal lesions. The cutting action is controlled via a foot pedal attached to a motor control with 800 rotations per minute. The handpiece remains stationary while the polyp is excised and aspirated through the window into the collection bag. Minimal bleeding occurred and stopped spontaneously. The institutional ethics committee exempted this case report from review, and we obtained informed written consent from the patient. Main Outcome Measure(s): All vaginal lesions excised in an outpatient setting via vaginoscopy technique without anesthesia. Result(s): The opera...

Seroma formation is a known complication after any surgery where excessive dissection of subcutaneous tissue leads to disruption of lymphatic channels. Seroma formation, its sequelae and frequent visits to doctor for their management are a common source of discomfort for patients. Objectives: Comparison of frequency of seroma formation after flap fixation versus convetional closure after modified radical mastectomy. Study Design: Randomized control trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: 6 months from May 1, 2016 to October 31, 2016. Material & Methods: After permission from Hospital ethics committee and informed consent from patients, 70 patients were randomly divided into two groups (35 participants in each group). Findings were noted and data was analyzed statistically. Results: It was observed that incidence of seroma formation following modified radical mastectomy was lower with flap fixation technique (14.29%) as compared to conventional closure of wound margins (42.86%). Conclusion: Flap fixation technique is better approach compared to conventional method to prevent seroma formation.