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Successful Surgical Embolectomy In Acute Massive Bilateral Pulmonary Embolism, Taimur Saleem, Saulat Hasnain Fatimi, Umair Khalid 2017 Aga Khan University

Successful Surgical Embolectomy In Acute Massive Bilateral Pulmonary Embolism, Taimur Saleem, Saulat Hasnain Fatimi, Umair Khalid

Saulat Fatimi

Acute massive pulmonary embolism is a life-threatening emergency that must be promptly diagnosed and managed. A 52-year-old man presented with progressively increasing dyspnoea for three days. He had a previous history of chronic obstructive pulmonary disease and was currently a heavy smoker. Examination revealed bilateral wheezing. Chest x-ray and electrocardiography showed non-specific changes. The patient was initially treated as a case of chronic obstructive pulmonary disease exacerbation secondary to pneumonia. However, despite optimum medical management, his oxygen saturation deteriorated. Emergent computed tomography scan of chest showed bilateral massive pulmonary emboli. As the patient's haemodynamic status rapidly deteriorated, cardiothoracic surgery ...


Successful Tricuspid Valvectomy In A Septic Patient With Tricuspid Valve Endocarditis, Taimur Asif Ali, Saulat Hasnain Fatimi, Syed Saad Naeem, Wasiq Faraz Rawasia 2017 Aga Khan University

Successful Tricuspid Valvectomy In A Septic Patient With Tricuspid Valve Endocarditis, Taimur Asif Ali, Saulat Hasnain Fatimi, Syed Saad Naeem, Wasiq Faraz Rawasia

Saulat Fatimi

Abstract Endocarditis is characterized by vegetations, which is a mass of platelets, fibrin, micro-colonies of micro-organisms, and inflammatory cells, in the endocardium. Over the past three decades, the incidence of right-sided endocarditis has risen dramatically in Pakistan. We report a 36-year woman with a history of repeated intravenous analgesic injections for low back pain, presenting with high grade fever, sepsis and a white cell count of 44,000 with 90% neutrophils. Echocardiography showed large mobile vegetations on TricuspidValve (TV). Tricuspid Valve Endocarditis (TVE) is generally responsive to medical treatment; however, about 25% of TVE patients require surgical intervention. Long-term survival ...


Successful Management Of A Stab Wound To The Left Ventricle, Jaleed Ahmad Gillani, Hamza AR Khan, Omar Irfan, Saulat H. Fatimi 2017 Ziauddin University

Successful Management Of A Stab Wound To The Left Ventricle, Jaleed Ahmad Gillani, Hamza Ar Khan, Omar Irfan, Saulat H. Fatimi

Saulat Fatimi

A 24 year old male presented to the emergency room with a 2 hour history of knife stab wound. He was haemodynamically stable with good bilateral air entry. However on X-ray an enlarged cardiac silhouette was seen. The patient suddenly became hypotensive and on suspicion of cardiac tamponade a catheter was introduced in pericardial space, but the measure was unsuccessful and he was rushed to the Operating Room. During the surgery a 2 cm long laceration was identified in the mid-left ventricular (LV) wall less than 1mm away from the Left Anterior Descending (LAD) Artery. The Left Anterior Descending Vein ...


Successful Resection Of Lymphangioma Of The Neck And Mediastinum Presenting As Stridor In A 12 Year Old Child, Babar Irfan, Maha Tahir, Omar Irfan, Hamza Abdur Rahim Khan, Saulat H. Fatimi 2017 Jinnah Sindh Medical University

Successful Resection Of Lymphangioma Of The Neck And Mediastinum Presenting As Stridor In A 12 Year Old Child, Babar Irfan, Maha Tahir, Omar Irfan, Hamza Abdur Rahim Khan, Saulat H. Fatimi

Saulat Fatimi

Lymphangiomas are congenital malformations of lymphatic tissue. This benign condition is generally found in the neck region and is discovered by 2 years of age. Here we report the case of a 12 year old child who presented with a cervical and mediastinal cystic hygroma that had progressed to such a space occupying nature as to cause the shifting of the trachea. The entire mass was successfully resected with a lower neck incision. Our case suggests the necessity of considering cystic lymphangioma in the differential diagnosis of lateral neck masses and use of adequate imaging to substantiate the preoperative diagnosis.


Primary Melanotic Schwannoma With Typical Histology, Usman B. Mahmood, Fazal Wahab Khan, Benish Fatima, Muhammad Usman Tariq, Saulat Hasnain Fatimi 2017 Aga Khan University

Primary Melanotic Schwannoma With Typical Histology, Usman B. Mahmood, Fazal Wahab Khan, Benish Fatima, Muhammad Usman Tariq, Saulat Hasnain Fatimi

Saulat Fatimi

Abstract We present a case of a 17-year male with a soft tissue density spreading from the neural foramina (T3) of the spinal cord and involving the right upper thoracic cavity. We managed the patient through surgical intervention and resected the complete tumor. Gross definition and microscopic findings of the resected tissue revealed the definitive diagnosis of melanotic schwannoma. The histological characteristics in this case were very specific and harbour an important diagnostic clue for this rare disease. Malignant melanoma was ruled out on the basis of histological findings. The patient recovered completely and was healthy on one-year follow-up.


Near Complete Aortic Transection And Its Successful Repair Using A Novel Cardiopulmonary Bypass Technique, Dania Aijaz Shah, Adil Aijaz Shah, Syed Jawad Shah, Muhammad Naseer Khan, Saulat H. Fatimi 2017 Dow University of Health Sciences, Karachi,

Near Complete Aortic Transection And Its Successful Repair Using A Novel Cardiopulmonary Bypass Technique, Dania Aijaz Shah, Adil Aijaz Shah, Syed Jawad Shah, Muhammad Naseer Khan, Saulat H. Fatimi

Saulat Fatimi

Abstract The case of a 38-year old female, victim of a road traffic accident who presented with a near complete aortic transection is presented. An emergent repair employing cardiopulmonary bypass was attempted in the operating room. Anticipating a high-risk of compromise to cerebral perfusion from air micro-emboli, the bypass was attempted with an innovative approach involving the successful cannulation of the pulmonary artery and descending aorta. The patient survived and was found to be doing well on subsequent post-operative visits.


Incidental Finding Of A Giant Aortic Root Aneurysm And Its Repair, Saulat H. Fatimi, Roheena Zainab Panni, Awais Ashfaq 2017 Aga Khan University

Incidental Finding Of A Giant Aortic Root Aneurysm And Its Repair, Saulat H. Fatimi, Roheena Zainab Panni, Awais Ashfaq

Saulat Fatimi

The prevalence of aortic aneurysms is 3-4% in individuals more than 65 years. Age and haemodynamic factors play an important role in the development of aortic aneurysms. Most patients with aortic aneurysms are asymptomatic at the time of discovery. Thoracic aneurysms are usually found incidentally after chest radiographs or other imaging studies. The most common complications of thoracic aortic aneurysms are acute rupture or dissection. Some patients present with tender or painful nonruptured aneurysms. Patients are thought to be at increased risk for rupture and should undergo surgical repair on an emergent basis We document a case of a 66-year-old ...


Giant Pulmonary Bulla With Mediastinal Shift In A 12 1/2 Year Old Girl, Saulat H. Fatimi, Asif Jafferani, Awais Ashfaq 2017 Aga Khan University

Giant Pulmonary Bulla With Mediastinal Shift In A 12 1/2 Year Old Girl, Saulat H. Fatimi, Asif Jafferani, Awais Ashfaq

Saulat Fatimi

Pulmonary bulla in children represent interesting entities. Mostly congenital bronchopulmonary foregut malformations and acquired cysts like pneumatocoeles have also been described. We present a case of a 12 1/2 years old girl with acute onset respiratory distress symptoms harbouring a huge pulmonary cyst exhibiting mass effects, resulting in mediastinal deviation. Following initial workup, cyst excision was carried out which revealed presence of fungal hyphae that was susceptible to Fluconazole therapy post operatively. The case points out how a pulmonary cyst can present in older children with symptoms of respiratory distress and mass effects.


Giant Aortic Root Aneurysm Associated With Postductal Coarctation Of Aorta, Raquib Ahmed Faruqui, Fazal Wahab Khan, Benish Fatima, Saulat H. Fatimi 2017 Dow Medical College

Giant Aortic Root Aneurysm Associated With Postductal Coarctation Of Aorta, Raquib Ahmed Faruqui, Fazal Wahab Khan, Benish Fatima, Saulat H. Fatimi

Saulat Fatimi

The aorta is a large blood vessel that carries blood from the heart to the rest of thebody. The aortic root consists of the aortic valve and the openings for thecoronary arteries (the coronary ostia). An aortic aneurysm is an abnormal bulgein the wall of the aorta. If an aneurysm develops in the aortic root, the aorta candilate and the aortic valve can leak. If the aneurysm continues to expand, it canrupture and can cause life-threatening internal bleeding.Aneurysms of the aortic root are often due to degenerative disease of media.Aneurysm of the aortic root often affects patients in ...


Enteric Cyst In The Left Posterior Mediastinum Mimicking A Hydatid Cyst On Chest Computed Tomography Scan, Shazib Sagheer, Abdul Malik Amir Humza Sohail,, Yousaf Bashir Hadi,, Saulat H. Fatimi 2017 Aga Khan University

Enteric Cyst In The Left Posterior Mediastinum Mimicking A Hydatid Cyst On Chest Computed Tomography Scan, Shazib Sagheer, Abdul Malik Amir Humza Sohail,, Yousaf Bashir Hadi,, Saulat H. Fatimi

Saulat Fatimi

Abstract Mediastinal enteric cysts are a rare occurrence among adults and are usually asymptomatic. In most cases they are an incidental finding in the right hemi-mediastinum and are associated with vertebral anomalies. We report the unusual case of a 23 year old male who had a mediastinal mass on chest X-ray as an incidental finding. Chest Computed Tomography (CT) scan revealed no vertebral anomalies and a cystic mass in the left posterior mediastinum with features similar to those of a hydatid cyst.Posterolateral thoracotomy was done and the cyst was excised. Histopathology report revealed it to be an enteric cyst.


Cardiac Surgery In Octogenarians, Asmatullah Khan, Hassan Khan, Saulat H. Fatimi, Asadullah Khan 2017 Aga Khan University

Cardiac Surgery In Octogenarians, Asmatullah Khan, Hassan Khan, Saulat H. Fatimi, Asadullah Khan

Saulat Fatimi

In Europe and North America, cardiac surgery can be done successfully on octogenarians, but differences in patient selection, surgical and bypass techniques prevent us from concluding similarly in Pakistan. This study investigated the short and long-term outcomes of cardiac surgery in octogenarians operated over a 5 years period at The Aga Khan University Hospital, from January 2001 to December 2006. Seventeen octogenarians, (mean age 81.7 ± 2.3) underwent coronary artery bypass graft (CABG). Thirty-days hospital mortality was reported in only 1 patient. Surgical complication of any kind was reported in 13 (76.5%) patients with pleural effusion being the ...


Delayed Presentation Of Forgotten Thyroid Goiter - 25 Years After Thyroidectomy, Fazal Wahab Khan, Ayesha Muhammad, Mohsin Abbas, Syed Usman Bin Mahmood, Benish Fatima, Saulat H. Fatimi 2017 Aga Khan University

Delayed Presentation Of Forgotten Thyroid Goiter - 25 Years After Thyroidectomy, Fazal Wahab Khan, Ayesha Muhammad, Mohsin Abbas, Syed Usman Bin Mahmood, Benish Fatima, Saulat H. Fatimi

Saulat Fatimi

Forgotten goiter is a rare occurrence (2 - 16% of retrosternal thyroid cases) that depicts recurrence of retrosternal thyroid mass due to growth of remnant thyroid tissue overlooked during an initial thyroidectomy. The patient is a 59-year female who presented with dyspnea and stridor 25 years after total thyroidectomy. She was diagnosed as having a mediastinal mass on radiographic imaging. There were only localized pressure symptoms due to mass effect. The mass was excised employing an extra-cervical approach and using a partial sternotomy. The profuse extension of thyroid tissue, adherent to vital structures in the thorax and the extra-cervical thyroidectomy was ...


Chylopericardium--A Rare Complication After Ventricular Septal Defect Repair, Saqib A Gowani, Ameer A Khowaja, Asmatullah Khan, Saulat H Fatimi 2017 Aga Khan University

Chylopericardium--A Rare Complication After Ventricular Septal Defect Repair, Saqib A Gowani, Ameer A Khowaja, Asmatullah Khan, Saulat H Fatimi

Saulat Fatimi

Chylopericardium is a rare complication of cardiac surgery. It may be caused by a lesion in the thoracic duct or its tributaries or by thrombosis in the confluence of the jugular and left subclavian veins, obstructing the drainage of the thoracic duct. The treatment may be conservative or surgical, depending on the duration and on the volume of the effusion. We report the case of a 1 1/2 year-old male, who, in the late postoperative period of VSD repair, was hospitalized with low-grade fever and breathlessness for one week due to the presence of chylopericardium. The clinical findings and ...


Congenital Diaphragmatic Hernia Presenting In The Sixth Decade Mimicking Pneumonia, Saulat H. Fatimi, Nida Sajjad, Marium Muzaffar, Hashim Muhammad Hanif 2017 Aga Khan University

Congenital Diaphragmatic Hernia Presenting In The Sixth Decade Mimicking Pneumonia, Saulat H. Fatimi, Nida Sajjad, Marium Muzaffar, Hashim Muhammad Hanif

Saulat Fatimi

Congenital diaphragmatic hernia presentation in adults is extremely rare. Patients who present with late diaphragmatic hernias complain of a wide variety of symptoms and diagnosis can be difficult. We report a case of a 64 year old male who presented with a six month history of cough, shortness of breath and weight loss. The most common strategy to treat a Bochdalek hernia is via a thoracotomy or laparotomy or both. In our patient the repair was performed with a thoracotomy.


Aspergilloma In A Patient With No Previous History Of Chronic Lung Disease, Sadaf Sheikh, Saulat H. Fatimi 2017 Aga Khan University

Aspergilloma In A Patient With No Previous History Of Chronic Lung Disease, Sadaf Sheikh, Saulat H. Fatimi

Saulat Fatimi

Patients with aspergilloma should undergo surgical treatment, because there is a risk of sudden life threatening hemoptysis and because there is no effective alternate medical therapy. We report a case of aspergilloma in a 47 year old man with no past history of tuberculosis presented with the complaint of hemoptysis for two weeks. It was diagnosed radiologically and treated with left upper lobectomy. Post operative course was complicated by cardiorhythmic disorder.


Atresia Of The Descending Aorta In A Young Woman Requiring Bypass Graft, Ammarah Mashhood, Taimur Asif Ali, Saulat H. Fatimi 2017 Aga Khan University

Atresia Of The Descending Aorta In A Young Woman Requiring Bypass Graft, Ammarah Mashhood, Taimur Asif Ali, Saulat H. Fatimi

Saulat Fatimi

Congenital aortic atresia is a malformation accounting for 4 - 6% of all congenital heart diseases in children. Left ventricular outflow obstruction due to atresia is common at the aortic valve but rarely has atresia been identified in the descending aorta. We report the case of a 25-year woman who was evaluated for headache and uncontrolled hypertension. CTscan chest showed a short atretic segment in the descending aorta at the isthmus, distal to the takeoff of the subclavian artery. She underwent surgery; a 22 mm Dacron graft was taken and jump graft was placed between the arch of the aorta and ...


Nutritional Parameters Predicting Postoperative Infections, Jamsheer Talati, M. Shameem, Mohammad Khurshid 2017 Aga Khan University

Nutritional Parameters Predicting Postoperative Infections, Jamsheer Talati, M. Shameem, Mohammad Khurshid

Mohammad Khurshid

Thirteen nutritional parameters viz body mass index (BMI), mid arm circumference (MAC), mid calf circumference (MCC), triceps skin fold thickness (TST), abdominal skin fold thickness (ASFT), abdominal girth at umbilicus (AG U), haemoglobin (Hb), total leucocytes count (WBC), absolute lymphocyte count (ALC), serum proteins (Prot.), serum albumin (AIb), serum total iron binding capacity (TIBC) and serum iron (Fe) were estimated in 52 (36 male and 16 female) consecutive patients admitted to a surgical service at the Abbasi Shaheed Hospital, Karachi. Nine males and one female developed surgical infections whilst the wounds of 27 males and 15 females healed by primary ...


The Strong Cell-Based Hydrogen Peroxide Generation Triggered By Cold Atmospheric Plasma., Dayun Yan, Haitao Cui, Wei Zhu, Annie Talbot, Lijie Grace Zhang, Jonathan H Sherman, Michael Keidar 2017 George Washington University

The Strong Cell-Based Hydrogen Peroxide Generation Triggered By Cold Atmospheric Plasma., Dayun Yan, Haitao Cui, Wei Zhu, Annie Talbot, Lijie Grace Zhang, Jonathan H Sherman, Michael Keidar

Surgery Faculty Publications

Hydrogen peroxide (H2O2) is an important signaling molecule in cancer cells. However, the significant secretion of H2O2 by cancer cells have been rarely observed. Cold atmospheric plasma (CAP) is a near room temperature ionized gas composed of neutral particles, charged particles, reactive species, and electrons. Here, we first demonstrated that breast cancer cells and pancreatic adenocarcinoma cells generated micromolar level H2O2 during just 1 min of direct CAP treatment on these cells. The cell-based H2O2 generation is affected by the medium volume, the cell confluence, as well as the discharge voltage. The application of cold atmospheric plasma (CAP) in cancer ...


Department Of Surgery Update, September 2017, Wright State University Department of Surgery 2017 Wright State University

Department Of Surgery Update, September 2017, Wright State University Department Of Surgery

Department of Surgery Updates

A three page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, and more.


Effects Of Bomb Blast Injury On The Ears: The Aga Khan University Hospital Experience, Talha Ahmed Qureshi,, Mohammad Sohail Awan, Nabeel Hamayun Hassan, Agha Hussain Aftab, Syed Adnan Ali 2017 King Saud University, Riyadh, Kingdom of Saudi Arabia.

Effects Of Bomb Blast Injury On The Ears: The Aga Khan University Hospital Experience, Talha Ahmed Qureshi,, Mohammad Sohail Awan, Nabeel Hamayun Hassan, Agha Hussain Aftab, Syed Adnan Ali

Section of Otolaryngology, Head & Neck Surgery

Abstract Objective: To evaluate the frequency and effects of blast-related otologic injuries. Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised charts of patients who were victims of bomb explosions between January 2011 and July 2013. Frequency and percentages were reported using cross tabulation with size of bomb, distance of person from blast and the presence of victim in open or closed space. Association of associated variables were also analysed. Results: Of the 100 patients, 81(81%) were men and 19(19%) were women. Besides, 68(68%) patients were aged <30 years. Also, 78(78%) subjects were exposed to < 80kg of explosives and 68(68%) were at a distance of>10m. Furthermore, 61(61 ...


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