Medicine and Health Sciences Commons^™

A Decade Of Cardiothoracic Surgery At A Tertiary Care Hospital In Karachi, Pakistan, Fahad Javaid Siddiqui, Shahid Ahmed Sami

Section of Cardiothoracic Surgery

Objective: The medical records at Aga Khan University were reviewed to analyze the trends, mortality and patients characteristics of cardiothoracic surgeries in the last decade.METHOD: The medical records of all adult cardiac, thoracic and combined cardiothoracic operations performed during January 1995 to December 2004 at the Aga Khan University Hospital were reviewed. Data were retrieved and analyzed for trends, patient characteristics, and procedure mortality.Results: From January 1995 - December 2004, 4553 cases were eligible for the study, of which 73% were males and 9.4% were children. Male to female ratio changed from 1.3:1 to 3:1 from childhood to adulthood. Number …

Ancient Schwannoma Presenting As A Thoracic Mass, Muhammad Z Tahir, Saulat H. Fatimi, S. Ather Enam

Department of Surgery

Abstract

BACKGROUND:

Ancient schwannoma is a rare variant of schwannoma, histologically showing atypical features that may result in erroneous diagnosis of a malignant tumor. There are only few reported cases in literature.

CASE DESCRIPTION:

We report a case of a 34-year-old man who was found to have giant mediastinal tumor. He underwent thoracotomy to remove the mass, which was proven to be ancient schwannoma on histopathology.

CONCLUSIONS:

Clinical and radiological findings are important aids for further consideration of surgical removal of these potentially respectable tumors with good outcome.

Traumatic Carotid-Cavernous Fistula: Clinical Presentation And Outcome, Atta A. Bhatti, S. Soulat Raza, Muhammad Ehsan Bari, S. Ather Enam, Tanveer Ul Haq, Zafar Sajjad

Section of Neurosurgery

Objective:To evaluate the presentation, clinical course and outcome of traumatic carotid-cavernous fistula (CCF) withendovascular treatment at our institution during the last five years.
Design: Retrospective descriptive study.
Setting: The study included patients seen at Aga Khan University Hospital from January 2000 to December 2005.
Methods: Retrospective analysis based on data retrieval from medical records using ICD coding system. Only those cases who had traumatic CCF and underwent endovascular treatment were included in the study.
Results: A total of 8 patients were diagnosed with post-traumatic CCF and 11 procedures were done. Mean age at presentation was 35.6 years; …

Neurosurgical Training In Pakistan, Ather Enam

Section of Neurosurgery

No abstract provided.

Imatinib Challenge Dismissed In India, Khabir Ahmad

Department of Surgery

No abstract provided.

Re: Various Irrigation Fluids Affect Postoperative Brain Edema And Cellular Damage During Experimental Neurosurgery In Rats, Syed Faraz Kazim, Ather Enam

Section of Neurosurgery

No abstract provided.

Role Of Surgery In The Management Of Low Grade Glioma, Faraz Kazim, Ather Enam

Section of Neurosurgery

No abstract provided.

Craniocerebral Aspergillosis In Immunocompetent Hosts: Surgical Perspective, Muhammad Shahzad Shamim, Arshad A. Siddiqui, Ather Enam, Ahmed Ali Shah, Rashid Jooma, Saleha Anwar

Section of Neurosurgery

Craniocerebral aspergillosis is a rare but dangerous variety of central nervous system infections. Surgery is being widely recognized as the cornerstone of management. Due to the rarity of the disease, difficulty and delay in diagnosis and poor outcome, there is very little in the literature regarding the various surgical strategies that may be adopted in these patients. Early aggressive surgery followed by chemotherapy offers the best chances. Surgical planning would depend upon the type and location of the disease process as well as the condition of the patient. Perioperative care holds immense importance and knowledge of possible complications is essential. …

Recurrent Pineal Apoplexy In A Child, Kashif Majeed, S. Ather Enam

Department of Surgery

No abstract provided.

History Of Epilepsy Surgery, Ather Enam

Section of Neurosurgery

No abstract provided.

Postoperative Sore Throat After Elective Surgical Procedures, Aliya Ahmed, Shemaila Abbasi, Hasham Bin Ghafoor, Muhammad Ishaq

Department of Anaesthesia

Postoperative sore throat is a common complication of anaesthesia and can lead to dissatisfaction after surgery. Many factors can contribute to postoperative sore throat and the incidence varies with the method of airway management Methods: In this prospective observational study elective gynaecological and general surgical patients were interviewed 24 hours postoperatively to determine the presence of sore throat. Information collected included demographic data, surgical procedure, duration of surgery, airway device used and position of patient during surgery. This study was done over a period of 3 months. Results: 312 patients were interviewed. 81(26%) patients suffered with sore throat postoperatively. 28% …

Postoperative Wound Leak And Anterior Chamber Reaction In Patients Undergoing Phacoemulsification Cataract Surgery With Sutured And Sutureless Corneal Incisions, Tanveer Anjum Chaudhry, Muhammad Shahzad Shamim, Sameer Khan, Khabir Ahmad

Department of Surgery

Purpose: To compare the rates of significant post operative wound leak and anterior chamber (AC) reaction in patients undergoing phacoemulsification cataract surgery with sutured and sutureless corneal incisions. Material and Methods: All eyes scheduled to have phacoemulsification surgery by two surgeons at two centers were selected. The first group of eyes underwent phacoemulsification surgery with 3.25 mm superior and superior-temporal clear corneal incisions. The incision was sutured using a single 10/0 nylon suture. The second group of eyes underwent an identical surgery, but the incision was not sutured. Patients were followed up at 24 hours, and 1 week and evaluated …

Total Parotidectomy Under Local Anesthesia: A Novel Technique, Kamran Shahid, Bilal Karim Siddiqui, Muhammad Hammad Tahir, Salman Bin Ayub, Ghulam Murtaza Memon, Adnan Yousuf, Arif Hussain, Osmani, Abdul Karim Siddiqui

Department of Biological & Biomedical Sciences

Parotidectomy is a common procedure usually done for a parotid mass necessitating a histological diagnosis. Operation is normally performed under General anesthesia with a nerve stimulator to facilitate facial nerve stimulation. We describe a new technique with reports of three cases, making total parotidectomy under local anesthesia possible. The ascending cervical branch of cervical plexus and the auriculotemporal nerve were anesthetized by bupivacaine 0.25% (2mg/kg) and lignocaine with adrenaline 7 mg/kg. Effective onset of anesthesia was within 15-25 minutes and the operations lasted between 2-3 hours without any complications. This offers advantage in high-risk patients where general anesthesia is contraindicated. …

An Unusual Abdominal Mass: Case Report, H. Saidi, U. Mohammed, M. Machoki

General Surgery, East Africa

The causes of intra-abdominal masses associated with chronic abdominal pain range from the benign to malignant; common to bizarre and some raise major medical legal issues. We present a case of a 40-year old African lady who presented with chronic right-sided abdominal pain with an associated mass on the right mid-abdomen. She had had a Caesarian section one year prior to presentation. Antecedent history of surgery and typical imaging features enabled a preoperative diagnosis of abdominal mass secondary to retained surgical gauze.The case illustrates the fallibility of the men and women in the operating theatres and the vital role of …

Mediastinal Parathyroid Adenoma Causing Primary Hyperparathyroidism, Farhat Abbas, Syed Raziuddin Biyabani, Amanullah Memon, Jamsheer Jehangir Talati

Section of Urology

An ectopically placed parathyroid adenoma in the anterior mediastinum is a rare cause of persistent or recurrent primary hyperparathyroidism (PHPT) and is recognized as an important cause of failed primary neck exploration. We encountered 3 such cases amongst 70 surgically treated patients with PHPT (4.3%) over a 20-year period. In 2 cases, the offending adenoma could be removed at first exploration whereas in the 3rd case, it was successfully removed with mediastinal exploration after 2 failed neck explorations. In established cases of PHPT with equivocal preoperative localization studies or negative neck explorations, an ectopically placed parathyroid adenoma should be considered …

Non-Cardiac Surgery In Patients With Prosthetic Heart Valves: A 12 Years Experience, Raja Parvez Akhtar, Abdul Rehman Abid, Hasnain Zafar, Syed Javed Raza Gardezi, Abdul Waheed, Jawad Sajid Khan

Section of General Surgery

Objective: To study patients with mechanical heart valves undergoing non-cardiac surgery and their anticoagulation management during these procedures.
Study Design: It was a cohort study.
Place and Duration of Study : The study was conducted at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore and Department of Surgery, Services Institute of Medical Sciences, Lahore, from September 1994 to June 2006.
Patients and Methods: Patients with mechanical heart valves undergoing non-cardiac surgical operation during this period, were included. Their anticoagulation was monitored and anticoagulation related complications were recorded.
Results: In this study, 507 consecutive patients with a mechanical …

Spectrum Of Intracranial Pathology: Tumors Versus Infections At A Tertiary Care Hospital, Muhib Alam Khan, Sukaina Aijazali Panju, Ather Enam

Section of Neurosurgery

Introduction: Aga Khan University Hospital Neurosurgery Department has evolved into a high-volume centre for treatment of neurosurgical diseases. We aimed to compare the relative outcomes of intracranial tumors and CNS infections seen at our facility.
Methods: Hospital records of patients admitted under the neurosurgery service between 1994-2003 were evaluated. Cases with a principal diagnosis of an intracranial lesion were identified for further study. Demographic, clinical,and surgical variables were extracted from the medical record. Length of hospital stay, ICU utilization, and in-hospital mortality were the primary outcome indicators. Data were analyzed through descriptive statistics and comparisons of meansand proportions. …

Neurosurgeons And Electrocautery, S. Ather Enam

Section of Neurosurgery

Abstract are not provided by the author/publisher

Reverse Sural Island Flap In Coverage Of Defects Lower Third Of Leg: A Series Of Nine Cases, S. O. Khainga, B. Githae, V. M. Mutiso, Ronald Wasike

General Surgery, East Africa

The distally based sural island flap was first described by Masquelet, et al, in 1992. It is a skin island flap supplied by the vascular axis of the sural nerve. lhe aim of this paper is to demonstrate that it can be applied in coverage of difficult wound in the lower third of the leg. We treated nine patients with nine distally based sural island flaps. All the flaps survived, most of the flaps had venous congestion. The largest flap was 10 x 8 em and Doppler was used in only one flap. This technique is easy and quick to …

Solitary Infantile Myofibromatosis Of The Skull, Farah Naz, Zafar Nazir, Khalid Chishti, Nadeem Aslam, Salman Siddiqui

Department of Surgery

This is the report of a 6 months old boy presenting with a firm, solitary mass on the temporal region, associated with lysis of local bone. Investigations lead to a diagnosis of infantile myofibromatosis (IM). Wide local excision was performed. At one year follow-up, no recurrence was noted.

Biliary Tract Obstruction In Chronic Pancreatitis, Abdallah Abdulkarim, Jake E. J. Krige, Philippus C. Bornman

General Surgery, East Africa

Bile duct strictures are a common complication in patients with advanced chronic pancreatitis and have a variable clinical presentation ranging from an incidental finding to overt jaundice and cholangitis. The diagnosis is mostly made during investigations for abdominal pain but jaundice may be the initial clinical presentation. The jaundice is typically transient but may be recurrent with a small risk of secondary biliary cirrhosis in longstanding cases. The management of a bile duct stricture is conservative in patients in whom it is an incidental finding as the risk of secondary biliary cirrhosis is negligible.

Initial conservative treatment is advised in …