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Full-Text Articles in Medicine and Health Sciences

Reducing The Donor Site Morbidity In Radial Forearm Free Flaps By Utilizing A Narrow Radial Forearm Free Flap, Safdar Ali Shaikh, Amber Bawa, Noman Shahzad, Zara Yousufzai, Muhammad Shahab Ghan Jul 2018

Reducing The Donor Site Morbidity In Radial Forearm Free Flaps By Utilizing A Narrow Radial Forearm Free Flap, Safdar Ali Shaikh, Amber Bawa, Noman Shahzad, Zara Yousufzai, Muhammad Shahab Ghan

Section of General Surgery

Background: The radial forearm free flap (RFFF) has remained a leading choice of many plastic surgeons as a fasciocutaneous flap due to its versatility, pedicle length, and simple elevation technique. However, donor site morbidity has led many reconstructive surgeons to limit their use of the RFFF and to use other flaps instead. We propose that using a narrow RFFF (nRFFF) decreases the aesthetic and functional morbidity of the donor site.
Methods: We report our experiences with the nRFFF from April 2012 through May 2015 at the Department of Plastic, Reconstructive, and Hand Surgery at Liaquat National Hospital, Karachi. The donor …


Fifteen Years Experience Of Managing Penetrating Extra-Peritoneal Rectal Injuries, Tanzeela Gala, Noman Shahzad, Ahmed Ibrahim Edhi, Fareed Ahmed Shaikh, Hasnain Zafar May 2018

Fifteen Years Experience Of Managing Penetrating Extra-Peritoneal Rectal Injuries, Tanzeela Gala, Noman Shahzad, Ahmed Ibrahim Edhi, Fareed Ahmed Shaikh, Hasnain Zafar

Section of General Surgery

Background: Although civilian injuries are generally less severe, they nevertheless remain a challenging problem for the surgeons. In isolated rectal injury patients, though proximal diversion, pre-sacral drainage, distal rectal wash-out and wound debridement are the various surgical options employed in various combinations, the optimum strategy especially for civilian injuries remains unknown. We reviewed our experience of managing penetrating extra peritoneal rectal injuries.
Methods: We conducted a Retrospective review of Adult patients with penetrating extra-peritoneal rectal injuries. Follow-up information of at least one month was needed for early post-operative complications.
Results: A total number of fifteen patients met …


Expression Of Androgen Receptor And Cancer Stem Cell Markers (Cd44 +/Cd24 - And Aldh1 +): Prognostic Implications In Invasive Breast Cancer, Nazia Riaz, Romana Idress, Sadia Habib, Iqbal Azam Syed, El Nasir Lalani May 2018

Expression Of Androgen Receptor And Cancer Stem Cell Markers (Cd44 +/Cd24 - And Aldh1 +): Prognostic Implications In Invasive Breast Cancer, Nazia Riaz, Romana Idress, Sadia Habib, Iqbal Azam Syed, El Nasir Lalani

Section of General Surgery

Background: Androgen receptor (AR) has emerged as a significant prognostic marker in early breast cancer (BCa). Association of AR with cancer stem cell (CSC) markers in BCa is unknown. Aim of the present study was to evaluate the immunohistochemical expression of AR, CD44, CD24 and ALDH1 in a cohort of Pakistani patients diagnosed with invasive BCa and to correlate the expression with 5- year disease free survival.
Patients and methods: We evaluated immunohistochemical expression AR, CD44, CD24 and ALDH1 in formalin fixed paraffin embedded archival blocks of 166 cases of primary invasive BCa (stage I-III) and correlated the expression with …


30-Day Readmission Rate And Its Causes In General Surgical Patients, Rizwan Sultan, Umme Hani Abdullah, Tabish Chawla Apr 2018

30-Day Readmission Rate And Its Causes In General Surgical Patients, Rizwan Sultan, Umme Hani Abdullah, Tabish Chawla

Section of General Surgery

Objective: To find out the 30-day readmission rate for different surgical procedures and determine the causes for readmissions.
Study Design: An audit report.
Place and duration of study: Department of Surgery, The Aga Khan University Hospital, Karachi, in the calendar year 2014.
Methodology: Records were retrospectively reviewed for 30-day readmission rate and their cause in general surgical patients who underwent a general surgical procedure at The Aga Khan University Hospital, Karachi, in the year 2014.
Results: Out of 217 (6.4%) readmissions in 3,387 patients, more than 50% unplanned readmissions were avoidable. The highest readmission rate was after placement of feeding …


Association Of Obesity And Thyroid Cancer At A Tertiary Care Hospital In Pakistan, Adnan Ali, Yumna Mirza, Urooj Faizan, Nida Zahid, Muhammad S. Awan Mar 2018

Association Of Obesity And Thyroid Cancer At A Tertiary Care Hospital In Pakistan, Adnan Ali, Yumna Mirza, Urooj Faizan, Nida Zahid, Muhammad S. Awan

Section of General Surgery

Objective: Thyroid cancer (TC) is one of the most common endocrine malignancies with a rapidly increasing worldwide presence. In Pakistan, it is more prevalent in females than males and has an incidence rate of 2.1%. Obesity and excess body mass index (BMI) has been linked to several cancers and is thought to be a risk factor for TC. We aim to investigate the incidence of TC in our population and understand it's correlation with obesity.
Subjects: The study was a retrospective case series conducted in the years 2000 to 2014, at the Aga Khan University Hospital (AKUH), Karachi, Pakistan where …


Improving Outcomes Of Emergency Bowel Surgery Using Nela Model, Rizwan Sultan, Hasnain Zafar Feb 2018

Improving Outcomes Of Emergency Bowel Surgery Using Nela Model, Rizwan Sultan, Hasnain Zafar

Section of General Surgery

Objective: To find outcomes of emergency bowel surgery and review the processes involved in the care of these patients on the same template used in National Emergency Laparotomy Audit (NELA).
Study Design: An audit.
Place & Duration of Study: Surgery Department, The Aga Khan University Hospital, Karachi, from December 2013 to November 2014.
Methodology: Patients undergone emergency bowel surgery during the review period were included. Demographic data, type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcome was recorded. Data was then compared with the data published by NELA team in their …


Pancreaticogastrostomy - An Alternate For Dealing With Pancreatic Remnant After Pancreaticoduodenectomy - Experience From A Tertiary Care Center Of Pakistan, Tabish Chawla, Hassaan Bari, Shahrukh Effendi Oct 2017

Pancreaticogastrostomy - An Alternate For Dealing With Pancreatic Remnant After Pancreaticoduodenectomy - Experience From A Tertiary Care Center Of Pakistan, Tabish Chawla, Hassaan Bari, Shahrukh Effendi

Section of General Surgery

Whipple's pancreaticoduodenectomy has been refined over the years to be a safe operation though the morbidity rate still remains high (30-50%). Pancreatic fistula is the most important cause of mortality following pancreaticoduodenectomy. To prevent it, surgeons have used two anastomotic techniques: pancreaticojejunostomy and pancreaticogastrostomy. Recent studies found that pancreaticogastrostomy is associated with fewer overall complications than pancreaticojejunostomy. This is a retrospective review of patients who underwent Whipple's at Aga Khan University Hospital and had pancreaticogastrostomy as a preferred anastomosis for pancreatic stump. Forty four patients met the inclusion criteria, 27 were male. No patient developed post-operative pancreatic fistula, 13 (31%) …


Development Of A Unifying Target And Consensus Indicators For Global Surgical Systems Strengthening: Proposed By The Global Alliance For Surgery, Obstetric, Trauma, And Anaesthesia Care (The G4 Alliance), Adil H. Haider, John W. Scott, Colin D. Gause, Mira Meheš, Grace Hsiung, Albulena Prelvukaj, Dana Yanocha, Lauren M. Baumann, Faheem Ahmed, Asad Latif Oct 2017

Development Of A Unifying Target And Consensus Indicators For Global Surgical Systems Strengthening: Proposed By The Global Alliance For Surgery, Obstetric, Trauma, And Anaesthesia Care (The G4 Alliance), Adil H. Haider, John W. Scott, Colin D. Gause, Mira Meheš, Grace Hsiung, Albulena Prelvukaj, Dana Yanocha, Lauren M. Baumann, Faheem Ahmed, Asad Latif

Section of General Surgery

After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health …


Choosing Between Endoscopic Or Microscopic Removal Of Third Ventricle Colloid Cysts, Ghani Haider, Altaf Ali Laghari, Muhammad Shahzad Shamim Sep 2017

Choosing Between Endoscopic Or Microscopic Removal Of Third Ventricle Colloid Cysts, Ghani Haider, Altaf Ali Laghari, Muhammad Shahzad Shamim

Section of General Surgery

Colloid cysts are benign lesions, found in the anterior part of the roof of the third ventricle. A PubMED search of literature was performed to identify the evidence on different treatment options and surgical approaches for removal of colloid cysts. Evidence on endoscopic versus microsurgical resection of colloid cysts showed that microsurgical approach had significantly higher rates of gross total resection, lower recurrence rate and lower re-operation rate. No significant difference with respect to the mortality rate or the need for a shunt was found between the two groups. However, the overall morbidity rate was lower for the endoscopic group. …


High Pati Score Is Associated With Increase Mortality In Patients With Penetrating Abdominal Injuries: A Retrospective Review, Syed Zohaib Gulzar Naqvi, Shahrukh Effendi, Hasnain Zafar Jan 2016

High Pati Score Is Associated With Increase Mortality In Patients With Penetrating Abdominal Injuries: A Retrospective Review, Syed Zohaib Gulzar Naqvi, Shahrukh Effendi, Hasnain Zafar

Section of General Surgery

Background: Worldwide, injuries due to violence constitute eighth leading cause of death. Penetrating abdominal injuries account for third most common area involved. Inliterature PATI has been utilized to estimate the severity of abdominal trauma, decision making regarding repairing the damage and even risk of post-operative complications. We aimed and intended to use PATI score (penetrating abdominal trau-ma index) as a more accurate method of quantifying the extent of damage in patients with the penetrat-ing abdominal trauma and association of high PATI score (>25) with mortality.
Objective: To determine the association of mortality in patient with penetrating abdominal trauma with …


Progressive Hair Coil Strangulation Of Penis, Shahzad Ms, Mohammed Shamim Jun 2013

Progressive Hair Coil Strangulation Of Penis, Shahzad Ms, Mohammed Shamim

Section of General Surgery

Strangulation of penis by hair strands is a well-known, but uncommon clinical entity. We report two cases occurring in circumcised boys causing progressive painless disfigurement of penis with strands of hair coiled around the penile shafts, strangulating the penis. Primary repair was done in one case and delayed primary repair was done in the other, both with satisfactory results.


Morbidity Meetings: What Makes It To; What Stays Out Of The Forum, Khawaja Muhammad Inam Pal, Amyn Pardhan, Junaid Haroon Feb 2013

Morbidity Meetings: What Makes It To; What Stays Out Of The Forum, Khawaja Muhammad Inam Pal, Amyn Pardhan, Junaid Haroon

Section of General Surgery

Objectives: To review the utility of morbidity and mortality forum in General Surgery at a tertiary care hospital in Karachi, Pakistan.
Methods: The retrospective study was conducted at the Aga Khan University Hospital and reviewed morbidity data from March to May 2009. Case notes of all patients admitted to the General Surgical service during the study period were reviewed to identify in-hospital morbidities.
Results: There were a total of 340 inpatients during this period. Case notes identified 61 (17.94%) patients with morbidities; 35 (57.37%) males and 26 (42.62%) females. The morbidity record for the same period identified 32 (52.5%) patients, …


Traumatic Pancreatic Injury: An Elusive Diagnosis: Experience From A Developing Country Urban Trauma Referral Centre, Ayaz Ahmed Memon, Hasnain Zafar, Rushna Raza, Ghulam Murtaza Jan 2013

Traumatic Pancreatic Injury: An Elusive Diagnosis: Experience From A Developing Country Urban Trauma Referral Centre, Ayaz Ahmed Memon, Hasnain Zafar, Rushna Raza, Ghulam Murtaza

Section of General Surgery

Objective: To determine the frequency of pancreatic injury in patients presenting with trauma and to review the mechanism of injury, management, subsequent complications and in-hospital mortality rate associated with these patients.
Methods: The retrospective study included all patients over 18 years of age presenting with pancreatic injury due to trauma at the Aga Khan University Hospital, Karachi, between January 1990 and December 2009. Patients with iatrogenic pancreatic injury were excluded. The severity of the injury was assessed using the Injury Severity Score, while it was graded according to the scale defined by the American Association for the Surgery of Trauma. …


Foleys Protection Caps: Inexpensive Alternative In Ilizarov Fixation, K Abbas, H Rashid Nov 2012

Foleys Protection Caps: Inexpensive Alternative In Ilizarov Fixation, K Abbas, H Rashid

Section of General Surgery

No abstract provided.


Laparoscopic Splenectomy For Haematological Disorder: Our Experience, Hasnain Zafar, Aamir Hameed, Amyn Pardhan, Ghulam Murtaza, Samia Mazahir Oct 2012

Laparoscopic Splenectomy For Haematological Disorder: Our Experience, Hasnain Zafar, Aamir Hameed, Amyn Pardhan, Ghulam Murtaza, Samia Mazahir

Section of General Surgery

Laparoscopic splenectomy has universal acceptance due to less morbidity and decreased incidence of per-operative and postoperative complication. It is not a popular procedure in Pakistan due to technical challenges. Here, we are presenting our experience of laparoscopic splenectomy for haematological disorders at Aga khan university hospital. A total of seven cases, underwent elective laparoscopic splenectomy for haematological disorders. The operative time was less than 3 hours with minimal blood loss with rapid and uneventful recovery. There was no procedure related morbidity or mortality; however, one patient expired due to overwhelming post splenectomy sepsis.Our initial report highlights the safety of laparoscopic …


Duhamel's Procedure For Adult Hirschsprung's Disease, Mehreen Adhi, Salma Khan, Hasnain Zafar, Muhammad Arshad Jan 2012

Duhamel's Procedure For Adult Hirschsprung's Disease, Mehreen Adhi, Salma Khan, Hasnain Zafar, Muhammad Arshad

Section of General Surgery

An adult presented with chronic constipation and abdominal mass. Clinical features, abdominal radiographs and barium enema revealed features consistent with Hirschsprung's disease. Full-thickness rectal biopsy was planned, but patient was lost to follow-up and presented 3 years later with intestinal obstruction. Exploratory laparotomy with resection of affected sigmoid colon and end colostomy were performed. Sequential rectal biopsies were obtained during the procedure to confirm the diagnosis. Later, Duhamel's procedure with a diverting loop ileostomy was successfully performed. Ileostomy reversal was done thereafter. There was complete resolution of symptoms and dramatic improvement in bowel function.


Factors Influencing The Opinion Of Individuals In Determining Tumour Spread After Biopsy, Tayyaba Z. Ansari, Adnan A. Zaidi, Asra Parekh, Owais Iqbal, Nehal Masood, Ahmed Mateen, Tehseen Fatima Dec 2011

Factors Influencing The Opinion Of Individuals In Determining Tumour Spread After Biopsy, Tayyaba Z. Ansari, Adnan A. Zaidi, Asra Parekh, Owais Iqbal, Nehal Masood, Ahmed Mateen, Tehseen Fatima

Section of General Surgery

Background: People often have concerns regarding tumour spread after biopsy which leads to a delay in seeking expert medical advice. The data regarding this perception is scanty. Therefore, we conducted this cross sectional study to explore the beliefs and perceptions of individuals regarding tumour spread after biopsy and the basis of those beliefs.
Methods: The survey was conducted in outPatient areas of two different tertiary care hospitals of Karachi namely Aga Khan University Hospital Karachi (AKUH) and Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN). We interviewed 600 individuals and documented their responses on a questionnaire. There were 400 responders …


Delayed Surgical Therapy Reduces Mortality In Patients With Acute Necrotizing Pancreatitis, Abdul Rehman Alvi, Ghulam Murtaza Shaikh, Syed Faraz Kazim Oct 2011

Delayed Surgical Therapy Reduces Mortality In Patients With Acute Necrotizing Pancreatitis, Abdul Rehman Alvi, Ghulam Murtaza Shaikh, Syed Faraz Kazim

Section of General Surgery

Objective: To review the trends in management and analyze the factors influencing outcomes of acute necrotizing pancreatitis.
Methods: It wa a retrospective analytical study. All adult patients with computed tomography with proven necrotizing pancreatitis managed at the department of surgery, Aga Khan University Hospital, Karachi were included in this study extending from January 1998 to January 2008. Outcome variables were hospital stay, complication rate and in-hospital mortality. Data analysis was carried out using SPSS version 16. For comparison, Pearson chi-square test, Fisher's exact test, t-test and ANOVA were used, where applicable. A p-value less than 0.05 was considered statistically significant. …


The Role Of Computed Tomography For Identifying Mechanical Bowel Obstruction In A Pakistani Population, Omair Shakil, Syed Nabeel Zafar, Ziaur Rehman, Sarah Saleem, Rehmatullah Khan, Khawaja Muhammad Inam Pal Sep 2011

The Role Of Computed Tomography For Identifying Mechanical Bowel Obstruction In A Pakistani Population, Omair Shakil, Syed Nabeel Zafar, Ziaur Rehman, Sarah Saleem, Rehmatullah Khan, Khawaja Muhammad Inam Pal

Section of General Surgery

Objective: To retrospectively review our experience of CT scan in cases with a final diagnosis of surgically confirmed mechanical bowel obstruction.
Methods: It is a retrospective analytical study, done from 2003 to 2008. All adult patients having undergone laparotomy in addition to a preoperative abdominal CT scan over a 5 year period were identified through the medical records and their case notes reviewed. Taking surgery to be the gold standard for diagnosing mechanical bowel obstruction, we compared results of the CT with operative findings to determine the sensitivity, specificity, positive and negative predictive values of CT scans. The data was …


Hepatic Artery Pseudoaneurysm: A Rare Complication Of Amoebic Liver Abscess, Anam Khan, Khawaja Muhammad Inam Pal, Hussain Ijaz Khan Aug 2011

Hepatic Artery Pseudoaneurysm: A Rare Complication Of Amoebic Liver Abscess, Anam Khan, Khawaja Muhammad Inam Pal, Hussain Ijaz Khan

Section of General Surgery

Hepatic artery pseudoaneurysm (HAP) is an infrequently encountered entity, usually seen secondary to blunt or penetrating trauma. The clinical presentation is often due to complications such as intrahepatic or intraperitoneal bleeding as a result of rupture of the pseudoaneurysm. Diagnosis is frequently delayed and made by splanchnic angiography. HAP associated with a liver abscess, has very rarely been described in the literature. We report the case of a 50-year-old man with amoebic liver abscess and right hepatic artery pseudoaneurysm which was suspected on high resolution contrast-enhanced abdominal computer tomography (CT). The lesion was confirmed by arteriography and treated prophylactically with …


Primary Non-Functioning Paraganglioma Of Liver: A Rare Tumour At An Unusual Location, Muhammad Rizwan Khan, Rushna Raza, Abdul Jabbar, Arsalan Ahmed Aug 2011

Primary Non-Functioning Paraganglioma Of Liver: A Rare Tumour At An Unusual Location, Muhammad Rizwan Khan, Rushna Raza, Abdul Jabbar, Arsalan Ahmed

Section of General Surgery

Pheochromocytomas are rare tumours, 22% of which are extra-adrenal and are known as paragangliomas. We report a case of a young male with non-functioning paraganglioma of the liver; a very uncommon primary site. A CT scan with contrast showed a huge, highly vascular mass lesion in the right lobe of the liver and a core biopsy confirmed it to be a paraganglioma. Whole body study with iodine-131-meta-iodobenzylguanidine (MIBG) tracer highlighted the liver tumour but was negative for any other active lesions depicting that the tumour was confined to the liver. The lesion was completely resected by extended right hepatectomy and …


Terrorist Bombings: Medical Response In A Developing Country, Hasnain Zafar, Ahmed Jawad, Muhammad Shahzad Shamim, Ayaz Ahmed Memon, Aamir Hameed Khan, Muhammad Shahrukh Effendi, Saeed Qureshi Jun 2011

Terrorist Bombings: Medical Response In A Developing Country, Hasnain Zafar, Ahmed Jawad, Muhammad Shahzad Shamim, Ayaz Ahmed Memon, Aamir Hameed Khan, Muhammad Shahrukh Effendi, Saeed Qureshi

Section of General Surgery

Objective: To evaluate the process of transport and immediate Emergency Department (ER) management of mass casualties following the recent bomb blasts in Karachi and review in detail the medical response and management of victims undertaken in these two incidents.
Methods: Eyewitness accounts of the victims, medical personnel and newspaper clippings were used to understand and identify difficulties faced during the rescue process. Data regarding presenting injuries and their outcomes was also collected from all victims presenting to the emergency department at Aga Khan University Hospital.
Results: Seventy nine individuals died and over 250 victims were injured in the two incidents. …


Leaking Pseudoaneurysm Of Hepatic Artery: A Potentially Life-Threatening Complication Of A Common Procedure, Muhammad Rizwan Khan, Rushna Raza, Basit Salam May 2011

Leaking Pseudoaneurysm Of Hepatic Artery: A Potentially Life-Threatening Complication Of A Common Procedure, Muhammad Rizwan Khan, Rushna Raza, Basit Salam

Section of General Surgery

We report a case of leaking pseudoaneurysm of right hepatic artery in a 54-year old female after laparoscopic cholecystectomy who presented with massive gastrointestinal haemorrhage and was successfully managed with angiography and coil embolization.


T-Tube Management Of Late Esophageal Perforation, Irfan Qadir, Hasnain Zafar, Mubashir Zareen Khan, Hasanat Mohammad Sharif Apr 2011

T-Tube Management Of Late Esophageal Perforation, Irfan Qadir, Hasnain Zafar, Mubashir Zareen Khan, Hasanat Mohammad Sharif

Section of General Surgery

Esophageal perforation is a serious condition with a high mortality rate. Management strategy of such a patient depends on the extent of perforation and the time interval between perforation and diagnosis. The use of a T tube to treat delayed esophageal perforation with complete resolution and no need for future definitive surgery has been less frequently described. We adapted this principle in successful management of a 73 year old patient with four days history of fever, shortness of breath, chest pain and radiological evidence of perforation.


Gradenigo's Syndrome: Surgical Management In A Child, Hassan Nabeel Humayun, Shabbir Akhtar, Shakeel Ahmed Apr 2011

Gradenigo's Syndrome: Surgical Management In A Child, Hassan Nabeel Humayun, Shabbir Akhtar, Shakeel Ahmed

Section of General Surgery

Otits media is a common problem. Some of its complications that were seen frequently in the preantibiotic era are rare today. We report a case of an 8 year boy who presented with earache, retro-orbital pain and diplopia secondary to a sixth nerve palsy--Gradenigo's syndrome. In this syndrome infection from the middle ear spreads medially to the petrous apex of the temporal bone. Work-up includes CT scan of the temporal bones. Timely management with intravenous antibiotics (+ surgery) is needed to prevent intra-cranial complications.


Pancreaticoduodenectomy: A Developing Country Perspective, Khawaja Muhammad Inam Pal, Hassaan Bari, Sana Nasim Mar 2011

Pancreaticoduodenectomy: A Developing Country Perspective, Khawaja Muhammad Inam Pal, Hassaan Bari, Sana Nasim

Section of General Surgery

Objective: To review retrospectively, the resultsof Whipple's procedure from 1986 to December 2009 at the Aga Khan University Hospital.
Methods: Patient's case notes were reviewed to extract information related to demographics, clinical and laboratory data, operative procedure and post operative period. Surgical mortality was defined as death within 30 days of procedure.
Results: Hundred and twenty one patients underwent a successful pancreaticoduodenectomy during this period. There were 78 males and 43 females. Most presented with clinical features of obstructive jaundice. Perioperative evaluation in the majority included an abdominal ultrasound and contrast enhanced CT scan. A preoperative ERCP was performed in …


Abdominal Angina: A Rare Cause Of Chronic Abdominal Pain, Ziaur Rehman, Abdul Rehman Alvi, Ziad Sophie Jan 2011

Abdominal Angina: A Rare Cause Of Chronic Abdominal Pain, Ziaur Rehman, Abdul Rehman Alvi, Ziad Sophie

Section of General Surgery

We report here a case of chronic postprandial abdominal pain and weight loss of more than one year duration. He was diagnosed to have abdominal angina (chronic mesenteric ischemia) on CT angiography. Open surgical revascularization procedure-right common iliac mesenteric polytetrafluoroethylene (PTFE) bypass graft achieved positive short and longterm outcome with follow-up of twenty two months.


Losartan Associated Anaphylaxis And Angioneurotic Oedema, Syed Faraz Kazim, Muhammad Shahid Aug 2010

Losartan Associated Anaphylaxis And Angioneurotic Oedema, Syed Faraz Kazim, Muhammad Shahid

Section of General Surgery

A case of anaphylaxis and angioedema induced by angiotensin II receptor blocker (ARB), losartan is reported. A 37 years old hypertensive female presented to the Emergency Department with swelling over the face especially the lips, urticarial rash all over the body, and dyspnoea within an hour of losartan administration. She did not have any previous history of drug allergies. The patient was managed with epinephrine. Although angioneurotic oedema and anaphylaxis are well documented adverse effects of angiotensin converting enzyme (ACE) inhibitors, very few cases of these adverse reactions with ARBs have been reported in medical literature.


Antibiotics In Acute Necrotizing Pancreatitis: Perspective Of A Developing Country, Afrasyab Khan, Sadaf Khan Feb 2010

Antibiotics In Acute Necrotizing Pancreatitis: Perspective Of A Developing Country, Afrasyab Khan, Sadaf Khan

Section of General Surgery

Prophylactic antibiotics in acute necrotizing pancreatitis is controversial. The mortality of acute necrotizing pancreatitis is 8-25% in the western world. In view of the limited resources available for managing the complications of infected pancreatitis in developing countries, the use of prophylactic antibiotics may be recommended in selected cases.
Various antibiotics show good penetration into the pancreatic tissue; imipenem and quinolones have better penetration. Clinical trials on the use of prophylactic antibiotics in necrotizing pancreatitis have been reviewed.
Prophylactic antibiotics have been considered if greater than 30% pancreatic necrosis as documented by CT scan. Imipenem can be given for a duration …


Intussusceptions In Adults: Clinical Features And Operative Procedures, Ziaur Rehman, Abdul Rehman Alvi, Salma Khan Jan 2010

Intussusceptions In Adults: Clinical Features And Operative Procedures, Ziaur Rehman, Abdul Rehman Alvi, Salma Khan

Section of General Surgery

Objective: To determine the clinical presentation and treatment outcomes of adult patients with intussusceptions.
Study Design: Case series.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 1988 to December 2008.
Methodology: Medical records of patients with diagnosis of intussusceptions in adults (above 15 years of age) from January 1988 to December 2008 were retrieved through ICD 9 coding system. Patients with complete records were included in the study and those with incomplete medical record or under 30 days follow-up were excluded. Data was analyzed on SPSS version 16. The treatment outcomes were hospital stay, 30 …