Medicine and Health Sciences Commons^™

Thymic Hyperplasia: A Cause Of Respiratory Distress, F K. Tareen, S Hussain, F Moazam

Department of Surgery

No abstract provided.

An Audit Of Blood Cross-Match Ordering Practices At The Aga Khan University Hospital: First Step Towards A Maximum Surgical Blood Ordering Schedule, T Chawla, G N. Kakepoto, M A. Khan

Department of Surgery

Objective: In the absence of an explicit maximum blood order policy, ordering for blood transfusion is frequently based on subjective anticipation of blood loss instead of evidence based estimates of average requirement in a particular procedure. This study was done to assess current practice and the feasibility of a prospective randomized work to develop practice guidelines.METHOD: We audited transfusion data for elective surgical procedures in our hospital during the last 2 years. Cross-matched to transfused ratio (C/T ratio) and Transfusion Index (Ti) for each of the elective surgical procedures was performed during the study period. C/T ratio is used as …

Treatment Of Tibial Diaphyseal Fractures With Closed Flexible Intramedullary Ender Nails: 39 Fractures Followed For A Period Of Two To Seven Years, Hussain R. Usman, Muhammad A. Umer, Masood Umer

Department of Surgery

Abstract

OBJECTIVE:

To assess the efficacy of flexible intramedullary Ender nails for the treatment of tibial diaphyseal.

MATERIALS AND METHODS:

This is a retrospective review of patients treated with the Ender Nail for both open and closed tibial shaft fractures. Between January 1989 and December 1994, 43 fractures were treated with these nails. The configuration of each fracture was determined using the Orthopedic Trauma Association classification and the extent of soft tissue damage was assessed using the Gustilo and Anderson's classification. Four patients were excluded from the study due to inadequate follow-up. There were 27 closed and 12 open fractures. …

Diagnostic Issues In Abdominal Tuberculosis, M R. Khan, I R. Khan, K M. Pal

Department of Surgery

Objective: To analyze the modes of presentation and diagnostic issues in the management of abdominal tuberculosis at a tertiary care hospital in a developing country, where most of the established diagnostic modalities are available.SETTING: The Aga Khan University Hospital, Karachi.Methods: This study is a retrospective review of medical records of all inpatients, diagnosed to have abdominal tuberculosis, from January 1991 to December 1997. The data was collected and particularly analyzed for spectrum of presentation and role of various diagnostic modalities. Of special interest was the sub-group of patients, who after all investigations did not have a firm diagnosis. Following a …

Human Subject Research, Ethics And The Developing World, F Moazam

Department of Surgery

No abstract provided.

Non-Small Cell Lung Cancer: Disease Spectrum And Management In A Tertiary Care Hospital, M R. Khan, S B. Hasan, S A. Sami

Department of Surgery

Objectives: To review the spectrum of presentation and the surgical management of Non Small Cell Lung Cancer (NSCLC) and the role of various diagnostic modalities in predicting the post-operative stage and the correlation of the post-operative stage with the chances of recurrence.SETTINGS: The Aga Khan University Hospital, Karachi--a tertiary care referral center in Paksitan.Methods: This is a retrospective study of medical records of all the patients who were managed at the Aga Khan University Hospital (AKUH) between 1988 and 1998. The patients with a diagnosis of lung cancer were identified using the ICD-9-CM coding system and the data was analyzed …

Pilomatrixoma And Pilomatrix Carcinoma Deceptively Similar But Distinct Entities, T S. Khan, A Khan

Department of Surgery

No abstract provided.

Diagnosis And Management Of The Neonatal Cloaca, A Samad, S Hussain, M Arshad, F Moazam

Department of Surgery

No abstract provided.

The Use Of Intra Aortic Baloon Pump In Patients Undergoing Coronary Artery Bypass Grafting At The Aga Khan University Hospital, Karachi, Aamir M. Jafarey, Muneer Amanullah, Sajid A. Khan, Sulaiman B. Hasan

Department of Surgery

Objective: To review the experience in the use of Intra Aortic Balloon Pump (IABP) in patietits undergoing Coronary Artery Bypass Grafting (CABG) at a tertiary care hospital with a new Open Heart surgery program. Design: Retrospective study. Setting: The Aga Khan University Hospital, Karachi.
Patients: Medical records of all patients undergoing CABG between November 1994 and July 1997 were reviewed and those in whom IABP device was used, were included in this study.
Results: A total of 15 patients had IABP suppOrt during the study period. Four surgeries were done urgently while two were emergencies. There were three mortalities. Ejection …

Small Bowel Strangulation As Yet Another Complication Of The Rectus Abdominis Donor Site., Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.

Preoperative Work Up: Are The Requirements Different In A Developing Country?, K M. Pal, I A. Khan, B Safdar

Department of Surgery

In developing countries there is a tendency to advocate routine testing in asymptomatic healthy patients to identify undocumented significant medical conditions. A retrospective review of pre- operative laboratory investigations undertaken in patients attending the General Surgical department was performed. Three hundred and twenty patients case notes were reviewed, patients were selected on the basis of common general surgical procedures. Two hundred and sixteen patients (67.5%) did not have any associated medical illness on history and physical examination. Analysis of laboratory results showed that 42/216 (19.4%) had low hemoglobin. An abnormal chest X-ray was the next common abnormality 11/103 (10.6%). Mild …

Appendicitis: A Continuing Challenge, K M. Pal, A Khan

Department of Surgery

Acute appendicitis is a common surgical emergency in urban setting, of a developing country. The computerised hospital patient database at Aga Khan University Hospital, Karachi, was utilised to obtain records of all adults with a histologically proven diagnosis of acute appendicitis. A review of patients treated over a 18 month period was undertaken. One hundred and three appendicectomies were performed for acute appendicitis during this period. The diagnosis was clinical in all cases. Investigations like leucocyte count and lower abdominal ultrasound scan were used to improve diagnostic accuracy without a clear advantage. A number of routine investigations like, haemoglobin estimation …

Hydatidosis: Experience With Hepatic And Pulmonary Hydatid Disease, T Pishori, R Azami, S M. Ali

Department of Surgery

From 1989-1992, 35 cases comprising of 20 hepatic and 15 pulmonary hydatid cysts were seen. Four patients with pulmonary hydatid disease had previous or concomitant hepatic hydatidosis compared to no concomitant pulmonary hydatid disease in the hepatic group. Hepatic hydatid disease had a greater tendency to be right sides, infected and calcified. Anaphylactic reactions occurred in 3 of 20 patients with hepatic hydatid disease against none in 15 patients with pulmonary disease. Management consisted of evacuation, drainage and obliteration of the residual cavity by capittonage in the lung and omentoplasty in the liver. Two patients, one hepatic and one with …

Open Fractures Caused By High Velocity Missiles: The Outcome Of Treatment Of 39 Fractures Followed For 1-3 Years, M A. Khan, R Hussain, S H. Khan, M Umar

Department of Surgery

Between 1993 and 1995, thirty-three patients having 39 fractures caused by missiles fired from a high velocity rifle were reviewed retrospectively between 1 and 3 years after injury and the outcome of treatment assessed. Majority (33 out of 39) were Grade III. Union was achieved in 35 out of 39 fractures, there was deep infection and delayed union in one case each. Non-union occurred in three fractures. The fractures were stabilized using different techniques, but highest complication rate was seen with the use of the static external fixator. This was related to the severe nature of the injury as well …

Protection With High-Pressure Irrigation Of Contaminated Wounds., Robert X. Murphy Jr, Md, Ms

Department of Surgery

No abstract provided.

Re: Midpalmar Approach To The Carpal Tunnel: An Alternative To Endoscopic Release., Robert X. Murphy Jr, Md, Ms

Department of Surgery

No abstract provided.

Punitive Damages...Just So You Know., Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.

Needle Localization Of Non-Palpable Breast Lesions, S Khan, N Mitha, F Kazi, M Siddiqui

Department of Surgery

Screening mammography identifies suspicious, non palpable mammary lesions. Mammographic needle localization (MNL) is currently being used to facilitate excision biopsy of these lesions. Thirty-two patients underwent biopsies of the breast after MNL for non-palpable lesions. Mammographic indications for biopsy consisted of microcalcifications (48%), mass or abnormal density (21%) or mass+abnormal density (24%). The carcinoma was identified in four cases (12%). Two of these were in situ, one was microinvasive and one was frankly invasive. Three were treated with a modified radical mastectomy. One of these non palpable lesion demonstrated nodal metastasis but none showed distant metastasis. All radiologically detected abnormalities …

Penile Fracture, M A. Khan, M N. Sulaiman

Department of Surgery

No abstract provided.

Prefabrication Of A Secondary Tram Flap., Geoffrey G. Hallock Md

Department of Surgery

A secondary TRAM flap was prefabricated in a rat model using the rectus muscle. The right rectus muscle was elevated as an inferiorly pedicled muscle flap in one experimental group (n = 6) and as a superiorly pedicled muscle flap in a second group (n = 5) and then sandwiched between a silicone sheet and the abdominal skin. Two weeks later, the abdominal skin and attached rectus muscle were elevated over the silicone sheet as a secondary TRAM flap. The surviving skin paddle areas of these prefabricated TRAM flaps were compared with superiorly (n = 7) and inferiorly (n = …

Complications, Untoward Events, And Reality., Geoffrey G. Hallock Md

Department of Surgery

The only surgeons who do not have deal with complications are those who do not operate.1

The Extranasal Glioma - A Cause Of Neonatal Respiratory Distress, Muneer Amanullah, F Attar Z

Department of Surgery

Normal brain tissue in an abnonnal configuration, occurring at a site away from the cranial cavity, is temied an Extranasal Glioma. Since its first description in 1852 by Reid², only 140 patients with this entity have been reported. Heterotopic brain tissue when present in a confined area may cause obstmction, pressure and pain. Its occurrence in the nasopharyngeal region is relatively rare and only 19 cases have been reported so far², the majority presenting with respiratory distress in the early neonatal period. The objective of this report is to create an awareness amongst the physicians of …

The Rat Tram Flap: A Human Analogue?, Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.

Cosmetic Trauma Surgery., Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.

Intestinal Obstruction In Adults At The Aga Khan University Hospital, S Q. Hasnain, M Ahmed

Department of Surgery

During the period January, 1987 to June, 1991, 208 adults with mechanical bowel obstruction were managed at The Aga Khan University Hospital (AKUH). Post-operative adhesions accounted for 34% of the cases and were the most frequent cause of intestinal obstruction. External hemia (16%), malignancy (13.5%) and tuberculous stricture (10%) were the next most frequent causes. The predominance of adhesive intestinal obstruction at AKUH shows a trend towards a Western disease pattern. Socioeconomic status was a significant determinant of the cause of obstruction. The proportion of self paying to welfare patients was significantly lower in tuberculous obstruction as compared with adhesive …

A Simple Technique Of Umbilical Port Closure In Laparoscopic Cholecystectomy, A Khan, M N. Siddiqui, M Ahmed

Department of Surgery

No abstract provided.

Retained Stones In The Common Bile Duct: Results Of Management, Kamran Hamid, R Azami, W Jaffery, T Hameed

Department of Surgery

Seventeen patients underwent treatment for retained common bile duct stones. In 7 patients the stones were removed via a T-tube tract using steerable catheters while 5 patients underwent ERCP and sphincterotomy and 5 underwent surgical re-exploration. Considering morbidity, mortality, success rate and patients' stay in the hospital, non-operative modalities should be the treatment of choice for retained common bile duct stones.

The Ring Butterfly Fragment, Philippe D`Sousa, Masood Umer, Riaz Hussain Lakdawala

Department of Surgery

No abstract provided.

Colorectal Cancer., Lester Rosen Md, Facs

Department of Surgery

No abstract provided.

Re: Recertification., Geoffrey G. Hallock Md

Department of Surgery

No abstract provided.