Medicine and Health Sciences Commons^™

Towards A Cure For Traumatic Paraplegia - Is There Cause For Hope?, Rashid Jooma

Section of Neurosurgery

In the past decade, great strides have been made in the field of CNS tissue repair and expectations have been raised that a cure of spinal paralysis is at hand. The two broad categories of investigational approaches to spinal regeneration are: (1) Enhancing the Regenerative Milieu of the Cord and (2) Cellular and Tissue Transplantation. Amongst the latter approaches, the early use of foetal cord tissue has given way to the more sophisticated studies on stem cell therapy and the implants of olfactory ensheating cells. These have engendered considerable public interest and are being offered as commercially available therapies in …

Role Of Surgery In Cerebral Venous Sinus Thrombosis, S. Ather Enam

Department of Surgery

Cerebral venous sinus thrombosis (CVST) usually is taken care of by medical management or neuro-interventional vascular techniques. Some cases of CVST may take a malignant course if the intracranial pressure increases excessively. This increase in pressure is because of oedema in brain tissue due to impediment in venous return and/or intracerebral haemorrhage. Neurosurgical experience has shown remarkable recovery in these moribund patients if appropriate surgical intervention is done within reasonable time. Emergent decompressive craniotomy or other neurosurgical interventions are the only appropriate treatment in these malignant forms of CVST to prevent mortality and severe morbidity.

Neck Recurrence In Early Carcinoma Tongue, Mubasher Ikram, Sadaf Fatima Jafferbhoy, Maisam Abbas Shiraz Onali

Section of Otolaryngology, Head & Neck Surgery

Objective: To study the efficacy of different locoregional treatment options for tongue cancer in determining the prognosis, with reference to recurrence of disease in neck.

Methods: This is a retrospective analysis of 80 patients with early (T1/T2) carcinoma tongue who had hemiglossectomy with or without neck surgery and radiotherapy for 14 years.

Results: Eighty patients were included in this study, 49 (61.3%) men and 31 (38.8%) women; 36 (45%) patients with T1 lesion and 44 (55%) with T2 lesion. Sixty two patients (77.5%) were staged cN0 and 18 patients had a clinically palpable neck nodes (cN+). Thirty seven patients were …

Incorporating Endoscope In Middle Ear Surgery, Shehzad Ghaffar, Mubasher Ikram, Ahsan Raza

Section of Otolaryngology, Head & Neck Surgery

We conducted a study to evaluate the use of a pediatric rigid otoendoscope for determining the extent of middle ear disease and for assessing ossicular integrity and mobility during tympanoplasty. Our study population was made up of 132 patients who were undergoing surgery for the treatment of chronic suppurative otitis media; of this group, 41 patients underwent otoendoscopy and 91 underwent scutum lowering for purposes of visualization. In the otoendoscopy group, the ossicles were successfully visualized and their mobility assessed in 34 patients; the remaining 7 patients subsequently underwent scutum lowering. A 30° endoscope allowed for complete visualization of the …

Surgery For Prolactinomas, Ashfaq A. Razzaq, Rashid Jooma

Section of Neurosurgery

A large proportion of prolactin secreting tumours of the pituitary gland are treatable by dopamine agonist drugs. however certain subgroups of these patients are better managed by surgical excision. the indications for surgery in prolactinomas remain controversial and this paper attempts to clarify these with illustrative cases. the factors favouring a surgical approach include poor tolerance of long term medical therapy, progression of visual deficits or recurrence while on medical treatment, cystic change in the tumour with pressure effects, csf fistula secondary to tumour shrinkage and prophylactic surgery in tumours anticipated to cause csf leak following medical therapy. the size …

Cerebral Embolism: Distal Subclavian Disease As A Rare Etiology, Iram Naz, Ziad Sophie

Section of Cardiothoracic Surgery

Subclavian artery occlusive disease is usually secondary to persistent compression caused by thoracic outlet syndrome (TOS) and rarely due to focal atherosclerosis. Emboli from diseased vessel can flow retrograde to the vertebral or carotid arteries to produce ischemic infarct with or without neurological deficit. We are reporting two cases of distal subclavian artery disease presenting with cerebral embolization, an unusual manifestation. Such surgically correctable lesions producing cerebral emboli and stroke needs consideration while evaluating patients with unusual presentation to prevent further occurrence of stroke.

Socio-Demographic Correlates Of Betel, Areca And Smokeless Tobacco Use As A High Risk Behavior For Head And Neck Cancers In A Squatter Settlement Of Karachi, Pakistan, Samia Mazahir, Rabia Malik, Maria Maqsood, Kanwal Aliraza Merchant, Farida Malik, Atif Majeed, Zafar Fatmi, Muhammad Rizwanulhaq Khawaja, Shehzad Ghaffar

Community Health Sciences

Background

Head and neck cancers are a major cancer burden in Pakistan. They share a common risk factor profile including regular consumption of products of betel, areca and tobacco. Use of paan, chaalia, gutka, niswar and tumbaku is acceptable in Pakistan and is considered a normal cultural practice. This cross-sectional study was carried out to understand the relation of socio-demographic factors for the consumption of paan, chaalia, gutka, niswar and tumbaku in Pakistani population. Through systematic sampling, 425 subjects from a squatter settlement in Karachi were interviewed using a structured questionnaire. High risk behavior was defined as Daily use of …

Trans-Mastoid Approach To Otogenic Brain Abscess, Ashfaq A. Razzaq, Rashid Jooma, Shahid Ahmed

Section of Neurosurgery

The treatment of otogenic brain abscess initially involves excision or aspiration of the abscess through a temporal or sub-occipital route depending on its location. This is followed by a mastoidectomy by the ENT surgeon to eradicate the primary source of infection. During the last three years, we have approached such lesions through a mastoidectomy followed by excision of the abscess through the same approach. This trans-mastoid approach is technically feasible in following the tract of suppuration, and clearing the cause and effect of pathology, at the same sitting. This paper describes our initial experience with the trans-mastoid approach to otogenic …

Life Threatening Mediastinal Haematoma: A Complication Of Central Venous Catheterization, Omer Ashraf, Hasanat Sharif

Section of Cardiothoracic Surgery

Central venous catheterization (CVC) has established risks and benefits in its application as a vascular access source, particularly in situations involving temporary cannulation. We present a rare case of life-threatening mediastinal haematoma resulting from CVC usage. Even though aggressive intervention yielded survival, the patient was left with permanent vocal compromise owing to traumatic palsy of the right recurrent laryngeal nerve. One should be careful in selection of venous access and be aware of alternatives routes.

Prevalence Of Diabetic Retinopathy Among Individuals Screened Positive For Diabetes In Five Community Based Eye Camps In Northern Karachi Pakistan, Jamal-U- Din, Mohammad Babar Qureshi, Akhtar Jamal Khan, Mohammad Daud Khan, Khabir Ahmed

Department of Surgery

Background: Population-based data on the prevalence of diabetic retinopathy in Pakistan are lacking. We determined the prevalence of diabetic retinopathy among individuals screened positive for diabetes in five community-based eye camps in northern Karachi, Pakistan. Methods: In summer 2002, five community-based eye camps were set up in Karachi, Pakistan’s largest city. All individuals aged 30 years or older who visited the camps were requested to participate in the study. Those who agreed were screened for diabetes and those found to have the disease were referred to an eye hospital for diabetic retinopathy screening. Verbal informed consent was obtained from all …

Prophylaxis Of Dvt With Enoxaparin In Patients Undergoing Total Knee Replacement, Abid Ullah Khan Niazi, Masood Umer, Mohammad Umar

Section of Orthopaedic Surgery

Objective: To evaluate the efficacy and safety of the low molecular weight heparin as prophylaxis against thromboembolism following total knee replacement surgery.
Methods: Post-operative bilateral lower extremity colour duplex scan was performed on 55 patients subjected to total knew arthroplasty. The scan was performed 7 days after surgery for detection of DVT. All patients were given Enoxaparin 40mg subcutaneous daily for 2 weeks as prophylaxis against DVT.
Results: Two patients were diagnosed as DVT by color duplex scanning and both were distal but only one was asymptomatic. Another patient developed pulmonary embolism and died subsequently. The major and minor wound …

Long Scarf Injuries, Arshad A. Siddiqui, Muhammad Shahzad Shamim, Rashid Jooma, Ather Enam

Section of Neurosurgery

Long scarf (Dopatta) traditionally worn by females in South-East Asia have been described to make the females prone to sustain specific injuries when they ride pillion on the cycle powered rickshaw or motor bike. Two cases of females have been described.

Coronary Artery Bypass Surgery In Guillain Barre Syndrome, Omer Ashraf, Hasanat Sharif

Department of Surgery

Guillain Barre Syndrome (GBS) is a rare autoimmune inflammatory polyneuropathy with established acute phase morbidity and mortality. Despite the positive outcome in majority of cases, there is hesitance in subjecting these patients to major surgical interventions under general anaesthesia. This case documents the successful undertaking of major coronary artery grafting under cardiopulmonary bypass and general anaesthesia, in a GBS patient. A review of the pathology is presented and the controversy addressed.

Cataract Blindness And Visual Outcome Of Cataract Surgery In A Tribal Area In Pakistan, K M. Anjum, B M. Qureshi, M A. Khan, Azam Ali, Khabir Ahmad

Department of Surgery

Abstract

Aim: To estimate the rates of cataract blindness and cataract surgical coverage and to assess the visual outcome of cataract surgery among individuals aged ⩾50 years in Orakzai Agency, Pakistan.

Methods: 1600 individuals aged ⩾50 years were selected using probability proportional to size sampling. The main outcome measure was bilateral cataract blindness which was defined as visual acuity of <3/60 in the better eye with best available correction and with obvious central lens opacities/absence of red reflex in both eyes.

Results: A total of 1549 people were examined; the coverage rate was 96.8%. Of individuals who were examined, 958 (61.8%) were men. The overall prevalence of bilateral cataract blindness was 4.8% (95% CI: 3.8% to 5.9%). Women had a 2.1-fold …

Gastric Stromal Tumors: Clinical Presentations, Diagnosis And Outcome, Dildar Hussain, Hasnain Zafar, Asad Jamil Raja

Section of General Surgery

Objective: To determine the clinical presentations, of gastric stromal tumors with diagnostic methods, pathology and outcome after surgery.
Study Design: A case series.
Duration and Setting: From January 1988 to December 2002 at The Aga Khan University Hospital, Karachi.
Patients and Methods: All patients of age 14 years and above, diagnosed histopathologically to have gastric stromal tumors were included. The data of these patients was collected retrospectively from January 1988 to December 1998, and prospectively from January 1999 to December 2002. All the patients were studied as a single group.
Results: There were 11 patients. Their mean age was …

Earthquake Relief Experience Of Aga Khan University Trauma Team, Masood Umer, Haroon Rashid, Hasnain Zafar, Kamran Majeed

Section of General Surgery

The volatile geo-political situation of the country after the events of September 11, compelled the department of Surgery at Aga Khan University (AKU) to initiate the formation of a comprehensive disaster plan and trauma team. Since its inception the trauma team has stood the test of time during multiple disaster situations in Karachi. This includes the bus bombing of the French engineers, Hyderi mosque bomb blast and various other bomb blasts inside the city of Karachi. All these disasters were successfully managed within the premises of AKU. This earthquake relief activity was the first of its kind when the AKU …

Necrotizing Fasciitis Of The Breast, Saira Nizami, Kamran Mohiuddin, Mohisin-E-Azam, Hasnain Zafar, Muhammad Ashraf Memon

Section of General Surgery

Necrotizing fasciitis is a potentially fatal condition that can affect any part of the body. It can occur after trauma, around foreign bodies in surgical wounds, or can be idiopathic. We describe a case of necrotizing fasciitis involving the breast following an initial debridement of an inflammatory lesion.

Restoration Of Glenohumeral Motion In Erb's Palsy By Tendon Transfers, Syed Kamran Ahmed, Pervaiz Mehmood Hashmi

Section of Orthopaedic Surgery

Background: Children with erb's palsy have significant functional disability, mainly related to the shoulder. The objective of this study was to analyze the functional outcome of tendon transfers performed for restoration of shoulder motion in patients with Erb's palsy.
Methods: This descriptive case series was conducted at Aga Khan University Hospital from May 1999 to December 2003. Ten patients who had functional deficit of shoulder elevation were operated by a single surgeon. The surgical procedure; modified Sever L'Episcopo procedure was uniform in all cases. The data was collected through patient interviewing and medical records maintained through Health Information Management System …

Perforated Meckel's Diverticulitis Presenting As A Mesenteric Abscess: Case Report, Ronald Wasike, Hassan Saidi

General Surgery, East Africa

Only 2% of patients with Meckel’s diverticulae (MD) will manifest clinical problems. Diverticulitis occurs in approximately 10-20% of patients with symptomatic MD and more often in the elderly population. We report a case of Meckels diverticulitis presenting with perforation and mesenteric abscess in a young African man. The authors present information on diagnostic pitfalls and advise a lower threshold for consideration of MD as a differential diagnosis of acute right iliac fossa pain especially when the CT scan denotes a normal appendix in a male patient.

Inflammatory Myofibroblastic Tumor Of The Lung In An Adolescent Boy, S Sheikh, Saulat H. Fatimi, N Yaqoob

Section of Cardiothoracic Surgery

Inflammatory myofibroblastic tumors of the lung are rare, here, an unusual case is described. A 14-year-old boy presented with a history of weight loss and clubbing and was found to have a solitary circumscribed mass in right lower lobe treated with lobectomy. This case indicates the need for early and complete removal of the inflammatory myofibroblastic tumor of the lung.

Primary Repair Of An Esophageal Rupture Using Pleural Flap, Saulat H. Fatimi, Sadaf Sheikh, Asif Anwar Ali

Section of Cardiothoracic Surgery

Esophageal perforation remains an important thoracic emergency. Aggressive operative therapy remains the mainstay for treatment. A case of esophageal perforation, consequent upon impacted food bolus, is presented. An 80 years old female, with multiple comorbidities, presented with dysphagia and right sided chest pain, who had a distal esophageal tear, secondary to accidental meat ball ingestion. Rigid esophagoscopy showed complete occlusion of the distal esophagus with a meat ball. Right thoracotomy was performed, which showed perforated esophagus with large meat ball protruding from it. Endoscopic removal of the food particles was done, and the rupture was repaired using a pleural flap. …

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

Section of Cardiothoracic Surgery

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.

Giant Multiple Intra-Abdominal Hydatid Cysts, Naila Nadeem, Hassan Khan, Saulat H. Fatimi, Mohammad Nadeemd Ahmad

Section of Cardiothoracic Surgery

No abstract provided.