Surgery Commons^™

Angioembolization In Itractable Epistaxis—A Tertiary Care Experience, Maqbool Ahmed Baloch, Mohammad Sohail Awan, Hassan Nabeel Humayun

Department of Surgery Docs

Objective: To review the role of angioembolization in the control of intractable epistaxis at our institution. Methods: A retrospective review of the charts of the patients between Jan 2001 to June 2010 at Aga Khan University Hospital, Karachi was done. All patients who underwent angioembolization for intractable epistaxis were included in the study. Patients with nasal or nasopharyngeal mass were excluded. Data was analyzed by using SPSS version 16. Results: Total numbers of the patients were 16. Fourteen (87.5%) patients were male and 2(12.5%) were female with mean age 51.2 ± 12.922 years (range 26-71 years). In 11(68.75%) patients there …

Emergency Incisional Hernia Repair: A Difficult Problem Waiting For A Solution, Hasnain Zafar, Masooma Zaidi, Irfan Qadir, Ayaz Ahmed Memon

Department of Surgery Docs

Background

Emergency repair of incarcerated incisional hernia with associated bowel obstruction in potentially or contaminated field is technically challenging due to edematous, inflamed and friable tissues with occasional need for concurrent bowel resection and carries high rates of post-operative infectious complications. The aim of this study was to retrospectively assess the wound related morbidity of use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. We also describe a new technique of leaving the mesh exposed to heal by secondary intention with granulation tissue.

Methods

Between 2000 and 2010 a total of 60 patients …

Sigmoid Volvulus In Pregnancy And Puerperium: A Surgical And Obstetric Catastrophe Report Of A Case And Review Of The World Literature, Muhammad R. Khan, Sameer Ur Rehman

Department of Surgery Docs

Sigmoid volvulus is a rare surgical complication occurring in pregnancy and puerperium. Only 84 cases of sigmoid volvulus in pregnancy have been reported in the English literature so far. We have reviewed the available literature on this subject and present another case recently managed at our institution. The available literature suggests that over the years, there has been an improvement in the maternal and fetal outcome for this critical condition, but delay in presentation and a further delay in diagnosis remain a challenge for the treating physicians. Our patient was a 30-week pregnant lady, who presented late with 6days history …

The Genetics Of Neuroendocrine Prostate Cancers: A Review Of Current And Emerging Candidates, M Hammad Ather, Tahmeena Siddiqui

Department of Surgery Docs

Prostate cancer (PC) displays a strong familial link and genetic factors; genes regulating inflammation may have a pivotal role in the disease. Epigenetic changes control chromosomal integrity, gene functions, and, ultimately, carcinogenesis. The most widely studied epigenetic event in PC is aberrant DNA methylation (hypo- and hypermethylation); besides this, chromatin remodeling and micro RNA (miRNA) are other studied alterations in PC. These all lead to genomic instability and inappropriate gene expression. Causative dysfunction of histone modifying enzymes results in generic and locus-specific changes in chromatin remodeling. miRNA deregulation also contributes to prostate carcinogenesis, including interference with androgen-receptor signaling and apoptosis. …

Mirizzi's Syndrome Masquerading As Cholangiocarcinoma: A Case Report, Muhammad Rizwan Khan, Sameer Ur Rehman

Department of Surgery Docs

Introduction: Mirizzi's syndrome is a rarely observed disorder that presents with obstructive jaundice. The condition is caused by a stone impacted in the gall bladder neck or cystic duct that impinges on the common hepatic duct, with or without a cholecystocholedochal fistula. The condition is often confused with other serious conditions such as hilar cholangiocarcinoma, which present with similar clinical and imaging findings, and a pre-operative diagnosis may be a serious challenge.CASE PRESENTATION: We present the case of a 44-year-old Asian man with Mirizzi's syndrome who was initially diagnosed as having cholangiocarcinoma based on his clinical presentation, raised cancer antigen …

Isolated Adult Hypoganglionosis Presenting As Sigmoid Volvulus: A Case Report., Irfan Qadir, Muhammad Musa Salick, Abrar Barakzai, Hasnain Zafar

Department of Surgery Docs

Introduction:Isolated hypoganglionosis is a rare cause of intestinal innervation defects. It is characterized by sparse and small myenteric ganglia, absent or low acetylcholinesterase activity in the lamina propria and hypertrophy of the muscularis mucosae, principally in the region of the colon and rectum. It accounts for 5% of all intestinal neuronal malformations. To the best of our knowledge, only 92 cases of isolated hypoganglionosis were reported from 1978 to 2009. Isolated hypoganglionosis usually manifests as enterocolitis or poor bowel function, and is diagnosed in infancy or childhood. We report the first case of isolated hypoganglionosis presenting with sigmoid volvulus …

Early Complications After Biliary Enteric Anastomosis For Benign Diseases: A Retrospective Analysis, Syed Nabeel Zafar, M. R. Khan, Rushna Raza, Muhammad N. Khan, Mahwash Kasi, Ammar Rafiq, Omer H. Jamy

Department of Surgery Docs

Background:Biliary-enteric anastomosis (BEA) is a common surgical procedure performed for the management of biliary obstruction or leakage that results from a variety of benign and malignant diseases. Complications following BEA are not rare. We aimed to determine the incidence and the factors associated with early complications occurring after BEA for benign diseases.

Methods:

We reviewed the medical records of all Patients who underwent BEA for benign diseases at our institution between January 1988 and December 2009. The primary outcome was early post operative complication. Logistic regression analysis was done to identify factors predicting the occurrence of complications.

Results:

Records …

Impact Of Age On Outcome After Colorectal Cancer Surgery In The Elderly - A Developing Country Perspective, M. R. Khan, Hassaan Bari, Syed Nabeel Zafar, Syed Ahsan Raza

Department of Surgery Docs

Background:Colorectal cancer (CRC) is a major source of morbidity and mortality in the elderly population and surgery is often the only definitive management option. The suitability of surgical candidates based on age alone has traditionally been a source of controversy. Surgical resection may be considered detrimental in the elderly solely on the basis of advanced age. Based on recent evidence suggesting that age alone is not a predictor of outcomes, Western societies are increasingly performing definitive procedures on the elderly. Such evidence is not available from our region. We aimed to determine whether age has an independent effect on …

P2-498 Parents' Perceptions And Practices Regarding Consanguinity Related To Β-Thalassaemia: A Matched Case Control Study, M Beg, R Siddiqui, Khabir Ahmad, Khadija Humayun

Department of Surgery Docs

introduction b-thalassaemia is most common genetically transmitted disorder in Eastern Mediterranean region including Pakistan. Like other recessive disorders, prevalence increases through consanguinity; Pakistan Demographic and Health Survey reports 50% consanguineous marriages. Perceptions about consanguinity in our population have recently not been studied. Objectives were to determine consanguinity related characteristics among parents of children with thalassaemia and without thalassaemia visiting a major health centre in Karachi-Pakistan. To compare consanguinity practices among such families and to assess susceptibility, benefits and barriers towards thalassaemia. Methods Sample of 340 cases and 340 controls; age-sex matched were selected from February to April 2010. Parents of …

Treatment Of Complex Fistula In Ano With Cable-Tie Seton: A Prospective Case Series., Ayaz Ahmad Memon, Ghulam Murtaza, Rizwan Azami, Hasnain Zafar, Tabish Chawla, Altaf Ali Laghari

Department of Surgery Docs

Objective:To determine the fecal incontinence and recurrence rate in Patients with complex fistula in ano managed with cable tie seton at a tertiary care teaching hospital.

Methods:

This is a prospective case series of Patients with complex anal fistula i.e. recurrent fistula or encircling >30% of external anal sphincter, managed with cable tie seton from March 2003 to March 2009. Patients were seen in the clinic after 72 hours of seton insertion under anesthesia and then every other week. Each time the cable-tie was tightened if found loose without anesthesia and incontinence was inquired according to wexner's score.

Results: …

Postoperative Sensitivity In Class V Composite Restorations: Comparing Soft Start Vs. Constant Curing Modes Of Led., Fahad Umer, Frahan Raza Khan

Department of Surgery Docs

Background: One of the major disadvantages associated with using composites is polymerization shrinkage, stresses are generated at the margins, and if these stresses exceed the bond strength, microleakage occurs at the tooth restoration interface which causes ingress of cariogenic bacteria, post-operative sensitivity, and secondary caries. LED offers several curing modes: constant cure, ramped cure, and soft start cure. It is claimed that soft start polymerization mode produces less polymerization shrinkage and consequently less postoperative sensitivity. Objective:To compare the postoperative sensitivity in Class V composite restorations using soft start and constant LED curing modes. Materials and

Methods:

Using the appropriate …

Developmental Dysplasia Of The Hip., Shahryar Noordin, Masood Umer, Kamran Hafeez, Haq Nawaz

Department of Surgery Docs

Developmental dysplasia of the hip (DDH) is a spectrum of anatomical abnormalities of the hip joint in which the femoral head has an abnormal relationship with the acetabulum. Most studies report an incidence of 1 to 34 cases per 1,000 live births and differences could be due to different diagnostic methods and timing of evaluation. Risk factors include first born status, female sex, positive family history, breech presentation and oligohydramnios. Clinical presentations of DDH depend on the age of the child. Newborns present with hip instability, infants have limited hip abduction on examination, and older children and adolescents present with …

Modification And Implementation Of Nccn Guidelines On Prostate Cancer In The Middle East And North Africa Region., Waleed A. Hassen, Farrok A. Karsan, Farhat Abbas

Department of Surgery Docs

Abstract

A prostate cancer committee was established to modify the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Prostate Cancer for adaptation and implementation in the Middle East and North Africa (MENA) region. The objective was to enhance the multidisciplinary approach to the treatment of prostate cancer. The committee, comprising regional experts in the fields of urologic, medical, and radiation oncology, reviewed the 2009 version of the NCCN Guidelines on Prostate Cancer and suggested modifications based on the unique needs of the regions determined through published evidence and local expertise. The committee identified several areas in the NCCN Guidelines …

Intricacies In The Surgical Management Of Appendiceal Mucinous Cystadenoma: A Case Report And Review Of The Literature., Muhammad Rizwan Khan, Rashida Ahmed, Taimur Saleem

Department of Surgery Docs

Introduction:Mucinous cystadenoma is a type of mucocele of the appendix that is rarely encountered in clinical practice. Dogmatic consensus on the optimal surgical modus operandi of appendicular mucocele is lacking in the literature and this remains a subject of controversy. There is little agreement with regard to the best procedure (right hemicolectomy versus appendectomy) or the best surgical approach (laparoscopic versus laparotomy). Case Presentation: We report the case of a 70-year-old Asian woman from Karachi who presented with pain in the right iliac fossa for 15 days. On physical examination, a mobile and firm mass was palpable in the …

Acute Mesenteric, Portal And Inferior Vena Cava (Ivc) Venous Thrombosis: Optimal Outcome Achieved With Anticoagulation, Abdul Rehman Alvi, Shahida Bibi, Zia Ur Rehman, Sameullah Khan Niazi

Department of Surgery Docs

The prevalence and clinical spectrum of acute mesenteric venous thrombosis (AMVT) in Pakistan is largely unknown. The authors report two patients with acute mesenteric, portal and inferior vena cava venous thrombosis confirmed on CT imaging. The diagnoses were established within 24 hours of presentation and both patients were successfully treated with therapeutic heparin during hospital admission and continued on oral warfarin because of hypercoagulable state. The protocol that we currently use is evidence based and is leading to optimal outcome.

Cases Of Subconjunctival Hemorrhage After A Joy Ride, Roomasa Channa, Sana Shoukat Memon, Tanveer Anjum Chaudhry, Khabir Ahmad

Department of Surgery Docs

No abstract provided.

Conjunctival Malignant Melanoma Mimicking As A Chalazion, Sana Shoukat Memon, Roomasa Channa, Tanveer Anjum Chaudhry, Khabir Ahmad

Department of Surgery Docs

No abstract provided.

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

Department of Surgery Docs

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.

Imatinib Challenge Dismissed In India, Khabir Ahmad

Department of Surgery Docs

No abstract provided.

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

Department of Surgery Docs

No abstract provided.

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 Docs

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 …

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

Department of Surgery Docs

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.

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

Department of Surgery Docs

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.

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 Docs

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 …

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

Department of Surgery Docs

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 …

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

Department of Surgery Docs

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.

Dural Metastases Presenting As An Extradural Hematoma: A Rare Presentation, Muhammad Shahzad Shamim, Muhammad Ehsan Bari, S. Ather Enam

Department of Surgery Docs

Abstract

We report a case of an elderly man who presented with hemiparesis and plain CT scan findings highly suggestive of an extradural hematoma as the underlying cause. This patient was later found to have dural metastases secondary to bronchogenic carcinoma. Dural metastases are rare, usually presenting as dural mass, but may also present as chronic subdural or extradural hematoma on non contrast CT scan, leading to an erroneous diagnosis in the unsuspecting.

Prevalence And Predictors Of Smoking In Pakistan: Results Of The National Health Survey Of Pakistan, Khabir Ahmed, Fahim Jafary, Imtiaz Jehan, Juanita Hatcher, Abdul Qayum Khand , Khan, Nish Chaturvedi, Tazeen Jafar

Department of Surgery Docs

No abstract provided.

Self-Rated Health In Pakistan: Results Of A National Health Survey, Khabir Ahmed, Tazeen Jafar, Nish Chaturvedi

Department of Surgery Docs

Abstract Background: Self-rated health (SRH) is a robust predictor of mortality. In UK, migrants of South Asian descent, compared to native Caucasian populations, have substantially poorer SRH. Despite its validation among migrant South Asian populations and its popularity in developed countries as a useful public health tool, the SRH scale has not been used at a population level in countries in South Asia. We determined the prevalence of and risk factors for poor/fair SRH among individuals aged ≥15 years in Pakistan (n = 9442). Methods: The National Health Survey of Pakistan was a cross-sectional population-based survey, conducted between 1990 and …

Conversion From Laparoscopic To Open Cholecystectomy: Multivariate Analysis Of Preoperative Risk Factors, M Tayeb, S A. Raza, M R. Khan, R Azami

Department of Surgery Docs

Background: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic cholelithiasis. Some patients require conversion to open surgery and several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion. However, there is a need to devise a risk-scoring system based on the identified risk factors to (a) predict the risk of conversion preoperatively for selected patients, (b) prepare the patient psychologically, (c) arrange operating schedules accordingly, and (d) minimize the procedure-related cost and help overcome financial constraints, which is a significant problem in developing countries.AIM: This study was aimed …