Surgery Commons^™

Giant Haemangioma Of Nasopharynx: A Rare Case Outcome., Haissan Iftikhar, Moghira Siddiqui

Department of Surgery Docs

Abstract

A 60-year-old female presented to us with a 5-year history of progressive right sided nasal obstruction and recurrent epistaxis. On examination lesion was seen in the right nostril which was firm and bled on probing. CT-scan paranasal sinuses showed a right sided lesion of nose and naso-pharnyx obstructing posterior nasal choanae. Dimensions were reported to be 9×4.1×3.8 cm. A punch biopsy was taken in operating room under general anaesthesia which resulted in profuse bleeding. Suction cautery was used to control bleeding and the nose was packed. The mass was firm to hard and provided resistance during the time of …

Unmet Need For Surgery In South Asia, Sanjay Nagral, Maharra Hussain, Sarder A Nayeem, Ranjan Dias, S. Ather Enam

Department of Surgery Docs

No abstract provided.

Effectiveness Of Plain X-Ray In Detection Of Fish And Chicken Bone Foreign Body In Upper Aerodigestive Tract, Talha Ahmed Qureshi, Mohammad Sohail Awan, Muntazir Hussain, Muhammad Wasif

Department of Surgery Docs

Abstract

OBJECTIVE:

To assess the use of plain film radiology in the detection of fish and chicken bones in the upper aerodigestive tract.

METHODS:

This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised medical charts of patients who had undergone oesophagoscopy for removal of fish and chicken bone from 1990 to 2015.SPSS 19 was used for data analysis.

RESULTS:

Of the 24 patients, foreign body was detected on X-ray in 7(29.2%) and through fibre optic laryngoscopy in 13(54.2%).All the patients underwent surgical intervention for removal of the foreign body. Also, 19(79.2%) patients underwent direct …

Extensive Mediastinal Aspergillosis Presenting With Dyspnoea And Cardiac Tamponade Symptoms, Syed F Mustafa, Hamza Ar Khan, Saulat H. Fatimi

Department of Surgery Docs

No abstract provided.

Bomb Blast In A Tertiary Care Hospital, The Challenges Faced During Management Of Victims In A Resource Limited Country, Rizwan Sultan, Hasnain Zafar, Umar B, Khabir Ahmed

Department of Surgery Docs

Abstract Introduction: A bomb blast in a hospital results in a many fold increase in the casualties. The affected health care in the region is the next challenge faced by the administration of the city. We discuss the challenges faced after a bomb blast in the civil hospital of Quetta, Pakistan on 8 August 2016. Methods: A retrospective review of the medical records of patients who were transferred by air to the Aga Khan University Hospital Karachi over a period of 86 h after the blast in Quetta. Results: Seventy-five patients were received in three separate waves; those received in …

The Many Guises Of Primary Hyperparathyroidism… An Unchanged Scenario, Tasnim Ahsan, Uzma Erum, K. M. Inam Pal, Rukhshanda Jabeen, Saima Ghaus Qureeshi, Urooj Lal Rehman, Zeenat Banu

Department of Surgery Docs

Abstract

OBJECTIVE:

To study the causes, characteristics and outcome of treatment of patients with primary hyperparathyroidism.

METHODS:

This retrospective cohort analysis was conducted at the Jinnah Postgraduate Medical Centre, Karachi, and comprised data of patients with primary hyperparathyroidism between 2004 and 2014. .SPSS 17 was used for data analysis.

RESULTS:

Of the 25 patients,1(4%)was male and 24(96%) were female. The overall mean age was 41.72±15.9 years, with a mean duration of symptoms of 4.1±3.3 years. The mean pre-operative parathyroid hormone level was 879.48±793.51 pg/ml. Skeletal manifestations were reported in 17(68%) patients, whereas 4(16%) patients had renal stone disease. Besides, 2(8.0%) …

Frequency Of Color Blindness In Pre-Employment Screening In A Tertiary Health Care Center In Pakistan, Shaukat Ali Chhipa, Farzeen K. Hash, Shehreen Ali, Mustafa Kama, Khabir Ahmed

Department of Surgery Docs

Abstract

OBJECTIVE:

To describe the frequency of color vision deficiency among Pakistani adults presenting for pre-employment health screening in a tertiary care hospital.

METHODS:

The cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, and the data was collected for color vision deficiency, age, gender, and job applied for from pre-employment examination during 2013-2014. IBM SPSS 20 was used for statistical analysis.

RESULTS:

Three thousand four hundred and thirty seven persons underwent pre-employment screening during 2013 and 2014; 1837 (53.44%) were males and 1600 (46.65%) females. The mean age was 29.01 (±6.53) years. A total of 0.9% …

Giant Ganglioneuroma In A 5-Year Child, Hamza Abdur Rahim Khan, Fazal Wahab Khan, Saulat H. Fatimi

Department of Surgery Docs

ABSTRACT We report a 5-year boy presenting with pain in the lower chest and upper abdomen. On evaluation with computed tomography scan of the chest, he was found to have a large 16 x 14 cm posterior mediastinal mass compressing the inferior vena cava and liver, and shifting the heart to the opposite side. Tumor was approached via right postero-lateral thoracotomy and dissected off from esophagus, heart, inferior vena cava and lungs. The entire tumor was resected without any complications. Postoperative course was unremarkable. Resection of the tumor was successful. The histopathology showed it to be giant ganglioneuroma with no …

Tailored Metabolic Workup For Urolithiasis – The Debate Continues, Hammad Ather, Imran Siddiqui, Tahmeena Siddiqui, M Nasir Sulaiman

Department of Surgery Docs

Abstract

Urolithiasis is one of the commonest afflictions of the urinary tract. Stones are of various chemical compositions, some share some common etiology; but most are specific to the structure and composition of stone. In view of highly recurrent nature of this condition, it is logical to have strategies for prevention. However, due to multiple factors most patients receive no or fragmented information on prevention. The current controversy is to the extent of metabolic workup in adult first time stone former. This requires longitudinal studies to show benefit in prevention strategies. Patients at high risk can have recurrence in weeks …

Hepatitis C Virus Seroprevalence In The General Female Population Of 9 Countries In Europe, Asia And Africa, Gary M. Clifford, Tim Waterboer, Bolormaa Dondog, You Lin Qiao, Dimitri Kordzaia, Doudja Hammouda, Namory Keita, , Nahid Khodakarami, Syed Ahsan Ali, Ang Tshering Sherpa, Witold Zatonski

Department of Surgery Docs

Abstract

BACKGROUND:

New oral treatments with very high cure rates have the potential to revolutionize global management of hepatitis C virus (HCV), but population-based data on HCV infection are missing in many low and middle-income countries (LMIC).

METHODS:

Between 2004 and 2009, dried blood spots were collected from age-stratified female population samples of 9 countries: China, Mongolia, Poland, Guinea, Nepal, Pakistan, Algeria, Georgia and Iran. HCV antibodies were detected by a multiplex serology assay using bead-based technology.

RESULTS:

Crude HCV prevalence ranged from 17.4% in Mongolia to 0.0% in Iran. In a pooled model adjusted by age and country, in …

Hookworm Infestation As A Cause Of Melena And Severe Anaemia In Farmer, Marvi Tariq, Syeda Maria Muzammil, Fareed Ahmed Sheikh, K. M. Inam Pal

Department of Surgery Docs

Abstract

Hookworm infections remain a major cause of morbidity in the developing world. Prevalence is highest in agricultural areas, where use of waste water for irrigation and poor hygiene increases infection rates among farmers. Infections present with gastrointestinal symptoms and chronic anaemia, and there are usually no signs of overt blood loss.
The following report describes a case of melena in a middle-aged farmer, where the diagnosis of hookworm infestation was delayed due to the unusual presentation. The patient underwent multiple blood transfusions before referral to the Aga Khan University Hospital (AKUH), Karachi and was managed conservatively with mebendazole at …

Superior Septal Approach Versus Left Atrial Approach For Mitral Valve Replacement: A Retrospective Cohort Study, Tooba Ansar, Taimur Asif Ali, Saneeha Shahid, Saulat H. Fatimi, Ghulam Murtaza

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare the outcomes of superior septal approach and left atrial approach for mitral valve replacement.

METHODS:

This retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients who had undergone isolated mitral valve replacement from May 2003 to April 2012. Cases were reviewed for the outcomes [primary: loss of normal sinus rhythm; secondary: complications, residual defect and mortality]. Patients with prior history of dysrhythmia, low ejection fraction (<30%), emergency/redo mitral valve replacement and concomitant coronary artery bypass grafting were excluded. SPSS 19 was used for data analysis.

RESULTS:

Of the 78 patients, 52(66.67%) were of superior septal approach and 26(33.33%) of left atrial approach. Both groups were comparable for …

Re-Structuring University Hospital’S Internship Program Using Kern’S Six-Step Model Of Instructional Design, M. Tariq, Muhammad Shahzad Shamim, Amna Subhan Butt, Sana Saeed, Zia Ur Rehman, Barkat Virani, Asghar Ashraf, Irum Qamar, Farah Qamar, Raheela Mohsin Rizvi, Swaleha Tariq, Qurratulain Naeem

Department of Surgery Docs

Abstract Background: Internship is a phase of training wherein a graduate learns in the context of practice, acquiring skills under supervision so that he/she may become capable of functioning independently. We are reporting the process of curriculum restructuring for strengthening the Internship Program at this university hospital. Methodology: We used Kerns’ six-step model to evaluate and restructure the internship curriculum. Step 01: Problem Identification & General need assessment- Thorough literature review revealed Internship as the crucial year of training that needs to be fashioned around the competencies required to make good doctors

Therapeutic Uses Of Pineapple-Extracted Bromelain In Surgical Care - A Review., Zehra Abdul Muhammad, Tashfeen Ahmad

Department of Surgery Docs

Abstract

Bromelain is an extract obtained from the pineapple plant and is used as a traditional folk remedy for several ailments. In this review, a comprehensive electronic database search was carried out to compile available literature on therapeutic implications of bromelain. Pharmaceutical value of bromelain has been demonstrated in different surgical sub-specialties. Diverse biological processes like anti-inflammatory, anti-oedematous, analgesic, anti-thrombotic, exfoliation etc. are involved in bromelain's therapeutic actions, mediated through the kallikrein-kinin and arachidonic acid pathways as well as through effects on cell mediated immunity. Bromelain equals non-steroidal anti-inflammatory drugs as an anti-inflammatory agent, but has been shown to have …

Successful Resection Of Lymphangioma Of The Neck And Mediastinum Presenting As Stridor In A 12 Year Old Child, Babar Irfan, Maha Tahir, Omar Irfan, Hamza Abdur Rahim Khan, Saulat H. Fatimi

Department of Surgery Docs

Lymphangiomas are congenital malformations of lymphatic tissue. This benign condition is generally found in the neck region and is discovered by 2 years of age. Here we report the case of a 12 year old child who presented with a cervical and mediastinal cystic hygroma that had progressed to such a space occupying nature as to cause the shifting of the trachea. The entire mass was successfully resected with a lower neck incision. Our case suggests the necessity of considering cystic lymphangioma in the differential diagnosis of lateral neck masses and use of adequate imaging to substantiate the preoperative diagnosis.

Bowled Over By Cricket: Impact Of Tape-Ball Injuries On The Eyes, Salman Naveed Sadiq, Azam Ali, Bushra Usmani, Khabir Ahmed

Department of Surgery Docs

Abstract

PURPOSE:

The aim of this study was to describe the type and severity of tape-ball cricket-related eye injuries seen at a tertiary care hospital.

DESIGN:

A descriptive case series.

METHODS:

This study included all cases of tape-ball cricket-related eye injuries presenting to the Section of Ophthalmology, Aga Khan University Hospital, Karachi, from January 2014 to January 2015.

RESULTS:

A total of 20 patients with tape-ball cricket-related eye injuries were treated during this period. The right eye was involved in most (14/20) of the cases. The commonest presenting symptoms included reduced/blurred vision, ocular pain, redness, and floaters. Sixty percent (12/20) …

Journey From Black To Pink Gums: Management Of Melanin Induced Physiological Gingival Hyper Pigmentation, Huma Farid, Muhammad Saad Shinwari, Farhan Raza Khan, Farzin Tanwir

Department of Surgery Docs

Abstract

Smile is an expression of happiness, self-confidence, kindness and beauty. Along with teeth and lips, gingiva is also a vital component of smile. Melanin induced gingival hyper pigmentation may appear un-aesthetic especially when it is associated with high smile line, upper anterior labial segment and is uneven in appearance. It affects individuals from all races. Generally, it is believed that melanin induced gingival hyper pigmentation is confined to individuals from dark races. But studies have shown that Iranian, Indian, Italian, Arabian, Greek. German, French, Japanese, Chinese, Jewish, Thai, Malaysian and other ethnic groups also display clinical gingival pigmentation.1 Gingival …

Hernia Of Morgagni Presenting As Constipation In A 65-Year-Old Male, Hamza A Khan, Adeel Samad, Omar A Khan, Farida K Chagan, Jamal K Khan, Saulat H. Fatimi

Department of Surgery Docs

Hernia of Morgagni is congenital defects in the diaphragm. They are mostly asymptomatic and present with vague symptoms when they do so. A high index of suspicion is required for timely diagnose of this condition. Here we present the case of a 65-year-old male patient presented to our institute with constipation for the past six months. Chest radiology raised the suspicion of a hernia which was further confirmed by contrast studies. Laparotomy was done and the hernia sac identified, colon and greater omentum reduced and defect repaired. He was discharged in stable condition and was doing well on follow-up.

Retrograde Bullet Migration From Inferior Vena Cava Into Right Common Iliac Vein Following Gunshot: A Case Report, Ibrahim Zahid, Hamza Abdur Rahim Khan, Omar Irfan, Benish Fatima,, Maha Tahir, Muhammad Tariq, Fazal Wahab Khan, Saulat H. Fatimi

Department of Surgery Docs

Abstract

Bullet embolization cases are rare and even rarer are its retrograde migration in the veins. We report the case of a 14 year old male with a gunshot wound to the left side of his chest. CT scan revealed bilateral haemothorax and foreign body in the right common iliac vein. The patient was immediately taken to the operating theatre and median sternotomy performed. Bullet entry tear was found in the inferior vena cava however, the bullet was found lodged in the right common iliac vein and slipped down against the flow of blood. The bullet was left in situ …

Difficulties In Laparoscopic Cholecystectomy: Conversion Versus Surgeon's Failure, Aun Ali, Summaya Saeed, Rabel Khawaja, Sunil Sadruddin Samnani, Farah Naz Farid

Department of Surgery Docs

Background: Laparoscopic cholecystectomy is considered to be gold standard treatment for symptomatic gall stones. Despite several benefits there are still disadvantages of laparoscopic cholecystectomy in difficult cases where anatomy is disturbed even in experienced hand. Aim of this study is to identify advantages of early conversion to open cholecystectomy in difficult cases and how it should not be associated with surgeon's failure.
Methods: Observational study was conducted at tertiary care hospital of Karachi, Pakistan from January 2012 till June 2015. All patients who presented to general surgery department with symptomatic gall stones and planned for laparoscopic cholecystectomy was included in …

Descriptive Epidemiology Of Karachi Road Traffic Crash Mortality From 2007 To 2014, Rashid Jooma, Masood Ali Shaikh

Department of Surgery Docs

Abstract

According to World Health Organization's estimate for Pakistan, there were 25,781 (95% CI: 20,979-30582) Road Traffic Collision (RTC) fatalities in year 2013. The Road Traffic Injury Research and Prevention Center, collects RTC data on injuries and fatalities from five major public and private hospitals' emergency departments in Karachi. For the eight-year period, from 2007-2014, 9129 fatalities were recorded. Males accounted for 8008 (87.7%) all RTC fatalities. Highest number of fatalities were recorded in the 21-25 age group with 1329 (15.3%) fatalities, while fatalities in 16-30 years old, recorded 3446 (39.7%) of all fatalities out of the total 8684 records …

Catamenial Pneumothorax: A Case Report., Hina Inam, Sumera Inam,, Munaim Tahir

Department of Surgery Docs

Abstract

Catamenial pneumothorax (CP) is a rare and complex clinical condition caused by endometrial tissues, commonly found in reproductive women (age 15-49 years).Its diagnosis is often delayed or overlooked by clinicians, which may result in recurrent hospitalizations and other complications. A case of Catamenial pneumothorax is presented of a 38-year-old young married woman, admitted to hospital with signs and symptoms including chest pain and shortness of breath that started with her menstrual period. Right pneumothorax was observed in the Chest x-ray. Patient underwent Video-assisted thoracoscopic surgery (VATS). Patient was kept under observation, and was discharged when stable with no pain.Catamenial …

Lower Red Cell Transfusion Rates With Use Of Tranexamic Acid In Single-Stage Bilateral Total Knee Arthroplasty: A Retrospective Audit, Muhammad Aziz, Salman Bin Mahmood,, Riaz Hussain Lakdawala, Tashfeen Ahmad

Department of Surgery Docs

Abstract

Bilateral total knee arthroplasty (BTKA) patients may require blood transfusion which has its risks. Anti-fibrinolytic drugs such as aprotinin, aminocaproic acid and tranexamic acid (TXA) have reduced transfusion requirements in major surgery. This retrospective audit was performed to assess effectiveness of TXA in reducing blood transfusion rate in single-stage sequential BTKA cases operated by a single surgeon. Records of 91 patients given TXA and 80 controls who were operated before 2012 and not given TXA were reviewed. TXA was given 15mg/kg intravenously (IV) before tourniquet deflation and 3 hours postoperatively.Blood transfusion was done in 9(10%) patients in the TXA …

Functional Outcomes After Successful Lower Extremity Arterial Injuries Repair, Zia Ur Rehman, Ziad Sophie, Lekhraj. Mal

Department of Surgery Docs

bstract

The study was conducted to measure functional outcome of patients who had successful lower extremity arterial reconstruction after vascular injury at a tertiary care centre in Karachi over 5 years from January 2008 to December 2013. In this descriptive cohort study, the functional outcomes were assessed with lower extremity functional scale (LEFS). The mean age the 75 patients in the study was 32±11 years. Limb salvage was successful in 72(96%) cases. The most common injured artery was superficial femoral artery 30(40%) followed by popliteal artery 19(25%). The most common method of repair was end-to-end using either polytetrafluoroethylene (PTFE) graft …

Versatility Of The Anterolateral Thigh Flap: An Akuh Experience, Muhammad Fazlur Rehman, Muhammad Asif Ahsan, Muhammad Ubaid Khan, Sami Ullah, Sara Khan

Department of Surgery Docs

Anterolateral thigh flap is used for reconstruction of various soft tissue defects. We planned the study to evaluate the versatility of the anterolateral thigh flap as it may be used for reconstruction of head and neck, torso and extremities with minimal donor-site morbidity. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised date from October 2012 to December 2015. Of the 75 patients in which anterolateral thigh flap was used for reconstruction, 6(8%) flaps did not survive. The overall flap survival was 69(92%). Anterolateral thigh flap was versatile enough to provide soft tissue coverage to defects …

Bacterobilia In Acute Cholecystitis: Bile Cultures' Isolates, Antibiotic Sensitivities And Antibiotic Usage. A Study On A Pakistani Population, Yousaf Bashir Hadi, Muhammad Waqas, Hafiz Muhammad Umer,, Ammar Alam, Abdul Rehman Alvi, Muhammad Rizwan Khan, Amir Hafeez Shariff

Department of Surgery Docs

Acute cholecystitis is one of the most common acute surgical conditions. Laparoscopic cholecystectomy remains the mainstay of treatment. In patients managed non-operatively, antibiotics play an important role in the treatment of cholecystitis. The current retrospective observational study was conducted at a tertiary care hospital in Karachi, and comprised medical records of patients admitted between 2008 and 2014with acute cholecystitis and in whom bile cultures were obtained. Of the 509 patients with a mean age of 51.15 ± 13.4years, early laparoscopic cholecystectomy (within 72hours) was performed on 473(92.9%) cases, while the rest underwent percutaneous cholecystostomy. Bile cultureswere positive in 171(33.6%) patients. …

Cervical Mediastinoscopy In The Diagnosis Of Lymphadenopathy In South Asia., Sulaiman B Hasan, Fazal Wahab Khan, Shiraz Hashmi, Ahsan Ehtesham, Rizwana Ahmed Magsi, Syed Shahabuddin

Department of Surgery Docs

Abstract

We planned to determine the clinical utility and safety of mediastinoscopy in the pathologic diagnosis of mediastinal lymphadenopathy and to determine disease patterns in a tertiary care setting in Karachi. The retrospective review comprised record of patients who underwent mediastinoscopy over 25 years between July, 1990 and August, 2015. Of the 122 patients, records were complete for 88(72%). Mean age was 42.5±12.9 years and 55(62.5%) were male. Overall, 60(68.2%) patients had benign inflammatory diseases; 25 (28.4%) had lymphoma or lung cancer which was accurately staged; 26(29.5%) had tuberculosis; 13(14.8%) sarcoidosis; and 11 (12.5%) had concomitant tuberculosis and sarcoidosis. No …

Pediatric Laparoscopic Surgery; Initial Experience From Pakistan; First 100 Cases In Single Center, Hassan Ishaq, Saqib Hamid Qazi, Sohail Dogar, Muhammad Younus Khan Durrani,, Ahmad Vaqas Faruque

Department of Surgery Docs

Abstract

In a developing country like Pakistan, laparoscopic surgeries are not considered favourable by many, possibly because of high costs or a lack of expertise. It is an established fact that laparoscopic surgery offers better surgical treatments with a shorter hospital stay and fewer complications. The current retrospective study was conducted at a tertiary care hospital in Karachi and comprised of laparoscopy cases performed by a single surgeon from March 2012 to September of 2014. A total of 100laparoscopic surgeries were performed; mostly appendectomies 49(49%) and undescended testes (UDTs) 34(34%). Overall, there were 70(70%) male patients. The mean age of …

Neurosurgery Training In Pakistan: Follow-Up Survey And Critical Analysis Of National Training Programmes., Dr Saqib Kamran Bakhshi, Muhammad Waqas, Muhammad Mehboob Alam, Muhammad Shahzad Shamim, Mohsin Qadeer

Department of Surgery Docs

No abstract provided.

Paediatric External Ventricular Drains: Experience From A Tertiary Care Hospital Of A Developing Country, Abbas Qalab, Rayaan Asad, Mahnaz Hakeem,, Maria Ahmad, Anwar Haq, Aneela Darbar

Department of Surgery Docs

Abstract

The aim of the study was to describe indications and complications of external ventricular drain (EVD) placement in children aged between 1 month and 16 years. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised all children who underwent EVD placement from January 2007 to December 2014. Of the 177 patients identified, 117(66%) were males 60(34%) were girls. The overall mean age was 5.4±5.2 years. The median Glasgow Coma Scale score on presentation and discharge was 13 (interquartile range [IQR]: 7) and 15 (IQR: 4), respectively. Major diagnosis included intracranial tumour 60(34%), bacterial …