Evaluation of canalis basilaris medianus using cone-beam computed tomography

The aim of this report is to present two cases of canalis basilaris medianus as identified on cone-beam computed tomography (CBCT) in the base of the skull. The CBCT data sets were sent for radiographic consultation. In both cases, multi-planar views revealed an osseous defect in the base of the skull in the clivus region, the sagittal view showed a unilateral, well-defined, non-corticated, track-like low-attenuation osseous defect in the clivus. The appearance of the defect was highly reminiscent of a fracture of the clivus. The borders of osseous defect were smooth, and no other radiographic signs suggestive of osteolytic destructive processes were noted. Based on the overall radiographic examination, a radiographic impression of canalis basilaris medianus was made. Canalis basilaris medianus is a rare anatomical variant and is generally observed on the clivus. Due to its potential association with meningitis, it should be recognized and reported to avoid potential complications.

Posterior interosseous neuropathy during appendicectomy

Intraoperative and anesthesia related radial nerve injuries have been reported in different surgical procedures and various mechanisms proposed for its occurrence. The present case resulted from a procedure of a short duration of 45 minutes. Understanding the pathophysiology of these events and correction of the patient's posture during surgery can prevent such complications

Vacuum assisted closure of laparostomy wounds a novel technique

Management of a laparostomy wound is contentious. Specific pathologies like severe intraabdominal sepsis, trauma requiring damage control, abdominal compartment syndrome, staged abdominal repair and other complex abdominal pathologies can be managed with a novel technique of Vacuum Assisted Closure dressing. This device applies sub-atmospheric pressure that leads to reduced bowel wall edema, bacterial count and inflammatory burden found in open abdominal wounds. This leads to a reduced need for frequent dressing changes, maintaining intact skin and improvement in fluid management. Controlled clinical studies are needed to establish the safety and effectiveness of this treatment strategy. We present our experience with this technique suggesting it to be safe and effective. A brief outline of the working of Vacuum Assisted Closure dressing is also presented

Simple repair is sufficient for most injuries to the duodenum - a case series of 23 patients

Duodenal injury is the most important hollow viscus injury in the abdomen. The study analysed the outcome of duodenal injuries at the unit. Prospectively collected data on a case series involving 23 patients over 3 years. It involved demographic details, part of duodenum injured, injury severity according to the AAST, injury-operation time lag, mode of repair, and the extent of significant associated injuries. M:F ratio was 4.75:1. Mean age 33yrs. Patients with non-perforating injury were excluded. All were operated by a senior registrar or senior. 7/23 were blunt, 13/23 firearm and 3/23 stab injuries. D2 was involved in 87%. Injury severity was graded according to AAST [American Association for Surgery of Trauma]. 17/23 were Grade II/III, 3 Grade IV and 3 Grade V injuries. Four had injury-operation lag of >18hrs. Two injuries were missed. All injuries up to Grade IV had simple repair. Two of them had T-tube duodenostomy. None had pyloric exclusion. Complex repairs wer e required for 3/23 patients. Five patients died, as a result of associated insults. One delayed repair developed duodenal fistula. Intra-abdominal abscess, septicaemia and wound dehiscence were seen in two patients each. Duodenum-related mortality was zero. Adverse prognostic factors towards morbidity were injury severity >GIII and injury-operation lag >18hrs. The mortality was related to associated injuries. Primary repair is sufficient for most non-resectional duodenal injuries

Day case laparoscopic cholecystectomy

Day case laparoscopic cholecystectomy [DC-LC] is being practised in the USA and at sporadic centres in the UK including our department. The aim was to evaluate the initial experience of DC-LC at the unit. Prospectively collected data was analysed retrospectively. The case notes of all patients were retrieved from the medical records and reviewed individually. Standard laparoscopic cholecystectomy was performed. All patients had anti-DVT prophylaxis [pneumatic compression and enoxaparin], per-operative antibiotic, oro-gastric tube, paracetamol suppository and local anaesthetic to all wounds. They were discharged the same day. The end point was 6-week follow-up [86% overall]. Over a 32-month period, 164 consecutive patients with symptomatic cholelithiasis and ASA score of III or less were included. M:F was 1:5 and median age 43y. There were two conversions. The direct admission rate [DAR] was 26/164 [14%]. The indication for direct admission included observation alone [7/26], wound pain [6/26], nausea [3/26], suction drain [2/26] and operation in the afternoon [2/26]. Six [3.6%] required re-admission. One had a cystic artery pseudo-aneurysm presenting with colonic bleeding and anot her with an injury to CBD. One had post-op mild pancreatitis and three had wound pain and bruising. DC-LC is safe and feasible in non-acute patients with symptomatic cholelithiasis

Adult intussusception - asurgical dilemma

Adult intussusception is rare. It is expected to be found in 1/30,000 of all hospital admissions, 1/1300 of all abdominal operations, 1/30'1/100 of all cases operated for intestinal obstruction and one case of adult intussusception for every 20 childhood ones. The authors encountered 4 cases of adult intussusception. M:F ratio was 1:1. Mean age was 47years. Small bowel obstruction was documented in all. They were investigated by radiographs, ultrasound exam, barium studies, endoscopy and CT scan. All however were diagnosed at operation although some pre-operative suspicion was raised in one case. All had a laparotomy. Two were ileo-ileal and two ileo-caecal intussusceptions. One was chronic intussusceptions and three sub-acute. One intussusception had a malignancy [lymphoma] as a lead point. Two had a submucous lipoma at the apex. In an interesting case the suture knot from a recent small bowel anastomosis [2-3 weeks prior] was forming the lead point of the intussusception! The 2 ileo-ileal intussusceptions had segmental resection. Right hemicolectomy was done for the 2 ileo-caecal cases. 'Target lesion' and leumen-within-leumen were the CT hallmarks on review. Retrospective barium enema review failed to show the intussusception. This may suggest the intussusception may have been recurrent or chronic. All 4 recovered uneventfully and remained well. One patient was referred for chemotherapy for intestinal lymphoma. Adult intussusception remains a rare cause of abdominal pain. The treatment almost always is surgical

Role of thyroid scan and FNAC in evaluation of solitary thyroid nodule

The study was carried out from May 1990 to November 1995 in the departments of surgery and pathology of a teaching hospital. The role of thyroid radioisotope scan and fine needle aspiration and cytology [FNAC] was studied in 172 patients with clinically solitary thyroid nodule [STN], all of whom underwent surgery. These patients were divided into two groups, Group A [72 patients] which underwent thyroid scan without FNAC and Group B[100 patients] which was subjected to both. Thyroid scan turned out to be dispensable except in hyperthyroidism where it had 100% sensitivity, specificity and accuracy in diagnosing hyperfunctioning thyroid adenoma. FNAC reaffirmed its superior value by low false negative [1.4%], high specificity [97.5%] and accuracy [96.5%]. FNAC however is liable to be overruled by clinical data especially when dealing with the cytologically "indeterminate" subgroup

Surgical affections of the duodenum

From April, 1995 to July, 1997, 18 consecutive patients with surgical diseases of the duodenum excluding perforated duodenal ulcer requiring an omental patch were managed in West Surgical Unit of Mayo Hospital, Lahore. Trauma [blunt or penetrating] was the most common affection. Time lag between injury and operation was the most important factor prognostically followed by the severity of injury. There was a random mortality of 33% rising to 65% after formation of duodenal fistula. T-tube duodenostomy, sump drainage and TPN may be the pillars of management of late, extensive or complicated duodenal surgery. Of the six patients who died in all, five of them did so due to trauma. "Treatment policies" should be overruled by individual case assessment where required

Piroxicam for postoperative analgesia

Analgesic effect of parenteral piroxicam in post operative pain was evaluated in 86 subjects undergoing general surgical operations in 1989-90. This drug gave satisfactory results in 75.6% of the patients. No untoward effects were noted except some local pain at the site of injection. The average time of onset of analgesia was 24.5 minutes with the duration of complete analgesia of 24 hours in 66% of the cases who had satisfactory results. We conclude that Piroxicam is a safe efficient and long acting drug for the post operative pain

Hydatid cyst

Hydatid disease is a universal problem more so in the sheep grazing areas of the world. It is caused by the larva of a tapeworm. Echinococcus granulosis. Liver gets involved more frequently though no part of the body is immune to this disease. Old surgical treatment has high recurrence which has been minimised by simultaneous administration of new drugs of benzimedazole group. While given alone, these benzimedazole compounds give a good response in the beginning but complete cure is unpredictable. These drugs are a good tool in the hands of a surgeon which should be given pre-operatively as well as post-operatively in every case of hydatid cyst

Hepatic injuries due to blunt abdominal trauma

Sixty-six cases of blunt abdominal trauma have been studied in two years out of which 15 were with the liver injury. Commonest cause of injury had been due to the bamboos of the Donkey Carts and the Horse Carts struck against the motorcycle rider. Overall mortality due to liver injury has been 13.3%

Aetiological factors in breast cancer in Pakistani women

A preliminary report of 101 cases of breast cancer treated by the authors in 8 years is presented. Breast cancer occurs more commonly in low socio-economic group, in young females, in the women who had their first delivery earlier than general population and had late menopause, multiparous women suffer more often from the breast cancer in our study especially those women who breastfed their children more and for the longer period. The authors have postulated that our cancers in Pakistani women are different from the West, the a etiological factor might be the different genetic origin and having more prolactin receptors in Pakistani women with breast cancer

Typhoid perforation

Typhoid fever still remains a major clinical problem in tropical countries. Intestinal perforation is a common and serious complication of typhoid fever and carries high mortality. Diagnosis of typhoid perforation depends upon more on a typical history rather than investigations. The management of typhoid perforation has been a subject of controversy for a long time. Old conservative management has been replaced by the operative treatment and resection of the involved intestine is the treatment of choice for typhoid perforation

Hydatid cyst treated by benzimedazole compounds

Nine cases of hydatid cyst treated by the authors by the benzimedazole compounds with or without surgery are reported. It is good tool in the hands of a surgeon. If given alone initially it gives a dramatic effect but complete eradication is unpredictable, so it is no alternative to the surgery