Solitary pulmonary nodule a rare case

A middle aged man presented with a solitary pulmonary nodule. He had a diagnostic dilemma as the CT guided FNAC was inconclusive. The frozen section exam reported it to be malignant so a lobectomy was performed for this lesion. The final histopathology report confirmed it to be a very rare tumor of extra skeletal synovial sarcoma

Frequency of anomalies associated with chest deformity in physically fit male candidates reporting for military recruitment

To identify the frequency of anomalies associated with chest deformity in physical fit male candidates reporting for military recruitment. Observational. Department of Thoracic Surgery, CMH Rawalpindi from 1[st] Jan 2008 to 31 Dec 2011. Normal healthy physically fit young adolescents being recruited for army were scrolled and those exhibiting chest deformity were isolated and subjected to evaluation. Convenience sampling was carried out. All cadidates of chest wall deformity thereafter underwent a thorough physical checkup, pulmonary function tests and echocardiography. A total of 3735 candidates of chest deformity reported at our center for evaluation over this duration. Single deformity patients 3380 [90.5%], mixed deformity patients 355 [95%]. We found that none of the candidates had any derangement of the lung function tests or electrocardiographic abnormality despite their deformity. However echocardiography detected an abnormality in 161 [4.3%] individuals who were otherwise asymptomatic. Chest deformity should be excluded before physical tests, in all the male candidates reporting for enrolment. If slightest of doubt exists that a candidate has chest deformity then he should be evaluated with echocardiography to exclude cardiac abnormality. Although the associated frequency is only 4.3% but this can subsequently result in a grave event like death

experience of corrective surgery of 37 cases of chest deformity

The study was carried out to ascertain the cosmetic outcome of corrective surgery for pectus deformity and to determine the morbidity associated with it. Quasi-experimental study. The study conducted in CMH Rawalpindi and CMH Quetta from 2007 to 2012. Total number of cases operated for chest deformity was 37. Modified Welch procedure with sub perichondrial resection was done with a strut of prolene mesh in a majority of exacavatum repairs and k wires in few. Pectoroplasty was subsequently carried out in all patients. Midline incision was made in a majority of patients. Subjmammary incision was made in some female patients with a lower deformity due to better cosmetic outcome. Inclusion criterion was patients with chest deformity without any cardiac and spinal deformity. Age range was between 4 years to 12 years with mean age of 8 +/- 2.3 years. twenty four [65%] deformities were of excavatum and 9 [24%] were of carinatum type. Four [11%] cases were of unilateral asymmetrical deformity. Mean operating time was 95 +/- 11 minutes. Transfusion was required in only 1 [3%] o the cases. There was no perioperative mortality. Four [11%] patients had formation of seroma and 3 [8%] developed pneumothorax which was aspirated without placement of chest tube. Two [5%] had surgical site infection. Fifteen [41%] patients were satisfied and 21 [57%] reported excellent results. Chest deformity correction is safe and effective procedure with acceptable cosmetic results. It is easy to perform and improves self image of the suffering individual

Frostbite during Kashmir conflict

The aim of this study was to evaluate different modalities of management of cold injuries including gradual re-warming, administration of vasodilators, and surgical intervention. A total number of 2564 cases of frostbite were treated during December 1988 to March 2003, mostly at local hospitals of Muzaffarabad, Azad Kashmir. The frost bitten cases were refugees who suffered frostbite during their movement across the line of control alongside the Himalayan mountains over 12000 feet altitude above sea level. Management of these patients involved multidimensional approach with prudent strategy [if frost bitten in January amputate in June.] The patients were categorized into four groups depending upon the severity of injury. All the patients were gradually rewarmed. The severally injured [100%] and moderately injured patients [50%] were administered 5 mg nifidepine, 5 ml 1% lignocain in femoral vessel, alongwith administration of systemic antibiotics accompanied by limited wound debridement and wound dressing. Patients were watched till clear demarcation line appeared between the live and dead tissue. Sequelae of cold injuries and the rate of complications reduced by adopting this management policy