Simultaneous off-pump coronary artery bypass grafting [CABG] and right upper lobectomy for critical left anterior descending artery [LAD] stenosis and aspergilloma

58 years old man with a history of ischemic heart disease presented with massive hemoptysis. On evaluation with CT chest, he was found to have a large aspergilloma in the left upper lobe. Coronary angiogram was also performed for increasing episodes of angina which showed critical 100% ostial left anterior descending [LAD] stenosis. In view of aspergilloma and hemoptysis, patient could not have conventional open heart surgery and heparinization. Therefore, coronary artery bypass grafting [CABG] was performed on beating heart and this was followed by left upper lobectomy at the same time. Patient had an uneventful post-operative course

Imminent pathology in microvascular decompression for idiopathic trigeminal neuralgia

Objective: to know about the impending pathology in microvascular decompression for idiopathic trigeminal neuralgia

Methodology: this was a prospective observational study conducted in the Department of Neurosurgery, Lady Reading Hospital Peshawar, from 20[th] August 2012 to 25[th] august 2013. The clinical and the operative records of the patients were noted and demographics such as the age, sex, side of the lesion as well as the per-operative impending pathology i.e. compression by an artery, vein or distortion by adhesions or a combination of them compressing upon the trigeminal nerve root was recorded on a predesigned proforma. All patients undergoing surgery for idiopathic trigeminal Neuralgia were included in the study. Patients who had trigeminal neuralgia secondary to a mass lesion were excluded from the study. The data was expressed in percentages and was analyzed through SPSS version 16

Results: total of 55 patients in the study period fulfilled the criteria. There were 28 males and 27 females with a male to female ratio approaching 1:1. The age range was from 28 to 73 years with a mean age of 54.6 years. In 56.4% the pathology was right sided and in 34.5% it was left sided while in 9.1% it was bilateral [operated unilateral at the time]. The impending pathology was compression by an artery in 76.6%, by a vein in 21.6% or purely by adhesions in 1.6% of cases

Conclusion: compression by an artery is the most common pathology en-countered in the microvascular decompression for trigeminal neuralgia

Frequency and pattern of ocular emergency in district Swabi

Objectives: To determine the frequency and pattern of ocular conditions presented to the ophthalmic casualty room at a secondary care hospital in District Swabi

Study design: Descriptive Cross- sectional study

Place and duration of study: Eye Department of District Head Quarter Hospital, Swabi over a period of two years from 1[st] March 2010 to 28[th] February 2012

Methodology: Nine hundred and Sixty patients who presented either with acute ocular condition or ocular injury through the outpatient or emergency routes were included in the study. The patients demographic data, detailed history, examination and final diagnosis were recorded in a questionnaire. Statistical analysis was based on age, gender, presentation, ocular features and diagnosis

Results: In our study male were 57.8% [n=555] and female were 42.2% [n=405]. Five hundred and thirty Six[55.8%] patients were in traumatic group while four hundred and twenty four [44.2%] patients were in non-traumatic group. Infective conjunctivitis [62.2%], Stye [12.6%], corneal ulcer [10.10%], retinal vascular disease [1.2%], acute post operative endophthalmitis [1.1%], acute uveitis [2.6%] and acute glaucoma [1.0%] were the leading causes in the non-traumatic group. In traumatic group 94.2% patients were non-infected while 5.8% were infected. In non-infected patients, both globe and extra globe injuries [44.6%], extraglobe injuries [23.8%] and globe injuries[23%] were present. In globe injuries, open globe injuries [OGI] were 39.7%.Post traumatic endophthalmitis was reported in 54.8% of traumatic ocular infection. Mechanical injuries [70.7%] were leading the list of traumatic ocular emergency. Work place [31.5%] was the most common place for ocular trauma

Conclusion: Common non- traumatic ocular emergency were Infective conjunctivitis, infective keratitis, acute glaucoma and acute uveitis. Females mostly middle age housewives had non-traumatic ocular emergencies. Traumatic ocular emergency commonly reported were both globe and extra globe injuries and open globe injuries. Males mostly young workers had traumatic ocular emergency. Mechanical injuries mostly the result of occupational accidents in workers