Primary melanotic schwannoma with typical histology

We present a case of a 17-year male with a soft tissue density spreading from the neural foramina [T3] of the spinal cord and involving the right upper thoracic cavity. We managed the patient through surgical intervention and resected the complete tumor. Gross definition and microscopic findings of the resected tissue revealed the definitive diagnosis of melanotic schwannoma. The histological characteristics in this case were very specific and harbour an important diagnostic clue for this rare disease. Malignant melanoma was ruled out on the basis of histological findings. The patient recovered completely and was healthy on one-year follow-up

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

Successful treatment of giant left subclavian artery pseudoaneurysm abutting the arch of the aorta and descending aorta

A 28-year-old woman presented with 3-month history of fever of unknown origin and progressively increasing cough. She was diagnosed with pulmonary tuberculosis on bronchial lavage cultures. A chest X-ray performed on follow-up showed a new opacity in the left apical area of the chest. Computed tomography scan of chest showed a large 10 cm pseudoaneurysm of the left subclavian artery 1 cm from its take off from the arch of the aorta. The pseudoaneurysm was approached through a left posterolateral thoracotomy and opened following a proximal and distal control. A 3 cm longitudinal defect was identified in the subclavian artery within its intrathoracic portion. This was debrided and repaired with an autologous pericardial patch. The patient had an uneventful recovery and remained well on follow-up

Delayed presentation of forgotten thyroid goiter - 25 years after thyroidectomy

Forgotten goiter is a rare occurrence [2 - 16% of retrosternal thyroid cases] that depicts recurrence of retrosternal thyroid mass due to growth of remnant thyroid tissue overlooked during an initial thyroidectomy. The patient is a 59-year female who presented with dyspnea and stridor 25 years after total thyroidectomy. She was diagnosed as having a mediastinal mass on radiographic imaging. There were only localized pressure symptoms due to mass effect. The mass was excised employing an extra-cervical approach and using a partial sternotomy. The profuse extension of thyroid tissue, adherent to vital structures in the thorax and the extra-cervical thyroidectomy was a novel experience. The mass was completely excised and the patients symptoms alleviated after the surgery. The patient recovered without any complications and there was no recurrence at 1 year of follow-up

Frequency of acute bacterial meningitis in children presenting clinically as first simple febrile seizures under 6 years of age

Objective: To determine the frequency of acute bacterial meningitis in children [6 months to 6 years] presenting with first episode of simple febrile seizures

Study Design: A Cross sectional study

Place and Duration: Rawal Institute of Health Sciences Islamabad over a period of one and half year from 1st August 2013 to 31st January 2015

Methodology: One hundred and fifty patients of both genders aged from 6 months to 6 years were included who presented with fever and first episode of seizures but with no definite signs of meningitis. Sample of cerebrospinal fluid was sent to laboratory for cerebrospinal fluid [CSF] routine examination including cell count, protein and glucose content of CSF

Results: There were 103 males and 47 females with mean +/- SD of age 2.31 +/- 1.65 years. The mean +/- SD of protein, glucose and TLC were 53.89 +/- 51. Mg/dl, 69.27 +/- 22.51 mg/dl and 4.91 +/- 4.37/mm3 respectively. Among 150 children, 14 children had an acute bacterial meningitis

Conclusion: Meningitis have been documented in significant number of children with fever and seizures. Children less than six years of age is a major group at risk and Lumbar Puncture [LP] should be performed in every case of febrile seizures in this age group

In hospital outcome of patients undergoing coronary endarterectomy: comparison between off-pump vs on pump CABG

Due to advancement of non-surgical methods of coronary revascularization the patients referred for surgery have extensive and complex coronary anatomy. Patients with diffuse atheromatous coronary artery disease required coronary artery reconstruction or coronary endarterectomy [CE]. Coronary endarterectomy on beating heart needs skill and better surgical technique. Coronary endarterectomy along with coronary artery bypass grafting [CABG] done on beating heart is compared with coronary endarterectomy done by using conventional CABG technique. Seven hundred and ninety five consecutive patients underwent CABG from January 2006 to March 2007 in a prospective randomized trial at cardiac surgery department, Punjab Institute of Cardiology, Lahore; out of these 115 patients underwent coronary endarterectomy [CE] and were included in this study. Coronary artery bypass grafting was performed in 115 patients. Seventy two [62.6%] were in group A on-pump and 43 [37.39%] were in group B off-pump. Mean age in group A was 55.68 +/- 1.06 and 52.63 +/- 1.40 in group B. Sixty six male and 6 female were included in group A, 40 male and 3 female patients were in group B. In-hospital mortality among patients undergoing CABG was 5.6% in on-pump group and 2.3% in offpump group [p=0.649], the duration of post-operative mechanical ventilation in on-pump was 6.78 +/- 9.34 hours and 5 +/- 4.0 hours in off-pump group [p=0.060], 66.7% patients in on-pump and 58.1% patients in off-pump group required blood transfusions, Intra-aortic balloon pump [IABP] was required in 5.6% of the patients in on-pump group. Other factors included, smoking 26.4% in on-pump and 41.9% in offpump group [p=0.01], Intensive care unit [ICU] stay was statistically significant 4 +/- 3 in on-pump group and 4 +/- 2 in off-pump group [p=0.02], and drain in on-pump group was 455 +/- 208 ml and 540 +/- 370 ml in off-pump group [p=0.01]. Coronary endarterectomy [CE] has higher post-operative morbidity and mortality but the post-operative outcome after the procedure on either technique is comparable and CE is feasible on off-pump technique as well

Prevalence of malignancy in resected specimen of patients operated for benign nodular goitre

To determine the frequency of malignancy on histopathology amongst resected specimen of thyroid gland in patients, who had no evidence of malignancy pre-operatively on clinical grounds and investigations. A retrospective descriptive study carried out from Jan. 2000 to Dec. 2005. Surgical Unit one, Civil Hospital, Karachi. A total of 190 patients who were operated for benign nodular thyroid disease during the study period; 100 cases had multinodular goitre and 90 solitary nodules. Biodata, clinical features, investigations, diagnosis, details of surgery, complications and histopathology reports of all the patients were reviewed and analyzed. Amongst the 190 patients the mean age was 33.42 +/- 12.4 years [range l7-45 years], while the male: female ratio was 1:6.6. Seven [3.6%] cases were found to be malignant on histopathology, with a frequency of 3% [3/100] amongst multinodular cases and 4.4% [4/90] amongst solitary nodules. Prevalence of malignancy in multinodular goiter does not differ significantly from solitary nodules. Hence, multinodularity should no longer be considered as an indicator of benign disease. Both varieties of nodular goitres should be considered for surgery even if there is no suspicion of malignancy

Risk factors stratification in 100 patients of acute stroke

To find out the relative frequencies of various risk factors associated with first ever stroke. This prospective observational study was conducted in medical B unit of the Department of Medicine, Post Graduate Medical Institute, Government Lady Reading Hospital, Peshawar, Pakistan from March 2001 to January 2002. A total number of 100 patients, 64 males and 36 females, with first ever stroke were included in the study. A questionnaire was designed comprising detailed history, general physical and neurological examinations. The association of different risk factors with stroke was studied. The ages of patients ranged from 17 to 100 years with mean age of 59 years +11.63 years standard deviation [SD]. Cerebral infarction constituted 68%, intracerebral hemorrhage 31% and subarachnoid hemorrhage 01%. Hypertension [HTN] was the most common risk factor [60%] followed by diabetes mellitus [DM] [28%], hyperlipidemia [28%], smoking [22%], ischemic heart disease [IHD] [18%], atrial fibrillation [12%] and history of oral contraceptive use [10%]. Main risk factors for stroke are Hypertension, Diabetes mellitus, Hyperlipidemia and Smoking. Stroke can be prevented by modification of these risk factors. There is a genuine need for health education programmes on stroke and their mortality