Comparative studies of salivary and blood sialic acid, lipid peroxidation and antioxidative status in oral squamous cell carcinoma [OSCC]

Oral squamous cell carcinoma [OSCC] is considered to be a serious life threatening issue for almost two decades. The objective of this study was to evaluate the over production of lipid peroxidation [LPO] byproducts and disturbances in antioxidant defense system in the pathogenesis of oral cancer. Lipid peroxidation and antioxidant status in OSCC patients were estimated and compared the sensitivity and specificity of circulating biomarkers [MDA, Sialic acid, Catalase, SOD, GSH and Neuraminidase] with B-2 microglobulin [B-2MG] at different thresholds in blood and saliva using receiver operating characteristics [ROC] curve design. Our results showed that the levels of MDA and Sialic acid were significantly increased in plasma of OSCC patients as compared to healthy subjects whereas antioxidant level was significantly decreased. ROC analysis indicated that MDA in saliva is a better diagnostic tool as compared to MDA in blood and B-2MG in blood is better diagnostic marker as compared to B-2MG level in saliva

Endoscopic third venfri'cufosfomy for obstructive hydrocephalus

To determine the success rate of endoscopic third ventriculostomy [ETV] for treating obstructive hydrocephalus. Cross-sectional observational study. The Neurosurgery Department of PGMI, Lady Reading Hospital, Peshawar, from May 2010 to November 2011. Patients with Obstructive hydrocephalus due to aqueductal stenosis, tectal and non-tectal tumour and already shunted patients for obstructive hydrocephalus presented with blocked shunt were included in the study. Patients with congenital hydrocephalus and secondary to meningitis were excluded. Endoscopic third ventriculostomy was performed. Success, complications and mortality was noted. Data was analyzed by descriptive statistics using SPSS software version 17. There were 155 patients including 72 males and 83 females with ratio of 1: 1.33. Success rate was 71%. Indication of surgery was obstructive hydrocephalus due to aqueductal stenosis, posterior fossa tumour, brain stem and CP angle tumour. Complications were seen in 18 patients including mortality in 3 patients. ETV is effective, safe and successful procedure in patients with obstructive hydrocephalus. It may be used as replacement procedure of ventriculo-peritoneal shunt as initial line of management in selected patients

audit of the mortality due to severe head injuries in a neuro-surgical intensive care unit

To analyze the data of patients died in neurosurgical intensive care unit due to severe head injuries. This retrospective study was conducted in neurosurgical intensive care unit in Lady Reading Hospital, Peshawar from January to December 2007. The Clinical record of all the patients presenting with severe head injuries, who then expired in neurosurgical intensive care unit was collected. The record was analyzed accordingly for discussion and recommendations. Out of 112 patients, majority were young adults [n=64, 57.14%] followed by children [n=34, 30.35%] and elderly [n=10, 8.92%]. Road traffic accidents were the major cause of presentation [n=75, 66.96%] followed by history of fall [n=23, 20.53%] and fire arm injuries [n=13, 11.60%]. The correctable surgical causes were present only in 18 patients [16.07%] and the majority 94 [83.92%] were given conservative management. Among the non-surgical cases, both ventilatory therapy in 7 [6.25%] and tracheostomy in 39 [34.82%] patients failed to change the outcome. Road traffic accident was the major contributor in the mortality in patients presenting to neurosurgical intensive care unit. Most involved were young adults

Frequency of causes of ventriculo-peritoneal shunt failure in hydrocephalus patients

To analyze ventriculo-peritoneal shunt [VP shunt] failure cases in hydrocephalic patients, in a tertiary care hospital. This descriptive study was carried out in the Department of Neurosurgery Lady Reading Hospital Peshawar, from June 2009 to May 2010 [one year].The medical record of all cases operated in last one year was checked from record room. Documentation was done according to proforma designed indicating age, sex, clinical features, investigations with findings on X-rays, CT and MRI and per operative findings. Complications related to upper end, lower end and shunt track were noted. Data was analyzed to assess the causes for shunt failure in hydrocephalus patients. A total of 56 patients were included in this study. There were 43 children and 13 adults. Among children, 26 were males and 17 were females while in adults, 5 were males and 8 were females. Out of these, 28 patients were having blocked shunt, 20 cases with infected shunt, 6 patients had eroded and 2 patients displaced shunt. Although shunt surgery is a common procedure performed for hydrocephalus, different complications were associated in our study where shunt failure was mainly due to shunt dysfunction, infection or breakage of shunt system. Complications were more with upper end. Infection was common in pediatric age group

Experience with 349 cases of intradural spinal tumors at Lady Reading Hospital Peshawar

To analyze the variables of patients operated for intradural spinal tumors at Lady Reading Hospital Peshawar. An analytical descriptive study Place and duration of study: Department of Neurosurgery Lady Reading Hospital Peshawar, from April 2003 to March 2010 [7 years]. Medical record of patients with spinal tumors were revised and patients suffering from intradural spinal tumors were searched. There were total 572 cases of spinal tumors, of which 349 had different intradural lesions. Their clinical features, radiological reports, peroperative findings and histological reports were analyzed in different aspects. Of the total 349 patients with intradural spinal tumors 201 were males and 148 female, with male to female ratio of almost 1.4:1. Age of the patients ranged between 2 years to 77 years, with median of 39.2 years. The common clinical features were backache, leg weakness, parasthesia and poor sphincters. Magnetic Resonance Imaging of the spine was the main [309 cases] diagnostic tool along with plain x-ray and myelography in limited cases [35 cases]. CT myelogram was done only in 5 cases. Dorsal spine was involved in 62.5% cases, lumber and cervical spine in 25.5% and 12% patients respectively. Neurofibroma was the commonest [51%] intradural spinal tumor, we also had meningioma in 30.66%. Other intraspinal lesions were dermoid, lipoma, ependymoma, astrocytoma, tuberculoma, arachnoid and hydatid cysts. Of all the spinal tumors intradural are more common [61%] than extradural. Neurofibroma and meningioma constituted majority of cases belonging to extramedullary intradural group, while ependymoma and dermoid were common intramedullary tumor. 3rd and 5th decade of life were the common age group for both intramedulary and extramedullary tumors. Intramedullary tumors were common in 3rd decade of life

Significance of trigger point in trigeminal neuralgia

To know the significance of trigger point as an indicator of aberrant vascular loop in patients with trigeminal neuralgia. Material and This study was performed in the department of neurosurgery Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from May 2003 to April 2006. Patients with clinical history of trigeminal neuralgia were admitted for micro vascular decompression. Detailed clinical history, along with clinical findings particularly side and site of trigger point of trigeminal pain were documented. Imaging studies like CT, MRI were done in these cases and per-operative findings were documented after surgical procedure. Forty-three patients with trigeminal neuralgia were operated for micro vascular decompression during the study period. There were 24 [55.8%] males and 19 [44.2%] females with ratio of 1.2: 1, and a mean age of 53 years. Duration of symptoms was from 3 to 7 years. A total of 43 cases of trigeminal neuralgia were recorded. Right side was involved in 19 and left side in 24 cases. Peri-oral and peri-nasal trigger point was observed in 39 [90.7%] cases during examination while offending arterial loop was seen in 35 [81.4%] cases per-operatively, thick arachnoid adhesion in 4 [9.3%] cases and veins in 4 [9.3%] cases. Trigger point during clinical examination indicated the presence of offending arterial loops in patients with trigeminal neuralgia

Efficacy of fine needle aspiration cytology in the diagnosis of breast lumps

To determine the sensitivity and specificity of fine needle aspiration cytology [FNAC], by comparing the results with excision biopsy. This observational and comparative study was conducted in Surgical B Ward of Khyber teaching hospital Peshawar, Pakistan from August 2002 to May 2003. A total of 50 women, who had a clinically palpable breast lump were subjected to concurrent FNAC and excision biopsy. Out of 12 malignant lesions on excision biopsy, FNAC correctly diagnosed 9, and 2 were diagnosed suspicious, and the remaining one was misdiagnosed as non malignant. So false negative being 1/12 [8.3%]. Of 38 benign cases on excision biopsy, FNAC diagnosed correctly duct ectasia 3, tuberculosis 2, and galactocele 1, while out of 22 fibroadenoma, FNAC diagnosed 20, and 2 were diagnosed as unsatisfactory. Ten cases diagnosed as fibrocystic disease on excision biopsy, FNAC picked only 6 cases correctly. The one case diagnosed on FNAC as fibrocystic disease, turned out to be malignant on histology. The remaining 4 cases of fibrocystic disease diagnosed on histopathology were either reported as unsatisfactory [3 cases] or suspicious [1 case] on FNAC. The sensitivity and specificity of FNAC was 91.66% and 96.96% respectively. Breast cytology was an effective and rapid method of diagnosis of breast diseases. It helps in deciding which patient needs early open biopsy. A negative cytology does not exclude the possibility of malignancy, as there was a false negative rate of 8.3%

Sentinel lymph node biopsy in the management of axillary involvement in breast cancer

To know the efficacy of sentinel lymph node biopsy in the management of axillary involvement in breast cancer. Material and This study was conducted in Surgical "A" unit of Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. A total of 30 patients with operable breast cancer diagnosed on fine needle aspiration cytology [FNAC] and clinically non-palpable lymph nodes in the axilla were studied. While on the operation table for modified radical mastectomy, one ml of sterilized solution of methylene blue was injected subdermally under the areola of the diseased breast. After 5-10 minutes sentinel lymph nodes were harvested via a small incision over the axilla, marked as blue nodes or blue lymphatics leading to a node. All the patients were females with mean age 45 +/- 13.48 years. Mean tumor size was 3.7 +/- 1.60 cm. The tumor was present in upper and outer quadrant in most [63.33%] of the patients. No complications were noted related to the procedure. The sensitivity of the method was found to be 85.7% and false negative rate was 7.1%. Sentinel lymph node biopsy with methylene blue is safe and cheaper and accurately predicts the axillary lymph node status in most of the patients

Morbidity and mortality in patients with colostomies - A study on 50 cases

To discuss the morbidity and mortality associated with the fashioning of colostomy and its closure. Material and This study was conducted in the Surgical 'A' unit of Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. A series of 50 consecutive patients with colostomy for various indications were managed in surgical 'A' unit and emergency departments of LRH. Fire arm injuries [34%] were the most common indication of colostomy, followed by blunt trauma [26%], anorectal malignancy [14%] and sigmoid volvulus [12%]. Total of 20 patients suffered from 24 stoma related problems. The hospital stay was between 5-46 days. Thirty six of these patients under went colostomy closure with an average hospital stay of 11 days. There was one death. Careful stoma formation minimizes risks of complications associated with it. In our study there was no difference between single layer and double layer closure