Angiographic anatomy of the coronary sinus venous system in adult Kashmiri population

Background: Knowledge of the coronary sinus venous anatomy is an important factor because of its relevance in electrophysiological procedures such as chronic resynchronisation therapy, mapping and ablation of arrhythmias. The advent of advanced invasive and interventional cardiac treatment and management tools for common disorders like heart failure has made understanding of coronary sinus anatomy necessary. The aim was to study the angiographic anatomy of coronary sinus and its tributaries in adult Kashmiri population and provide anatomical basis for cannulation of coronary sinus and its tributaries.Methods: Authors analysed the levophase angiogram of 150 subjects undergoing routine coronary angiography in the right anterior oblique and left anterior oblique view with the necessary caudal or cranial angulations.Results: The coronary sinus was formed by the union of GCV+LMV in 93.3% of subjects and by the union of GCV+PLV in 6.7% of subjects. The GCV and the MCV were the most consistent tributaries present in all the subjects. The mean length of CS was 71.70±9.7 mm when it was formed by GCV+LMV and 70.18±14.98 mm in case of GCV+PLV. The diameter of the CS ostium was 8.48±1.21mm. The mean diameter of GCV was 2.90±1.24 mm, MCV was 2.76±1.08 mm, LMV was 2.23±0.51 mm and the PLV was 2.25±0.53 mm. The opening angle of GCV was obtuse in all the cases, MCV drained at an acute angle in 62% subjects and LMV draining angle was acute in 31.33% cases. The valve of the CS was present in 32.7% subjects and absent in 67.3% subjects. The tortuosity was absent in 75.3%. The distance between CS ostium and the ostium of the vein ideal for lead implantation was between 10-40 mm in 76% subjects.Conclusions: The basic knowledge of coronary sinus and its tributaries play a significant role during electrophysiological procedures. The data obtained from the study can be utilised by interventional cardiologist for cannulation of coronary sinus in Kashmiri population.

New cases and types of leprosy in Interior Sindh: an analysis of 3 years [2012-2014]

Objective: To evaluate the new cases and clinical types of leprosy in interior Sindh

Methods: Data analysis and evaluation of 3-year record of leprosy centers/clinics in Interior Sindh

Results: Of total 238 new registered cases, 98 [41%] were diagnosed after a delay of 1 year. The types of disease found were tuberculoid 59 [25%], borderline tuberculoid 100 [42%], borderline 13 [5%], borderline lepromatous 53 [22%] and lepromatous lepromatous 13 [5%] cases. Multibacillary cases were 179 [75%] and paucibacillary 59 [25%]

Conclusion: The 3-year analysis of Interior Sindh shows endemic regions of leprosy in Pakistan which will help in devising strategy for an effective leprosy control program

Discectomy in single level lumbar disc disease

There is a controversy regarding the treatment of lumbar disc herniation. Most of patients with lumbar disc herniation and radiculopathy improve with rest and medicine. Lumbar disc surgery gives rapid relief to the patients with severe root pain in legs. This study was conducted to see the risks and benefits of surgery in single level symptomatic lumbar disc disease. This prospective study was conducted in Department of Neurosurgery, Liaquat University of Medical and Health Sciences, Jamshoro during 2007-2009. Patients with severe leg pain, positive straight leg raising, and confirmed disc extrusion on imaging were included and conventional open discectomy was performed. Patients were followed up for one year after the surgery. Forty-five patients were operated for lumbar root pain due to a single disc. Most common disc involved was L4-5 and discectomy was performed. Recurrence of disc occurred in 4 patients. Proper selection of patients is necessary for excellent postoperative results in back surgery. Failed back surgery continues to rise with high rate of lumbar spine surgery as many patients are selected inappropriately.

Inaugural hernia repair with poly-propylene darn: safe and cost-effective

To know the safety and cost-effectivity of inguinal hernia repair with prolene darn in respect of morbidity and recurrence rate. Descriptive analytical study. The study was conducted in Saidu group of teaching hospitals, since January 1999 to May 2002. Total of three hundred and eighty six patients collected by non probability convenient sampling technique, and 390 repairs [4-patient with bilateral repair] were included in the study. 180 were indirect, out of these 15 were strangulated, while 210 were of direct vanity. 90 repairs were made under local anaesthetic block, 300 were operated under general anaesthesia. All the patients were discharged on either 1st or 2nd postoperative day. 3 patients [0.76%] were readmitted for wound infection and were discharged on 8th postoperative day. Patients were examined on day 7th and 14th for early complications and then subsequently on 6th month and yearly for 3-4 years, for delayed complications. Ages ranged in our study 20-80 years [mean of 50 years]. 180 patients had indirect hernia [46.15%], while 210 [53.84%] were of direct Varity. Among 390 repairs 15 patients [3.8%] developed superficial wound infection, 5 patients [1.28%] established wound infection. 3 patients [0.76%] developed scrotal heamatoma, only one case [0.25%] was re explored. 20 patients [5.18%] went intro urinary retention, catheterized for 24 hours. 2 patients [0.5%] developed recurrence. 1 patient [0.25%] presented with hydrocele. 2 patients [0.51%] complain of neuralgia at groin. We conclude that Darn repair with polypropylene is safe and cost-effective, and recommend it for primary hernia repair

Diagnostic yield of fast plaque TB TM Test for rapid detection of mycobacterium in tuberculosis suspects

To compare the diagnostic yield of FAST Plaque TB' test with the conventional methods for detection of mycobacterium tuberculosis in sputum of Tuberculosis suspects at Jinnah Postgraduate Medical Center Karachi Pakistan. A comparative study of diagnostic yield of FAST Plaque TB' test with the culture and ZN staining, conducted from January to June 2004. The study was completed on 48 samples, 31 [64.58%] male and 17 females [35.42%]. Half of the cases were sputum positive. Culture positive was in 17 [35.41%] and negative in 28 [58.3%] wereas 3 [6.25%] were contaminated. FAST Plaque TB' test was positive in 16 [33.33%] and negative in 32 [66.6%] specimens. Out of 17 culture positive, 2 [11.7%] were negative and in 28 culture negative, 1 [3.57%] specimen was positive for FAST Plaque TB' test. Out of 24 smear positive, 11 [45.83%] were negative and in 24 smear negative, 3 [12.5%] were positive, for FAST Plaque TB' test. Compared to culture it has sensitivity of 86.23% and specificity of 96.42%, positive predictive value of 93.75% and negative predictive value of 93.1%. FAST Plaque TB' test is a simple test that can detect viable mycobacterium in 2 days. It has a good sensitivity and specificity. The cost is three times less than the other available tests like PCR. Thus it can be useful in the diagnosis of tuberculosis as an adjunct to sputum microscopy in endemic countries

Proportion of gastroesophageal reflux symptoms in patients with chronic obstructive pulmonary disease

To determine the proportion of gastroesophageal reflux symptoms in patients with chronic obstructive pulmonary disease and its association with the severity and worsening of the symptoms of chronic obstructive pulmonary disease [COPD]. A prospective, questionnaire based, case control, analytical study was conducted in the Department of Pulmonology, Jinnah Postgraduate Medical Centre, Karachi during June 2002 to January 2005. Gastroesophageal reflux symptoms were compared between 100 chronic obstructive pulmonary disease patients who fulfilled the inclusion criteria and 150 control subjects. Both groups were interviewed according to modified version of Mayo clinic GER questionnaire. Chronic obstructive pulmonary disease patients were divided into two groups according to pulmonary function tests [PFTs] results into FEV1 <50% and FEV1 >50%. Chronic obstructive pulmonary disease patients had more frequent gastroesophageal symptoms than controls [25% vs. 9.33% respectively; p=0.001], heartburn/acid regurgitation [70% vs. 43.33% and 56% vs. 30.66% respectively; p-value=0.001], dysphagia [15% vs. 4%; p-value=0.002] and chronic cough [89% vs. 29.33%; p-value=0.001]. Twenty six COPD patients reported respiratory symptoms associated with reflux, whereas control subjects denied such association. Of the 11 patients with frequent gastroesophageal symptoms, 10 patients increased their inhaler use [p=0.001]. Frequent gastroesophageal symptoms had shown a significant association with decreased FEV1 [25% vs. 0% p-value 0.001]. In contrast Pulmonary function test results were similar among chronic obstructive pulmonary disease patients with and without gastroesophageal symptoms [48.13+20.81 vs. 50.94+23.33]. Anti-reflux medication proton pump inhibitor and H2-blockers were utilized more by COPD patients as compared to control subjects. A higher proportion of frequent gastroesophageal symptoms were noted by COPD patients than control subjects and higher proportion of gastroesophageal symptoms was present in severe COPD patients

outcome of darning method of inguinal hernia repair using polypropylene in a district general hospital

To evaluate the darning method of inguinal hernia repair with polypropylene.500 patients of unilateral inguinal hernia were admitted. After thorough investigations, all patients were operated for hernia repair by st and ard procedure using No.-l polypropylene. Patients were operated under local, spinal or general anaesthesia. Patients were followed up at one week, six weeks and six months after operation for wound healing and complications. Out of 500 patients, ranging in age from 20 to 70 years, 300 patients were given spinal anaesthesia, 100 patients [20%] were operated under local anaesthesia. 496 patients were discharged from the hospital on the following day. 3 patients went into urinary retention and one patient had large haemotoma requiring exploration. Recurrence rate was 0.8% [n=4]. Darning methods of inguinal hernia repair with polypropylene is a safe and cheaper method of hernia repair