Primary tuberculosis of thyroid gland

We present a case of primary tuberculosis of thyroid gland in a 21 years old female with a solitary swelling of the thyroid gland. Clinically and biochemically, she was euthyroid. After investigations, subtotal thyroidectomy was done. Histological examination shows tuberculosis of thyroid gland

Post traumatic sub arachnoid hemorrhage; effect of nimodipine on associated headache

To study the effect of Nimodipine on headache associated with post traumatic sub arachanoid hemorrhage. Study prospective study This study was conducted at the Department of Neurosurgery and General Surgery, District Headquarters Hospital Rawalpindi. 6 months 60 Patients from both genders, undergoing hospital admissions that fulfill the inclusion criteria were included in the study. 12 patients were lost due to poor patient follow up. Of the remaining 48 patients, 29 [60.4%] patients suffered road side accidents, 12 [25%] had assaults and 7[14.6%] had fall. The patients were classified according to Hunt and Hess and Fischer Grading. 34 patients had grade 1 and 14 had grade 2 injuries according Hunt and Hess classification. 31 had grade 1 injuries and 17 had grade 2 injuries according to Fischer Grading. The mean age was 34.02 years with a range of 4 to 71. The mean interval since trauma and admission were 1.4 hour. The patient score on the visual analog pain scale before treatment had a mean of 4.46. The patient score on visual analog scale after treatment was 2.33 and P-value was calculated to be<0.001. The above results signify that Nimodipine should be prescribed to patients with Grade 1 and 2 post traumatic sub arachanoid hemorrhage. Headache was considerably reduced after the use of nimodipine

Complications of thyroid surgery

To determine the percentage of complications in thyroid surgery and compare these complications with the other national and international studies, Study Design: A descriptive study, The study was conducted in the department of Surgery, Foundation University Medical College and Fauji Foundation Hospital Rawalpindi from 1 [st] January 2009 to 31[st] December 2009. Patients and Methods: 192 patients above the age of 14 who consented were included in the study. General physical ansd loco regional examination was done in OPD. Thyroid function tests [T3, T4, and TSH] were done in all the patients besides other routine investigations. FNAC and thyroid scan was done in only selected patients. Anemia, hypertension and other comorbid condition, if present, were corrected and assessed by anesthetist in the pre admission clinic. Only euthyroid patients, both clinically and biochemically and fit for general anesthesia were admitted for operation. Subsequently all the patients were subjected for surgery and the specimens were sent for histopathology after visual examination. Pre as well as per operative findings were recorded on a specially designed proforma. The data were then entered in the computer for analysis and conclusions were drawn. Total of 192 patients operated for benign thyroid disease in year 2009. Age ranges between 14 to 80 with 120 patients below the age of 40. Out of 192 patients, only 6 were males.90 patients were operated for pressure symptoms, 78 for cosmetic reasons and 24 for toxic symptoms. Subtotal thyroidectomy was done in 132 patients while 24 patients ended up with near total and 36 were candidates for lobectomy. 6 patients had symptoms of RLN damage while 24 develop parathyroid insufficiency post operatively. All these patients managed conservatively and discharge on 2[nd] or 3[rd] post op day. They regain normal voice and normal serum calcium levels by the end of 3 months. Subtotal thyroidectomy is one of the commonest procedure done by the surgeons of Rawalpindi Islamabad region. Maximum effort should be done to optimize the patients preoperatively. If patients are euthyroid and assessed carefully for anesthesia fitness before operation, chances of per or post- operative complications are negligible

Frequency of ventricular arrhythmias during first 24 hours of acute myocardial infarction in patient thrombolysed with streptokinase

To assess the frequency of ventricular arrhythmias during first 24 hours complicating first episode of Acute Myocardial Infarction in patients thrombolysed with Streptokinase. Cross-sectional, prospective, observational and qualitative study. This study was conducted at Sialkot Medical Complex for six months from March 2010 to August 2010. 200 consecutive patients with acute myocardial infarction who received Streptokinase were assessed for ventricular arrhythmias. Monitoring of the patients for ventricular arrhythmias for 24 hours from the time of admission was done. Arrhythmias from the cardiac monitor's memory noted and documented. Ventricular arrhythmias studied were ventricular fibrillation [VF], sustained ventricular tachycardia, accelerated idioventricular rhythm, non-sustained ventricular tachycardia and premature ventricular beats > 10 beats per hour. Findings were recorded on a specially designed proforma. The data were then entered in the computer for analysis and conclusions were drawn. Reperfusion arrhythmias were observed in 20% of the patients [40/200] in first 24 hours after thrombolytic therapy presenting with first acute myocardial infarction. All the patients included in the study showed the ECG criteria of STEMI and positive quantitatively Troponin T test. Inferior wall MI was the most common type of acute MI. All the patients received IV Streptokinase as thrombolytic agent. The patients with sustained VT [33%] received cardioversion and IV amiodarone. Non-sustained VT were managed by observation only [77%]. A total of 35 patients survived in first 24 hours, five died. Reperfusing arrhythmias are commonly observed in first 24 hours after Streptokinase therapy for acute myocardial infarctions. Most of the non-sustained reperfusion arrhythmias are left untreated and requires observation only but sustained ventricular arrhythmias [VF, VT] can be life-threatening and therefore must be considered for treatment, Electrical cardioversion is preferred over pharmacological treatment in case of sustained ventricular arrhythmias. Survival can be maximized if these arrhythmias are recognized and managed efficiently