Role of Percutaneous Radiofrequency Rhizotomy for atypical facial pain syndrome

Background: Atypical facial Pain is a debilitating condition characterized by stabbing, burning and dysesthetic sensation. With a variety of underlying causes neurosurgeons has struggled to find its effective treatments. Surgical options available for the treatment of atypical fascial pain are radiofrequency Rhizotomy, glycerol Rhizotomy and balloon compression. Radiofrequency Rhizotomy is currently use in Pakistan. Studies have shown that it is less costly with minimal complication rate as compared with the other surgical interventions. But up till now, no study has been conducted in Pakistan to assess its efficacy

Objective: The objective of this study was to determine the effectiveness of RFR for atypical facial pain syndrome in terms of complete pain relief

Study Design: It is a descriptive case series. Period of study: One year from 01-12-2016 to 30-11-2017

Place of Study: Department of Neurosurgery Lahore General Hospital [LGH] Lahore

Methods: The objective of this study was to determine the effectiveness of RFR for Atypical Facial Pain syndrome in terms of complete pain relief. It is a descriptive case Series. Research was conducted at Department of Neurosurgery, Lahore General Hospital Lahore. Duration of study was 1 year. This study involved 38 patients of both genders aged between 35 to 75 years diagnosed case of Atypical fascial pain syndrome for more than 12 months. All the patients were assessed per operatively according to functional pain score

Results: The mean age of the patients was 49.47+/-11.92 years and there were 15 [39.5 percent] male and 23 [60.5 percent] female patients in the study group. Most of the patients were aged between 30-40 years [28.9 percent]. The duration of pain ranged from 7 months to 15 months with a mean of 10.74+/-2.34 months. The functional pain score before the treatment ranged from 2 to 5 with a mean of 3.84+/-1.00 while the function pain score after treatment ranged from 0-3 with a mean of 1.50+/-.73. The frequency of patients with pain relief was 47.4 percent

Conclusion: Pain relief was observed in 18 [47.4 percent] patients, 6 weeks after treatment. The frequency of pain relief was insignificantly lower with increasing duration and severity of pain at admission

Surgical outcome of tethered cord syndrome

Objective: surgical outcome of tethered cord syndrome

Study Design: retrospective descriptive

Period and Place of study: Neurosurgery Department Allied Hospital Faisalabad over 6 months from October 1, 2014 to March 28, 2015

Materials and Methods: forty patients were selected at Neurosurgical Department, Allied Hospital, Faisalabad with age ranging from 2 months to 27 years[average 2.58 years]. These were assessed clinically and their orthopedic and urological aspects were also assessed. MRI of relevant area was advised. Counselling was done regarding surgery under general anesthesia and its outcome. Laminectomy or laminotomy was done. Cord was detethered from its attachments from dura, and, in case of lipomeningocele, from its extradural component. In case of diastometomyelia, bony spur was extirpated and dura- plasty was done. Tight filum terminale was divided. Surgery was done using microsurgery techniques. Postoperative assessment was done immediately at the time of discharge, at 6 and 12 months

Results: a total of 40 patients, M:F ratio was5:3. Average age was 2.58 years.Age was ranging from 2 months to 27 years. Power improved in 44 % to grade 5/5 and 37% in grade 4/5 at one year. There was 65 % improvement in anal sphincters and 71% improvement in urinary sphincters at one year

Conclusion: our clinical and neurological evaluation showed satisfactory outcome after surgery, particularly when performed before the onset of irreversible deficit. Neurological status prior to surgery has profound impact on the outcome

Comparative study on neem leaf extract and nimolicin [NC] on gastric mucosa of albino rats

Compare the anti ulcer effect of Methanolic Neem [Azadirachta indica, A Juss, Meliaceae] Leaf Extract [NLE] and Neem compound Nimolicin on gastric mucosa of albino rats. Azadiradione also called Nimolicine coded as NC has been studied for its anti insect effect but anti ulcer effect has never been studied. Experimental study. This study was carried out at the Pharmacy and Physiology Department of Baqai Medical College for duration of two years. Gastric ulcers in albino rats were induced in group-1 [check group] by a single oral dose of 1 ml 100% ethanol. After 24 hours the treatment was started. Group-2 was treated with oral administration of pea nut oil 1 ml/day for 5 days [control of the treated group]. Group-3 was treated with NLE [1 ml/day for 5 days] and Group-4 with NC 1% [1 ml/day for 5 days]. The healing effects of neem were compared to oral administration of anti ulcer drugs ranitidine [50mg/kg daily for 5 days] and omeperazole [2.5 mg/kg daily for 10 days]. Histopathology of the stomach was performed to confirm the presence or healing of ulcers. Ulcers were scored and indexed on the basis of histopathology. Ranitidine had the highest ulcer inhibition of 84%. NLE proved to be better than omeperazole by showing an ulcer inhibition of 82 % compared to 73% ulcer inhibition of omeperazole. NC showed least anti ulcer activity with an ulcer inhibition of only 69%. HPLC was performed to show the tissue concentration of NC, omeparazole and ranitidine showing their retention time, area and concentration compared to their controls. It is concluded that NLE proved to be better anti ulcer agent as compared to NC and can be used as an anti ulcer drug after clinical trials

Neurosurgical outcome of aute traumatic EDH. Based on GCS

Objective: Assessment of Neurosurgical Outcome of Acute Traumatic Extramural Hematoma based on GCS

Study Design: Clinical Trial

Place and Duration: Neurosurgery Department Allied Hospital Faisalabad, 20 Months from July 31-2011 to 28-2-2013

Clinical Material and Method: One hundred and thirty patients were selected for study. CT scan brain was done of every patient. The size of EDH was assessed. GCS was assessed. Patients were grouped in three groups A [GCS >8, EDH volume <30 ml], B [GCS <8, EDH volume > 30 ml] and C [GCS > 8, EDH volume > 30 ml]. Outcome was assessed according to Glasgow outcome scale

Conclusion: Patients with group A [EDH < 30ml and GCS > 8] can be managed conservatively. Their outcome was comparable with operated patients EDH > 30ml. However group B has mortality of 4.3% and outcome was different from group A and C which have no mortality

pattern and frequency of diseases associated with lymphadenopathy

A study of 351 patients of lymphadenopathy was carried out to observe the pattern of various diseases with which these patients were affected. There were 168 male and 183 female patients with male to female ratio of 1:1.09. The youngest patient was 1 year old and the oldest was 80 years of age. The commonest lesion found was tuberculosis in 165 [47%] followed by reactive hyperplasia in 121 [34.5%], metastatic carcinoma in 36 cases [10.3%], malignant lymphoma in 27 cases [7.7%], kikuchi's lymphadenitis in one case [0.28%], and fungal lymphadenitis in one [0.28%]

Pattern of surgically treated thyroid disease in Karachi

The study was carried out to evaluate the histologic spectrum of these surgically treated thyroid disease in Karachi. A total 0/662 cases were collected, 570 were females and 92 were males i.e. 6.19:1 ratio. The age range was from 12 to 70 years. Multinodular goiter was the commonest thyroid disease [61.63%], follicular adenoma was encountered next, 93 cases [14.05%]. Amongst 26 cases of thyroiditis, lymphocytic thyroiditis were seen in 22 [3.32%] which was commoner than Hashimoto's thyroiditis [0.06%]. The overall incidence of malignancy was 14.35%. Papillary carcinoma was found to have higher incidence [11.17%] than follicular carcinoma [1.81%]

Pattern of female breast diseases in Karachi

The study was conducted to know the pattern of female breast diseases in Karachi. In this study there were a total of 307 breast biopsies and mastectomy specimens of which 67 were inflammatory, 166 benign and 74 malignant. Fibroadenoma was the commonest [35.179%] followed by invasive ductal carcinoma [21.824%], fibrocystic disease [16.286%], breast abscess [7.166%] and chronic mastitis [7.817%]. Fibroadenoma was common in second decade and infiltratiue ductal carcinoma in fifth decade. Breast carcinoma occurs at a younger age group in [Karachi - Pakistan] than in western countries.

Traumatic basal ganglia haemorrhage

Traumatic Basal Ganglia Haemorrhage [TBGH] is a relatively rare lesion seen in traffic accidents. Traumatic Basal Ganglia Haemorrhage is probably secondary to shifting of the brain as a result of acceleration or deceleration forces. The purpose of the study was to asses outcome of TBGH cases managed conservatively among head injury patients at our hospital and compare with other studies. We studied 16 patients with TBGH diagnosed on Plain CT Scan done on admission between Jan 2000 to Dec 2002. All patients were treated conservatively. We evaluated outcome in these patients. Consciousness became clear in all patients. Expressive and nonfluent aphasia occurred in 6 patients, weakness of opposite side was observed on 10 patients. Good recovery was seen in 11 patients and 4 had moderate disability. In TBGH a good outcome was observed

Traumatic fronto basal cerebrospinal fluid fistula; neurosurgical treatment

CSF rhinorhoea is one of the complications of head injury which should initially be managed conservatively and on failure surgical intervention is m and atory to prevent life threatening meningitis.In the present study we analyzed 75 cases of CSF rhinorrhoea from Jan 1998 to Jan 2002 secondary to head injury. There were 61 males and 14 females with an average of 35 years. CT and MRI were the main diagnostic modalities used for the investigation of the site of fistula. Twenty two patients were operated. Surgical treatment consisted of intra cranial approach. Spontaneous closure of the fistula was observed in 53 patients with conservative management. In 22 patients surgical intervention was required. Post operative closure of the CSF fistula was seen in 91% of cases with minimal morbidity. Intra cranial approach is effective, safe and intra cranial traumatic pathologies can be dealt along with the CSF fistula

Microbial flora in chronic otitis media and their susceptibility pattern

Ear swabs from 396 patients suffering from chronic suppurative otitis media were analysed by standard microbiological techniques. The isolates were identified by conventional methodology. The susceptibility to antibiotics was determined by disc diffusion techniques. A total of 332 out of 396 swabs [83.8%] were culture positive. 313 [94.28%] were bacteria And 19 [5.72%] were fungi belonging to the Aspergillus spp. Pseudomonas and Staphylococci were found in 52.077% and 33.227% respectively among six types of bacteria. All Staphylococci were sensitive to Ciprofloxacin. 94.8% of Staphylococci were susceptible to Gentamicin, 94.3% to Arnoxycillin / Clavulanic acid, 92.4% to Cloxacilllin, 63.8% to Erythromycin, 62% to Doxycycline, 58.7% to Cotrimoxazole and 9.1% to Ampicillin. Out of Pseudomonas aeruginosa, 97.2% were susceptible to Ciprofloxacin, 93.6% to Cefoperazone. 90.3% to Ofloxacin, 89.3% to Amikacin, 87.7% to Enoxacin, 72.4% to Ceftazidine and 70.6% to Gentamicin. Staphylococcus was highly sensitive to Ciprofloxacin, Gentamicin and Amoxycillin/Clavulanic acid but resistant to Ampicillin

value of fine needles aspiration cytology in the diagonsis of lymphodenopathy

A study of one hundred and five patients of lymphadenopathy was carried out to determine the diagnostic role of Fine needle aspiration cytology [FNA] and to see the pattern of diseases with which patients presented. The commonest lesion encountered was tuberculosis [55.238%] followed by reactive hyperplasia [28.571%], malignant lymphoma [7.169%] and metastatic carcinoma [5.714%]. Biopsy results were compared with cytological findings which revealed an accuracy of 95%. As the sensitivity of FNAC in cases of tuberculosis and malignancy is 100% and specificity 98% in the present study, it is recommended that this highly useful technique should be routinely adopted

Prevalence and susceptibility pattern of urinary pathogens

Urine specimens from 3125 cases were received in the laboratory, on which culture and sensitivity tests were performed. Only 24.8% of cases with significant bacterial growth [100,000 organisms per ml] were tested for their susceptibility to various antibiotics. The organisms were identified by conventional methodology. The susceptibility to antibiotics was determined by disc diffusion technique. Escherichia coli was the commonest [50.97%] of all the isolates to cause UTI, followed by Klebsiella spp [16%] and Pseudomonas aeruginosa [9.03%]. 93.0% of E. coli were susceptible to Ofloxacin, 90.12% to Norfloxacin, 89.11% to Ceftriaxone, 84.05% to Nitrofurantion, 82.02% to Gentamicin, 77.21% to Cephradine, 75.94% to Pipemidic acid, 31.89% to Cotrimoxazole and 29.87% to Ampicillin. Out of Pseudomonas, 97.14% were susceptible to Amikacin, 82.85% to Aztreonam, 51.42% to Ofloxacin, 48.57% to Pipemidic acid, 47.14% to Norfloxacin, 32.85% to Tobramycin and 31.42% to Gentamicin. E. coli was highly sensitive to Ofloxacin and Norfloxacin but highly resistant to Ampicillin and Cotrimoxazole

Multidrug resistant salmonella typhi in Gujranwala

One hundred and thirty strains of Salmonella typhi were isolated from the blood of patients clinically suspected to be suffering from typhoid fever for the 5-year period from Jan 1995 to Dec. 2000. The blood cultures were taken in brain heart infusion broth. The isolates were identified based on morphological, biochemical and serological characteristics. The susceptibility of the strains was tested by disc diffusion tests as per standard methods. A high level of resistance to first-line drugs was observed. 43.85 percent strains of S. typhi revealed resistance to chloramphenicol, 42.3 percent to ampicillin, 46.15 percent to co-trimoxazole, 37.69 percent to Amoxicillin, 6.15 percent to ciprofloxacin, 0.77 percent to pefloxacin, enoxacin, and ofloxacin. No resistance to ceftriaxone and cefotaxime was observed