Traumatic brain injury: experience at divisional headquarter teaching hospital, Mirpur, AJK

Traumatic brain injury is one of the leading causes of morbidity, mortality and severe economic loss; especially in the patients who are in productive years of life. The objective of our study was to find out the etiological pattern and distribution of traumatic brain injury at Mirpur, Azad Kashmir. Prospective study. This study was carried out at surgical wards at DHQ hospital, Mirpur from Nov 2012 to April 2013. In this study epidemiological and clinical data of all the patients with traumatic brain injury admitted in surgical wards at DHQ hospital, Mirpur were included. A total of 309 patients with traumatic brain injury were admitted. The age range was between 3 years to 80 years. The mean age was 23.8 years. The most commonly affected age group was between 25-30 years [89.3%]. Males were predominant [81.9%]. Students involved constituted 44.7% of patients. Commonest mode of trauma was pedestrians hit by motorized vehicles [70%] followed by physical assaults [15.9%]. Majority of the patients [88.3%] were from local district and 70.2% reached the hospital within two hours of trauma. 46.6% of the patients had a GCS of 13-15 on arrival. 3.9% had subdural hematoma while 1% of patients had skull fractures and intracerebral bleeds. Overall mortality was 5.8%. Road traffic accidents are the leading cause of traumatic brain injury affecting the young population at Mirpur and led to 5.9% mortality and 9.5% total dependency in the affected population. Better traffic control system and awareness can reduce the incidence of traumatic brain injuries

Comparison between signs and symptoms of medulloblastomas and desmoblastic medulloblastomas

To compare the signs and symptoms of Medulloblastomas and Desmoblastic Medulloblastomas. Retrospective study. This study was conducted at King Khalid University Hospital, Rayadh, Saudi Arabia from 1[st] January 2001 till 31[st] December 2010. Total of 37 patients were included in the study. After taking written consent from all the patients or their relatives, this study was conducted. Permission was also taken from the ethical committee of the hospital. 37 patients were included in the study. Percentage of important symptoms of intracranial tumors like headache, reduced vision and hydrocephalus was comparatively higher in medulloblastomas as compare to desmoblastic medulloblastomas. None of the desmoblastic variety had metastasis on presentation, hence all of them completely excised. Unfortunately, we were able to excise only 82.14% of medulloblastomes. 14.28% were partially excised while in 3.57% of cases, surgeon was only able to take biopsy. Desmoblastic variety of medulloblastoma had better prognosis as compare to Classical Medullblastoma

Chronic subdural haematoma: clinical presentation and surgical outcome

Chronic subdural hematoma having diversity of clinical features, poor index of suspicion and non availability of CT scan is still diagnosed very late in AJK. The objective of study was to find out the clinical status at the time of admission and outcome of surgery in these patients managed in our hospital. Descriptive study. This study was conducted at the DHQ Hospital Mirpur AJK from March 2006 to April 2010. A total number of 47 patients with chronic subdural hematoma of all age groups were operated at DHQ hospital Mirpur in this period. Clinical presentation of the patients at the time of admission was recorded. Patients were followed for a period of 2-3 months after surgery. Forty seven patients were studied. Among them 40[85%] were male and 7[15%] were female. The age range was 2 months to 100 years with average age 52.5 years. Thirty one [66%] had positive history of head trauma whereas 16 patients [34%] did not remember any injury. Thirty one [66%] had headache, 35[74.5%] had hemiparesis, 19[40.4%] had behavioral changes and urinary incontinence. Six patients [12.8%] were having GCS 3 with reactive pupils. One [2.1%] patient came with decreased vision. CT scan showed unilateral hematoma in 37 [78.7%] and bilateral in 10 [21.3%] patients. Twenty five [53%] patients had hematoma on left side, 12[25.5%] had hematoma on right side and 10[21.3%] had bilateral hematoma. Thirty four [72.3%] had good recovery. Four [8.5%] could not survive. Chronic subdural hematoma due to diversity of symptoms, poor index of suspicion, and non availability of CT scan is still diagnosed very late in AJK. Elderly patients with diversity of confusing neurological symptoms need to be kept under high index of suspicion for diagnosis of chronic subdural hematoma. Drainage of Chronic hematoma with two burr holes and placements of subdural drain offered excellent

prospective randomized trial comparing the spinal and general anesthesia in lumbar disc surgery: a study of 44 cases

General anesthesia is most frequently used for lumbar disc surgery despite the evidence that spinal anesthesia is as safe and may offer some additional advantages. The purpose of this study was to compare the intraoperative parameters and postoperative outcome after spinal and general anesthesia in demographically well matched patients undergoing elective lumbar Decompressive surgery. Prospective randomized controlled study. This study was carried out DHQ Hospital Mirpur AJK from January 2007 and May 2010. In this randomized controlled study we analyzed the outcome obtained in 44 patients in whom either spinal or general anesthesia was induced for lumber disc surgery. The variables recorded were anesthesia related class, surgical diagnosis, disc levels operated and pre, peri and postoperative measurements of variables like BP, and heart rate. All aspects of surgery, recovery, post anesthesia care and pain management were same irrespective of anesthetic type The narcotic and antiemetic requirement and length of stay in the hospital and incidence of urinary retention were also recorded in the post operative course. Demographically both groups were well matched. Anesthesia time was longer in patients receiving GA with increased heart rate and MABP perioperatively. There was more nausea and greater requirements for antiemetic and analgesics in patients receiving. GA [p value<0.05]. Perioperative heart rate and MABP was on normal side and there was no urinary retention in patients who received spinal anesthesia. Spinal anesthesia was a safe and effective as GA for patients undergoing lumbar Decompressive surgery. Spinal anesthesia had added advantages of short anesthesia duration, decreased antiemetic and analgesic requirements. GA general anesthesia, HR heart rate, I/V intravenous, MAP mean arterial pressure, PACU post anesthesia care unit, RCT randomized controlled trial, SA spinal anesthesia

Conservative breast surgery in our setup

Background: Breast conservative surgery [BCS] has been time tested in terms of outcome for early stage carcinoma breast. The disease free period and 5 year survival is almost similar to that of modified radical mastectomy. The benefits remains in terms of breast preservation and avoiding the psychological trauma of mastectomy in females especially the younger age group. This study focuses on 50 patients undergoing breast conservative surgery. Hence discussing the outcome in terms of local recurrence and need for adjuvant therapy

Materials and Method: A total of 50 female patients were operated on between July 2002 and August 2010. Following surgery patients underwent adjuvant therapy with chest wall radiation and hormonal therapy depending upon receptor status. Patients were followed up on 1,6, 12 months and later on yearly basis

Results: Mean age of the patients was 45.04 yrs and mean diameter of the tumor was 3.21cm [SD=+/- 0.923]. Preoperative biopsy was +ve in 92% and ve in 8% patients. Mammograms of all the patients showed malignant changes. Five patients required neoadjuvant chemotherapy for downsizing the tumor from stage 3 to stage 2. Receptor status was +ve in 14 and ve in 36 patients. Local recurrence was present in 10 %[5] patients at follow up. Mean follow up was 48.5 months

Conclusion: BCS is an excellent tool for early stage breast carcinoma when combined with axillary clearance and whole breast irradiation. The benefits are same in terms of outcome and survival as those of formal mastectomies, with less disfigurement. There is however need for patient education as well as strict adherence to multidisciplinary approach in treatment of this overwhelming problem

Comparison of tapp and open mesh hernioplasty

Background: The objective is to determine the outcome of TAPP and Open Methods [Lichtenstein] for inguinal Hernia repair in terms of post operative pain, hospital stay, wound infection and recurrence. TAPP technique is newer modality in the treatment of laparoscopic hernia repair. With advantages over open methods of repair and various potential complications along with greater learning curve it has point of interest for various studies. This study focuses on 100 patients undergoing hernia repair by either method, and elaborating the outcome in terms of pain, operative time, wound infection and recurrence

Materials and Method: Atotal of 100 patients were operated on between July 2005 and August 2010. They were divided into group A for TAPP mesh hernioplasty and group B for Lichtenstein tension free mesh hernioplasy, 50 patients in each group. All the patients were followed up at 1,6, 12 and 24 months for outcome measures

Results: Atotal of 100 male patients with mean age 50.4 underwent hernia repair. There were 58 indirect, 31 direct and 11% mixed types of inguinal hernias. The mean operating time for TAPP was 104.7 higher than in the open technique Mean=35.7 minutes. Post operative pain in majority of TAPP group was mild in 40 [80%] patients and for open technique was moderate in 27 [54%]. The infection rate for the Open technique was 10%. Of the TAPP group 4 patients [8%] had early recurrence, and 1 [2%] patient in the open technique presented with recurrence after 12 months follow up

Conclusion: TAPP technique for inguinal hernia repair is better than Open repair with regards to less pain and early mobilization of patients. The rate of infection is also less. The disadvantages include longer learning curve but it tends to vary in various centers. So the emphasis remains on the need for developing a learning environment for such techniques in order to provide better patient care

Sleeve gastrectomy, the most feasible surgical weight loss procedure for morbidly obese patients in pakistan: early results

Background: The laparoscopic sleeve gastrectomy is a new tool in the surgical treatment of the morbidly obese patients which is now increasingly used as a primary surgical procedure for the morbid obesity as it has comparable weight loss to laparoscopic adjustable gastric banding and better safety profile than the Gastric Bypass with no malabsorption. We describe initial results of laparoscopic sleeve gastrectomy for morbid obesity in two academic centers of Pakistan

Materials and Method: Prospective data was collected on consecutive morbidly obese patients undergoing laparoscopic sleeve gastrectomy, and evaluated retrospectively

Results: Twenty one consecutive patients underwent laparoscopic sleeve gastrectomy from October 2008 to August 2010 with follow up ranging from 2 to 15 months. The 8 men and 13 women had an average age of 42.1 years [range 2152 years] and an average body mass index [BMI] of 49.6 kg/m2 [range 35.272.2 kg/m2]. No operation required conversion to laparotomy. Mean length of stay was 2.1 days [range 110 days]. There was no death in the 30 days postoperatively. One patient was admitted with pain abdomen after 10 days of operation with portal pyemia but settled conservatively. Other complications included one suspected clinical leak but no radiological leak. Patient got settled with conservative management in one week. Two patients had repeated vomiting off and on for one month and inability to take water which resolved spontaneously. At 1 -year follow-up all patients had lost an average of 52.0% excess body weight

Conclusion: Laparoscopic sleeve gastrectomy has much to offer for the morbidly obese. We present data showing weight loss rivaling gastric banding and bypass and acceptably low complications