Surgical management and outcome analysis of extradural hematoma at combined military hospital Rawalpindi

The aim of this study is to see the frequency of extradural hematomas [EDH] at neurosurgical centre CMH Rawalpindi. Descriptive study. Department of Neurosurgery CMH Rawalpindi over a period of 2 years [Jan 2001 to Jan 2003]. All patients with head injury reporting to trauma center CMH Rawalpindi from 2001 to 2003 were reviewed. Using non-probability convenient sampling, patients with closed head trauma were included in the study. A total of 1215 patients were reviewed during the study period. Maximum patients were under 12 years of age. Extradural haematoma was found in 23 [2%] patients. Out of 23 patients, 18 [78%] were males and 5 [22%] were females, the male to female ratio was 3.5:1. Alteration of consciousness was the most common presentation [61%]. Location of EDH was temporoparietal in majority of patients. Bilateral EDH was found in 1 patient only. At 6 months follow up, good recovery was observed in 15 [65%] patients. Level of consciousness at the time of surgery is the single most important decisive factor in the outcome hence early diagnosis and surgical intervention is essential

Management of multilevel lumbar disc herniation

To identify and document more then one level symptomatic lumbar disc herniation and to find its frequency presentation and outcome. Descriptive study Combined Military Hospital Rawalpindi from 2001 to 2002. A total number of 260 male patients were selected from out patient department over a period of 1 year. After clinical evaluation, confirmation was done by nonenhanced Electro-resonance imaging [MRI] of the lumbar spine. All the patients with multilevel disc herniation on MRI underwent never conductions [NCS] electromyography [EMG] studies. All the patients were males. Maximum number of patients was between 32 - 40 years of age; mean age was 35 with a standard deviation of 2. 48 belonged to military setup and 82 were civilians. Out of all, 14 had multilevel lumbar disc herniations, the frequency being 5.8 in our study. All the patients with multilevel disc herniations underwent surgery. Only 4 patients had multilevel discectomy where 10 had discectomy at single level. Mortality was nil and there were no postoperative neurological deficits. All the patients were back to work at 6 weeks. Data was analyzed using the descriptive SPSS package. The identification of symptomatic multilevel disc herniation is extremely important in order to manage the patients with multilevel disc herniation as single level discectomy in such patients will not ameliorate the symptoms and may require another difficult surgery

Peripheral vascular trauma an experience of two years

The incidence of vascular trauma has increased considerably during last 40 years. The study was carried out to describe the causes of injury, presentations, surgical approaches, outcome and complication of vascular trauma of the upper and lower limbs. This was a descriptive study. Surgical Department CMH Kharian, in which this study lasted from Oct 1997 to Oct 1999. In the study, 30 patients were operated for peripheral vascular injuries. Diagnosis was made by physical examination and hand Doppler alone. Primary vascular repair was carried out where possible; if not interposition vein graft was placed. Early liberal fasciotomy was considered as and when required. Patients with isolated venous trauma and patients with obviously unsalvageable lower extremity injury requiring primary amputation were excluded from the study. The limb salvage rate was 93.3%. A total no of 30 patients were included in this study. Out of these 24 [80%] were males and 6 [20%] were females, all were young adults with age ranging from 14 to 52 years, a mean age of 22 years and a standard deviation of. Gun shot wound [GSW] constituted the major cause of trauma and was present in 18 [60%] Patients, road traffic accident [RTA] in 6 [20%] patients and stab wound in 6 [20%] patients which are comparable to international studies. Primary end-to-end anastomosis was done in 20 [66.07%] patients and graft interposition was done in 10 [33.3%] patients. Vein graft was used in 20 [66.07%] patients lateral repair was done in 7 [23.3%] patients while in 3 [10%] patients ligation was performed. Early complications included bleeding in 2 [6.7%], thrombosis in 4 [13.3%] and wound infection in 3 [10%] patients respectively. Late complications are amputation in 2 [6.7%] patients and muscle ischaemia in 2 [6.7%] patients. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present. Early fasciotomy is warranted if there is any suspicion of occurrence of compartment syndrome