Traumatic extradural hematoma

Objectives: To determine the frequency, clinical presentation and outcome of extradural hematoma in patients with head injury. Study Design: Cross sectional descriptive st study. Setting: Neurosurgery department of Hayatabad Medical Complex, Peshawar. Period: 1[st] January 2011 to 1[st] July 2012

Patients and Methods: All patients of head injury, from all ages and both genders were included. Patients in whom EDH caused by bleeding disorders or vascular malformations of the dura mater and post surgical EDHs were excluded from the study. CT scan brain was done for all patients to confirm their diagnosis. The information regarding patient demographical details, clinical presentation and site and size of hematoma was documented in patient's Performa. The data was analyzed by SPSS version 16

Results: A total of 331 patients with head injuries were included in the study. Out of 331 patients, there were 221[66.76%] males and 110[33.23%] females. Majority of patients 90[27.2%] were in the age range of 21-30 years. EDH was found in 29[8.76%] patients. The commonest location of extradural hematoma was temporo-parietal region i.e 3.93%. One patient had left side weakness postoperatively and two [6.89%] died

Conclusions: The outcome of operated extradural hematoma patients was good in those patients having higher GCS score

Endoscopic third ventriculostomy [ETV]

To know the surgical outcome of endoscopic third ventriculostomy [ETV] in non communicating hydrocephalous. Cross sectional descriptive study. Neurosurgery department of Hayatabad Medical Complex, Peshawar. 1[st] March 2010 to 1[st] march 2011. A total of 41 patients with non-communicating hydrocephalous, irrespective of gender discrimination were included in this study. Patients below two years of age and hydrocephalus with infected CSF or hemorrhage were excluded. Hydrocephalous was diagnosed on CT scan brain. The information regarding patient demographical details, causes of hydrocephalus and complications of procedure was documented in patient's Performa. The data was analyzed by SPSS version 16. Frequency and percentage was calculated for categorical variables. Mean +/- SD was calculated for age. Results were presented as tables. A total of 41 patients with non-communicating hydrocephalous were included in the study. Out of 41 patients, there were 26[63.41%] males and 15[36.58%] females. The mean age was 21 years. Etiologically tuberculous meningitis was the commonest cause of non communicating hydrocephalous. Post-operatively CSF leakage was present in 4[9.75%] patients, pseudomeningocele in 2[4.87%] patients, transient memory loss in 2[4.87%] patients and pneumocephalous in 1[2.43%] patient. The complications of endoscopic third ventriculostomy are transient. Those patients who meet the criteria, endoscopic third ventriculostomy offers the possibility of freedom from shunt dependency

Efficacy of endoscopic third ventriculostomy in noncommunicating hydrocephalus

Hydrocephalus is common problem requiring either extra-cranial [shunts] or intracranial [ventriculostomy] diversion of cerebrospinal fluid. Endoscopic third ventriculostomy obviates all the complications of shunts and has been accepted as the procedure of choice for the treatment of obstructed hydrocephalus in adults and children because of the minimally invasive nature. This study was conducted to determine the efficacy of endoscopic third ventriculostomy in the treatment of noncommunicating hydrocephalus. This cross sectional descriptive study was done in neurosurgery department of Hayatabad Medical Complex, Peshawar, from 2[nd] February 2011 to 1[st] march 2012. A total of 171 patients with non-communicating hydrocephalous, irrespective of gender discrimination and Glasgow coma scale score of 10 and above were included in this study. Patients below one year of age, with lesion in the floor of the third ventricle or near basilar artery, and hydrocephalus with infected CSF or haemorrhage were excluded. Hydrocephalous was diagnosed on CT-scan brain. All the patients were followed up till 72 hours post-operatively for the determination of effectiveness in terms of improvement in Glasgow coma scale by at least 2 points. All the above mentioned information including name, age, gender and address were recorded in a predesigned proforma. The data was analysed using SPSS-17. Frequency and percentage was calculated for categorical variables. Mean +/- SD was calculated for age. A total of 171 patients with noncommunicating hydrocephalous were included in the study. Out of 171 patients, there were 104 [60.8%] males and 67 [39.2%] females. Age ranged from 1-70 years with majority of the patients was below 10 years of age. Majority of the patients had hydrocephalus due to tuberculous meningitis 39.2% of the whole. In 134 [78.4%] patients the procedure was effective. Procedure was more effective in hydrocephalus due to space occupying lesion. Endoscopic third ventriculostomy is a very effective procedure for the treatment of non-communicating hydrocephalus.

Symptomatic complications of ureteric stents

To calculate the frequencies of symptomatic complications of pigtail ureteral stents and to determine the effect of stent duration on symptomatic complications. All s tented adult patients [PTFE Coated Cook_ 6 Fr Double J Stent] presenting at the Institute of Kidney Diseases Hayatabad Peshawar were evaluated by history, examination, urine analysis and cultures, X-ray KUB and ultrasound KUB. SPSS version 11.0 was used for the data entry and analysis. Results are presented in the form of tables. Out of 100 patients, 68% were males and 32% females. Stent indications included stone surgery in 14% of cases, prior to extracorporeal shockwave lithotripsy [ESWL] in 36%, ureteric obstruction in 36%, pyeloplasty in 10%, and anuria in 4% of cases. Complications at 2 and 4 weeks were hematuria in 52% and 40% of cases, flank pain in 48% and 58%, frequency of micturation in 66% and 78%, dysuria in 72% and 80%, urgency in 60% and 72% and suprapubic pain in 42% and 50% of cases respectively. Ureteric s tenting is a life saving procedure but associated with significant morbidity. It's unnecessary and prolonged use should be avoided

Atrial fibrillation following coronary artery bypass graft surgery

To know the frequency of atrial fibrillation [AF] after coronary artery bypass graft surgery and the risk factors which predispose these patients to develop post-operative AF. This prospective, observational, analytic study was carried out at National Institute of Cardlovascular Diseases Karachi, from January 2001 to January 2002. It included 200 patients undergoing elective or emergency coronary artery bypass graft [CABG] surgery without concurrent valvular heart disease, prior history of AF, ventricular arrhythmias or redo CABG surgery. All patients underwent CABG and were followed for three weeks for incidence of AR Patients who developed AF [group A] were compared with patients without AF [group B] for different variables. Univariate analysis was done using Student's t-test for continuous variables and Chi-square test for categoric variables. The mean age was 52.78 +/- 8.32 years. The average bypass time and cross clamp time were 83.20 [SD +/- 18.73] minutes and 29.73 [SD +/- 7.25] minutes respectively. The mean ejection fraction was 49.34%. The median number of grafts was three. The frequency of AF was 12 [6%]. Univariate analysis revealed that advanced age, male sex, right coronary artery lesion, prolonged bypass time and low ejection fraction were statistically significant risk factors [p<0.005]. AF is a common, but potentially preventable, complication following CABG surgery. The Advanced age, low ejection fraction, prolonged cross clamp and bypass time are the important risk factors which may predispose these patients to develop postoperative atrial fibrillation

Early outcome of transvesical prostatectomy for large prostatic adenoma

To determine the immediate postoperative course and complications following transvesical prostatectomy for large prostatic adenoma. Description study. This study was carried out in surgical A ward lady reading Hospital Peshawar, from 1[st] February 2004 to 31[st] July 2005. All patients who presented with bladder outflow obstruction and fulfilled the instruction and exclusion criteria were included in the study. After taking an informed consent history, clinically examination and related investigations were carried out. All these patients underwent prostatectomy by transvesical approach followed up for six months. The total number of patients was 173. The mean age of patients was 63.42 years and most of the patients [n 104-60 percent] presenting with benign prostatic enlargement were in the age range of 56-60 years. The common presenting complaints were prostatectomy by transvesical approach. The postoperative complications were recorded in 23 [13.29 percent] patients. Some patients had more than one complication. These were urinary tract incontinence in 3 [1.73 percent], urethral stricture in 3 [1.73 percent] and wound infection in 2 [1.16 percent] patients. One [0.58 percent] patient died due to myocardial infarction. Transvesical prostatectomy having a low incidence of complications, requiring no special equipment, is a good procedure for large prostatic adenomas

Frequency of carcinoma in specimens of clinically benign enlarged prostate

To determine the frequency of carcinoma prostate on histology.in specimens obtained from patients with clinically benign enlarged prostate. Descriptive study. This study was carried out in Khyber Teaching Hospital [KTH]Surgical ward D and Lady Reading Hospital [LRH] surgical ward A. Peshawar from January 2004 to December2004. A total of 107 patients who presented to Surgical OPD with bladder outflow obstruction and fulfilled the inclusion and exclusion criteria of the study were included in the study. After an informed consent history.clinically examination and related investigations were carried out. All the patients underwent transvesical prostatectomy [TVP] and their prostate specimens were subjected to histopathology. Total number of patients was 107. Most of the patients [58.88%] with benign prostatic hypertrophy [BPH] were in age range of 56 - 60 years. The common presenting complaints were prostatism [57.94%] and acute retention [34.58%]. All patients underwent trans vesical prostatectomy [TVP]. On histopathology 3.74% turned out as adenocarinoma prostate while 96.26% biopsies showed BPH. The mean age of presentation with carcinoma [Ca] prostate was 65 years.In this study the frequency of Ca prostate in specimens of clinically benign enlarged gland was 3.74%. Therefore all specimens must be submitted for histopathology after prostatectomy