Frequency of causes of ventriculo-peritoneal shunt failure in hydrocephalus patients

To analyze ventriculo-peritoneal shunt [VP shunt] failure cases in hydrocephalic patients, in a tertiary care hospital. This descriptive study was carried out in the Department of Neurosurgery Lady Reading Hospital Peshawar, from June 2009 to May 2010 [one year].The medical record of all cases operated in last one year was checked from record room. Documentation was done according to proforma designed indicating age, sex, clinical features, investigations with findings on X-rays, CT and MRI and per operative findings. Complications related to upper end, lower end and shunt track were noted. Data was analyzed to assess the causes for shunt failure in hydrocephalus patients. A total of 56 patients were included in this study. There were 43 children and 13 adults. Among children, 26 were males and 17 were females while in adults, 5 were males and 8 were females. Out of these, 28 patients were having blocked shunt, 20 cases with infected shunt, 6 patients had eroded and 2 patients displaced shunt. Although shunt surgery is a common procedure performed for hydrocephalus, different complications were associated in our study where shunt failure was mainly due to shunt dysfunction, infection or breakage of shunt system. Complications were more with upper end. Infection was common in pediatric age group

Microvascular decompression for idiopathic trigeminal neuralgia: ultimate solution to the management dilemma

Idiopathic Trigeminal Neuralgia is one of the most distressing craniofacial pain syndromes and micro vascular decompression is claimed to be the only best treatment option. The objectives of the study were to analyze the theory of neurovascular conflict as the basic pathology and prove the ineffectiveness of ablative procedures. A prospective observation study was carried out on 110 consecutive patients of idiopathic trigeminal neuralgia who went under micro vascular decompression. Clinical presentations and operative findings were recorded, analyzed and statistically correlated. Speical note was made of the previous interventions. All cases of secondary trigeminal neuralgia were excluded with the help of MRI brain. The result showed that in 90% cases superior cerebellar artery was the cause of compression on the root entry zone. It was concluded from this study that basic cause of the idiopathic trigeminal neuralgia is a vascular compression of the trigeminal nerve near its root entry zone and micro vascular decompression is the only best treatment option available at present. Moreover, correct interpretation of the symptoms is essenital to avoid inappropriate intervention

Idiopathic trigeminal neuralgia: clinical presentations and operative findings on microvascular decompression

To analyze the clinical presentations of idiopathic trigeminal neuralgia and its operative findings on microvascular decompression. This descriptive case series study was conducted in the Department of Neurosurgery, PGML Govt. Lady Reading Hospital, Peshawar from July, 2003 to November, 2007. A total of 110 consecutive patients of idiopathic trigeminal neuralgia undergoing microvascular decompression in the Department of Neurosurgery, Lady Reading Hospital were included in the study. Clinical presentations and operative findings were recorded and analyzed. All cases of secondary trigeminal neuralgia were excluded with the help of MRI brain. Ratio of Male: female was 2:3. Age ranged from 28-80 years, mean age being 57 years. Right side was affected in 60% cases. Maxillary and mandibular divisions in combination were involved in majority of cases. Pain-free period varied from few hours to years. The common triggering stimuli were chewing and touching. A trigger point was found in [77%] cases. Superior cerebellar artery was the cause of compression in 90% of cases. In 90% of cases compression was on the root entry zone. The nerve compression was found on superomedial aspect in 66 [60%] of cases. Almost all cases of idiopathic trigeminal neuralgia are caused by a vascular compression of the trigeminal nerve, superior cerebellar artery being the commonest cause 90%

Triage and management of mass casualties in a train accident

The purpose of this study was to assess the practicality and usefulness of different scoring systems of triage process in mass casualty management. Design: Descriptive/observational. Place and Duration of Study: An experience of management of train accident in Balochistan in the year 2003. Subjects and One hundred and twenty-two patients injured in train accident of Quetta Express were included in the study. A trauma team reached the site of the accident. Triage was done at three levels. "Triage sieve" scoring system was used at the site of accident, "field categories of trauma patients" at Primary Health Care Centre, and "ATLS [Advanced Trauma Life Support] secondary survey" at tertiary referral centre. Helicopters and ambulances were used for evacuation of patients. There were 122 injured patients. " Triage sieve " system scored 14[11.47%] patients in priority I, 21[17.21%] patients in priority II, 80[65.57%] patients in priority III and 7[5.73%] dead individuals in priority IV at the site of accident. Casualties clearing time was three and half hours. By utilizing "field categories of trauma patients" at primary health care centre, 7[5.7%] patients were placed in category I who were air lifted, 19[15.57%] patients in category II, 89[72.95%] patients in category III and 7[5.73%] dead remained in category IV. Application of ATLS secondary survey in CMH, Quetta triaged 4[57.14] patients in priority I and 3[42.85] patients in priority II. There was only one death after the triage process started. Proper triage, appropriate resuscitation, and timely evacuation definitively decrease morbidity and mortality in trauma patients, and facilitates utilization of the available resources appropriately

Hepatic duct strictures: presentation and management

A prospective study was conducted in Combined Military Hospital Rawalpindi from January 1998 to December 2000[about 3 years]. A total of 11 patients with radiologically proven strictures of hepatic ducts were included in the study. All the cases were thoroughly investigated by history, physical examination, liver function tests [LFT's], Ultrasound abdomen, Percutaneous Transhepatic Cholangiography[PTC], Endoscopic Retrograde Cholangio-Pancreatography[ERCP] and Computerised Tomography [CT]scan. Out of 11 cases, 8 [72.72%]were male and 3 [27.27%]female with male to female ratio of 2.7:1. The age ranged from 33 years to 66 years with a mean age of 48 years. There were 8[72.72%] cases of benign stricture and 3[27.27%] with malignant pathology. Of the benign strictures, 4 were Type-I, 3 type -11 and 1 Type-III[Bismuth classification] while among malignant strictures 2 were Type-II and 1 Type-I [Klatskin's classification]. The jaundice was the main presenting symptom except in 1 case. Seven patients had abdominal pain, 5 had fever, 2 presented with weight loss and pruritis and mass was palpable in only one case Surgical bypass[hepatico-jejunostomy] was done in 9 cases, 1 with malignant pathology and 8 with benign strictures including redo surgery in two of the later group. Two patients found unfit to undergo surgery or because of advanced malignancy, were subjected to Percutaneous transhepatic biliary drainage[PTBD]. Patients follow- up post-operativly varied from 3 months to 2 years. Outcome of surgical bypass compared favorably with the other studies on this subject