Outcome in patients undergoing endoscopic lumbar discectomy for prolapsed para spinal intervertebral disc

Background: Backache is second most common problem presenting to the primary healthcare providers. Lumbar discectomy has been revolutionized from open conventional discectomy to endoscopic removal. Endoscopic procedures are proving their superiority regarding good outcome, less wound site pain and shorter hospital stay, in Neurosurgery as well. Micro discectomy and Endoscopic discectomy is used only in few centres in Pakistan. This study aimed to share our experience of early surgical outcome endoscopic lumbar discectomy in terms postoperative pain improvement and duration of hospital stay

Methods: This prospective study was carried out at Neurosurgery Department, Jinnah Hospital, Lahore from Jan 2014 to Jan 2016. During this period, 35 patients of both sexes, aging between 20 and 60 years, with symptoms and signs of lumbago with sciatica were enrolled. Data was collected on a questionnaire after informed verbal and written consent

Results: A total of 35 patients were operated including 10 males and 25 females. Their age ranged from 20 to 60 years with mean age 33.14+/-8 years. Majority [32, 91%] of the patients had left side prolapsed paracentral disc, and remaining [3, 9%] had right sided prolapsed disc. Regarding the level of disc 19 [54%] patients had L4- 5 while 15 [43%] had L5-S1 and remaining one [2.9%] patients had L3-4 level. The post-op wound site visual analogue score was 1.57+/-1.1. Twenty-five patients had VAS of 1 [71.4%]. Minimum hospital stay was 1 day in 16 [45.75%] patients and maximum was 4 days in 3 [8.6%] patients. Mean hospital stay was 1.83+/-0.95 days. The only complication encountered was iatrogenic dural tear seen in one patient but with no CSF leak from wound site. No surgical site infections were reported at follow-ups

Conclusion: Endoscopic Lumbar discectomy is a safe procedure with short hospital stay

Frequency of placenta accreta on doppler studies in patients with previous caesarian section

To determine frequency of placenta accreta in patients with previous Caesarian section on Doppler ultrasound examination. A descriptive study. The study was conducted in Radiology Department CMH / MH Rawalpindi which is a tertiary care hospital from April 2006 to February 2007. All patients who were pregnant and had previous LSCS were included in our study. The patients were included on the basis of Non-probability convenience sampling. Patients who had all previous normal deliveries were not included in our study. The method adopted on Doppler ultrasound studies placenta accreta in patients with previous caesarian section was confirmed in the first trimester if sac was low lying and attached to anterior wall of uterus with little or no myometrium between sac and bladder. In the second and third trimester visualization of multiple irregular vascular spaces/ sinuses within placenta and visualized vascular bundles leaving the placenta and reaching lower part of bladder was diagnostic of accreta. We found the frequency of placenta accreta in patients with previous caesarian deliveries to be 3% [3/100] in CMH / MH Rawalpindi which is almost consistent with other studied performed in Pakistan and abroad. Out of 100 selected patients 3 were given suspicion of accreta on Doppler studies and confirmed to have accreta by our obstetrician and hysterectomy was done. Placenta accreta is a life threatening condition with increase risk to mother morbidity and mortality. Doppler ultrasound is a reliable radiological technique to diagnose placenta accreta

Validity of colour doppler ultrasonography with d-dimers in clinically suspected deep venous thrombosis of the lower LIMB

This study was designed to evaluate the validity of colour Doppler ultrasonography with D-dimers in clinically suspected deep venous thrombosis of the lower limb. Validation study Place and Duration of study: Radiology Department CMH/MH Rawalpindi Six months from 15 June 2006 to 31 December 2006. Subjects and Thirty cases of clinically suspected deep venous thrombosis of the lower limb were included in the study selected on non probability convenience sampling technique. Colour Doppler ultrasonography examination of the affected lower limb was carried out and results compared with D-dimers assays results. Among 30 patients who underwent colour Doppler ultrasonography examination of the affected limb for diagnosis of deep venous thrombosis, 27 [90%] were diagnosed to have deep venous thrombosis, 3 [10%] were diagnosed not to have deep venous thrombosis. Amongst them 2 patients had raised D-dimers levels and repeat Doppler ultrasound advised. On revised ultrasound deep venous thrombosis in these patients was confirmed. This showed that colour Doppler ultrasonography examination has sensitivity of 93.1%, specificity 100%, positive predictive value 100%, negative predictive value 33.33% and overall accuracy of 93.33%. Colour Doppler ultrasonography has a high diagnostic yield in cases of deep venous thrombosis of lower limb when used in conjunction with D-dimers assays

Colloid cyst of the third ventricle; endoscopic excision

Cerebrospinal fluid shunting or microsurgical resection of the colloid cysts of the third ventricle have long been a standard treatment. The emergence of neuroendoscopy has lead to its application in various neurosurgical problems. Colloid cyst of the third ventricle is one such pathology where endoscopic treatment has been performed with great clinical success during the past decade. We now Although considered less efficacious than microsurgical excision endoscopic excision is less invasive and much simpler. [1] to assess the extent of excision [2] to assess the morbid anatomy of the colloid cyst [3] to assess the risk of complications [4] to assess the functional outcome. Eight years [Jul 2001-June 2009]. Endoscopic resections of 15 colloid cysts of the third ventricle with obstruction of Foramina of Monroe in all cases. Total removal was achieved in 10 [66.7%] cases. In 5 [33.3%] patients the colloid material was evacuated completely while the remnant of the capsule adherent to its origin was left behind. Two [13.3%] patients developed meningitis one week postoperatively and one died subsequently. Nine [60%] patients had excellent recovery as the symptoms were relieved during a period of 3 to 24 months. Five [33.3%] of the total patients required ventriculoperitoneal shunt for obstructive hydrocephalus which developed with in 2 weeks after surgery. One out of the total number of patients deteriorated postoperatively on the existing neurological deficit. There has not been any recurrence until now with subtotal excision of the capsule. Keyhole surgery under endoscopic visual control offers an alternative, very effective minimally invasive approach for the excision of colloid cyst of the third ventricle and is likely to replace microsurgical resection as a standard procedure

Hypospadias repair; Seven years experience at Allied Hospital Faisalabad

To compare the results of Tubularized Incised Plate Urethroplasty with Mathieu repair and transverse inner perpuitual skin flap [Asopa's repair]: For Distal Hypospadias repair 30 patients were treated with Tubularized Incised Plate Urethroplasty and 30 were managed with Mathieu repair. For proximal hypospadias repair 20 patients were treated by Tubularized Incised Plate Urethroplasty and 20 patients were managed by Asopa's repair. The mean age at presentation was 7 years. Good cosmetic and functional results were achieved by all techniques. The overall success rate of Tubularized Incised Plate Urethroplasty was 86.6% and that of Mathieu repair 83.3% for the management of distal hypospadias. Success rate of Tubularized Incised Plate Urethroplasty was 85% and that of Asopas repair was 75% for the management of proximal hypospadias. Regarding Distal Hypospadias. In Mathieu repair; Urethrocutaneous fistula developed in 04 patients and total disruption in 01 patient. Meatal stenosis occurred in 02 cases who responded well to regular dilatation. In Tubularized Incised Plate urethroplasty 03 patients developed urethrocutaneous fistula. Total disruption in 01 patient and meatal stenosis was seen in 03 cases which responded well to regular dilatation. Regading proximal Hypospadias. In Tubularized incised plate Urethroplasty; 03 patients developed urethrocutaneous fistula and 01 patient presented with total disruption. Meatal stenosis was seen in 01 patient that needed meatatomy. In Asopas repair 03 patients developed urethrocutaneous fistula and 02 presented with total disruption. All the techniques are good for hypospadias repair. However Tubularized incised plate Urethroplasty proved to be the better technique for management of all type of hypospadias

Breast lump; its co-relation with malignant lesions and management

To find out correlations between benign and malignant lesions of the breast. Material and Methodss: A total of one hundred female patients who came to surgical outdoor with lump in breast or nipple discharge between ages of 20 and 75 years. Retrospective Study Setting: DHQ/Allied Hospitals, Faisalabad. Duration: 2 years, April 1996 to April 1998. In our study fibrocystic mammary dysplasia was the most common breast lesion in female patients of 20 to 30 years age. Carcinoma of the breast was the most common breast lesion in 35 to 45 years age patients. In majority of the cases lump was found in upper outer quadrant; while in three cases the whole breast was involved. In 12[36.4%] cases, right breast lump was found; while in 21 [63.6%] left breast was involved. ConclusionS: Our females are mostly illiterate and poor. They are unaware of the importance of the disease. In this regard it is suggested that we should organise Breast Screening Programmes, Breast Self Examination Teaching Centres and also Tumour Registries for data collection throughout the country