Transcallosal, transforaminal approach for excision of colloid cysts of third ventricle

Objective: To study the efficacy of transcallosal, transforaminal approach in excision of colloid cysts of third ventricle in terms of complete excision and post-operative complications. Study Design: Prospective observational study. Place and Duration of Study: Study was carried out in neurosurgery department of CMH Rawalpindi, from July 2009 to Jun 2014

Material and Methods: All suspected cases were subjected to CT scan and MRI of brain for diagnosis and size and site of colloid cyst. All patients having colloid cyst of anterior third ventricle irrespective of age, sex and size of the cyst were included in the study. Patients with recurrence or previous surgery were excluded from the study. Patients with psychiatric illness and abnormalities of memory were also excluded. A uniform approach in terms of position of patients, craniotomy site and flap elevation was adopted for all patients. Post operatively the complications were recorded at 2nd day and 6th week. Derangement of short and long term memory, beads stringing and touch localization were recorded on a specific proforma

Results: A total of 19 patients with colloid cyst of 3[rd] ventricle were included, thirteen were male and 6 were female patients. The most common presentation was headache and vomiting. Most frequent cyst size was 1-2 cm and was present in 57.9%, while 4 patients presented with a large cystic swelling measuring 2-3 cm. A preoperative shunt had to be inserted in two cases due to sudden deterioration of the neurological status. Most of the cases [68.4%] presented with hydrocephalus, and it was absent only in 6 cases. Complete excision was obtained in 17 cases while in 2 cases the cyst could not be removed completely. Most frequent complication on 2[nd] postoperative day was the impaired short term memory which was present in 13 patients. Beads stringing was impaired in 9 patients on 2[nd] post-operative day. On sixth post-operative week, only 2 cases had short term memory loss as improvement occurred in all complications

Conclusion: Transcallosal, transforaminal approach is an effective and safe approach for the excision of colloid cysts of anterior third ventricle. Very few complications of less severity and temporary nature are associated withthis approach

Patterns of nasal trauma during close combat training in military training institutions

Objective: To identify the patterns and optimum management of nasal trauma during close combat training in military training institutions. Study Design: Descriptive study

Place and Duration of Study: The study was conducted in ENT department, Combined Military Hospital Abbottabad from August 2007 to July 2010

Material and Methods: All patients who reported with nasal trauma during the training were included in the study. A total of 200 cases were studied. They were all males and their ages were between 16 to 24 years

Results: The most common presentation of nasal trauma was epistaxis [92.5%] while 7.5% of cases were having no nasal bleed. Nineteen percent cases had external deviation of nasal axis while only 17% revealed inferior turbinate injury after initial treatment. Septal hematoma was present in 15% and was drained immediately in all cases. Nasal bone fracture was present in 36.5%. Anterior nasal packing was sufficient to stop nasal bleed in 80% cases of episatxis while 20% cases of nasal bleed required post nasal packing

Conclusion: The close combat techniques in army training institutions have increased the risk of nasal trauma and many different patterns of this trauma have been identified. Addressing the epistaxis, septal heamatoma and fracture nasal bone reduces the chances of complications

Comparison of permeatal medial placement of graft without raising the tympanomeatal flaps to conventional methods of myringoplasty: an experience at tertiary care hospital in Pakistan

Objective: To compare the results of permeatal approach without raising the tympano-meatal flap to end-aural or post-aural approach in myringoplasty

Methods: This Quasi-experimental study was carried out in CMH [Combined Military Hospital] Peshawar, from August 2006 to July 2013. Three hundred fifty patients of chronic suppurative otitis media [CSOM] with dry central; small, medium and large perforations were selected

They were divided into two groups depending upon the type of approach. In Group-A [n-200]; permeatal approach without raising tympano-meatal flap was used; while in Group-B [n-150] end-aural or post-aural approach was used. Subjects were followed up for two years; graft take was checked regularly by examinations of ear under microscope. Data was collected on structured Performa and analysed by SPSS-17

Results: Male and female were 74% and 26% respectively; Age ranged from 15 to 46 Years. There was no significant difference in the graft success at the end of two years in Group-A [80%] and Group-B [85%] [p-0.261]. Type of approach had a significant impact on duration of surgery [p<0.001] and post-operative recovery time [p<0.001]

Conclusion: The permeatal approach and end-aural/post-aural approach had almost equal graft success rates, but former is more useful as it causes lesser morbidity, decreased post-operative hospital stay and reduced operative time. It is under-utilized and should be employed more frequently

Journal of the college of physicians and surgeons of Pakistan: five years bibliometric analysis

To conduct the bibliometric analysis of the Journal of the College of Physicians and Surgeons Pakistan [JCPSP] from 2012 to 2014. The prime objectives of this report were to determine the number and percentage of articles by year, authorship pattern, gender and geographical affiliation, ranking by subject and citation analysis. A data collection instrument was developed as bibliometric form. The data was analysed using the Microsoft Excel spread sheet. Editorials and letters to editors were excluded. There were 1106 total research documents, including 721 original articles and 385 case reports. A rapid increase in number of articles per year was noticed, more original papers than case reports. Majority of the authors were male. The contribution of Balochistan and Khyber Pakhtunkhwa was less than the other provinces. JCPSP was the most cited document in the reference list of the research documents. The scholars of Khyber Pakhtunkhwa and Balochistan and female researchers should give more attention in writing quality articles eligible for consideration at this Journal. It is also suggested that writers should be compelled to address such fields of medical sciences as neurology, nephrology, anatomy and pharmacology, while writing original articles and case reports

Nasal hirudiniasis-an unusual cause of epistaxis

Common causes for unilateral nasal bleeding in adults are benign or malignant tumours, deviated nasal septum, nasal trauma and foreign bodies. Nasal leech infestation has not been identified as a cause of nasal bleeding in most of the textbooks of Ear Nose and Throat. Over 3 years, at Combined Military Hospital Muzaffarabad, and Combined Military Hospital Abbottabad, we have dealt with 38 such cases presenting with epistaxis where the cause was found to be leech infestation. A descriptive study was carried out at Combined Military Hospital Muzaffarabad and Combined Military Hospital Abbottabad over a period of 3 years. All patients whose epistaxis was due to leech infestation were included in the study regardless of age and sex. A total of 38 such cases presented with nasal Hirudiniasis as a cause of unilateral epistaxis. 29 were male and 09 female. All of the patients related their problem to the intake of fresh water of stream origin. The mean duration of symptoms was 12 weeks SD 3.0. It is concluded that nasal Hirudiniasis [nasal leech infestation] is a cause of unilateral epistaxis in areas like Muzaffarabad, Azad Kashmir and Abbottabad, where leeches are a common inhabitants of fresh water streams

Office management of benign paroxysmal positional vertigo with Epley's maneuver

The underlying cause of benign paroxysmal positional vertigo is free floating endolymph particles [otoconia displaced from the otolithic membrane of the utricle] in the posterior semicircular canal. Particle repositioning techniques are one of the effective method of treatment. The purpose of the study was to determine the effectiveness of Epley's maneuver against expectant treatment and to find out if this treatment should be used more frequently than watchful waiting for the treatment of BPPV. This study was carried out at outpatient clinic, departments of ENT, Combined Military hospital Rawalpindi and PNS Shifa hospital Karachi over a three years period from Jan, 2002 to Jan, 2005. Based upon history and Dix-hallpike testing 44 patients diagnosed as benign paroxysmal positional vertigo were collected by convenient sampling from these hospital's outpatient departments and divided by non probability convenience into two groups of 22 each. The control group [group A] was given placebo and the test group [group B] received single treatment by Epley's maneuver in the OPD. The results were analyzed at the end of one and two weeks by history taking and Dix-hallpike testing. Computer software SPSS version 10 was used. At the end of week one 14 [63.63%] patients of group B were symptom free and 2 [9.1%] patients was much better as compared to the control group where only 1 [4.5%] patient reported as symptom free and another 5 [22.7%] reported as much better. At the end of second week out of those treated by Epley's maneuver 16 [72.7%] reported as symptom free and another 2 [9.1%] as much better whereas 4 [18.2%] patients reported no improvement at all. In the control group only 4 [18.2%] patients reported as symptom free, 3 [13.6%] as much better, 6 [27.3%] as better and 9 [40.9%] reported no change in the symptoms. Chi square test was applied and the value of p came out to be 0.001 and 0.002 at week one and week two respectively. It was concluded that Epley's maneuver is a much better form of management for benign paroxysmal positional vertigo

Primary tuberculous otitis media

This study was conducted to determine the frequency of primary tuberculous otitis media [TOM] in north-west region of Pakistan. This observational study was conducted at ENT and Head and Neck Surgery unit of Naseer Teaching Hospital, Peshawar from 1st April 1999 to 31st March 2005. Diagnosed cases of primary tuberculous otitis media were included. The inclusion criterion was histopathology of biopsy specimen and acid-fast bacilli [AFB] examination of ear discharge after Ziel Nielsen [ZN] staining. Patients with pulmonary tuberculosis were excluded from study. A total of 12 cases of primary tuberculous otitis media were included. Young adults [15-56 years] were mainly affected. Majority [66.66%] of patients belonged to Afghanistan. Main presenting features were painless otorrhoea in 12 cases [100%] followed by abundant granulations, total perforation and failure to conventional medical therapy in 9 cases [75%] each. Ten cases [83.30%] were diagnosed on presence of granulation on histological examination while 2 cases [16.7%] were diagnosed on AFB demonstration after ZN staining. Anti-tuberculous chemotherapy was given to all patients and surgical treatment was offered to 8 patients. Four patients had radical mastoidectomy, 3 underwent aural polypectomy and 1 had simple [cortical] mastoidectomy. Response to chemotherapy was tremendous [100%]. Six patients from Afghanistan were lost to follow up. The primary TOM in northwest region of Pakistan is more common in Afghan refugees. TOM, when properly diagnosed, has got excellent response to chemotherapy

Allergens in allergic rhinitis

Allergic rhinitis disrupts the quality of life of a large segment of our population. Mostly it effects young individuals and can lead to considerable morbidity and complications. There were two main objectives of the study. To find out the allergens responsible for causing allergic rhinitis in the Armed forces personnel and their families residing in Rawalpindi and Islamabad. To determine the rate of positivity of the skin prick test in these selected patients. The study was carried on 200 cases in ENT department CMH Rawalpindi during March 2001 to March 2003. Patients were selected irrespective of sex, between the age brackets of 12-60 years. Patients presented with clinical features of allergic rhinitis were clinically examined and then skin prick test were carried out in AFIP Rawalpindi to find out the causative allergens. Common allergens on skin prick test were found to be house dust [72.6%], house dust mites [64%], mixed pollens [59.5%], grass pollens [46%], paper mulberry [21.5%], cannabis [13.5%] and moulds [20%]. The rate of positivity of skin prick test was found to be 88% among the selected patients of allergic rhinitis. It is concluded that determination of causative allergens form the cornerstone in the management of allergic rhinitis. Based on these findings a patient can take preventive measures against the causative allergens and a physician can diagnose and treat the patients in a better way