Reducing the donor site morbidity in radial forearm free flaps by utilizing a narrow radial forearm free flap

BACKGROUND: The radial forearm free flap (RFFF) has remained a leading choice of many plastic surgeons as a fasciocutaneous flap due to its versatility, pedicle length, and simple elevation technique. However, donor site morbidity has led many reconstructive surgeons to limit their use of the RFFF and to use other flaps instead. We propose that using a narrow RFFF (nRFFF) decreases the aesthetic and functional morbidity of the donor site. METHODS: We report our experiences with the nRFFF from April 2012 through May 2015 at the Department of Plastic, Reconstructive, and Hand Surgery at Liaquat National Hospital, Karachi. The donor defects were closed primarily. The Stony Brook Scar Evaluation Scale and comparison with the contralateral hand were used to assess aesthetic and functional outcomes, respectively. RESULTS: A total of 24 patients underwent nRFFF procedures during the study period. The donor arm showed excellent motor function in 22 cases (91.7%), and very good function in the remaining two cases (8.3%). The aesthetic outcomes were excellent in four patients (16.6%), very good in eight patients (33.3%), good in 10 patients (41.6%), and fair in two patients (8.3%) who developed a hypertrophic scar. All flaps were successful and there were no cases of partial or complete loss. CONCLUSIONS: For small to medium-sized soft tissue defects, the nRFFF had acceptable outcomes due to its thinness, pliability, and major reduction in donor site aesthetic and functional morbidity.

Types of traumatic lens dislocations at Larkana

The objective of this study was to determine the pattern of traumatic lens dislocations presenting at our institute. This may help develop the preventive strategies. The number of cases of traumatic lens dislocations, presented at the Department of Ophthalmology, Chandka Medical College, Larkana, Pakistan, from January 2002 to June 2015, were 59 including 61.02% [n=36] males and 38.98% [n=23] females. Cause of trauma was wood or plant impalement in 35.6% [n=21] cases, cracker blast in 13.55% [n=8] cases, fall on ground in 11.86% [n=7] cases, penetrating injuries with needle, scissors or knife in 10.16% [n=6] cases, road traffic accidents in 10.16% [n=6] cases, sports injuries [cricket ball and gulle danda] in 8.47% [n=5] cases, firearm injuries in 5.1% [n=3] cases, and fist hitting in 5.1% [n=3] cases. Lens was dislocated posteriorly in 33.90% [n=20] cases, anteriorly in 25.42% [n=15] cases, inferiorly in 11.86% [n=7] cases, medially in 10.17% [n=6] cases, laterally in 10.17% [n=6] cases, superiorly in 6.78% [n=4] cases, and a single [1.69%] case of lenticele was seen

Relationship of physical stress and hypertension among cardiovascular disease patients

Objective the aim of the study is to find out amount of physical stress among cardiovascular disease [CVD] patients and its relation with hypertension

Background physical stress is defined as a pressure - force and strain a state of physical mental tension. Stress is among the mental factors that has for some time been recorded among the potential. Furthermore, essential hazard variables of hypertension and coronary illness

Methodology a cross-sectional study was conducted in the patients of department of Cardiology at tertiary hospitals, Karachi, from January 2014 to December 2014. Sadaf stress scale [SSS] 2.0 was used to find out the physical stress

Results it showed physical stress among CVD patients about n=39 [43.3%] have moderate physical stress. which was decreased over time after 5 year of illness as compared to the patient who have disease for less than 5 years. While systolic blood pressure among subjects with severe physical stress showed an average systolic B.P. of 147mmhg, moderate have 146mmhg and patients with mild physical stress have 135mmhg

Conclusion this report concluded moderate physical stress among CVD patients which was decrease over time due different coping mechanism and blood pressures are directly related to severity of physical stress mainly systolic which lead to hypertension

Association of chemical stress with type I and II diabetes

Background: Diabetes mellitus is characterized by absolute or relative deficiencies in insulin secretion or insulin action correlated with chronic hyperglycemia and other disturbances in carbohydrate, lipid and protein metabolism results in weakening immunity. In addition, various biochemical disorders associated with diabetic vascular complications, such as hyperlipidemia and oxidative stress frequently co-exist with diabetes mellitus. Previous studies have also suggested that these and additional factors might involve with increasing chemical stress in diabetic patients

Material and methods: The questionnaire based survey was conducted including both close and open ended questions along with the assessment of chemical stress using Sadaf Stress Scale [SSS] version 2 among diabetic patients. This study was conducted in tertiary care hospitals of Karachi from October 1st till November 10th, 2014. Data was analyzed and plotted using SPSS version 20.0

Results: This study showed that 28% of diabetic patients were in severe chemical stress. However, the various symptoms of severity included body temperature alterations [50%], feeling of dehydration [56%] and shortness of breath [63%] were obtained

Conclusion: It is concluded that the diabetes patient with type 2 diabetes are at higher risk of developing chemical stress that may indicate multiple metabolic and as indicated by prominent symptoms that can be a oxidative alterations on sequence of increase use of medications and altered glucose metabolism

Demographic features of tuberculosis lymphadenitis patients

Background: Tuberculosis is an infectious disease, having high morbidity and mortality

Objective: This study was conducted to determine the demographic features of tuberculous lymphadenitis

Material and Methods: This cross-sectional study was carried out at Amir Clinical Laboratories Chiniot from 1[st] February, 2013 to 15[th] April, 2014. All of the 127 patients who presented with the complaint of cough, fever and clinical finding of cervical lymph node enlargement were included in this study. They were diagnosed having tuberculosis with the help of clinical examination and laboratory investigations. They were managed according to the standard protocol. FNAC was performed. The cases of tuberculous lymphadenitis were evaluated according to the age and gender groups. The data was entered and analyzed by using SPSS version11

Results: A total of 127 patients having cough, fever and enlarged lymph node were included and it was found that 85 [67%] were having Tuberculosis Lymphadenitis on FNAC. It was found that 29[34%] belonged to < Rs.10000 monthly income, 43[51%] belonged to Rs.11000- 20000 monthly and 13[15%] belonged to

Conclusion: The frequency of tuberculous lymphadenitis is more in age group of 1- 10 years and 11-20 years. In each group the frequency of males being affected is relatively more

Comparison of dietary intake and dietary requirement in post operative adult cardiac surgical patients in ICU

To estimate optimum energy and protein intake and to examine the differences in actual intake versus optimum protein and energy requirement during first three days of patients at surgical ITC of AFIC. A descriptive, cross sectional study was conducted by using purposive sampling technique. One hundred patients admitted in adult ITC of Armed Forces Institute of Cardiology and National Institute of Cardiovascular Diseases between periods of 10[th] July to 10[th] December 2013, fulfilling study criteria were included in study sample. Data was collected from hospital records [bedside charts] and food frequency questionnaire [FFQ]. Protein and energy intake on 1[st], 2[nd] and 3[rd] post operative day was calculated and compared with pre- calculated optimum protein and caloric requirement. Mean caloric intake on 1[st] post operative day was 583 k/cal, on 2[nd] post operative day 679 kcal and on 3[rd] post operative day was 820 k/cal which were 70%, 65% and 68% respectively less than the optimum requirement. Whereas mean protein intake was 13 grams on the 1[st] post operative day and 13.2 and 22.3 grams on the 2[nd] and 3[rd] day respectively which was 85%, 83% and 72% less respectively on first, second and third post operative day. The results suggest that the energy and protein intake of patients was below estimated requirements. Attention must be paid to malnutrition and nutrition in general in the hospital wards

Frequency of dysnatremia and dyskalemia in cardiac surgical intensive care unit

To determine the frequency of dysnatremia and dyskalemiain cardiac surgical intensive care unit patients and to identify the factors associated with the changes in potassium and sodium levels. Cross Sectional study. Cardiac surgical intensive care unit [ICU] of Armed Forces Institute of Cardiology / National Institute of Heart Diseases [AFIC/NIHD] from July 2013 to November 2013. Post-operative patients in cardiac surgical intensive care unit were selected through non probability convenient sampling. Demographic and clinical data was collected for all patients including: age, sex etc. Additionally, laboratory data such as potassium and sodium serum concentrations were recorded of day one of the first five post operative days. Out of 100 patients, 51% had dyskalemia, 33% had episodes of hypokalemia, and 19% had hyperkalemia. On the other hand 79% patients had dysnatremia, among them 71%had hyponatremia, and 8% had hypernatremia. Dyskalemia and dysnatremia are common problems in cardiac surgical ICU with higher frequency of hyponatremia as compared to hypernatremia, and hypokalemia as compared to hyperkalemia

Reduction in platelet count in post CABG patients with or without IABP- an experience at AFIC/NIHD Rawalpindi

To study the reduction in platelet count in patients after coronary artery bypass grafting having IABP placed peri operatively with and without IABP placed. Descriptive Study. Armed Forces Institute of Cardiology/National Institute of Heart Diseases [AFIC/NIHD] from Jan 2012 to Dec 2013. All cases with intra-aortic balloon pump [IABP] placed peri operatively [coronary artery bypass grafting, CABG] during this time period were examined in detail. Only those patients who had a platelet count of 150,000 or more pre operatively were included in the study. Patients taking medicines pre operatively that lead to decrease in platelet count were excluded. Platelet counts of each patient were analyzed till the third post-operative day. One hundred and fifty patients were divided into two equal groups, group A without IABP and group B with IABP. Patients without IABP [group A] pre operatively had mean platelet count of 223.57 +/- 83.02, on first post op day the mean platelet count was 171.0 +/- 59.0 which was 76.48% of preoperative level, on second post op day the mean platelet count was 168.1 +/- 59.4 which was 75.20% of preoperative level and on third post op day the mean platelet count was 167.5 +/- 60.0 which was 74.95% of pre-operative level. Patients with IABP [group B], pre operatively had mean platelet count of 205.32 +/- 50.257, on first post op day the mean platelet count of 152.71 +/- 43.77 which was 74.37% of preoperative level, on second post op day the mean platelet count was 112.11 +/- 42.571 which was 54.60% of preoperative level and on third post op day the platelet count was 90.87 +/- 41.538 which was 44.25% of preoperative level. There was significant reduction in platelet count from the pre-operative level in both the groups. Reduction in platelet count in post CABG patients is similar in both the groups i.e. in whom IABP is and those patients who are not treated with IABP

Pattern of skin malignancies in patients presenting to dermatology department Hayatabad Medical Complex Peshawar

This study was conducted to determine the pattern of cutaneous malignancies among patients attending the skin out-patient department Hayatabad Medical Complex Peshawar. This was descriptive analysis of skin cancers carried from January 2011 to December 2011. Histologically diagnosed skin cancers were reviewed and analyzed according to age, gender, site of distribution and histological types. Hundred histologically diagnosed skin malignancies were reported during the period under review. Sixty cases [60%] were males and 40 cases [40%] females with a male to female ratio of 1.5:1. Age ranged from 22 years to 86 years. Mean age was 57.05 +/- 11.39 SD. Mean duration of disease in months were 16.78 +/- 9.07SD. Basal cell carcinoma [BCC] was the most common malignancy consisting of 32[32%] cases followed by Squamous cell carcinoma [SCC 18%] with 10 [10%] cases of melanoma and 9[9%] cases of Mycosis Fungoides. Actinic Keratosis, Kaposi's sarcoma, Bowen's disease, Dermatofibroma, Atypical fibroxanthoma constituted the remaining. The most common skin malignancy was BCC followed by SCC and melanoma. Larger studies should be conducted to ascertain the actual prevalence of skin tumors

audit of laparotomies; carried out in combined military hospital Panno Aqil over three years period

To make an audit of laparotomies carried out at Combined Military Hospital Pano Aqil over a three year period. Cross sectional, retrospective study. Study was carried out at surgical department of combined military hospital Panno Aqil over a period of three years from Jan 2009 to Dec 2011. Patients with significant intra-abdominal pathology presenting as acute abdomen and who underwent laparotomy were included in study. Patients were either electively admitted via outpatient department or through Accident and Emergency [A and E] department. Patient charts and records were used to collect data. All 174 patients underwent laparotomy. In [27.6%] cases, intestinal perforation was the underlying cause; gynaecological pathology was found in [21.2%] patients. In 19.5% cases blunt and penetrating abdominal trauma was the cause of acute abdomen. Acute intestinal obstruction was found in [21.3%], tumors were found in [7.9%] and miscellaneous causes were identified in [2.3%] cases. Laparotomies carried out at Combined Military Hospital Pano Aqil fulfilled the evidence based medicine criteria

Treatment of fractures in 15 cases of osteitis fibrosa cystica - hyperparathyroidism: a case series

To study retrospectively the results of treatment of cases of pathological fractures presenting with osteitis fibrosa cystica due to hyperparathyroidism. Records of cases of hyperparathyroidism treated for pathological fractures in the past seven years were reviewed to assess success of treatment by various modalities. All patients had been investigated for vitamin D deficiency, parathyroid levels, serum calcium and phosphate levels along with renal function tests. All X-rays were restudied for evidence of osteitis fibrosa cystica. Thirteen cases healed uneventfully, one died of unrelated reasons and one failure led to non union. All patients had received oral calcium supplements and injectable vitamin D for three months at least. There were no complications of this treatment regimen. Pathological fractures due to bone weakness caused by hyperparathyroidism can be treated by various treatment modalities supplemented by oral calcium and injectable vitamin D

Mammographic-Sonographic co-relation in the diagnosis of breast lump

This study investigated the sensitivity of adding ultrasound [US] to mammography in the diagnosis of breast lumps. All women attending Radiology department Sir Ganga Ram Hospital, Lahore for mammography during a period of three months from June to August 2008 underwent bilateral mammography followed by whole-breast US and results were documented prospectively and preoperatively and verified by histopathology. Among the total 129 patients screened at our hospital in the three month period 73 patients came with the history of breast lump. US was positive in 69 [94%] and mammography in 67 [93%]. But when both the imaging techniques were combined the number of breast lumps detected was 72[98%]. So the ultrasound examination detected cancer in three additional women. Adding a screening ultrasound examination to routine mammography reveals more breast cancers were found than mammography alone. The combination of US and mammography is significantly better than either modality used alone, together resulting in 9% more breast cancers detected. High-quality breast ultrasound after mammography is of great value in diagnostic breast imaging and is being explored for supplemental screening of selected groups of women When ultrasound and mammography are properly correlated, abnormalities noted on screening mammography and even many palpable abnormalities can be dismissed as benign findings after complete work-up. For suspicious findings that can be seen sonographically, core biopsy under ultrasound guidance is desirable

Role of high resolution ultrasound in diagnosing diabetic muscle infarction

The study was carried out on eight patients with clinical presentation of non-traumatic painful swelling of lower limbs and were examined with high resolution Ultrasound probe of 12 MHz on Logic 700 expert series, with average patients age of about 37 years with H/O of uncontrolled diabetes Mellitus, showed discrepancy of circumference / thickness of Calf muscles compared to the opposite normal lower limb with areas of low echogenicity and one patient showed areas of necrosis / abscesses in muscle planes. All were diagnosed and latter confirmed on biopsy as Diabetic muscle infarctions with superadded inflammation

Effectiveness of combined thoracic epidural and light general anaesthesia in patients undergoing non-cardiac thoracic surgery

The specialty of thoracic anaesthesia has emerged as a scientifically based discipline just 30 years back. At the start of the 20'1i century empyema and tuberculosis were the main indications for the thoracic surgery. Later on with the introduction of antibiotics lung malignancies were more commonly operated. Recent resurgence of tuberculosis and associated medical illnesses put these patients in high risk for surgery and anaesthesia, necessitating introduction of more skilful approach. The objective of this study was to evaluate the effectiveness of combined thoracic epidural anaesthesia and light general anesthesia in patients undergoing non-cardiac thoracic surgery. This study was conducted at the department of Anesthesia and Intensive care, Pakistan Institute of Medical Sciences, Islamabad from 1st Jan 2001 to 31st August 2002. Ten adult patients of both sexes of ASA grade I-III, < 68 years of age, who were undergoing non-cardiac thoracic surgery were included. Thoracic epidural and central venous lines were placed 20 to 30 minutes before the start of procedure. All patients received same premedication, induction agents, analgesics, inhalational agents and muscle relaxants. All patients were transferred to Surgical Intensive Care unit after completion of the procedure. Seventy% patients were operated on lungs, twenty% on mediastinum and one% for carcinoma of esophagus. Only one patient had co morbid disease of hypertension. One patient [10%] died of massive intraoperative hemorrhage. One patient [10%] developed superior vena caval obstruction, that was to be operated for mediastinal growth. Rest of eight [80%] patients were extubated in the operation theatre. All [100%] patients received intraoperative blood transfusion. 20 patients required additional analgesia in the postoperative period. 20% developed postoperative arrhythmias. Combined use of light general anaesthesia and thoracic epidural is effective in patients undergoing non-cardiac thoracic surgery

Blood proteins and iron status relationship in mothers and newborns

Blood of sixty women and their newborns [cord blood] was analysed for different protein contents and iron. Correlations among the parameters were studied separately within the mothers and the newborns. The effect of mother's blood parameters on those of cord blood was analysed in all the cases. Correlations of serum total protein, albumin, globulin and haemoglobin in mothers and newborns were found positive and significant. However, these were found to be non-significant in the case of albumin globulin [A.G] ratio, serum iron and serum total iron binding capacity [TIBC]