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Introduction: Sella turcica (ST) is a saddle-shaped structure located on the intracranial surface of the sphenoid bone in the middle cranial fossa. The sella turcica serves as an important anatomical reference in orthodontics partly because the s-point, placed centrally in the sella region, is a central fix point in cephalometric analysis and partly because the contour of the anterior wall is used in evaluation of craniofacial growth. Morphologically, three basic types - oval, round, and flat - have been classified, the oval and round types being the most common. Aim and objectives: To describe the predominant morphological shape of sella turcica. Materials and methods: Prospective clinical study which was conducted in the Postgraduate Department of Oral Medicine and Radiology of Government Dental College and Hospital Srinagar. This prospective study included total of digital lateral cephalometric radiographs of 180 patients (90 males and 90 females) between 12-65 years of age, Digital lateral cephalometric radiographs were taken by using CARESTREAM SC8100 machine Results: Morphology of sella turcica was found to be typical in just 33.9% of cases. Within the atypical sellae most had oblique anterior wall (27.2%), followed by double contour of the floor (15%), pyramidal shape (14.4%), irregular dorsum sella (6.7%) and bridging (2.8%). Conclusion: Morphological types of sella turcica in this study can be used as reference for additional investigators such as radiologists, orthodontists, maxillofacial surgeons, and neurosurgeons to interpret and plan surgical procedures involving the sellar region
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Background: Carotid plaques contribute a significant cause of stroke and transient ischemic attacks together with long term disability worldwide. About 20-30% of cerebral infarction has been correlated with carotid atherosclerotic plaque and artery stenosis. The characterization of carotid artery plaque presents an opportunity to quantify patients with risk of cerebrovascular events and may be used to improve the therapeutic decision-making process such as carotid endarterectomy or angioplasty or stent placement. This study attempted to evaluate the imaging characteristics of carotid plaques using ultrasonography with Magnetic Resonance Imaging correlation and predict the risk of plaque rupture based on plaque enhancement characteristics as a surrogate marker. Materials and methods: Aim of the study was to evaluate and compare morphological characteristics of carotid plaques with Doppler ultrasonography and MRI and to predict plaque enhancement characteristics on MRI as a potential surrogate marker for plaque rupture leading to recurrent strokes. The present study evaluated 113 patients (65 males and 48 females) with stroke and transient ischemic attacks with ultrasound documented carotid plaques. These cases underwent Doppler evaluation of the carotid plaques and contrast enhanced MRI on the same day. The plaque morphology was evaluated both in the longitudinal as well as the transverse axis, and the stenosis was calculated based on the pulsed- wave Doppler evaluation of blood flow velocity as well as the area and diameter of the stenosis together with the signal and enhancement characteristics of the carotid plaques on MRI. The carotid artery at the region of maximal intimal thickness was evaluated for maximal area stenosis and diameter stenosis. The area stenosis was calculated as percentage stenosis in axial sections at the site of maximal thickness of the plaque. Results: The maximum incidence of carotid plaques was noted in the 61-80 years age group. The incidence was maximal at 71-80 years of age. Out of the 113 lesions, 65 (57.5%) were in men and 48 (42.4%) were in women. 44(38.9%) lesions were in patients who presented with TIA, while 69 (61.06%) presented with Ischemic stroke. 67 (59.29%) lesions were found on the left side and 46 (40.7%) on the right side. 67(59.3 %) lesions were found in the carotid bulb. The intimal thickness ranged from 1.1 mm to 5.6 mm with a mean of 2.97 mm. The range of stenosis was from 0% to 100%. Heterogeneous plaques were associated with symptomatic lesions in 76.2 % and homogeneous plaques were seen in 23.8%. The incidence of plaque calcification was inversely proportional to symptomatic plaques. Only 47.2 % of patients showed concordance between US and MRI with regard to homogeneity of the plaque. T2 weighted MR imaging of exvivo atherosclerotic plaques aided in the detection and evaluation of fibrous caps. 39 (34.1%) patients were given a gadolinium-based contrast agents, out of which 19 (48.7 %) did not show enhancement and 20 (51.2%) showed enhancement of the carotid plaque tissue. Doppler showed abnormalities in 29 patients (61.7%), whereas in MRA it is 18 patients (38.2 %), p value = < 0.004* in cases with less than 50% stenosis (n=47). In cases with 50-69% stenosis (n=29), doppler showed abnormalities in 19 patients (65.5%) whereas in MRA it was (34.4 %); P value was 0.431, The difference was not found to be statistically significant. While as in cases with 70-90% stenosis (n=37), MRA showed abnormalities in 25 patients (67.5%) whereas Doppler showed it in 12 (32.4%); P value was 0.017. Calcification was seen in 22 patients which appeared as hypointense focus on T1, T2, and TOF images. The heterogeneous lesions were better visualized on ultrasound compared to MRI. Conclusion: Ultrasound is a more sensitive modality than MRI for plaque size < 1.5 mm and a better tool in assessing the plaque characteristics when the area of stenosis is less than 50%. Hence, ultrasound is better as a screening tool. The homogenous lesions on ultrasound appeared homogenous on MRI with the plaque content of fat. The heterogeneous plaque on ultrasound, however, did not correlate with MRI. Enhancement of carotid plaque tissue, which implies vascular wall inflammation, is a marker of vulnerable plaque. MRA has a better discriminatory power compared with duplex ultrasonography in detecting 70-90% stenosis
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Background: An accidently ingested foreign body may get lodged within the lumen of gastrointestinal tract, pass uneventfully with feces or may migrate extraluminally into the surrounding tissues in which case it may lead to suppurative or vascular complications. The aim of the endeavor was to study the spectrum of imaging findings in patients with accidental ingestion of foreign bodies with trans-gastric migration of metallic foreign bodies.Methods: Total 33 patients with history of accidental ingestion of foreign bodies were subjected to preliminary radiograph of neck, chest and abdomen followed by upper gastrointestinal endoscopy. Failure to retrieve/ localize foreign body endoscopically from upper gastrointestinal tract with check radiograph reiterating the presence of foreign body in upper abdomen were subjected to computed tomography of abdomen.Results: A total of 33 patients comprising of 27 females and 6 males with mean age of 23.76 years with history of foreign body ingestion were studied. Ingested foreign bodies were lodged in pharynx (n=7), esophagus (n=3), stomach (n=13) or duodenum (n=3). In 7 patients in whom endoscopy failed to locate and/or retrieve foreign body, computed tomography confirmed the presence of trans-gastrically migrated foreign body in the surrounding structures. The location of migrated foreign bodies was in lesser sac (n = 2), greater omentum (n = 3), lesser omentum (n = 1) and transmural (n = 1). Two patients had evidence of collection formation around the migrated foreign bodies.Conclusions: Sharp or pointed metallic foreign bodies may migrate trans-luminally with various implications. Though radiography is the preliminary workhorse for the confirmation of ingested foreign bodies, computed tomography owing to its volumetric data acquisition helps in exact localization of migrated foreign bodies and should precede any therapeutic intervention for retrieval of migrated foreign bodies.
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Background: PACS (Picture archiving and communication systems) and digital imaging (DI) has revolutionized radiology bringing about a paradigm shift in the way radiodiagnosis is perceived and practiced with a slew of benefits like elimination of the need for manual handling of films, helping in long term storage of digital images, easy transfer and retrieval of radiographic images. The objective of this study was to analyse the influence of PACS and digital imaging on the workflow in the radiology, performance of the radiographer and image storage and retrieval capabilities.Methods: It was a questionnaire-based study in which questions were asked to the radiographers working in our hospital at five different working sites. Each questionnaire was aimed to evaluate the effect of digital imaging on radiology workflow, improvement in the performance of radiographers, reduction in the work-related frustration levels due to use of digital imaging and finally the utility of digital imaging in image storage, query and retrieval.Results: Among the 50 questionnaires 41 were completed and retrieved. Among the respondents, 90.24% indicated that digital imaging has obviated the need for repeat examinations, 95.12% agreed with the fact that it resulted in the reduction of the number of reject images, 95.1% said it helped them in improving their performances, 92.6% of the respondents said they did not face any issue with its use and 95.1% of the participants agreed that the image query and retrieval could be accomplished in a hassle-free manner.Conclusions: The digital imaging technique not only improves the performance of the radiographers but also increases the workflow of the health care hospitals or clinics. The digital imaging reduces the number of rejected images thus reducing radiation exposure to the patients. Further, it is highly cost-effective and time-saving.
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Background:Radiological determination of gender relies predominantly on the skeletal radiology and assumes importance in mass natural disasters, bomb explosions, exhumations and warfare where skeletal fragmentation is common. Varied literature is present regarding the role of foramen magnum in establishing gender identification.The objective of the study wasto establish normative values of cross-sectional area of foramen magnum in both genders using NCCT and try to ascertain any significant difference in cross-sectional area in the two genders which may help in gender identification.Methods:NCCT head images of 378 subjects were analysed in individuals beyond the age of skeletal immaturity. Free ROI technique using electronic calliper tool was used. The cross-sectional area of foramen magnum was automatically obtained after tracing its whole inner circumference.Results:Mean cross-sectional area of foramen magnum in females was 806.79±106.58 mm2and was 878.33±98.42 mm2in males. Although the cross-sectional area in males was greater than females no statistically significant difference was found. The correlation coefficient was found to be weaker (R=0.0413). Conclusions: No statistically significant difference was found between the two genders. The correlation coefficient was also weak to draw any inference about the gender of the skull on CT imaging. Further studies are needed to include other parameters like the sagittal and transverse diameters of foramen magnum in a larger sample to show importance of foramen magnum, if any, in helping gender identification of skeletal remains
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Background: Ultrasonography (USG) is a cheap, easily available and painless modality for the diagnosis of carpal tunnel syndrome. However, the main sonographic criteria of cross sectional area (CSA) and flattening ratio (FR) of median nerve show a wide normal variation which warrants establishment of normal range of variability in the dimensions of median nerve in different populations. Objective: The main aim of this study was to calculate the mean cross sectional area (CSA) and flattening ratio (FR) of median nerve at wrist in asymptomatic adults. Materials and methods: This prospective observational study included asymptomatic adults visiting our tertiary care hospital for unrelated heath conditions with no symptoms to suggest carpal tunnel syndrome. Ultrasound examination of both wrists was carried out by high frequency linear array transducer with frequency of 10MHz with the arm in supine neutral position on LOGIQ P5 (GE Healthcare, Chicago, Illinois, USA) ultrasound machine. The cross-sectional area (CSA) and flattening ratio (FR) of the median nerve was measured at the level of carpal tunnel inlet and mean values with standard deviation were calculated. Results: Three hundred seventy six (376) wrists of 188 subjects were examined. 36 wrists were excluded owing to presence of anatomic variations of the median nerve in them. 340 wrists of 170 patients were included in the study. Mean cross sectional area of median nerve was 9.2 mm2 (±1.2). Arshed Hussain Parry, Abdul Haseeb Wani, Naseer Ahmad Choh, Tariq Ahmad Gojwari. High-resolution ultrasonography measurement of dimensions of median nerve at wrist in asymptomatic adults. IAIM, 2019; 6(4): 144-149. Page 145 Mean value of flattening ratio was 2.4 (±0.6). Mean CSA (9.26 ±1.2 mm2 ) and FR (2.41 ±0.6) of males was not significantly different from mean CSA (9.16 ±1.2 mm2 ) and FR (2.4±0.55) of females. However, mean CSA of right wrist (9.4 ±1.2 mm2 ) was significantly different from mean CSA of left wrist (9.10 ±1.1 mm2 ). Conclusion: We found a higher mean cross sectional area (CSA) of 9.2 mm2 of median nerve in our population. There was a significant difference in the cross sectional area of median nerve between right and left wrists. However, we did not find statistically significant difference in the CSA and FR between the males and females. Establishment of normative data for the dimensions of median nerve is essential for different populations given the wide range of variations in the dimensions of median nerve
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Background: An enormous number of artefacts are encountered in magnetic resonance imaging (MRI) which jeopardize the image quality. A comprehensive knowledge of the sources and the remedial measures needed is pivotal to enhance and optimize the image quality in magnetic resonance imaging (MRI). Objectives: The primary objectives of the study were to identify different MRI artefacts, to find the reason/cause of these artefacts and to find methods for correction of these artefacts. Materials and methods: This was a prospective study which included all the patients that were referred to our department for various MRI examinations. The study was carried at 1.5 tesla Magnetom Avanto Siemens, Germany. All the MRI examinations were performed by trained technologist in presence of an experienced radiologist. The MR images acquired were studied for the presence of any artefacts during the performance of MRI examination, the MR parameters at which the artefacts appeared and subsequently the remedial measures undertaken. Results: A total of 209 patients comprising 95 females and 114 males, referred to our department for MRI examinations of various body parts were studied. The commonest artefact observed was motion artefact in 43 (20.6%) patients followed by susceptibility artefact and aliasing artefact. Less common artefacts observed were chemical shift artefact, herring bone artefact, Gibb’s artefact, Moiré fringe artefact, zipper artefact and magic angle phenomenon. Arshed Hussain Parry, Abdul Haseeb Wani, Abdul Momin Jan, Tariq Ahmad Gojwari. Artefacts in magnetic resonance imaging (MRI) and their remedies. IAIM, 2019; 6(4): 122-130. Page 123 Conclusion: Thorough understanding of the sources of magnetic resonance imaging (MRI) artefacts and the mechanism of their production enables
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<p><b>PURPOSE</b>Bear maul injuries are the most common wild animal inflicted injuries in India. More than 300 bear maul injuries report to our hospital per year.</p><p><b>METHODS</b>Twenty-one consecutive patients over a period of 1 year reported to our department for orthopaedic management of bear maul injuries. All the patients were referred either from peripheral hospitals or from other surgical departments of our hospital.</p><p><b>RESULTS</b>All the patients had facial/scalp injuries of variable severity. In all the patients the severity of limb and facial trauma was inversely proportional to each other. Pattern of upper limb trauma in most of the patients was similar. Fifteen patients had either fractures of distal humerus or mid shaft/proximal forearm bone fracture. Two had distal forearm bone fracture, 2 had carpal/metacarpal fractures and 1 had clavicle fracture. Only 1 had lower limb fracture. Thirteen out of 21 patients had associated neurovascular injury of the involved limb. The characteristic feature was extensive soft tissue involvement of the affected limb.</p><p><b>CONCLUSION</b>Upper limb injuries in bear maul patients usually have similar pattern. The severity of upper limb and facial/scalp trauma is inversely proportional to each other. Multistage orthopaedic surgeries are needed for such complex limb injuries.</p>
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Objective: To determine the diagnostic accuracy and cut-off values of serum cystatin C as early diagnostic biomarker of diabetic kidney disease. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Pathology, Army Medical College, Rawalpindi in collaboration with Endocrinology Department, Military Hospital [MH], Rawalpindi from November 2015 to November 2016
Methodology: One hundred and nineteen diagnosed patients of type 2 diabetes mellitus were enrolled in the study from the outpatient Endocrinology Department of the MH Rawalpindi. Fifty disease-free controls were also included. Fasting blood samples of the patients and controls were analysed for creatinine by Jaffé's kinetic method and estimated GFR was calculated using MDRD-based equation for GFR. Serum cystatin C was estimated by quantitative turbidimetric method
Results: Serum cystatin C was higher in the diabetic group [mean = 1.022 +/-0.33 mg/dl] as compared to the control group [mean = 0.63 +/-0.14 mg/dl]. ROC curve analysis, keeping less than 60 ml/min/1.73 m2 GFR [CKD-MDRD based] as reference value of the stat variable/gold standard; revealed an area under the curve of 0.914 [95% CI 0.85-0.98] and at optimal sensitivity of 88.2% and specificity of 84.8% the established cut-off of serum cystatin C was 1.26 mg/L
Conclusion: Cystatin C is an accurate biomarker of diabetic kidney disease with good sensitivity and specificity
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Objective: To compare e-GFR estimated by creatinine or cystatin C based and combined creatinine and cystatin C based equations in type 2 diabetics in different stages of albuminuria. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Chemical Pathology, Army Medical College Rawalpindi in collaboration with endocrinology outpatient department Military Hospital Rawalpindi, from Nov 2015 to Nov 2016
Material and Methods: A total of 119 type 2 diabetic subjects of either gender, aged 30- 60 years were enrolled in the study with duration of diabetes less than 15 years and were divided into further sub groups on the basis of degree of albuminuria determined by spot urine albumin to creatinine ratio [uACR]. Fifty age matched disease free controls with no history of any systemic disease were also included in the study. Known patients of type 1 diabetes, chronic inflammatory disorders, uncontrolled hypertension, thyroid disease, chronic kidney disease, on lipid lowering drugs, steroids, ACE inhibitors and pregnant ladies were excluded from the study. Serum creatinine serum cystatin C were assessed on fully automated chemistry analyzer selectra. E-GFR was calculated by online GFR calculator by National Kidney Foundation. Comparison of means of e-GFR calculated by various equations was carried out by one way ANOVA and post-hoc Tukey tests. Degree of agreement between various equations for the estimation of GFR was assessed by kappa statistics. A p-value less than 0.05 were considered statistically significant
Results: Mean e-GFR [ml/min/1.73m[2]] was lowest in cystatin C based CKD-EPI equation [89.56 +/- 39.84] followed by combined cystatin C and creatinine based CKD-EPI [92.34 +/- 37.88]. Values of e-GFR by creatinine based CKD-EPI equation [95.84 +/- 27.24], and by creatinine based MDRD equation [105.37 +/- 64.98] were both higher. In creatinine based MDRD, equation normo albuminuria and micro albuminuria groups did not show statistically significant difference as compared to each other and control group. The mean value of e-GFR was found to be lowest in the normo albuminuric diabetics when estimated by cystatin C based CKD-EPI equation [88.82 +/- 46.98] followed by combined creatinine and cystatin C based CKD-EPI equation [95.73 +/- 42.96]
Conclusion: Cystatin C based CKD-EPI equation for e-GFR identifies more patients with glomerular dysfunction in normo-albuminuric stage of DKD as compared to cystatin C and creatinine based CKD-EPI and creatinine based MDRD equations. Therefore, e-GFR estimated by serum cystatin C based CKD-EPI formula is a better option for assessing the renal status in patients of early DKD
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An ablative surgical procedure in the oral cavity is curative for oral and maxillofacial pathologies, but simultaneously produces hard and soft tissue defects. These defects produce functional and psychological problems in the post operative period
The Objective of the present study was to evaluate the efficacy ofbuccalfatpad in reconstruction of intra-oral defects, elaborate the surgical technique used and also identify its post operative complications
A prospective study was conducted on patients with oral defects covered by Buccalfatpad between July 2008 and January 2016 in department of oral and maxillofacial surgery of Khyber College of Dentistry Peshawar. The variables of the study were, Age, gender, cause of surgery and location of intraoral defect. Patients were subsequently evaluated for signs of epithelialisation and Post operative complications
A total of 50 patients [33 males and 17 females] were recruited in the study. Male to female ratio of patients was 1.94: Land Mean age of 51.25 years SD + 12.94. The most common cause of intraoral defect was because of excisions of malignant tumors of oral mucosa and salivary glands. Maxilla was the most common site for the surgical defects observed. The epithelialisation process was completed in 3 weeks without any complications in 44 patients. However dehiscence of the graft was seen in 6 patients, yielding success rate of 88%. We also noted limited mouth opening in cases of retro molar area defects, but this problem was resolved with post operative physiotherapy
It was concluded that buccal fat pad is a convenient, feasible and quick method of reconstruction for sealing intraoral defects
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Adipose Tissue , Prospective Studies , Intraoperative Complications , Surgery, Oral , Administration, BuccalABSTRACT
Objective: to evaluate the outcome of percutaneous antegrade endopyelotomy as a primary intervention for Secondary Ureteropelvic junction [UPJ] obstruction
Methodology: this study was conducted from 20th January 2011 to 19th January 2012 at Institute of Kidney diseases, Hayatabad, Peshawar. A sample of 31 cases having evidence of secondary ureteropelvic obstruction were listed for the study of which 21 cases as males and the rest females. Ultrasound, intravenous urogram and DTPA Scanwere carried out. Patients with severe hydronephrosis, renal function <30%, anterior crossing vessel and UPJ>2 cm stenosed segment were not included in the study. Stenosed segment was incised posterior-laterally until periureteral and peripelvic fat was visualized. At completion of 8 weeks postoperatively the ureteric stents were removed as day cases and the patients were evaluated at follow-up of 3 months and every subsequent 6 months in the out-patient department with data relevant collected on a predesigned proforma
Results: demographically the findings were observed and mean age at both sexes was similar. The mean split GFR on the affected side was 36.5 mg/ml. The average time taken to completion of the procedure was 63 min. Hospital stay averaged 3.8 days [ranging form 2-6 days]. Success rate was 81% [25 of 31] at 10.25 months. Failure was noted clinically in 6 cases with presentation variably at completion of first to the third month postoperatively
Conclusion: percutaneous antegrade endopyelotomy has significant advantages in term of reduced hospital stay, shorter operative time, early postoperative recovery, minimal morbidity and decreased postoperative analgesic re-quirements. It is successful in selected patient who have good renal functions, no crossing vessels, mild to moderate hydronephrosis and dependent ureters
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Objective: surgical outcome of tethered cord syndrome
Study Design: retrospective descriptive
Period and Place of study: Neurosurgery Department Allied Hospital Faisalabad over 6 months from October 1, 2014 to March 28, 2015
Materials and Methods: forty patients were selected at Neurosurgical Department, Allied Hospital, Faisalabad with age ranging from 2 months to 27 years[average 2.58 years]. These were assessed clinically and their orthopedic and urological aspects were also assessed. MRI of relevant area was advised. Counselling was done regarding surgery under general anesthesia and its outcome. Laminectomy or laminotomy was done. Cord was detethered from its attachments from dura, and, in case of lipomeningocele, from its extradural component. In case of diastometomyelia, bony spur was extirpated and dura- plasty was done. Tight filum terminale was divided. Surgery was done using microsurgery techniques. Postoperative assessment was done immediately at the time of discharge, at 6 and 12 months
Results: a total of 40 patients, M:F ratio was5:3. Average age was 2.58 years.Age was ranging from 2 months to 27 years. Power improved in 44 % to grade 5/5 and 37% in grade 4/5 at one year. There was 65 % improvement in anal sphincters and 71% improvement in urinary sphincters at one year
Conclusion: our clinical and neurological evaluation showed satisfactory outcome after surgery, particularly when performed before the onset of irreversible deficit. Neurological status prior to surgery has profound impact on the outcome
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Objective: To determine the efficacy of tamsulosin therapy for the treatment of lower urinary tract symptoms [LUTS] in women
Methodology: This study was conducted in Institute of kidney diseases, Hayatabad medical complex Peshawar from April 2011 to September 2012. All female patients aged 13 and above with LUTS were included. After taking history, physical examination and baseline investigations, specific investigations such as urine culture, urodynamics and ultrasound with postvoid residual volume were performed. Base line international prostate symptom score [IPSS], maximal flow rate [Qmax] and post-void residual volume [PVR] were recorded for each patient before starting treatment. Tamsulosin therapy was initiated at 0.4 mg once daily and continued for 6 weeks. In follow up visits after 6 weeks, IPSS, Qmax, and PVR were repeated for evaluation of outcomes
Results: Out of 94 patients, 10 did not come for follow up. Mean age of the sample was 43 years. Presenting complaints were increased frequency [n=67, 79.8%], Urgency [n=62, 73.8%], Nocturia [n=64, 54.8%], Feeling of incomplete bladder emptying [n=17, 20.2%], Poor stream [n=15, 17.9%], Hesitancy [n=5, 6.0%], and Intermittency [n=2, 2.4%]. Mean PVR and IPPS decreased and Qmax improved significantly with p value <0.01. Efficacy was 90.5%. It was 52[96.3%] in pre-menopausal and 24[80.0%] in postmenopausal women. Only Two patients experienced drowsiness
Conclusion: Tamsulosin significantly decrease IPSS, PVR and improve Qmax, so they should be used as first line treatment for moderate to severe LUTS in women
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The aim of the study was to know the effects of the seat belts on the severity and pattern of facial injuries in road traffic accidents. Sixty patients with road traffic accidents in four wheel vehicles were investigated for mild-moderate and severe facial injuries with and without seat belt usage during driving. This study was carried out in the Department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar. These patients with maxillofacial injuries and associated fractures were studied for age, gender distribution, severity of facial injuries and their association to restrained or unrestrained with seat. Among 60 patients only 12 were wearing seat belts when accidents occurred. Male were dominant and most RTA occurred in patient in 20s. The mean age of the patient in the present study was 21.9 years SD +/- 3.5. The age range was 6 - 50 years. The most commonly involved age group was the 3rd decade [32.25%] followed by 1[st] decade [25%] and 4[th] decade [18.25%]
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To evaluate the efficacy of Percutaneous Nephrostomy [PCN] for the management of pyonephrosis. This descriptive study of 78 cases of pyonephrosis was conducted at Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar Pakistan from July 2010 to December 2011. Ultrasound guided percutaneous nephrostomy was performed and pus was sent for culture and sensitivity. Urine output in the PCN was monitored. Patients were clinically observed. Blood chemistry was analyzed. Patients were put on antibiotics based on culture and sensitivity. Efficacy was defined as the symptomatic relief of a patient in respect to pain and fever and biochemical improvement in terms of decreased TLC count and improved RFTs in early post PCN period. Data was collected on a structured proforma and was analyzed on SPSS version 10. Out of 78 patients who underwent percutaneous nephrostomy for pyonephrosis, 42[53.84%] were male and 36[46.15%] were female. The majority, 69[88.46%] patients had underlying obstructing urinary calculi. Other causes of obstruction included, benign strictures 5[6.41%]; pelviureteric junction obstruction 3[3.84%] and malignant stricture 1[1.2%]. Culture of the drained pus was positive in 73[93.58%] patients. After 2 to 3 weeks of PCN, 53[69%] patients underwent minimally invasive procedures as definitive treatment of the obstructing lesion whereas 23[31%] patients required major surgery after 4 to 6 weeks. Percutaneous drainage for pyonephrosis is an effective diagnostic and therapeutic method, decompressing the obstructed and infected pelvicaliceal system and rapidly stabilizes the patient's clinical condition and makes him fit for definitive treatment
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Objective: Assessment of Neurosurgical Outcome of Acute Traumatic Extramural Hematoma based on GCS
Study Design: Clinical Trial
Place and Duration: Neurosurgery Department Allied Hospital Faisalabad, 20 Months from July 31-2011 to 28-2-2013
Clinical Material and Method: One hundred and thirty patients were selected for study. CT scan brain was done of every patient. The size of EDH was assessed. GCS was assessed. Patients were grouped in three groups A [GCS >8, EDH volume <30 ml], B [GCS <8, EDH volume > 30 ml] and C [GCS > 8, EDH volume > 30 ml]. Outcome was assessed according to Glasgow outcome scale
Conclusion: Patients with group A [EDH < 30ml and GCS > 8] can be managed conservatively. Their outcome was comparable with operated patients EDH > 30ml. However group B has mortality of 4.3% and outcome was different from group A and C which have no mortality
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To compare the outcomes of wide open excision and Karydakis procedure in terms of postoperative complications, hospital stay and recurrence rate. Comparative interventional study. Surgical unit Hayatabad Medical Complex Peshawar, from April 2006 to March 2009. A total of 40 patients with pilonidal sinus were admitted through OPD. Patients with osteomyelitis of sacrum, fistula with anal canal or rectum, and those who were lost during follow up, were excluded. Patients were divided into 2 groups. In group A [20 patients] wide open excision was done whereas in group B [20 patients] Karydakis procedure performed. Patients were followed up in OPD for 6 months and postoperative outcomes were recorded. Out of 40 patients, 36 [90%] were males and 4 [10%] females [M:F = 9:1]. Age range was 15 to 40 year with mean age of 26.5 year +/- 2.4 year. In group A, postoperative complications encountered were pain [75%], bleeding [10%], wound infection [25%], scar pain [30%] and numbness [15%] at the site of surgery. While in group B, postoperative morbidity included pain [25%], hematoma/seroma formation [10%], wound infection [15%], scar pain [15%], numbness [20%] and wound dehiscence [10%]. Average hospital stay was 5.6 days in group A and 2.5 days in group B. Recurrence rate was 25% following wide open excision and 5% after Karydakis procedure. Karydakis procedure is better than wide open excision in terms of less postoperative complications, reduced hospital stay and low recurrence rate
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Objectives: Traumatic Subarachnoid Hemorrhage [Tr SAH] is a part of traumatic brain injury [TBI]. Traumatic brain injury has worst impact on society converting useful citizens to severely disabled and vegetative patients. Traumatic subarachnoid hemorrhage is a negative prognostic factor. We have tried to study the contribution of traumatic subarachnoid hemorrhage to this lethal entity
Methods: Thirty patients with head injury with traumatic subarachnoid hemorrhage, diagnosed in emergency ward, were included and managed. They were assessed by GCS and Fissure grading at admission. Outcome was assessed by Glasgow outcome scale at the time of discharge and at thirty days after discharge
Results: Traumatic subarachnoid hemorrhage is a negative prognostic factor. Outcome depends upon clinical condition at time of admission [mild head injury and severe head injury p<0.05], distribution of the blood in the brain [F2 and F4, F2 and F3 p <0.05] and associated brain injury [p<0.05]
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Carcinoma breast is the commonest malignancy of females all over the world and second leading cause of death due to cancer among females. In Pakistan it is more common at a young age contrary to the West where it is more common in old age [after 60 years]. The objectives of this cross sectional study were to determine the frequency of HER-2/neu receptor over-expression and its association with some of the features of breast cancer like patient age, ER/PR status, tumour size, histological grade and axillary lymph node involvement. This study was conducted at Surgical C Unit, Postgraduate Medical Institute of Lady Reading Hospital, Peshawar, from January 2007 to December 2007. Study included all patients with breast cancer admitted in Surgical 'C' unit LRH, Peshawar for Modified Radical Mastectomy [MRM]. The resected specimens were sent to histopathologist for immunohistochemical [IHC] studies [HER-2/neu receptor and ER/PR] and detailed histopathological analysis including tumour subtype, size, histological grade and involvement of axillary lymph nodes. Patients refusing HER-2/neu receptor immunohistochemistry were excluded from the study. Name, age, sex, other relevant data, detailed history and clinical examination findings and results of investigation were recorded. Data was analyzed with SPSS version 10 This study included 24 female patients of breast cancer having modified radical mastectomy [MRM]. Age distribution ranged from 32-75 years with a Mean +/- SD of age 48.3 +/- 18.2 years. Fifteen out of 24 patients [62.5%] were >40 years, while nine patients out of 24 [37.5%] were 0.05], number of axillary lymph nodes involved [p > 0.05] and histological grade [p > 0.05]. While, it was significantly associated with tumour size [P < 0.05] and negative ER/PR status [P < 0.05]. Due to high prognostic significance and frequency in Pakistani females with breast cancer, HER-2/neu receptor should be checked in all patients with breast cancer so that the positive cases should have herceptin therapy and benefit from anthracycline based chemotherapeutic agents which can improve survival in these patients