Surgical management of mandibular fractures by different treatment modalities

To evaluate the results of mandibular fractures treated by different techniques. Cross sectional, observational study. Department of Oral and Maxillofacial Surgery, Nishtar Hospital, Multan and Plastic Surgery Department of Sheikh Zayed Medical College/Hospital Rahim Yar Khan, from July 2007 to June 2010. A total 105 cases of mandibular fractures were included in this study. Patients were assigned into three groups according to the type of surgical technique used. Outcome was measured by postoperative variables; duration of intermaxillary fixation [IMF], duration of admission, malunion, nonunion, infection, and facial nerve function. A total of 174 fractures in 105 patients were treated by different surgical techniques. The mean age was 27.3 year with male to female ratio of 6:1. All the three treatment modalities were successful in restoring functional occlusion. Ten patients required readmission and a total of 25 complications were noted. These complications included 05[4.8%] soft tissue infection, 09[8.5%] malocclusion, 04[3.8%] malunion, 05[4.7%] mental nerve dysfunction, and 02[1.9%] cases of facial nerve [mandibular branch] damage. There was no case of non-union or osteomyelitis. Bone healing was satisfactory in 100% of the cases. All the three surgical techniques were successful in restoring functional occlusion. Overall closed reduction plus intermaxillary fixation with 2.7-mm cortical bone screws was the simplest, less invasive, efficient, and cost-effective technique

incidentally discovered asymptomatic para-aortic paraganglioma with peutz-jeghers syndrome

Peutz-Jeghers syndrome [PJS] is an autosomal dominant inherited disorder characterized by mucocutaneous melanin pigmentation and gastrointestinal [GI] tract hamartomatous polyps and an increased risk of malignancy. In addition to polyposis, previous studies have reported increased risk of GI and extra GI malignancies in PJS patients, compared with that of the general population. The most common extraintestinal malignancies reported in previous studies are pancreatic, breast, ovarian and testicular cancers. We report the case of a 17-year-old boy who presented with generalized weakness, recurrent sharp abdominal pain and melena, had exploratory laparotomy and ileal resection for ileo-ileal intussusception. Pigmentation of the buccal mucosa was noted. An abdominal computed tomography scan [CT] revealed multiple polyps in small bowel loops. Gastroscopy revealed multiple dimunitive polyps in stomach and pedunculated polyp in duodenum. Colonoscopy revealed multiple colonic polyps. Pathological examination of the polyps confirmed hamartomas with smooth muscle arborization, compatible with Peutz-Jeghers polyps. CT scan guided left para-aortic lymph node biopsy revealed the characteristic features of extra-adrenal para-aortic paraganglioma. Although cases of various GI and extra GI malignancies in PJS patients has been reported, the present case appears to be the first in literature in which the PJS syndrome was associated with asymptomatic extraadrenal para-aortic paraganglioma. Patients with PJS should be treated by endoscopic or surgical resection and need whole-body screening

Computed tomography [CT] scan for pulmonary embolism

Objective: To determine the role of helical CT scan in the diagnosis of pulmonary embolism in our population and compare the results with published data

Methods: One-hundred ten cases of pulmonary embolism were selected for this study. Helical CT chest scanning was performed in all patients. Other imaging tests for pulmonary embolism [PE] including scintigraphy, Doppler ultrasound of leg veins and pulmonary angiography were performed at clinician's discretion. The helical CT findings were obtained from medical record and three months follow up was done in those patients in which CT findings were negative for pulmonary embolism. Sensitivity, specificity, negative predictive value [NPV], positive predictive value [PPV] and accuracy of helical CT scan was calculated. SPSS version 14 was used for data analysis

Results: Among 50 patients diagnosed of having pulmonary embolism, CT scan was positive for PE in 40 patients. There were 10 false negative and no false positive results. Sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and accuracy of helical CT was 80%, 100%, 100%, 86% and 91% respectively

Conclusion: Helical CT chest is a very quick, easy, non-invasive and accurate imaging modality in the diagnosis of pulmonary embolism

Non contrast helical CT scan for acute flank pain: non calculus urinary and extra urinary causes

To determine the value of non contrast helical CT in the diagnosis of non calculus renal and extraurinary causes of acute flank pain. A prospective descriptive study. Radiology Department, Aga Khan University Hospital Karachi from January 2005 to June 2005. 130 consecutive patients with acute flank pain underwent Noncontrast enhanced helical CT scan [NHCT]. 100[73%] were male and 30[23%] were female. Scans were observed for noncalculus renal and extraurinary causes of acute flank pain. Out of 130 patients, 30 patients were excluded. In 23[23%] patients non calculus causes of pain were diagnosed. In 5 [5%] patients incidental findings were recorded which were most likely not cause of pain. Three patients had non calculus renal abnormalities which included renal cell carcinoma, horseshoe kidney adult polycystic kidney disease. The accurate and timely diagnosis of an obstructing ureteral calculus, a non calculus urinary abnormality or an extra urinary tract pathology, establishes non contrast helical CT as the diagnostic study of choice for the evaluation of patients with flank pain

Percutaneous radiologic gastrostomy: results and complications

Percutaneous endoscopic gastrostomy is usually difficult in patients with malignant involvement of oral cavity, pharynx and esophagus. Flouroscopic guided insertion of Gastrostomy catheter with Gastropexy have gained acceptance because it is easy and less time consuming as well as less invasive as compare to surgical procedure[5]. This study was done to evaluate the safety and efficacy of percutaneous placement of gastrostomy with gastropexy using imaging guidance in patients with oropharyngeal and esophageal cancers. Over five years, 105 patients were referred to our department for percutaneous radiologic gastrostomy. In five patients the procedure was not performed because of overlying viscera and high position of stomach. We performed 100 gastrostomies with gastropexy procedures using seldinger technique. Success rate for percutaneous radiologic gastrostomy was 100%. No major complication had occurred. There were 11 minor complications occurred including 4 stomal infection, 3 catheter obstruction, one peritonism and three were extensive pneumoperitoneum. Stomal infection and catheter obstruction were not related to procedure. So, our true minor complications were only 4 [4%] which is comparable to literature. Percutaneous radiologic gastrostomy is an effective and safe procedure for enteric access of nutrition in patients with oral, pharyngeal and esophageal cancer where percutaneous endoscopic gastrostomy is difficult

Median survival time of patients after transcatheter chemo embolization for hepatocellular carcinoma

To determine the effect on survival after transarterial chemoembolization [TACE] in patients with unresectable hepatocellular carcinoma [HCC]. Longitudinal cohort study. Radiology Department, The Aga Khan University Hospital, Stadium Road, Karachi, from December 1997 to September 2005. Patients undergoing TACE procedure for HCC were prospectively followed. Fortythree patients were enrolled from December 1997 to March 2003 in the study and subjected to chemoembolization therapy. Eight out of 43 patients were excluded from the study, who lost to follow-up. All the patients were followed till their death. Median and mean survival were calculated. The median survival of these 35 patients was 410 days [13.6 months], with 95% confidence interval [236 days lower bound and 536 days upper bound]. Mean survival time was 603 days [20.1 months] with 95% confidence interval [394 days lower bound and 812 days upper bound]. There was significant difference in mean survival time [in days] by Child's Pugh class [c2 = 12.384; df=2, pvalue= 0.002]. The study showed that TACE is an effective palliative treatment. TACE increases the median survival time

Role of computed tomography in acute pancreatitis and its complications among age groups

To determine value of CT scan in diagnosis of acute pancreatitis, its complications and to correlate with severity among different age groups. The study was carried out from August 2001 to August 2002 at the Radiology Department, Aga Khan University Hospital. A total of 40 patients [33 male and 7 female] with age range from 16-71 years were divided in three groups. Group I was less than 40 years [12 patients], Group II was between 40-60 years [17 patients], and Group III was more than 60 years [11 patients]. CT scans were assessed for pancreatic necrosis and its complications. CT Severity Index [CTSI] was calculated according to Balthazar's method. In 17 patients with mild pancreatitis, 5 had necrosis involving one-third of pancreas. In 13 patients with severe pancreatitis, 8 had necrosis involving more than half of the pancreas and 5 had necrosis involving half of the pancreas. No significant correlation was demonstrated between moderate pancreatitis and degree of necrosis. Thirty patients had complications, 8 had mild CTSI, 9 had moderate CTSI and 13 patients had severe CTSI. The study demonstrated a relationship between CTSI and severity of pancreatic damage and incidence of complications

Role of computed tomography in acute pancreatitis and its complications among age groups

To determine value of CT scan in diagnosis of acute pancreatitis, its complications and to correlate with severity among different age groups. The study was carried out from August 2001 to August 2002 at the Radiology Department, Aga Khan University Hospital. A total of 40 patients [33 male and 7 female] with age range from 16-71 years were divided in three groups. Group I was less than 40 years [12 patients], Group II was between 40-60 years [17 patients], and Group III was more than 60 years [11 patients]. CT scans were assessed for pancreatic necrosis and its complications. CT Severity Index [CTSI] was calculated according to Balthazar's method. In 17 patients with mild pancreatitis, 5 had necrosis involving one-third of pancreas. In 13 patients with severe pancreatitis, 8 had necrosis involving more than half of the pancreas and 5 had necrosis involving half of the pancreas. No significant correlation was demonstrated between moderate pancreatitis and degree of necrosis. Thirty patients had complications, 8 had mild CTSI, 9 had moderate CTSI and 13 patients had severe CTSI. The study demonstrated a relationship between CTSI and severity of pancreatic damage and incidence of complications