Effective Debridement And Subsequent Obturation Of Tooth With Morphoanatomic Variations In Non Syndromic Patients– A Series Of 3 Case Reports

Taurodontism is a morphoanatomical anomaly of teeth characterised by enlarged pulp chamber with apically displaced pulp chamber floor and furcation.Endodontic treatment of a taurodont is challenging and requires special handling because of proximity and apical displacement of roots. In performing root canal treatment on such teeth, one should appreciate the complexity of the root canal system, canal obliteration and configuration, and the potential for additional root canal systems. Careful exploration of the grooves between all orifices particularly with magnification, use of ultrasonic irrigation; and a modified filling technique are of particular use. This paper presents three case reports on diagnosis and successful endodontic management of hypertaurodontic teeth, in non-syndromic patients

Impact of depressed skull fracture surgery on outcome of head injury patients

Objective: To assess outcomes in surgically managed patients with depressed skull fractures and associated moderate to severe head injury

Methods: The study was conducted in the Department of Neurosurgery Jinnah Postgraduate Medical Centre, Karachi, from January 2016 to December 2017. We analyzed 90 patients with depressed skull fracture managed surgically from January 2015 to December 2016. The patients selected for this study belonged to all age groups with clinically palpable depressed skull fracture confirmed by CT brain with bone window. Outcome was assessed by Glasgow outcome score

Results: Total 90 patients were included in the study. Sixty [66.7%] were male and 30 [33.3%] were female with mean age of years 27.58+11.329. Among 90 patients, 38.8% were aged between 21 and 30 years. Road traffic accident was seen in 72 [80%] patients. The commonest site of fracture was frontal region in 50 patients [55.6%]. GCS improved post operatively on comparison to preoperative. Five patients expired

Conclusion: Depressed skull fracture is common neuro surgical issue. Timely surgical management gives excellent results by decreasing morbidity and mortality

Outcome of burr-hole aspiration of brain abscess

Objective: To determine the clinical outcome of burr-hole aspiration of brain abscess

Methods: We analyzed 100 cases of intracranial abscess, treated surgically from January 2015 and October 2016 at Jinnah Postgraduate Medical Centre [JPMC]. All patients were treated with burr hole aspiration. Medical records were analyzed for demographics, clinical presentation, predisposing factors, abscess location on imaging and clinical outcomes were charted

Results: The study included 100 patients with 73 [73%] males and 27[27%] females with a mean age of 36.69+10.96 years. Mean duration of signs and symptoms was 8.50+/-4.2 days. The most common presenting complaint was altered sensorium in 70 [70%] patients and commonest source of infection was otitis media een in 27 patients [27%]. The GCS on presentation was 13 in 57 [57%] cases. The parietal region was the most common site in 43 patients [43%], followed by frontal region in 33 patients [33%].Complete resolution of abscess with recovery of preoperative neuro-deficit was seen in 77 [77%] patients and recovery with major neuro-deficit was observed in 10 [10%] cases while 13 [13%] patients expired

Conclusion: Early diagnosis, optimum follow-up and timely burr-hole aspiration are the keys in the proper management of brain abscess

Posterior occipito cervical decompression with fixation [ and fusion in Cranio vertebral junction compression

Objective: To find out the clinical outcome of posterior decompression with occipitocervical fixation ani fusion in patients with Craniovertebral junction instability

Methods: Eighty consecutive patients of cranio vertebral junction [CVJ] compression were treated the department of neurosurgery, Jinnah Postgraduate Medical Centre [JPMC], Karachi over a periodol 05 years from 1st January 2012 till 31st August 2016. All patients underwent posterior decompression witty occipitocervical fusion [OCF] and fixation. The clinical outcome was assessed by Japanese Orthopedic Association [JOA] score and grading

Results: Out of 80 patients with CVJ instability, 64 [80%] were due to non traumatic causes, while II [20%] were secondary to trauma. All 80 patients [100%] showed post operative relief in pain. Sixty to [80%] patients showed improvement in power post operatively while six [7.5%] had no change, four [51] showed deterioration and six [7.5%] patients expired. Sixty four [80%] patients had improvement of the J01 scores at last follow-up. According to etiology, the JOA score for patients with trauma improved in 12[7S] patients and 52[81.25%] for non traumatic causes while six patients [7.5%] expired. Fusion was achieved 64 [80%] patients at last followup

Conclusion: Posterior decompression with occipitocervical fusion and fixation is safe and can be recommended in cases of CVJ compression

Lateral mass screw fixation in cervical spine injury

Objective: To determine clinical outcome in patients with cervical injury after lateral mass screws fixation in a tertiary care hospital

Methods: This study included 88 patients, with cervical injury confirmed radiologically. Patients <12 or >70 years, with traumatic discs, cord compression without subluxation and previously operated on cervical spine were excluded from this study. All patients underwent fixation with lateral mass screws through posterior approach under fluoroscopic guidance. Frankel grading was used to assess the clinical status of these patients pre-operatively and post-operatively

Results: There were 60[68.18%] males and 28[31.8%] females. The ages varied from 18 to 55 years with a mean of 32 yrs +/- 8 yrs. The most common level of injury was C5-C6 in 46[52%] patients. According to Frankel grading system, 35 [39.8%] patients were placed in Grade A, 15[17.05%] in Grade B, 22[25%] in Grade C, 12 [13.6%] in Grade D, four [4.5%] in Grade E on admission. Postoperatively, 16 [18.2%] patients were placed in Grade A, 23 [26.1%] in Grade B, eight [9.1%] in Grade C, nine [10.2%] in Grade D and 26[29.6%] patients in Grade E with an overall improvement in neurological function in 51[58%] and power in 37[42%] patients. The major complications encountered were respiratory infections in 10[11.36%] and wound infection in four [4.5%] while eight [9.1%] patients expired

Conclusion: Lateral mass screws technique is a safe and effective method for cervical fixation after proper reduction

Presentation and precipitating factors of diabetic Ketoacidosis in children

Diabetes mellitus is a metabolic disorder caused by absolute or relative deficiency of insulin. It is the most common metabolic disorder of childhood and is caused by deficiency of insulin [type 1]. Its prevalence is 1 per 500-600 children. The incidence is 1.2-1.9 cases per 1000 children. The complications of diabetes are multiple and severe. Immediate complications include Diabetic Ketoacidosis [DKA] and Coma. 10-30% children present with DKA. The main contributing factor is relative lack of insulin. This occurs when there is increased requirement for insulin due to increased physiological stress as seen in infection, trauma, surgery and psychological stress, etc. [1] To identify the frequency of various presentations of DKA in children. [2] To identify the frequency of various precipitating factors of DKA in children. [3] To correlate the incidence of DKA with age and socioeconomic conditions. A cross-sectional study. JMDCH, January 2004 - October 2004. The convenient sample of 50 histories was collected from pediatric departments of various public and private sector hospitals of Karachi. Results were analyzed using MS Excel 2000. A total of 50 cases were analyzed out of which most of the cases were undiagnosed [64%] and belonged to low socioeconomic group [58%]. Mean age of male patients was significantly lower as compared to females [5.5 +/- 2.31 vs. 7.54 +/- 3.05, p<0.05], while status of hydrogen ion concentration [pH] was significantly lower in females [7.16 +/- 1.46 vs. 7.26 +/- 0.08, p<0.05]. Most frequent presenting complaints were vomiting, abdominal pain, dehydration and respiratory distress [34%]. The most frequent precipitating factor was fever in 17[34%] cases. More than half of the cases are undiagnosed and belong to low socioeconomic group. The level of awareness towards diagnosis of disease increases with the socioeconomic conditions. DKA affects both the genders equally; males being affected at an earlier age group. Most frequent presenting complaints are vomiting, abdominal pain, dehydration and respiratory distress while fever is the chief precipitating factor

Hyperferritinemia and Pyrexia of Unknown Origin

By the time a patient is formally categorized as having 'Pyrexia of Unknown Origin', a battery of tests have been performed and many physicians have run out of differential diagnoses. Adult Still's Disease is considered a rheumatologic disorder and is, therefore, not considered if the patient does not have joint symptoms. We present the case of such a patient who presented with high spiking fever, and review how we gained confidence in establishing the diagnosis

Successful treatment of diabetes insipidus with oral desmopressin

Acute-onset polyuria, with urine volumes exceeding 3 litres per day, is a relatively uncommon clinical condition. If managed on appropriate guidelines, an excellent recovery is expected