Endoscopic third ventriculostomy [ETV]

To know the surgical outcome of endoscopic third ventriculostomy [ETV] in non communicating hydrocephalous. Cross sectional descriptive study. Neurosurgery department of Hayatabad Medical Complex, Peshawar. 1[st] March 2010 to 1[st] march 2011. A total of 41 patients with non-communicating hydrocephalous, irrespective of gender discrimination were included in this study. Patients below two years of age and hydrocephalus with infected CSF or hemorrhage were excluded. Hydrocephalous was diagnosed on CT scan brain. The information regarding patient demographical details, causes of hydrocephalus and complications of procedure was documented in patient's Performa. The data was analyzed by SPSS version 16. Frequency and percentage was calculated for categorical variables. Mean +/- SD was calculated for age. Results were presented as tables. A total of 41 patients with non-communicating hydrocephalous were included in the study. Out of 41 patients, there were 26[63.41%] males and 15[36.58%] females. The mean age was 21 years. Etiologically tuberculous meningitis was the commonest cause of non communicating hydrocephalous. Post-operatively CSF leakage was present in 4[9.75%] patients, pseudomeningocele in 2[4.87%] patients, transient memory loss in 2[4.87%] patients and pneumocephalous in 1[2.43%] patient. The complications of endoscopic third ventriculostomy are transient. Those patients who meet the criteria, endoscopic third ventriculostomy offers the possibility of freedom from shunt dependency

Traumatic extradural hematoma

Objectives: To determine the frequency, clinical presentation and outcome of extradural hematoma in patients with head injury. Study Design: Cross sectional descriptive st study. Setting: Neurosurgery department of Hayatabad Medical Complex, Peshawar. Period: 1[st] January 2011 to 1[st] July 2012

Patients and Methods: All patients of head injury, from all ages and both genders were included. Patients in whom EDH caused by bleeding disorders or vascular malformations of the dura mater and post surgical EDHs were excluded from the study. CT scan brain was done for all patients to confirm their diagnosis. The information regarding patient demographical details, clinical presentation and site and size of hematoma was documented in patient's Performa. The data was analyzed by SPSS version 16

Results: A total of 331 patients with head injuries were included in the study. Out of 331 patients, there were 221[66.76%] males and 110[33.23%] females. Majority of patients 90[27.2%] were in the age range of 21-30 years. EDH was found in 29[8.76%] patients. The commonest location of extradural hematoma was temporo-parietal region i.e 3.93%. One patient had left side weakness postoperatively and two [6.89%] died

Conclusions: The outcome of operated extradural hematoma patients was good in those patients having higher GCS score

Primary effects of intravitreal bevacizumab in patients with diabetic macular edema

To evaluate the efficacy of primary intra vitreal bevacizumab [IVB] injection on macular edema in diabetic patients with improvement in best corrected visual acuity [BCVA] and central macular thickness [CMT] on optical coherence tomography [OCT]. This prospective interventional case series study was conducted at Retina Clinic, Al-Ibrahim Eye Hospital, and Isra Postgraduate Institute of Ophthalmology Karachi. Between December 2010 to June 2012. BCVA measurement with Early Treatment in Diabetic Retinopathy Study [ETDRS] charts and ophthalmic examination, including Slit-lamp bio microscopy, indirect ophthalmoscopy, Fundus fluorescein angiography [FFA] and OCT were done at the base line examination. At monthly interval all patients were treated with 3 injections of 0.05 ml intra vitreal injection containing 1.25 mg bevacizumab. Patients were followed up for 6 months and BCVA and OCT were taken at the final visit at 6 month. The mean BCVA at base line was 0.42 +/- 0.14 Log Mar units. This improved to 0.34 +/- 0.13, 0.25 +/- 0.12, 0.17 +/- 0.12 and 0.16 +/- 0.14 Log Mar units at 1 month after 1[st], 2[nd] 3[rd] injections and at final visit at 6 months respectively, a difference that was statistically significant [P > 0.0001] from base line. The mean 1mm CMT measurement was 452.9 +/- 143.1 microm at base line, improving to 279.8 +/- 65.2 microm [P < 0.0001] on final visit. No serious complications were observed. Primary IVB at a dose of 1.25 mg on monthly interval seems to provide stability and improvement in BCVA and CMT in patient with DME

Efficacy of endoscopic third ventriculostomy in noncommunicating hydrocephalus

Hydrocephalus is common problem requiring either extra-cranial [shunts] or intracranial [ventriculostomy] diversion of cerebrospinal fluid. Endoscopic third ventriculostomy obviates all the complications of shunts and has been accepted as the procedure of choice for the treatment of obstructed hydrocephalus in adults and children because of the minimally invasive nature. This study was conducted to determine the efficacy of endoscopic third ventriculostomy in the treatment of noncommunicating hydrocephalus. This cross sectional descriptive study was done in neurosurgery department of Hayatabad Medical Complex, Peshawar, from 2[nd] February 2011 to 1[st] march 2012. A total of 171 patients with non-communicating hydrocephalous, irrespective of gender discrimination and Glasgow coma scale score of 10 and above were included in this study. Patients below one year of age, with lesion in the floor of the third ventricle or near basilar artery, and hydrocephalus with infected CSF or haemorrhage were excluded. Hydrocephalous was diagnosed on CT-scan brain. All the patients were followed up till 72 hours post-operatively for the determination of effectiveness in terms of improvement in Glasgow coma scale by at least 2 points. All the above mentioned information including name, age, gender and address were recorded in a predesigned proforma. The data was analysed using SPSS-17. Frequency and percentage was calculated for categorical variables. Mean +/- SD was calculated for age. A total of 171 patients with noncommunicating hydrocephalous were included in the study. Out of 171 patients, there were 104 [60.8%] males and 67 [39.2%] females. Age ranged from 1-70 years with majority of the patients was below 10 years of age. Majority of the patients had hydrocephalus due to tuberculous meningitis 39.2% of the whole. In 134 [78.4%] patients the procedure was effective. Procedure was more effective in hydrocephalus due to space occupying lesion. Endoscopic third ventriculostomy is a very effective procedure for the treatment of non-communicating hydrocephalus.

Symptomatic complications of ureteric stents

To calculate the frequencies of symptomatic complications of pigtail ureteral stents and to determine the effect of stent duration on symptomatic complications. All s tented adult patients [PTFE Coated Cook_ 6 Fr Double J Stent] presenting at the Institute of Kidney Diseases Hayatabad Peshawar were evaluated by history, examination, urine analysis and cultures, X-ray KUB and ultrasound KUB. SPSS version 11.0 was used for the data entry and analysis. Results are presented in the form of tables. Out of 100 patients, 68% were males and 32% females. Stent indications included stone surgery in 14% of cases, prior to extracorporeal shockwave lithotripsy [ESWL] in 36%, ureteric obstruction in 36%, pyeloplasty in 10%, and anuria in 4% of cases. Complications at 2 and 4 weeks were hematuria in 52% and 40% of cases, flank pain in 48% and 58%, frequency of micturation in 66% and 78%, dysuria in 72% and 80%, urgency in 60% and 72% and suprapubic pain in 42% and 50% of cases respectively. Ureteric s tenting is a life saving procedure but associated with significant morbidity. It's unnecessary and prolonged use should be avoided

Audit of five years of burn ICU in BMC hospital Quetta

Burns are series form of trauma with grave consequences for the patient and Family, with high morbidity and mortality. Since the establishment of burns ward at Bolan Medical College and Complex Hospital Quetta in 2002, we have been Receiving and managing a great variety of patients with burns from Kerosene oil, Petrol, gas, fire, scalds, chemical and Electric bums, Patients were received from With in [balochistan and sindh] and outside Afghnistan and Iran [Irani Balochistan] and as victims of war on terror from the region as a results on going war. An audit of our patients received from 2004 to 2008 has been presented which Consists of patients out of which 58% were male and 42% were female, Major Pathogens isolated were staphylococcus aurous [MRSA] and pseudomonas. Indicates of infection was high in patients with longer stay and extensive burns out Come of admit patients is also mentioned

Hybrid external fixation in treatment of metaphyseal fractures of long bones of the lower extremity

This study was conducted to evaluate the clinical results of metaphyseal fractures of tibia and distal femur after operative treatment by Hybrid External Fixators. A prospective descriptive study from 2004 to2008, conducted in Orthopaedic unit I, Bolan Medical Complex Hospital, Quetta. We have prospectively analyzed the results of Hybrid external fixation in the management of metaphyseal fractures tibia and femur in 21 patients [17 open and 4 closed fractures]. The mean age of the patient was 36.5 years. Age range was 14 yeas to 60 years. Eighteen patients were males and 3 were females. In 19 patients hybrid fixation was the primary procedures while 2 patients were initially dealt by local bone setters. Four patients subsequently required surgeries such as bone grafting and soft tissue cover. The mean follow up our patients was 14.8 months [5-24 months]. We achieved excellent results in 10 fractures, good results in 4 fractures, fair in 4 fractures and poor results in 3 fractures. Bony union was achieved in 18 of the fractures. Hybrid external fixation is an effective and useful treatment modality in the management of fractures close to joints in case of tibia, providing excellent to good results. In ease of distal femur it proved to be less effective. It combines the advantage of both Ilizarov and A.O. external fixators. It is minimally invasive, safe, modular and yet efficient in promoting massive new proliferative callus formation at the fracture site

Plate augmentation for femoral non-union after intramedullary nailing

This study was conducted to evaluate the clinical results of femoral non-union after intramedullary nailing treated by plate augmentation with or without autogenous bone grafting. a prospective descriptive study from 2004 to 2007, conducted in Orthopaedic unit I, Bolan Medical Complex Hospital, Quetta. We have prospectively analyzed the results of augmentation plate fixation in the treatment of femoral non-union after Intramedullary nailing in 36 patients. The mean age of the patient was3 1.4 years, 34 patients were males' and 2 were females. Age range of the patients was 22 years to 58 years. In 7 patients showing atrophic non-unions, autogenous bone grafting was done. The mean follow up of our patients was 1 year [4-18 months] post-operatively. Solid union was achieved in 34 femoral non-unions, [94.4% union rate]. Two cases showed non-union, requiring further surgery. Plate augmentation is a useful treatment option in the management of non-union of femoral shaft fractures after intramedullary nailing

Orthopedic implant failure a retrospective review of 100 cases

Internal fiuxation with various devices for the repair of fractures is widely used in orthopedic surgery. A stable osteo synthesis obtained which allows early mobilization and promotes fracture healing. however these are not free from complication; many of them are due to poor surgical technique and/or inadequate monitoring. Breakage due to fatigue of the material is riot un common in our setup, where there is no any quality control system. A review of too cases was made who reported to OPD section of department of orthopedic surgery Bolan Medical College Quetta, Initially operated in this department or elsewhere, during the period Jan. 1998 to Dec. 2008. This study shows Plate failure more common than nail failure in long bone fracture of lower limb. In most of failure cases there was significant retrauma during the healing phase. In significant number of case there was inadequate post operative immobilization, in adequate fixation and poor surgical technique

Wide subtalar release in congenital talipes Equino Varus deformity of foot

There is controversy regarding preferred operative procedure for correction of Congenital Talipes Equino Varus [CTEV]. Objective of this study was to determine the efficacy of wide subtalar release as described by Mackay in 1983 in children having CTEV. Twenty patients up to the ages of 3 with grade-Il, Ill congenital club foot were treated with this procedure; those having deformity secondary to diseases like CP, arthrogryposis multiplex congenital were excluded. Patients were followed for a minimum of one year after operation. Results were graded as per Frank and Hem criteria. Clinical and radiological evaluations were done and compared with other soft tissue procedures. 72.41% patients had satisfactory, 17.24% moderate and 10.34% poor results. Club foot surgery is instituted when well planned cast correction fails. Children up to the age of 3 years can be successfully treated with this method under skilled hands

Atrial fibrillation following coronary artery bypass graft surgery

To know the frequency of atrial fibrillation [AF] after coronary artery bypass graft surgery and the risk factors which predispose these patients to develop post-operative AF. This prospective, observational, analytic study was carried out at National Institute of Cardlovascular Diseases Karachi, from January 2001 to January 2002. It included 200 patients undergoing elective or emergency coronary artery bypass graft [CABG] surgery without concurrent valvular heart disease, prior history of AF, ventricular arrhythmias or redo CABG surgery. All patients underwent CABG and were followed for three weeks for incidence of AR Patients who developed AF [group A] were compared with patients without AF [group B] for different variables. Univariate analysis was done using Student's t-test for continuous variables and Chi-square test for categoric variables. The mean age was 52.78 +/- 8.32 years. The average bypass time and cross clamp time were 83.20 [SD +/- 18.73] minutes and 29.73 [SD +/- 7.25] minutes respectively. The mean ejection fraction was 49.34%. The median number of grafts was three. The frequency of AF was 12 [6%]. Univariate analysis revealed that advanced age, male sex, right coronary artery lesion, prolonged bypass time and low ejection fraction were statistically significant risk factors [p<0.005]. AF is a common, but potentially preventable, complication following CABG surgery. The Advanced age, low ejection fraction, prolonged cross clamp and bypass time are the important risk factors which may predispose these patients to develop postoperative atrial fibrillation

Early outcome of transvesical prostatectomy for large prostatic adenoma

To determine the immediate postoperative course and complications following transvesical prostatectomy for large prostatic adenoma. Description study. This study was carried out in surgical A ward lady reading Hospital Peshawar, from 1[st] February 2004 to 31[st] July 2005. All patients who presented with bladder outflow obstruction and fulfilled the instruction and exclusion criteria were included in the study. After taking an informed consent history, clinically examination and related investigations were carried out. All these patients underwent prostatectomy by transvesical approach followed up for six months. The total number of patients was 173. The mean age of patients was 63.42 years and most of the patients [n 104-60 percent] presenting with benign prostatic enlargement were in the age range of 56-60 years. The common presenting complaints were prostatectomy by transvesical approach. The postoperative complications were recorded in 23 [13.29 percent] patients. Some patients had more than one complication. These were urinary tract incontinence in 3 [1.73 percent], urethral stricture in 3 [1.73 percent] and wound infection in 2 [1.16 percent] patients. One [0.58 percent] patient died due to myocardial infarction. Transvesical prostatectomy having a low incidence of complications, requiring no special equipment, is a good procedure for large prostatic adenomas

Frequency of carcinoma in specimens of clinically benign enlarged prostate

To determine the frequency of carcinoma prostate on histology.in specimens obtained from patients with clinically benign enlarged prostate. Descriptive study. This study was carried out in Khyber Teaching Hospital [KTH]Surgical ward D and Lady Reading Hospital [LRH] surgical ward A. Peshawar from January 2004 to December2004. A total of 107 patients who presented to Surgical OPD with bladder outflow obstruction and fulfilled the inclusion and exclusion criteria of the study were included in the study. After an informed consent history.clinically examination and related investigations were carried out. All the patients underwent transvesical prostatectomy [TVP] and their prostate specimens were subjected to histopathology. Total number of patients was 107. Most of the patients [58.88%] with benign prostatic hypertrophy [BPH] were in age range of 56 - 60 years. The common presenting complaints were prostatism [57.94%] and acute retention [34.58%]. All patients underwent trans vesical prostatectomy [TVP]. On histopathology 3.74% turned out as adenocarinoma prostate while 96.26% biopsies showed BPH. The mean age of presentation with carcinoma [Ca] prostate was 65 years.In this study the frequency of Ca prostate in specimens of clinically benign enlarged gland was 3.74%. Therefore all specimens must be submitted for histopathology after prostatectomy