An unusual presentation of an orbital schwannoma due to intratumoural haemorrhage / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To report an unusual presentation of a rapid increase in size of an orbital schwannoma secondary to intratumoural haemorrhage.·METHODS: A case report.·RESULTS: A 79-year-old male patient had a 2 year history of a slow-growing lump over the medial aspect of his left upper eyelid. The lump had further increased in size recently. An incision biopsy was undertaken. However, during the following 4 weeks, the mass rapidly grew in size and had reduced his vision in the left eye to 6/18. He was referred to the orbit service for further management. On examination, he had a large mass emerging from the supero-medial aspect of his orbit. He had mechanical ptosis and the globe was displaced infero-laterally. Eye movements were limited in the left eye, especially in upgaze. A CT scan demonstrated an extraconal mass in the medial aspect of the left orbit. A left anterior orbitotomy with excision biopsy of the mass showed a well encapsulated mass. Histological examination demonstrated a schwannoma with cystic changes and thrombosed blood vessels. The patient had an uneventful postoperative course. Postoperatively his vision improved to 6/6 and he no longer experienced diplopia. ·CONCLUSION: Our case emphasises the point that orbital schwannomas should be regarded as an important differential diagnosis for a slow growing tumour, but the rapid growth, of a previously presumed benign tumour, which can make it highly suspicious for malignancy or inflammation, could also represent intratumoural haemorrhage.

Detection of helicobacter pylori antigen in stool

Objective: to detect H. Pylori antigen in stool and to determine the diagnostic accuracy of H. pylori stool antigen

Design: comparative analytical study

Setting: this study was carried out at Pakistan Medical Research Council [PMRC], at Jinnah Postgraduate Medical Centre, Karachi from May 2006 to September 2006

Material methods: endoscopic biopsy specimens were collected for rapid urease test and histopathology examination. Stool samples were taken for detection of antigen of Helicobacter pylori. The stool antigen test is a rapid immuno-assay based on "lateral flow chromatography technique" using monoclonal antibodies for qualitative detection of Helicobacter pylori antigen in human stool

Result: fifty males and 50 females were selected for this study by non-probable purposive sampling technique. Their mean age was 39 years ranging from 15 to 55 years? The sensitivity and the specificity of Helicobacter pylori stool antigen test [HPSA] with rapid urease test was found to be 89.1% and 92.6% respectively and the sensitivity and specificity of HPSA test with histopathology was 92.8% and 89.6% respectively

Conclusion: helicobacter pylori stool antigen [HPSA] is an accurate easily carried out in routine laboratory and is non-invasive

Managing small intestinal obstruction: a Sheikh Zayed Hospital experience

Managing intestinal obstruction continuous to challenge surgeons all over the World. Between January 2001 to December, 2004, 54 patients with maw to female ratio of 1.8:1 and mean age of 51 presented with small bowel obstruction. They were divided in to two groups; group A and B. Group A comprised of 30 patients [55%] and were managed conservatively. Whereas group B had 24 patients [44%] who required surgery. Conservative management was observed for 12 to 36 hours and beyond this time patients were explored in the face of deterioration. In group a, 83% patients had history of previous surgery whereas 17% patients had no prior surgical intervention. In group B 38% patients had abdominal surgery in the past whereas 62% had no previous surgical intervention. Predominant symptoms of bowel obstruction were abdominal pain, [100%] constipation [60%] and vomiting [48%]. Common causes of obstruction were post-operative adhesions 38% [n=7] obstructed hernias 25% [n=6] ileoceacal tuberculosis 21% [n=3] intestinal ischemia 8% [n=2] and ceacal carcinoma 8% [n=2]. Two patients died to septicemia, subsequent to anastomotic leak. We conclude that adhesive bowel disease and obstructive external hernias are the commonest causes of small bowel obstruction. A good clinical acumen and repeated clinical examinations are necessary to avoid the stage of bowel gangrene while managing small intestinal obstruction

Effect of fresh and freeze dried human amniotic membrane on quantitative bacterial courts in burn wounds

Amniotic membrane in fresh or freeze dried from has been used at times in the management of burn wounds as a biological dressing. One of the qualities with which it is credited [by virtue of animal studies] is the reduction of the bacterial count of burn wounds. The present study was designed to test this claim in human burn wounds in a prospective controlled trial. Acute burn cases matched for age, sex and burn extent were randomly assigned to three group i.e. fresh membrane freeze dried membrane, and saline soaked gauze. The wound was tangentially excised and four biopsy samples one from each corner of the test site were taken on day zero, two, four and six. Each sample was weighed, homogenized and inoculated on blood agar plates. Colony counts were made at 24 hours. The results revealed that in the membrane groups by day four a decrease in the bacterial count begins which by day six becomes statistically significant as opposed to the controls [saline soaked]. The bacterial counts showed no statistically significant difference between the fresh and freeze dried membrane group. We conclude that amniotic membrane in either or properly prepared and used can contribute in diminishing the bacterial colonization of burn wounds of moderate extent [2-40% total body surface area]

Method of obtaining and preparation of fresh human amniotic membrane for clinical use

Amniotic membrane was obtained from 36 mothers seronegative for hepatitis B surface antigen and syphilis, undergoing caesarean section. Membrane was separated from placenta and was washed first with saline and then saline solution containing penicillin. The processed membrane was found to be sterile and useable for up to one week. Of 36 placentas obtained, 33 were utilized in 22 patients, with no history of penicillin allergy, as biological dressing In acute burns. Each patient received three applications of membrane one every other day, over a period of six days. This method of obtaining amniotic membrane was simple and more practical for maintaining the biological effectiveness of membrane, as shown by quantitative reduction of bacterial counts in burn wounds

Amniotic membrane in burn wounds: does vascularization from bed really occur?

To establish whether role of amniotic membrane as biological dressing is because of blood vessel growth into it. Design: Prospective study of 22 cases of indoor burn patients. Setting; Plastic, Reconstructive Surgery and Burns Unit, Dow Medical College and Civil Hospital, Karachi. Subjects: Twenty two cases of indoor burn patients were studied. In nine cases freeze dried amniotic membrane and in thirteen cases fresh amniotic membrane was applied. Main outcome measures: Histopathological examination of biopsy specimen to see capillary budding and vascular ingrowth into membrane. Result: In none of the 22 cases studied capillary budding and any blood vessel growth into the membrane was found. The role of amniotic membrane in the management of burn wound stands the test of time and failure of documentation of vascular ingrowth into it does not alter its clinical utility

Typhoid bowel perforation: Lessons learnt at shaikh zayed hospital, Lahore

This study comprises of 41 patients with typhoid perforation managed over a 4 years period at Department of Surgery, Shaikh Zayed Hospital Lahore. Peritonitis due to typhoid bowel perforation was the commonest cause observed in 33.5% cases. The disease is prevalent in rainy season commoner in males [2.1:1] and in the younger age group [mean age 27.8 years]. Twenty four% patients were resistant to chloramphenicol and presentation to the hospital after perforation was late [mean lag 3.5 days]. Quinolone derivatives have changed the management scenario in perforated typhoid enteritis. Defunctioning procedures [loop ileostomy, tube ileostomy, or end ileostomy] in patients with advanced sepsis and toxemia in typhoid enteric perforation are found safe with low morbidity [p < 0.05] and zero mortality. Inspite of late presentation, the overall mortality is low [9.7%] on account of better perioperative management of the patients

Percutaneous drainage of amoebic liver abscess

This prospective study of 12 patients of amoebic liver abscess presenting to the department of Surgery, Shaikh Zayed Hospital, Lahore, over a one year period evaluates the results of ultrasound-guided percutaneous drainage of large amoebic liver abscesses. The results indicate short hospital stay, no mortality and minimal morbidity. This procedure may be safely recommended as the preferred primary method of managing ameobic abcesses larger than 6cm in diameter

Ketamine in burn wound management

Modern day treatment of burns often involves early tangential excision of the wound, followed by autografting or coverage with biological dressings. These procedures are painful and frightening for patients. Most general anesthetic agents cause immunosuppression in already metabolically stressed patient and may cause liver damage. They also require full time attention of anesthesiologist. To counter these difficulties a short acting anaesthetic agent Ketamine, was tried in burn patients. Ketamine was given intravenously in a dose of 2mg / kg body weight. Thirty-two cases were studied and total dose of Ketamine administered ranged between 50 mg and 200 mg. Duration of the procedures ranged between 20 minutes and 50 minutes. Untoward reactions included only increased salivation, vomiting and unpleasant dreams in two cases. We conclude that Ketamine is a useful agent for minor intervention of the burn wound

Comparison of ringer lactate with low molecular weight dextran in ringer lactate [Saviosol] in early burn resuscitation: a prospective study of 10 cases

This prospective study tests one brand of low molecular weight dextran [LMWD] in ringer lactate [SAVIOSOL] against Ringer Lactate [RL] alone in burn resuscitation. Ten cases of fresh burns, split into two random groups of five cases each were studied over a period of forty-eight hours and their response to the two types of intravenous [I/V] fluid administration was observed. Average age in the RL group [Group-I] was 22.6 years and burn extent 44.6% total body surface area [TBSA]. LMWD group [Group-II] was aged 18.6 years with 41.2% TBSA burns. Sex ratio was similar in both groups. Total I/V fluid received by Group-I was 7.6 L on day one and 5.141 L on day two. Corresponding figures for Group-II were 7.02 L and 5.03 L respectively. Composition of fluids was similar except that Group-II received SAVIOSOL [mean: 1.86 L] on day one while Group-I received no colloid. Resuscitation was evaluated by clinical and laboratory observations. Statistically significant differences between groups were noted in one clinical and one laboratory parameter. Pulse rate during the last 12 hours of study [36-48 hours postadmission] at 111/minute in Group-II, as against 121/minute in Group-I, indicated full volume restoration in the former but continued hypovolemia in Group-I. Platelet count lowered much more in Group-II, suggesting platelet disaggregation and improved microcirculation. Parameters that fell short of statistical significance but were nevertheless suggestive of improved performance by LMWD group included 24-hour urine output, Base deficit and Plasma protein values. It is concluded that addition of LMWD to ringer lactate in early resuscitation of acute burns in helpful in correcting hypovolemia and improving urinary output thus reducing chances of renal shutdown

race factors in surgical scars part I: recognition of ethnicity through facial anthropometry

Many factors participate in the determination of the final appearance of a surgical scar. Of these, race has been quoted as an important factor although no controlled studies seem to be available to substantiate such a claim. Our study, conducted in Karachi, was planned in two parts: first to identify objective characters that would distinguish the two major ethnic groups of Karachi, viz. the caucasoid and the negroid and in the second phase to observe long term scar characteristics in elective surgical wounds. This paper deals with the first part of the study. Forty-eight male volunteers between the ages of 10 and 50 years were enrolled and their genealogy for three generations ascertained through interview. Skin color, hair color and hair form were recorded through inspection. Six craniofacial indices were then measured and designated, respectively, facial, orbital, intercanthal, nasal, soft tissue nose and upper lip indices. Data were integrated and submitted to statistical analysis. Age between the two groups differed significantly in the numerical but not in a practical sense. Of the observed and measured parameters there was a considerable overlap between the two groups. Skin complexion and hair color were not significantly different. Of the craniofacial indices, nasal index, relating nasal width to its length, and upper lip index, relating lip height to its width were both significantly larger in the negroid group. The remaining four indices did not differ significantly between the two groups. We conclude that it is possible to distinguish the two ethnic groups through interview, supported by observation of the hair form and measurement of nose and upper lip dimensions

Colorectal cancer[A clinico-epidemiological study]

A retrospective review of 45 cases of colorectal cancer managed in the Department of Surgery, Shaikh Zayed Hospital, Lahore from January, 1987 to May, 1990 is presented. Mean age was 45 years, which was 10-15 years younger than that reported from the West. Male to Female ratio was 4:1, showing much higher male preponderance than reported earlier. Twenty nine percent of the cases were younger than, 39 years and 30% cases presented with bowel obstruction. Overall operability was 96% with 78% undergoing curative resection. Remarkable feature was zero mortality and low complications; particularly anastomotic failure of 3.3%. Over 90% of the patients are alive after a follow-up of 2-30 months

Surgery for colorectal cancer

The present study is a retrospective review of 45 cases of colorectal cancer managed in the Department of Surgery Sheikh Zayed Hospital, Lahore from January 1987, to May 1990. Mean age was 45 years [range 17-72 years] which was 10-15 years younger than that reported from the west. Male to female ratio was 4:1, showing much higher male preponderance than reported earlier. 29% of the cases belong to the group, [39 years or less]. 30% of the cases presented with bowel obstruction. Overall operability was 96% with 78% undergoing curative resection, which is encouraging. Remarkable feature is zero mortality and low complications. [particularly of anastomotic failure of 3.3%]. Over 90% of the patients are alive a follow-up [2-30 months]

Surgical treatment of ascites, with peritoneovenous shunt

At Shaikh Zayed Hospital, during the past one year, Leveen peritoneovenous shunt has been used to palliate three patient with ascites due to portal hypertension refractory to medical measures. Standard procedure of shunt placement was adopted as described by Leveen et al in 1974. Peritoneovenous shunt functioned well in all the three patient providing good palliation. Two patients were followed upto 14 weeks, the third patient did well upto the 2nd week, when he was lost to follow-up we have found the procedure simple and very effective. The preliminary reports is presented alongwith a brief review of the subject

Sugarcane juicer injuries: a retrospective study and plan of management

The subject of wringer-roller arm and hand injuries has been relegated to the background in the litera-ture and standard textbooks of surgery of the past couple of decades. One device that continues to produce considerable mutilation by its wringer or roller action in this part of the world is the common sugarcane juicer. Hand injuries produced include skin avulsion, crushed tendons, nerves and vessels and comminuted fractures of small bones of hands and wrist. Surgical care of such hands should be carrid out in a properly equipped operating room. Observance of principles of surgical toilet, adequate debridement, periodic inspection of the wounds, elevation of the Limb, early resurfacing of lost skin, reconstruction of tendons, nerves and bones and intensive physical therapy are needed to obtain the best results in a hand injured by sugercane juicer Amongst 59 mutilated hands seen during 28 months, 39% were due to roller machine injuries, 74% of these being sugarcane juicers. Half of the patients were between the ages of 14-24 years. Only 4 of 23 hands [17%] functioned normally after treatment while 44% became practically useless as assessed at the end of 2 months to 2/2 years of follow-up

Pigmentary response of skin to chemopeel: a controlled study of phenol and trichloracetic acid applications

Chemopeel is a process in which chemical solutions are used on the skin with the intention of eliminating fine wrinkles, solar keratosis and certain other superficial dermatoses. A study was conducted on 10 volunteers, 4 females and 6 males, with phenol 48% on one side and trichloracetic acid 27% on the opposite side of the mastoid region. Color changes were observed for a period of upto 16 weeks. Scab fell off in 8.2 +/- 1.7 days with phenol and 10 +/- 2.5 days with trichloracetic acid [TCA] indicating a deeper burn with TCA. No hypertrophic scarring occurred. With both modalities, color returned in the majority of cases by 16 weeks but 40% of phenol and 20% of TCA group were still lighter-complexioned than their normal color at the end of the study. Females tended to get significantly lighter than males, with both chemicals and ethnic origin of the patient had no influence on the outcome

Human amniotic membrane as a versatile biological dressing: a preliminary report

The subject of human amniotic membrane as a biological dressing is reviewed and experience of four wounds, three from acute burns and one from trauma is presented. Freeze dried amniotic membrane was used as the material for application next to the wound after the usual surgical cleansing. This process was repeated daily or on alternate days depending on the individual response. Beneficial effects noted included reduction of pain, promotion of healthy granulation and increased tendency of graft take in acute burns. In the chronic post-traumatic ulcer the treatment was not as effective in reduction of bacterial counts as a topical antibiotic [soframycin] used in an adjacent area of the same wound. Its trial as a biological dressing in burns merits consideration in view of this preliminary trial

Latissimus dorsi - a very versatile flap for reconstruction

The latissimus dorsi myocutaneous flap is useful in a number of situations. Experience with use of this flap in six patients, the anatomical basis of the flap, and its advantages are described