Endoscopic trans-sphenoidal surgery: efficacy and response in pituitary adenoma

Objectives: The purpose of the study was to access the efficacy and response of the endoscopic transsphenoidal surgery in pituitary adenomas

Methods: It was descriptive case study, conducted at Neurosurgery Department in collaboration with the Endocrine Unit [Medical Unit-II] Of Jinnah Post Graduate Medical Center Karachi from January 2015 to July 2017. Patients with sellar, supra sellar and para sellar tumors were enrolled in the study. Patients with prolactinoma and recurrent pituitary tumors were excluded. Data was analyzed using SPPS 17

Results: Sixty three patients were included in the study with mean age of 42+/-8.34 years. There were 40[63.5%] male patients and 23[36.5%] female patients with pituitary adenoma. Headache and visual impairment were the main presentation 55[87.3%] and 56 [88.8%] respectively. Out of all these patients the pituitary adenomas, 51[81%] patients had non secretory and 12 [19%] patients had secretory tumor. Out of these pituitary adenomas 53[84.1%] were macroadenomas and 10[15.9%] were microadenoma. Post operatively marked improvement in the headache was in all 100% patients and vision improved in 54 [96.4%]. The most common post operative complication was cerebrospinal fluid [CSF] leak in 10 [15.9%] with 44 [69.8%] having no post complications at all. Mortality was reported to be just 1.6% i-e one patient

Conclusion: The endoscopic transsphenoidal approach for pituitary adenoma is the safest procedure with marked improvement in complications and reduction in patient's hospital stay

Prevalence of anxiety and depression among doctors; the unscreened and undiagnosed clientele in Lahore, Pakistan

Objectives: To analyze prevalence of anxiety and depression among doctors serving in a tertiary care hospital in Lahore, with a study of impact of relevant demographic features

Methods: A cross sectional study was conducted at Combined Military Hospital, Lahore, from February 2014 to Jan 2015. Participants were doctors serving in subject hospital for at least six months duration. Standardized Hospital Anxiety Depression Score [HADS] inventory was selected as inventory. Formal approval from hospital ethical committee and written informed consent from participants were obtained. Demographic characteristics of participants were recorded as independent variables; anxiety and depression scores being outcome variables. Data analysis was done via descriptive statistics [SPSS-20], qualitative data expressed as frequencies, percentages; quantitative as mean +/- standard deviation[SD]. Cross tabulation was done via chi-square, p-value < 0.05 considered as significant

Results: Out of 203 volunteers, 97[47.78%] responded. Score of anxiety was 7.04 +/- 4.470, maximum being 19, scores of depression was 4.94 +/- 3.605, maximum score being 15. Mild to moderate anxiety and depression were revealed in 33[34%] and 24[24.8%] respectively, while 7[7.2%] and 1[1.0%] had severe anxiety and depression respectively. There was strong positive relation between anxiety and depression[p<0.001]. There was significant impact of service years on depression[p-0.011] and gender on anxiety[p-0.002],9[17.31%] males and 24[53.33%] females had mild to moderate anxiety while 4[7.69%] males and 3[6.66%] females revealed severe anxiety and other variables did not reveal significant impact on HADS scores

Conclusion: Doctors showed high grades of anxiety and depression. They must be promptly screened and managed at all medical institutions

Personality profile of psychoactive substance use presenting to a tertiary care hospital

Objective: The present study aimed at finding out the personality factors that are associated with drug addiction

Methodology: It was a quantitative research design, descriptive study and was carried out at department of Psychiatry Military Hospital Lahore from June 2013 to March 2014. Sixty patients admitted in Psychiatry Department Lahore with diagnosis of mental and behavioural disorder due to psychoactive substance abuse were selected by purposive sampling technique. Patient's diagnosis was made on ICD-10 criteria. Assessment of personality factors were done by using The 16 Personality Factor Questionnaire. Data was analysed by using SPSS version 18 and descriptive statistics were used

Results: Results revealed that some sample scored high on two personality factors that were vigilance [61.66%] and apprehension [65%]. This sample scored low on reasoning [68.33 %] and emotional stability [71.66 %] as well

Conclusion: Low emotional stability, low reasoning, over vigilance and apprehension are significantly associated with psychoactive substance use. The findings have preventive and therapeutic implications

Analysis of physiological [PAO[2], pulse and blood pressure] changes during modified ECT under general anaesthesia

To study the changes in physiological parameters ie PAO[2], pulse and blood pressure changes during ECT under GA. Quasi-experimental study. Department of Psychiatry and Department of Anaesthesiology, Combined Military Hospital Abbottabad from Sep 2009 to Feb 2010. A total of 50 patients with depression were given four separate ECT sessions each. All patients were anaesthetized using propofol 180-200 mg I/V and suxamethonium 50 mg ie 0.75-1 mg per kg I/V without atropine. They were stratified according to physiological changes including PAO[2], pulse and blood pressure at 1, 2 and 5 min after ECT. Oxygen saturation was measured using a pulse oximeter, which measures saturations in the range of 65-100%. Age range was 19-65 years; mean 46 years [SD +/- 13]. Mean diastolic BP before ECT was 84.72 that decreased post ECT ie 78.02 and 77.46 and 74.44 at interval of 1, 2 and 5 minute respectively. Post-ECT pulse and PAO[2] behaved similarly. Post ECT systolic BP decreased at land 5 minutes. Pulse rate decreased after ECT. ECT under propofol is one of the most effective and safe modality of treatment for psychiatric patients under the supervision of qualified psychiatrists and anaesthesiologists and it gives more stable hemodynamic changes

Personality factors more prone towards deliberate self harm; a study on 50 patients presenting to a tertiary care hospital

Objective: the study is aimed to identify the personality factors of patients admitted with the history of recent deliberate self-harm [DSH]

Methodology: descriptive study with purposive sampling was carried out at Department of Psychiatry Combined Military Hospital [CMH] Lahore, Pakistan from July 2013 to January 2014. Personality profile of total 50 inpatients with DSH admitted in psychiatry department, CMH Lahore were assessed by using The Sixteen Personality Factor Questionnaire. Respondents were informed and assured of the complete confidentiality of their responses. Quantitative research design was employed. The data was analyzed by using SPSS version 17

Result: results indicated that inpatients with the history of DSH scored high on three factors i.e. Dominance [58%], Apprehension [48%] and Tension [52%]. Individuals scored low on 3 factors that are reasoning [4%], Emotional stability [4%] and Liveliness [8%]

Conclusion: the findings revealed some personality factors that are more consistently prominent in DSH patients. These increase vulnerability while the later considered lowering the vulnerability to DSH. The findings have thera-peutic and preventive implications

Cerebral blood flow patterns using single photon emission computed tomography in patients with dissociative disorders and healthy controls

To compare the cerebral blood flow [CBF] changes in patients diagnosed to have Dissociative Disorder with healthy controls. Cross Sectional Comparative study. The study was done in the Department of Psychiatry Military Hospital Rawalpindi in collaboration with Nuclear Medical Centre [NMC] Armed Forces Institute of Pathology [AFIP], a tertiary care centre of Pakistan Armed Forces from Dec 2004 to May 2005. This cross sectional comparative study was done at Dept of Psychiatry Military Hospital Rawalpindi in collaboration with nuclear Medical Centre [NMC], at Armed Forces Institute of Pathology [AFIP] which is a tertiary referral center. A sample of 30 patients diagnosed as having Dissociative Disorder was compared with 10 controls for brain perfusion changes using TC-99m HMPAO [Hexamethyl-propylene-amine-oxime] Tc-99m. In group 1 perfusion changes were observed in 27 [90%] cases whereas unremarkable and insignificant changes were noted in 3 [10%] cases but no perfusion were noted in controls [P< 0.001] In patients who were suffering from different types of dissociative disorder marked cerebral hypoperfusion was observed in frontal, frontomotor, orbitofrontal and temporal regions whereas hyperperfusion was noted in frontal and orbitofrontal areas in few cases. Cerebral blood flow changes in the fronto parietal brain are associated with symptomotology in dissociative disorders

Presentation and evaluation of renal masses

To find out the various disorders presenting as renal mass to a referral centre for Urology over a 2 year period. A descriptive study. The study was conducted at Armed Forces Institute of Urology Rawalpindi and Combined Military Hospital, Kharian Pakistan from March 2002 through March 2004. A total number of 43 patients who presented as a renal mass or found to have renal mass during the course of investigations and subsequently underwent treatment at the institute were analyzed in the study. Their mode of presentation as various age group distribution and workup, histological break-up, treatment offered and follow-up was recorded. A total number of 43 patients presented as renal mass during the period of study. Seventy four percent of the masses turned out to be renal cell carcinoma and radical nephrectomy was the most common procedure performed [34 patients]. Hematuria was the most common mode of presentation as seen in 32 [74%] patients followed by lumbar pain in 30 [70%] patients. Majority of the lesions was in 46-55 year age group with 33 [77%]. Advances in diagnostic modalities such as CT and MRI will continue to expand the role of preoperative imaging for the diagnosis of renal masses. Surgery remains the mainstay of treatment for the majority of such masses and with increasing detection at an early stage, may possibly improve the cure rate of renal malignancies as well

Tissue repair for inguinal hernia: should they be deleted from literature?

This is a pilot study to evaluate the status of herniorrhaphy procedures in the modern day surgery. Mar 1995 to Mar 2005 Military hospitals Descriptive and Analytical All entitled patients were included in this study and only those non-entitled patients were included who came for regular follow up. All the patients were booked at first admission and their record was maintained. They were subjected to herniorrhaphy by a modified Bassini's procedure. They were called for follow up at 3 months, 6 months then annually for 2 years. A total of 210 patients were operated for inguinal hernia by tissue repair over the period of study. Out of these 164 patients were operated by pure tissue repair, of which 148 were followed up completely and were included in the study. The average age was 50.16 +/- 19.12 years. The mean operation time was 20 +/- 5.84 minutes. Mean Hospital stay was 3 +/- 0.6 days. Recurrence was noted in 1 [0.68%] patient in a follow up period of 2 +/- 0.46 years. Tissue repairs hold good even today in the deserving patients and should be undertaken without hesitation where necessary. We should not hesitate in deciding for easier and cheaper alternatives when available

Primary non-hodgkin's lymphoma of vagina associated with pregnancy

We report a case of non-Hodgkin's lymphoma [NHL] in 23 years old, 36 weeks pregnant female, who presented with a swelling in the vagina. Biopsy of the lesion led to profuse haemorrhage and emergency caesarean-section along with bilateral ligation of internal iliac arteries were required. Recovery was smooth and she was discharged from the hospital on the 5th postoperative day. Histopathology revealed non-Hodgkin's lymphoma, diffuse large B cell type [DLBCL]. Further treatment by medical oncologist led to complete resolution of the tumour at three months

Massive splenic hydatid cyst

Hydatid disease can involve any organ of the body and a high suspicion of this disease is justified in endemic regions. A case of massive splenic hydatid cyst with hepatic hydatidosis presented with 5 years history of abdominal distension with discomfort is reported. Clinically she had massive splenomegaly with hepatomegaly. Laboratory and radiological findings were diagnostic of hydatid disease of the liver and spleen. Peroperatively huge [35 x 20 cm] splenic hydatid cyst with two liver cysts was seen. Splenectomy was performed and hepatic lesions were subjected to endocystectomy with capsulorrhaphy

Injuries and fatalities resulting from the 2005 south Asia earthquake. A hospital experience

The South Asia quake struck South Asia with its epicentre in Pakistan on 8[th] October 2005, originating from a previously recognized fault line but of unsuspecting magnitude of death and destruction. The Earthquake measured 7.6 on the Richter scale and caused massive loss of life and extensive damage to property never seen before in the history of Pakistan. Earthquake related admissions and deaths to one of the two major tertiary care hospitals receiving casualties from the quake zone from 8[th] October 2005 through 1[st] November 2005 were analysed. All medical data from the hospital records was reviewed for quake related injuries and information about pattern of injuries received and treatment administered. A total of 3128 earthquake related admissions were recorded in the hospital with 39 in-hospital deaths. Admission rates were approximately 2:1 by gender, males affected more. Earthquake related injuries are varied and multifactorial. Comprehensive surveillance and a well developed plan for all Medicare setups need to be in place and when actively rehearsed, can help lead to better management preparedness

Follicular carcinoma thyroid in pendred syndrome

Pendred syndrome is a rare inherited disorder of bilateral sensorineural deafness with goitre. Presence of follicular carcinoma thyroid makes it even rarer. A case of a young girl is described with the features of Pendred syndrome and euthyroid state. Follicular carcinoma of thyroid was detected on histopathology requiring re-tailoring of the management

Management of vascular trauma

To characterize the vascular injuries, their management and the results. Design: Descriptive study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Kharian Cantonment, between October 2000 and October 2003. Subjects and Cases of vascular injuries received at the hospital amongst the total of 3134 trauma patients were evaluated. Thirty six cases with 41 vascular lesions were evaluated, excluding the three primary amputations. Vascular injuries were then characterized by age, gender, site, mechanism, associated injuries, need and type of surgery. Penetrating trauma accounted for 94.4% of all vascular admissions. Five% of the vascular injuries developed complications. Surgical intervention was required in all cases [100%]. Reverse saphenous vein graft was used in 82.9%. The injured veins were mostly ligated except one, which was managed by saphenous vein graft. The average time lapsed between injury and intervention of patients ranged between 2 to 18 hours. No mortality or secondary haemorrhage was documented. Vascular trauma represents a small percentage of all trauma admissions. It has a high morbidity and most require surgical intervention. The operative intervention rates are higher in patients with vascular injuries than in the general trauma population but with prompt surgery, the chances of limb salvage increases and the overall complication rate reduces