Zuckerkandl tubercle: an important landmark in thyroid surgery

To find out the frequency of Zuckerkandl Tubercle [ZT] and the position of recurrent laryngeal nerve with reference to ZK. Cross-sectional observational study. Surgical Ward-3, Jinnah Postgraduate Medical Centre [JPMC], Karachi, from June 2010 to August 2011. Patients having goiter, aged between 12 - 60 years were admitted through OPD and operated after informed written consent. After admission, they underwent surgery. ZT and recurrent laryngeal nerve position i.e. whether medial, lateral or posterior to ZT was identified during surgery. Data was collected on pre-designed proforma and analysed on SPSS version 15 for descriptive statistics. Out of the 84 patients ZT was found in 52 [61.90%] patients. Nineteen patients had grade-I [less than 0.5 cm], 22 [42.3%] had grade-II [0.5 - 1 cm] and 11 [21.1%] had grade-III [more than 1 cm] ZT. During surgery, 33 [63.4%] patients had recurrent laryngeal nerve medial to ZT, 15 [28.8%] patients had lateral and in 4 [7.6%] patients recurrent laryngeal nerve was engraved posteriorly. Zuckerkandl tubercle was found in about 62% cases; recurrent laryngeal nerve was located pre-dominantly medial to ZT

Single centre experience of transperitoneal radical tumour nephrectomy

Objective: To share the experience of radical nephrectomy through transperitoneal approach

Material and methods: After approval from ethical committee and the consent from patients a retrospective study vas conducted extending from January 2012 to January 2014 to identify clinical characteristics of renal ell carcinomas, staging, per operative and early post operative complications. The study included all renal cancer patients presented to Sheikh Zayed Hospital Lahore with in this specified period. Detailed history nd physical examination was performed. Haematological and radiological investigations including ibdominopelvic ultrasonography and CT scan abdomen and pelvis were performed to stage the renal umour. High resolution CT chest was performed where indicated. Radical nephrectomy performed hrough transabdominal approach and outcomes measured in terms of per-operative and early postoperative complications

Results: There were total of 50 cases. The male to female ratio was 3:2. Vlean age of patients was 52.38 [18-93] years. Most common clinical presentation was gross haematuria [66%]. The mean tumour size was 8.34 [3-24] cm. Operative findings were suggestive of tumor limited to Gerota's fascia in 40 patients [80%] and in 6 [12%] tumor was extending into renal vein or inferior vena cava. In these cases, venacavatomy had to be performed. Lymphadenectomy was performed in 2 patients [4%] who were having enlarged hilar lymph nodes. Total operative time ranged between 120 to 180 minutes. Intra-operative splenic injury was seen in 2 [4%], while aortic injury was observed in one [2%] patient. Post operatively one [2%] developed pulmonary embolism, 2 [4%] chest infection while 2 [4%] developed wound infection and 3 patients [6%] required blood transfusion. Tumour histology was clear cell in [84%], papillary transitional cell carcinoma [12%] and oncosytoma contributed 4%

Conclusion: We observed that large number of the patients presented with haematuria and most of them were male. Radical nephrectomy along-with removal of tumour thrombus is a valuable method for the treatment of renal cell carcinoma having tumour thrombus either in renal vein or inferior vena cava. Common pathological type was clear cell carcinoma

MRI brain findings in patients with high serum prolactin levels

The purpose of the study was to find MRI findings in patients with Prolactin levels above1000mIU/L. Methodology: This Retrospective study was conducted in Radiology Department, Rehman Medical Institute,Peshawar, from December 2009 to October 2012. A total of 86 patients, aged 16-48 years with high Prolactinlevels, were screened with MRI for pituitary gland abnormalities. Only new undiagnosed patientswere considered for the study. Children and patients with known causes for hyperprolactinaemia wereexcluded.The most common abnormality on MRI was microadenoma [n=34, 39.5%] followed by macroadenoma[n=14, 16.3%]. 12[7%] cases of complete/partial empty sella syndrome were seen. Macroadenomawas more common in males [n=6 out of 14, 42.3%] while microadenoma was more common in females[n=32 out of 72, 44.4%]. Majority of Patients had an abnormal MRI finding, showing that MRI screening should berecommended for Prolactin levels above 1000mIU/L. Microadenoma was the most common abnormality,having higher incidence in female patients

Resistance and sensitivity pattern of Staphylococcus aureus; a study in lady reading hospital Peshawar

This study was done to determine the sensitivity and resistance pattern to the most common antibiotics in use. The data for this retrospective study was obtained and analysed from October 2010 to October 2011 in Lady Reading Hospital, Peshawar. Purposive sampling and univariate analysis was done. 2058 samples were cultured for sensitivity using Kirby Bauer's Diffusion technique and in a period of one year, growth of Staphylococcus aureus was obtained in 723 samples. These 723 growths were obtained from clinical isolates of pus [699], blood [16] and urine [8]. Fourteen drugs from five different classes of antibiotics were tested for sensitivity against Staphylococcus aureus. Most of the growth was obtained from pus [96.7%]. Resistance was high to all groups of antibiotics except glycopeptides. There was no case of Vancomycin Resistant Staphylococcus aureus [VRSA]. Out of 723 samples, 228 [31.5%] were Methicillin Resistant Staphylococcus aureus [MRSA]. The resistance to a representative antibiotic of each group is as follows: Ciprofloxacin [Fluor quinolone] 51.7%, Cephradine [Cephalosporin] 46.2%, Amoxicillin+Clavulanic Acid [Penicillin group] 45.6%,Imipenem+Cilastatin Sodium [Carbapenem] 42.0% and Teicoplanin [Glycopeptide] 19.8%.Resistance of Staphylococcus aureus to Teicoplanin and most of the antibiotics is high and strict guidelines are required to control unnecessary prescriptions and over the counter sale of antibiotics

Coverage and causes of non immunization in national immunization days for polio; a consumer and provider perspective study in Peshawar

Polio is a viral disease that may cause paralysis and infant death. Despite ongoing efforts, polio has not been eradicated from Pakistan. The purpose of this survey is to estimate the coverage of polio vaccine during National Immunization Days and to determine the factors associated with lack of immunization. A Cross-sectional survey was conducted in Peshawar, Pakistan, from 1[st] June to 9[th] June 2010. Confidence level of 95% and confidence interval of 4 was used to derive the sample size [for a population more than 20,000]. Parents of 600 children under 5 years were asked about immunization during NIDs of January - May 2010 [5 NIDs]. Questions regarding demographics, income, education, occupation, accessibility to health centers and frequency of visits from health workers was inquired. Knowledge and views on immunization were also asked. 40 health personnel involved in immunization were also interviewed and they were asked about hurdles faced in immunization. 83.7% children were vaccinated in all National Immunization Days, while 94.7% had at least, taken polio vaccine once. 5.3% had not taken polio vaccine during National immunization Days of 2010. Main reasons for not vaccinating were; Vaccinator absent/not visiting home/vaccine not available [63.36%], no awareness [17.4%], Child ill [5.8%], family problem/mother busy [3.3%] and wrong ideas/sterility [3.3%]. Many health personnel [32.5%] considered lack of awareness among people and low accessibility to vaccine as the main hurdles in immunization, besides the poor salaries and incentives. Polio vaccination during National Immunization Days 2010 was a partial success because some pockets of poor children and afghan refugees were poorly vaccinated. In order to eradicate polio, they must be vaccinated

Role of newspapers in health policy making in Punjab

This paper looks at the role of newspapers in health policy making in Punjab, the largest province of Pakistan in terms of population, with nearly 56% of the country's entire population. For the inclusive progress of socio-economic facet of the general public, government should give top priority to the investment in the health sector. Health is the second biggest public sector when it comes to physical infrastructure and human capital in Punjab. Health sector of Punjab is faced with numerous anomalies and the government has been undertaking reforms with intervals. Announcement of health policy is an important initiation for government's plan for the advancement of health sector, in this regard how the media and in case of this study, newspapers, impact health policy making. Newspapers provide a channel which is used by the policy makers to make promises and deliver intentions. Public's Feedback is an essential part of this process and is under investigation in this study. Newspapers can set the direction for public's welfare by covering a specific matter and overlooking the other. With regard to this function of the newspapers this research endeavors to discover the role newspapers in health policy making by adopting the technique of content analysis of four sampled newspapers for the period of six months

Urological complications in ureteric stenting live related renal transplantation

To determine the frequency and types of post-transplant urological complications in live-related kidney transplantation with reference to the impact of JJ ureteric stent. Case series. Shaikh Zayed Postgraduate Medical Institute and National Institute of Kidney Diseases, Lahore, from June 2006 to July 2010. Consecutive renal transplantations, donors being alive were relatives, reterospectively reviewed. All patients underwent extravesical ureteroneocystostomy and all, except one were stented. From the retrieved clinical records, the frequency and types of various minor and major urological complications and their management was studied. All the complications were managed according to standard guidelines. The overall incidence of urological complications among transplant recipients was 11.9%, observed in 12 patients. The complications were urinary leakage in 2 [2%] and clot retention, ureterovesical junction obstruction and wound infection in one [1%] patient each. Urinary tract infection was observed in 7 [6.9%] patients. Urinary tract infection was the most common urologic complication in the studied cases. The technique of stented extravesical ureteronecystostomy had a low rate of urological complications in this series. Other factors which may reduce the urological complications are preserving adventitia, fat and blood supply of ureter by delicate dissection during donor nephrectomy and prevent kinking and twisting of ureter are important factors in reducing the post-transplant urological complications

Percutaneous nephrolithotomy; randomized comparison of large bore, small bore and tubeless

We compared postoperative outcome of conventional large bore percutaneous nephrolithotomy [PCNL] with small bore and tubeless percutaneous ephrolithotomy [PCNL]. prospective randomized trial. August 2008-2009 Setting: Shaikh Zayed Hospital Lahore. The study included 90 patients randomized in three groups. Group. 1 included 30 patients who underwent conventional PCNL with large bore 16 fr nephrostomy tube, Group2 included 30 patients, PCNL with small bore 10 fr nephrostomy tube, and Group3 included 30 patients who had tubeless PCNL. Comparison was made in the terms of analgesia requirement, fever, duration of urinary leak and hospital stay. In Group 1 analgesia requirement ranged from 40-70mg mean 50mg, in Group II, it was 30-60mg with mean 47.3mg while in Group III, The requirement of analgesia was 10-50mg with mean 21.1mg, p<0.005. Hospital stay was between 4 to 7days, mean 5.7days in group I while in group II, stay was between 3 to 5 days, mean 4.3days and in group III, it was between 1 to 4 days, mean 3.17days, p<0.005. Twelve patients had fever in group I, In group II, eleven patients while in group III, five patients developed fever, p<0.005. Leakage of urine from site of wound in group I was observed between 0 to 5 days while in group II leakage was between 0 to 4 days, and the leakage period reduced in group III from 0 to 2 days p<0.005. Tubeless PCNL is associated with the least postoperative pain, urinary leakage, fever and hospital stay, it's a good option after an uncomplicated percutaneous renal procedure

Coverage and causes of missed Haemophilus influenzae type B vaccination in urban and rural areas of Peshawar

Haemophilus influenza type b [Hib] is a major cause of morbidity and mortality in Pakistan. Hib vaccine was introduced in 2009 in EPI programme. The purpose of this study was to find out the coverage and factors associated with non-immunization of Hib in urban and rural areas of Peshawar. Data was collected through random sampling in Peshawar University, Peshawar Saddar, Hashtnagri, Naway Kalay and Pawaka from 9th to 19th of June 2010. A questionnaire was used to interview parents of 600 children aged 1 year and below about demographics, Hib vaccination status, reasons for missed vaccination and views on immunization. Pearson's Chi-square test was used for statistical testing, and p<0.05 was considered significant. Completely vaccinated children were 64.2%, 25% not vaccinated at all, and 11% were incompletely vaccinated. The reasons for not vaccinating were lack of awareness [26%], family problem/mother busy [18%], centre too far [16.9%], wrong ideas [12.2%], fear of reaction [5.4%], child illness [8.1%] and miscellaneous causes [13.7%]. Low Hib vaccination coverage in Peshawar is mainly due to low awareness among people, poor economic conditions and illiteracy

Role of ultrasound in early detection of cirrhosis liver

To determine the accuracy of three ultrasonographic signs that are liver surface nodularity, caudate lobe hypertrophy and hepatic vein flow pattern on Doppler ultrasound in detecting severe liver fibrosis in chronic liver disease. Validation study. Department of Radiology PNS Shifa, Karachi. Duration of the study was 6 months, September 2005 to March 2006. This study included 50 patients of both sexes from 30 - 60 years of age who presented with chronic liver disease in Department of Radiology PNS Shifa, Karachi. TOSHIBA [NEMIO 20] Doppler Ultrasound Machine with 3.5 and 5MHz probes was used to look for liver surface nodularity, caudate lobe hypertrophy and pattern of hepatic vein flow. After performing ultrasound, patients were sent for liver biopsy to compare the results with histopathological findings taken as gold standard. On ultrasound the sensitivity, specificty, positive predictive value, negative predictive value and accuracy were highest for liver surface nodularity in detecting severe liver fibrosis. Ultrasound determination of liver surface nodularity is a significantly accurate method for identifying severe liver fibrosis or cirrhosis

Live renal donors; comparison of CT angiographyand per operative findings

To compare the findings of helical computed tomographic angiography and intra-operative findings in live related donors. To evaluate the accuracy of helical computed tomography with advanced 3D techniques in depicting the renal vasculature, parenchymal and anatomy of collecting system. Sheikh Zayed Post Graduate Medical Institute and National Institute of kidney diseases Lahore. Between June 2006 to May 2009 eighty potential donors underwent CT angiogram as a part of their preoperative workup. We retrospectively studied the CT angiogram and compared the finding with the surgical findings. The results were reviewed with radiologists to determine the discrepancy in discordant cases. The accuracy of CT angiography was 93.40% to predict number of vessels. Five arteries and one vein was missed, this disconcordant comprised 7.59% during initial CT interpretation. The overall concordance between CT angiography and operative findings in delineating the arterial anatomy was found in 74 [93.67%] and venous in 78 [98.73%] donors. All CT scans demonstrated normal collecting system except one, which showed a dilated right pelvicalical system and ureter. Simple renal cysts about the size of 2-4 cm were found in the four left kidneys. CT scan supplied additional important anatomical information including kidney size and the presence of nephrolithiasis. Helical CT angiography is very specific for arterial and venous anatomy as well as other anatomical and functional details. It provides all the information required by a surgeon. It can become the single imaging modality for preoperative assessment of potential donors in place of conventional angiography and intravenous urography. CT angiography is minimally invasive and cost effective

Extracorporeal shock wave lithotripsy; outcome in pediatric urolithiasis

[1] To determine the efficacy of extra-corporeal shock wave lithotripsy with reference to stone size, site and radiodensity in children. [2] To determine acute early complications during and following extra-corporeal shock wave lithotripsy in children. Analytical case series study. Fifty patients of either sex below the age fourteen [14 years] having renal, ureteric and bladder stones between 5-20 mm in size along with their long axis presented to department of urology Shaikh Zayed Hospital Lahore during the period of one year extending from 02-02-2008 to 02-02-2009 were included in this study. Children with serum creatinine level greater than or equal to 3mg/dl, obstruction distal to the stone, patient with active bleeding disorders, uncorrected hypertension, patient unfit for general anaesthesia, untreated urinary tract infection and patients with gross anatomical anomaly were excluded from study. All the patients were given shock waves under intravenous sedation or general anaesthesia in a standard manner on out door basis. All the children were evaluated for stone clearance and early complications at first 24-72 hours. At the end of three months ESWL treatment was considered successful, if the patients were stone free or had residual fragments 4 mm or less in size. Out of the fifty patients, 40 [80%] were males and 10 [20%] females with male to female ratio of 4.1. The age range of patients was 2-14 years [mean +/- SD 9.24 +/- 3.48 years]. Thirty three patients [66%] had renal stones, 7 [14%] ureteric and 10 patients [20%] had bladder stones. Single successful treatment session was noted in 22 patients [44%], 18 patients [36%] received two sessions and 10 patients [20%] required three sessions for successful stone fragmentation. Seventeen patients did not show stone clearance even after three sessions within three months follow-up. Twenty one patients [42%] felt pain after lithotripsy session, and they were given injectable analgesia and the pain settled, haematuria in 17 patients [34%], impacted stone in five [10%], ureteric colic and urinary tract infection in three, three cases respectively and only one case developed steinstrasse. Twenty patients [40%] developed minor complications of anaesthesia, like nausea, vomiting which relieved with injectable antiemetics

Per-operative findings of blocked ventriculoperitoneal shunt: a study of 72 cases

Most patients with hydrocephalus are treated with ventriculo-peritoneal [VP] shunt placement; however, malfunction is common and is usually caused by mechanical failure. The aim of this study was to evaluate the per-operative findings accompanying presumed VP shunt malfunction. This is a descriptive study of 72 patients operated for shunt malfunction in the Department of Neurosurgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from January to December 2008. Presenting symptoms and signs, clinical shunt function, operative findings and outcome were recorded. Common presenting features were vomiting, irritability and general toxic look of patients. Male to female ratio was 3:1. Upper end block was observed in 39 patients while lower end and reservoir block was noted in 13 and 2 patients respectively. Choroids plexus was found in 29.2% of cases with upper end block, shunt revision was performed in most of cases [80.6%]. The importance of clinical features cannot be overlooked in a patient with shunt malfunction. Upper end block due to choroids plexus is common operative finding

Extracorporeal shockwave lithotripsy; impact of diuresis on the clearance of lower pole renal calculi

Treatment of renal stone is always a challenge. High incidence of recurrence of renal stone compels the treating physician to opt for minimally invasive treatment. With the advent of extra corporeal shock wave lithotripsy the treatment has been completely revolutionized. The treatment of lower polar stone is always tiring, and usually involves multiple modalities, the low lie of the stone, difficult clearance, narrow infundibulum, and higher incidence of regrowth make it difficult to treat. We assessed the role of diuretic in the clearance of lower polar stone after shock wave lithotrispsy, [SWL]. 60 patients were selected from both sexes and divide them in two equal groups, with age 20-75 Y for group 1, and 5-72 Y for group II. Stone size from 5- 20mm were included in our study. The patients underwent ESWL. The group I was offered inj Frusemide 20 mg intravenously after shock wave lithotripsy, while patients in group II were kept as control. The stone clearance in group I was 73.3, and 60% in group II. Which is quite significant. The use of diuresis after ESWL significantly increases the clearance rate for lower polar stones

Accuracy of ultrasonography in detection of severe liver fibrosis/cirrhosis in chronic liver disease

To determine the accuracy of three ultrasonographic [US] signs; liver surface nodularity, caudate lobe hypertrophy and hepatic vein flow pattern on Doppler ultrasound, in detecting severe liver fibrosis in chronic liver disease. Descriptive study. Department of Diagnostic Radiology, PNS Shifa Karachi. Duration of the study was 6 months -SEPTEMBER 2005 TO MARCH 2006. The study included 50 patients of both sexes [20-60 yrs], presenting with chronic liver disease to department of Ultrasound. TOSHIBA [NEMIO- 20] Doppler Ultrasound Machine with Doppler 3.5 and 5.0MHz probes was used to look for liver surface nodularity, caudate lobe hypertrophy and pattern of hepatic vein flow. After performing US, liver biopsy on these patients was performed under US guidance and sent for histopathology findings; taken as gold standard. On US, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were highest for liver surface nodularity in detecting severe liver fibrosis. However, the above-mentioned values were relatively higher when the three ultrasound signs were collectively considered; compared to single US sign. US determination of liver surface nodularity is a significantly accurate method for identifying severe liver fibrosis or cirrhosis. The accuracy of ultrasound further increases when hepatic vein flow pattern and caudate lobe hypertrophy are also taken into account

Survival following radical nephrectomy: review of a surgeon's experience

36 patients underwent radical nephrectomy for renal tumors between 1990 and 1996 at Sheikh Zayed Hospital, Lahore by one consultant [MUK]. The records of all the patients were reviewed to see the presentation, stage and grade of tumor, survival and the different factors that led to better survival. 20 patients were male and 16 females, ages ranged from 1 to 80 years, mean age 43 years. At presentation hematuria was present in 23 [63.8%] patients, mass was present in 26 [72.7%], pain in 19 [52.7%], fever was recorded in 11 [30.5%] cases and weight loss was complained by 16 [44.4%] patients. At the time of diagnosis 8.3% [3] had stage 1 disease, 11.11% [4] had stage 2 disease, 41.6% [15] had stage 3 disease, and 38.8% [14] had stage 4 disease. 3 patients [8.3%] had transitional cell carcinoma of the collecting system, 4 [11.1%] had a Wilms tumor, while 29 [80.5%] patients had renal cell carcinoma. To date 33.3% [12] remain alive and well, 63.8%[23] did not survive the disease and 5.5%[2] were lost to follow up. Radical nephrectomy is the treatment of choice for patients with renal malignancies