Rapunzel syndrome

A trichobezoar may be confined to the stomach or unusually it may extend from stomach to the small intestine or beyond when it is labelled as Rapunzel syndrome. Bezoars are concretions in the gastrointestinal tract that increase in size by continuous accumulation of non-absorbable food or fibre. Most bezoars in children are trichobezoars from swallowed hair. Repunzal syndrome is an uncommon condition in children with less than 40 cases reported. We present a case of an 8 year old girl with Rapunzel syndrome. She presented with vague abdominal pain and epigastric fullness of one year duration. On investigation she was found to have a trichobezoar. At laparotomy a large dark foul smelling trichobezoar that occupied the stomach, duodenum and proximal jejunum was removed via gastrostomy

Vascular access for haemodialysis

The aim of this study was to report our results of vascular access surgery and the factors affecting the outcome. Descriptive study with prospective data. This study was carried out at the Combined Military Hospital Rawalpindi, the Military Hospital Rawalpindi and the Armed Forces Institute of Urology form January 1997 to July 2000. Patients with end stage renal disease needing chronic haemodialysis were included in the study. The operative technique used was relatively standard. The fistula initially sited was distal in the arm for as long as possible and in an easily accessible position. Patients who received renal transplant, discontinued dialysis with a functioning shunt and patients who died were excluded form the study. The primary cumulative at one year patency Cimino AV fistula, elbow AV fistula and graft AV fistula is 66%, 70% and 37% respectively. Diabetic patients had much lower patency than non- diabetics. A distal autogenous radio-cephalic fistula should be the first choice in patients requiring chronic haemodialysis. The elbow arterio-venous fistula should he the second choice before planning a prosthetic graft

Leiomyosarcoma of femoral vein in an adult

A middle aged female presented with a swelling in the groin on the left side. On examination, it was an oval mildly tender firm mass, adherent to underlying structures and extending into the pelvis with pulsatility and bruit. It was diagnosed as leiomyosarcoma of femoral vein on fine needle aspiration cytology and selective left common iliac and common femoral angiography of the lesion. En-bloc wide excision of the mass including the femoral vessels was carried out with saphenous vein graft interposition for restoration of vascular continuity for both vessels. Femoral nerve was sacrificed for tissue clearance. The defect was large and led to permanent limp and walk with a support. The lady was followed up for two years. She was found to have no local recurrence or detectable metastases

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 and outcome of extremity soft tissue sarcomas

To analyze the results of various treatment modalities applied to soft tissue sarcomas of the extremity. Design: An analytical study. Place and Duration of Study: Combined Military Hospital, Rawalpindi during the period January 1994 - January 1996. Subjects and Data was collected from 32 patients. It included age, gender, presentation, diagnostic work-up, treatment instituted followed by evaluation of management. All patients were followed up for 24 months. Seventeen [53%] were males and 15 [46%] were females. Mean age of presentation for males was 50 years and for females 40 years. Most common presentation was a lump on proximal part of the limbs. Surgery was the primary treatment modality in 20 [62.5%] patients followed by adjuvant radio-chemotherapy, whereas in 12 [37.5%] only radiotherapy was employed to local site. In this latter group, 6 [18.75%] were subjected to chemotherapy as well, due to metastatic disease. The management of soft tissue sarcomas of the extremity carried out in our set up was not satisfactory leading to increased incidence of local recurrence and mortality. Appropriate management requires updated knowledge and its application by health professionals. Preferably these tumours should be managed by a dedicated multi-disciplinary team

Peripheral vascular diseases in patients with coronary artery diseases

The prevalence of peripheral vascular disease [PVD] in patients with coronary artery disease [CAD] has been investigated in many different ways. It depends on the diagnostic methods used and definition of atherosclerotic manifestations in the different vascular beds. This study was carried out to determine the prevalence of PVD in the lower limbs in group of patients with CAD. Design: This is a prospective observational study. Place and Duration of Study: The study was conducted at combined military hospital / Armed forces institute of Cardiology, Rawalpindi, over a period of one year [January 1998 to January 1999]. Subjects and A total number of 200 patients [171 males and 29 females] aged 55-77 years with CAD Diagnosed by coronary angiography were included in the study. In all patients blood pressure was recorded in both arms by sphygmomanometer and ankle systolic pressure by Doppler ultrasound. Ankle brachial index was calculated. Demographic data were obtained from the patient's hospital files. The prevalence of PVD was 22.5% in patients with CAD in agreement with the results of most previous investigations. There was tendency towards increasing prevalence of PVD with more advanced CAD. Thirty patients [27%] showed evidence of triple vessel disease as compared to 13 patients [18%] with double vessel and 2 patients [1%] with single vessel disease. A non-invasive investigation of peripheral arterial circulation should be included early in the clinical consideration of patients with chest pain or similar symptoms suggesting coronary artery disease. Ankle systolic pressure appears to be simple and cheap technique for evaluation of results

Minilap cholecystectomy

A retrospective review of 292 consecutive minilap cholecystectomies carried out in one surgical unit of Combined Military Hospital Rawalpindi during 1993-1995, is presented. A different technique was used. we employed a 4 cm subcostal transverse incision. Anterior rectus sheath was incised longitudinaly, right rectus abdominus muscle was retracted laterally and posterior sheath and peritoneum incised transversely. The conversion to midline incision was 3% [9 patients]. An average hospital stay was 2 days. Follow-up is recorded by information gained through postal questionnaires. The complication rate was 4%. No patient has yet reported with incisional hernia. One patient died due to septicaemic shock.

Minilap cholecystectomy is safe and effective alternative to laparoscopic cholecystectomy. It requires no special training or expensive equipment. These advantages translate into decreased hospital expenses and reduced hospital health care cost

Screening for abdominal aortic aneurysm: a hospital based study

This hospital based one year study was carried out to find the incidence of abdominal aortic aneurysm in our population and to identify associated risk factors. A total of 410 males and 94 females all above the age of 65 years admitted for various ailments were subjected to ultrasound screening. Twenty two males [5.4%] and one female [1.1%] were found to have an abdominal aortic aneurysm. The overall incidence is 4.6%. Amongst male patients the incidence is 4.8% in the age group 65-70 years, 5.3% in 71-75 years and 6.9% in those above 80 years of age. Those with ischaemic heart disease, hypertension and peripheral vascular disease were particularly at a greater risk of having an abdominal aortic aneurysm. Of all the aneurysms detected 61% were between 3-4 cm in size, 26% between 4-4.9 cm and only 13% were larger than or equal to 5 cm. The incidence of abdominal aortic aneurysms in our studied population is similar to that found elsewhere in the world