Frequency of hydrocephalus in myelomeningocele patients in a tertiary care hospital

Background: Myelomeningocele is most complex form of spin a bifida and most of the times, it is associated with hydrocephalus

Objective: To find the frequency of hydrocephalus in Myelomeningocele patients

Methodology: Study design: Cross sectional Study. Setting: Department of Neurosurgery, Sheikh Zayed Hospital, Rahim Yar Khan. Study duration: From 1[st] January 2012 to 31[st] December 2013. Study subjects: 52 patients of Myelomeningocele were included in our study and were assessed for different variables like age, sex, site of lesion, presence of hydrocephalus and status of lower limbs [power, sensation and sphincter control]. The data was entered and analyzed by using SPSS version 15

Results: 34 patients [65.38%] were male and 18 patients [34.61%] were female and common site of lesion was lumbar region [48%] followed by thoracolumbar region [42%]. The power of legs was G0-G2 in majority of patients [90%]. 40 patients [76%] had hydrocephalus detected by CT Scan brain

Conclusion: Our study suggests it is better to put VPShunt before going for treatment of Myelomeningocele, as majority of the patients of myelomeningocele have hydrocephalus

Result of surgical decompression and internal fixation with titanium cage in patients with carries spine

The objective of the study is to assess, the postoperative outcome of the intervertebral titanium cage, in patients operated for Caries spine with unstable spine with/without neurological deficits. This is a retrospective study, carried out in department of Neurosurgery Sheikh Zayed Hospital, Rahim Yar Khan, during 2 years, from January 2006 to December 2007. All patients underwent a neurological and radiological assessment. Those patients who had collapse of vertebral body/s, with/without gibbus formation having some neurological deficit were included. Patients fit for surgery, were operated upon, with placement of intervertebral adjustable titanium cage. These patients were followed up for eighteen months. The study comprised of 11 patients, with their age ranging from 20 to 53 years having 7 males and 4 females. The patients were admitted through OPD or the emergency department in neurosurgical ward of Sheikh Zayed hospital, Rahim Yar Khan. The majority of the patients had D10-11 lesion [36.3%] followed by L2 in 18.1%. The neurological status of the patients received showed paraplegia in 27.27% while paraparesis in 72.72% of patients. The neurological outcome of 11 patients, after eighteen months of follow up, showed marked improvement in 72.72% patients of incomplete spinal cord compression [paraparesis]. While some improvement in 27.27% patients of complete spinal cord damage [paraplegia]. All patients with kyphotic lesions had near normalization of the anatomical curve of the spine. All patients were kept on antituberculous chemotherapy for one year. Our experience with usage of the titanium cage for internal fixation in Caries spine showed very promising results, especially in patients of paraperesis with/without gibbus formation. This technique may become a main stay of surgical management in Caries spine for thoracolumber region in our setup

study of complications seen in 300 cases of ventriculo peritoneal shunts managed at Sheikh Zayed Hospital, Rahim Yar Khan

The objective of the study is to assess, the postoperative complications of 300 hydrocephalic patients, operated with ventriculo peritoneal shunting system. This is a retrospective study, carried out in the department of Neurosurgery Sheikh Zayed Hospital, Rahim Yar Khan. 300 patients including both adults [20.3%] and children [79.6%] with various causes of hydrocephalus were operated upon. All patients underwent a neurological and radiological assessment, and all those patients who had clinical and radiological evidence of hydrocephalus and were fit for surgery, were operated. All patients underwent a ventriculo peritoneal shunt placement. The follow up of the patients was for six months and all the complications were noted and dealt with. The common cause of hydrocephalus seen in children was Aequeductal stenosis, followed by post meningitis hydrocephalus, whereas in adults, trauma and tumours were responsible for the disease. Most common complication seen in our study was shunt blockade [33%] followed by wound infection and meningitis [23%].The study was to identify complication rate of ventriculoperitoneal shunt in our setup. Inspite of low socioeconomic setup and poor hygiene our results are still comparable to some foreign studies

Small bowel volvulus leading to gangrene and short bowel syndrome

A young man was operated for acute abdomen. Laparotomy revealed small bowel diverticulosis with very short mesentery leading to volvulus of near total small bowel. Resection and end to end anastomosis was performed. Patient ended up with short bowel syndrome

External abdominal hernias

To document our experience of external abdominal hernias at Rahim Yar Khan Design: A descriptive study. Place and Duration: This study was conducted in Surgical Unit-II of Sheikh Zayed Hospital, Rahim Yar Khan from May, 2002 to August, 2002. Patients And All patients admitted with the diagnosis of external abdominal hernia were registered for the study. History, Clinical presentation and relevant investigation were recorded. Commonest type of external abdominal hernia was the inguinal hernia [65%]. Second commonest was paraumbilical hernia [16%]. Third in series was incisional hernia [8%]. Remaining varieties, in descending order were umbilical [5%], ventral [3%], epigastric [2%] and fatty hernia of linea alba [1016]. Most of the findings were similar to those found in other parts of the country except that in our study no adult male suffered from ventral, epigastric or umbilical hernia. Complications were very low and no case of femoral hernia was seen