Pseudoaneurysms in intravenous drug abusers

lntravenous drug abuse can lead to vascular complications, most frequent of which is pseudoaneurysm. These pseudoaneurysms [false aneurysms] are prone to rupture, leading to profuse hemorrhage and death. To evaluate pseudoaneurysms in intravenous drug addicts for the site, mode of presentation, management and outcome. Descriptive study. Surgical unit I, Combined Military Hospital, Rawalpindi. Surgical unit 2, Combined Military Hospital, Lahore. January 2006 to September 2010. All cases of pseudoaneurysms in intravenous drug addicts who presented to a single vascular surgeon, between 1st January 2006 and 30 th September 2010, were evaluated for site, mode of presentation, treatment and the outcome. Surgical procedures included excision of pseudoaneurysm with interpositioning of graft, repair of vascular rent, ligation of vessel and debridement. All cases were referred to psychiatrist for management of drug addiction. Total 12 cases of pseudoaneurysms due to IV drug abuse were included in our study. Arteries affected included 9[75%] common femoral arteries [CFA]. ln 3[25%] cases, both common femoral artery and vein were involved with arteriovenous fistula between them. There was 1[8.3%] pseudoaneurysm each of external iliac artery, superficial femoral artery and brachial artery. Nine cases [75%] presented with recurrent hemorrhage from a swelling while in 3[25%] cases there was swelling with no history of hemorrhage. ln 7[58.3%] cases, repair/grafting, while in 5[41.6%] cases ligation and debridement was done. There was seroma formation in 1[8.3%] case after excision and grafting. ln none of the cases, in which artery was ligated, critical limb ischaemia occurred. Common femoral artery is the most frequent site of pseudoaneurysms in lV drug abuse. ln those cases where vascular reconstruction is not possible due to extensive skin necrosis or infection, ligation of affected vessel is not only a life saving procedure but a safe option also.

Quality of life assessment in patients with locally advanced head and neck malignancy after ablative surgery and reconstruction with microvascular free flaps

To assess the improvement in Quality Of Life [QOL] after ablative surgery in locally advanced head and neck malignancies by microvascular free flaps reconstruction. Quasi-experimental. Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from September 2005 to February 2007 A total of 44 patients with locally advanced stage III and IV malignancy of head and neck were included in the study. All patients were treated with ablative surgery and reconstruction with microvascular free flaps. QOL was assessed by using a scoring questionnaire [including 5 parameters for extra oral cancers including physical and role function, body image, weight loss score and pain donor site morbidity; and an additional 5 parameters for intraoral tumours that included swallowing, speech, drooling of saliva and mouth opening]. A high score indicated a poor QOL. Patients were assessed pre-operatively and then at 2, 4 and 6 months postoperatively. Mean accumulative score and mean individual parameter scores for both extra- and intraoral tumours were significantly improved [p < 0.05]. Microvascular free flap reconstruction after ablative surgery in locally advanced head and neck malignancy had a profound impact on the improvement of QOL. There was an initial deterioration of physical scores postoperatively and postradiotherapy, followed by gradual improvement. By the end of 6 months, it surpassed the pre-operative QOL scores

Tuberculous tenosynovitis: a cause of carpal tunnel syndrome

To highlight the presentation of tuberculous tenosynovitis as Carpal Tunnel Syndrome [CTS]. A descriptive study conducted with purposive sampling on the patients presenting between April 2004 to January 2005 to the department of Plastic Surgery, CMH Rawalpindi, with the clinical picture of CTS. Symptoms and signs were recorded. The carpal tunnels were explored under nerve blocks. Where tenosynovitis was observed per-operatively, specimen of excised synovium were sent for histo-pathological examination, acid fast stains and bacterial cultures, to ascertain or rule out the presence of tuberculosis. A total of 53 patients predominantly males were included in the study. The median age was 43 years and average duration of symptoms was 9 months. Tenosynovitis was observed in three patients [6%] per-operatively, with histopathology suggestive of Tuberculous tenosynovitis. Point Prevalence of tuberculous tenosynovitis as a cause of CTS was 6%. These patients reported clinical improvement with anti-tuberculosis treatment. NCS/EMG co-related well with clinical relief. Tuberculous tenosynovitis is an uncommon cause of median nerve compression at the wrist. As symptoms are usually typical of CTS, diagnosis is frequently missed. Consideration of the possibility, examination of the opened canal at surgery and proper treatment can result in a successful outcome