A case of nasopharyngeal carcinoma and precious pregnancy

@#Cancer during pregnancy is a rare condition. We report here a case of a lady diagnosed with nasopharyngeal carcinoma (NPC) at University of Malaya Medical Centre during her first pregnancy conceived via In Vitro Fertilisation (IVF). A multidisciplinary (MDT) meeting among Oncology, Obstetrics, Rheumatology and Otolaryngology teams was conducted to discuss her treatment options. She opted for treatment with Complementary and Alternative Medicine (CAM). This case illustrates the unique challenges in the oncological management of a patient diagnosed with NPC during pregnancy. It also serves as a reminder that the use of CAM in cancer patients is prevalent. It is important for doctors to inquire about use of CAM and to be well-informed about it. Transparent communication and taking cognizance of the goals and concerns of the patients are essential in delivering patient-centred care.

Distal radius fracture; functional outcome in patients with distal radius fracture irrespecitive of radiological deformities

The objective of the study is to find out functional outcome in patients with distal radius fractures irrespective of radiographic deformities after close reduction and cast splint age

Design: Case series study

Setting: Department of Orthopedics and Spine Surgery, Hayatabad Medical Complex Peshawar

Period: May 2010 to April 2015

Materials and Methods: 28 consecutive patients of either sex with age above 40 years, having distal radius fracture. Functional outcome was assessed with disability of arm, shoulder and hand [DASH] and Patient Rated Wrist/Hand Evolution [PRWHE] questionnaire

Results: Out of 28 patients male were 12[42.9%] and female were 16[57.1%]. minimum age was 40 maximum 81 and average was 50. Right side was involved in 17 [60.7%] while left side was involved in 11[39.3%]. The DASH Score Record shows that no Disability was seen in 13[46.4%], Minimal Disability in 7[25%], Mild Disability in 5[17.9%], Moderate Disability in 1[3.6%] and Severe Disability in 2[7.1%] patients. While the PRWHE Score Record shows that no Disability was seen in 14[50%], Minimal Disability in 6[21.4%], Mild Disability in 5[17.9%], Moderate Disability in 1[3.6%] and Severe Disability in 2[7.1%] patients

Conclusion: A majority of the distal radius fractures can achieve good results after treatment by closed reduction and cast immobilization, for which conservative treatment should be the first choice. Deformity of the distal radius cannot affect the functional outcome of the wrist and hand

Assessment of L.V. function by multislice cardiac Ct as compared to 2d_echocardiography

Assessment of left ventricular function and volumes provides valuable information in patients with heart disease. It is also considered a prognostic marker in coronary artery disease. Two- dimensional transthoracic echocardiography is the most widely used method for Left Ventricular function assessment, but this modality is operator dependent and can be impaired by a poor acoustic window. To validate a single tertiary center experience in Multi Detector Computed Tomography for the evaluation of cardiac function in patients undergoing coronary CT angiography. A cross sectional study, conducted at Ibn Albitar center from September 2012 till May 2013. Patients included are those who already underwent 64-slice CT coronary angiography to evaluate known or suspected coronary artery disease, CT coronary angiography is performed using a 64- slice Multi Detector CT-scanner. Transthoracic Echocardiography was done by a single operator served as the reference standard. Eighty patients [66.3% male] were included in the study, the mean age was 53.19 +/- 10.6 years. The mean Left ventricular End Diastolic Volume by Cardiac CT and Echocardiography were 125.31 +/- 41.92, 126.75 +/- 41.894 ml respectively, with excellent correlation [r =0.912; P< 0.001]. Average Left ventricular End Systolic Volume [LVESV] by Cardiac CT and Echocardiography were 58.08 +/- 34.18, 53.74 +/- 33.15 mL respectively

Spine surgery; complication of iliac crest bone graft harvesting

The objective of this study is to find out the complication directly related to iliac bone graft harvest in spine surgery. Observational prospective study. Department of Orthopedic and Spine surgery, Hayatabad Medical Complex Peshawar. January 2007 to April 2012 on 139 patients. Only those cases were included in whom bone grafting was done for fusion as part of their spine surgery and were successfully followed for at least 6 months. Out of 139 patients 59[42.4%] were female patients while 80[57.6%] were male. Minimum age of the patients was 4 years while maximum was 70 years. In 119[85.6%] patients cortico-cancellous bone graft was taken. While in 20[14.4%] patients, tri-cortical graft was taken. In majority 106[76.3%] cases graft was obtained from the posterior iliac crest while in 33[23.7%] it was obtained from the anterior iliac crest. 45[32.4%] had some pain at the bone graft site. 8[5.8%] had early deep infection while 6[4.3%] had early superficial infection. Nine [6.4%] of our patients had nerve injury evident by parasthesia in the zone of distribution. Iliac crest is an excellent source and best available material for autogenous bone grafting. However it is not free of complications. The most common complications are persistent chronic donor site pain, infection and heamatoma

Oswestry disability index for the assessment of postoperative disability in spinal trauma

Objectives: The objective of this study was to assess functional disability measured with the Oswestry Disability Index in patients with thoracolumbar spine instrumentation

Study Design: A descriptive study

Place And Duration: Department of Orthopedics and Spine Surgery, Hayatabad Medical Complex Peshawar from July 2007 to June 2012

Methodology: This descriptive study was performed in Department of Orthopedics and Spine Surgery, Hayatabad Medical Complex Peshawar from July 2007 to June 2012 on 52 consecutive patients of either sex with age above 17 years, have unstable fracture of thoracolumbar spine with intact neurology that has been treated by posterior spinal fixation with pedicular screws and rods. Using Oswestry Disability Index questionnaire which assess the functional disability the data was collected by a proforma and analyzed with SPSS version 10

Results: There were total 52 patients. Male patients were 35 [67.3%] while female were 17 [32.7%]. Minimum age was 18 years, maximum 75 while average age was 35.90. The Oswestry disability index was grade D in 24[46.2%] patients and grade E in 28[53.8%] patients preoperatively. Postoperatively at six months the index was grade A in 33[63.5%]patients, grade B in 15[28.8%] and grade C in 4[7.7%] patients while minimum Oswestry disability index was 10%, maximum 56% and average was 22.76

Conclusion: Our study shows improved results based on Oswestry Disability Index, in patients with fracture of thoracolumber spine undergoing posterior spinal fixation with pedicular screws and rod. Our findings also document the effectiveness of surgical techniques that has been done, suggesting that a bed bound or crippled patient was enabled almost to live independently

Postoperative analgesia with tramadol in orthopedic surgery: continuous infusion versus repetitive bolus administration

To compare the effect of infusion of tramadol with repetitive administration of bolus on postoperative pain in orthopedic surgery. Comparative study. Department of Orthopedics and Spine Surgery Hayatabad Medical Complex Peshawar, form October 2009 to April 2010. Patients with American Society of Anesthesia clinical grade I and II, age >18 year scheduled for ambulatory orthopedic and trauma surgery were included. Half of the randomly selected patients were placed in infusion group [Group I] who received an initial intravenous loading dose of 100 mg tramadol followed by an infusion of 12 mg/hour tramadol for 24 hours after recovery from anesthesia; if necessary, repeated bolus of 50 mg tramadol was given. Half of randomly selected patients were in bolus group [Group II].These patients received a placebo infusion instead of tramadol infusion and only received bolus doses of 50 mg on demand. The pain relief was assessed as excellent or good by 78% of group I and 70% of group II patients. In group I, 65% requested only one or no repetitive bolus, compared with 40% in group II, while two or more bolus were demanded by 30% in group I and 60% in group II. The average analgesic consumption after 6 hours was 222 +/- 50 mg tramadol in group I and 200 +/- 50 mg tramadol in group II, respectively. After 24 hours it was 438 +/- 50 mg tramadol in group I and 250 +/- 50 mg tramadol in group II. While the consumption during the first 6 hours was comparable. From then on the consumption in group I increased significantly. Side effects were reported by 30% in both the groups. Continuous infusion is better than bolus in term of easy administration and better pain control throughout postoperative care

Comparison of Ponsetitechnique with Turco's posteromedial release in the management of congenital talipes equinovarus

To compare the results of Ponseti technique with one stage Turco's posteromedial release for correction of clubfoot in children of less than 12 month of age Comparative study Department of Orthopedics and Spine Surgery Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar, from October 2008 September 2010. Patients were randomly selected by drawing lots, with even number included in group A [Ponseti Technique] and odd number in group B [Turco's posteromedial release]. Patients of either sex with age less one year having congenital talipes equinovarus were evaluated preoperatively by Pirani score, postoperatively by Mac Key score and were followed up for 2 years. Out of sixty patients, 23[38.3%] were males and 37 [61.7%] females. Fourteen [23.3%] patients had bilateral while 46 [76.7%] had unilateral deformity. Minimum age was 2 week, maximum 52 week and average 5.58 week. Using Pirani score preoperatively, there were 36[60%] patients with severe abnormality and 24[40%] feet were moderately abnormal. Using Mac Key score the functional results at last follow up in Group A were excellent in 16[26.7%], good in 13[21.7%] and failure noted in 1[1.7%] patient. At last follow up, functional results in Group B were excellent in 14[23.3%], good in 10[16.7%], fair in 4[6.7%] and poor in 1[1.7%] patient. Ponseti technique for an idiopathic clubfoot should be the choice for clubfeet. When there is recurrent deformity or resistant club foot then operative treatments may be considered

Olecranon fracture

The objective of the study is to assess the clinical and radiological outcome after tension band wiring of olecranon fractures. Descriptive study. Department of Orthopedics and Spine Surgery, Hayatabad Medical Complex Peshawar. July 2007 to June 2010. 29 consecutive patients of either sex with age above 20 years, having olecranon fracture. Fracture osteosynthesis was achieved with the insertion of two parallel 1.8 mm Kirschner wires from the tip of the olecranon and an 18 gauge wire in a figure of eight fashion. Then functional outcome is evaluated with Mayo Elbow Performance scores [MEPS] while radiological outcomes is evaluated with standard radiographs. Out of 20 patients, male were 19[65.5%] while female were 10[34.5%]. Minimum age was 20, maximum 80 and average age was 47.5 years. There were 7[24.1%] patients with type A, 6[20.7%] type B, 9[31%] type C, 6[20.7%] type E and 1[3.4%] with Schatzker type F fracture. Mayo Elbow Performance Score was Excellent in 13 [44.8%], Good in 10[34.5%], Fair in 4[13.6%] and Poor in 2[6.9%] patients. There were 10[34.5%] complications including prominent wire in 3[10.3%], osteoarthritis in 1[3.4%], broken skin in 3[10.3%], irritation of skin in 1[3.4%], erythema in 1[3.4%] and serous discharge in 1[3.4%] patient. There was no non union recorded in this study. Olecranon fractures heal well in most instances achieving recovery of normal function in more than 95% of patients. Functional outcome is dependent on fracture severity, length of immobilization, and patient factors

Compartment syndrome, a neglected diagnosis

To find out the frequency of compartment syndrome in extremities using Whitesides' infusion technique. Descriptive case series. Orthopedic Department of Hayatabad Medical Complex Peshawar, from April 2008 to April 2010. All patients with fractures, either open or closed, were clinicallay evaluated for compartment syndrome initially. All clinically suspected cases then underwent measurement of compartment pressure by Whitesides' infusion technique. There were thirty six patients in the study. Minimum age was 3 years and maximum 45 years with median age of 30 years. There were 25 [69.45%] males and 11 [30.55%] female patients. There were only two [2.77%] open fractures in this series. Two [5.55%] patients had femur fracture, 4 [11.11%] had radius/ulna fracture, one [3.33%] had supracondylar fracture of humerus and 24 [66.66%] tibia fracture. Five [13.88%] patients had injury to the foot. Minimum compartment pressure was 35 mmHg and maximum was 55 mmHg with a mean of 40 mm Hg. Traumatized limbs have high risk of developing compartment syndrome. A careful clinical examination at the time of admission and diligence with serial examinations of the extremity at risk, may identify majority of compartment syndrome patients. The pressure should then be measured to confirm compartment syndrome

Distraction osteogenesis in segmental bone defects in tibia by monoaxial external fixator

To evaluate the results of segmental bone transport using monoaxial external fixator in patients with non union of the tibia with segmental bone loss. This descriptive study was carried out at orthopedic unit of Hayatabad Medical complex Peshawar from July 2004 to January 2007 with 32 patients of tibial non union with segmental bone loss. Locally made "Naseer-Awais" uniplanner external fixator was applied and osteotomy performed. Distraction started at tenth post operative day. Patients were followed fortnightly. Check radiographs were taken on every visit. At the end of consolidation phase fixtor was removed. Results were assessed using Association for the Study and Application of the Method of ILIZAROV [ASAMI] scoring system. Out of 32 patients 29 were male and 3 were female. Eighteen patients had road traffic accidents, 10 fire arm injuries and 4 bomb blast injuries. Average length of bone transport was 7cm. Average duration of fixator was 8 months and average follow up was 25 months. Eight[25%] patients had some additional procedure in form of fibular osteotomy, fasciocutaneous flap and bone grafting. Twentyeight[87.5%] patients had pin tract infection. Repositioning of pins was done in 18[56.25%] patients. External fixator was changed in 10[31.25%] patients. Four patients developed mal-alignment which required fixator resetting. Four[12.5%] patients had re-osteotomy. Five[15.62%] patients developed persistent equinus deformity. Nine[28.12%] patients had to modify their profession. Distraction osteogenesis can be achieved with locally made Naseer Awais fixator in non union of tibia with segmental bone loss

comparative study on the effect of air scaler and hand instruments on the root surface using the scanning electron microscope

In vivo study was carried out to compare the effect of Gracey curette hand instrument and calcus sonic air scaler on root surface concerning roughness production and their efficiency in removing plaque and calculus using scanning electron microscope [SEM]. Twenty teeth with single roots have been used in this study. The teeth were apportioned into 2 groups, 9 teeth in each group with 2 planed site mesially and distally. The first group planed with Gracey curette each side with new cutting edge, the second group planed with calcus sonic air scaler with perio-tip mesially and distally. The other 2 teeth served as a control specimens, one single non-instrumented periodontally involved root, the other one was free of periodontal disease. When the teeth preparation were complete, they were prepared for the SEM. The specimens were examined at microscope power X500, 1000, 3000, 10000. The result revealed that there was no significant difference between the 2 instruments in removing plaque. Also the study showed no statistical difference between the 2 instruments in calculus removal. There was highly significant difference between the 2 instrument in roughness production on the root surface after root planning. The hand curette proved to be superior to the air scaler in producing a smoother surface