Delayed presentation of an unusual transpharyngeal penetrating neck injury by a wooden stick: a case report

Penetrating neck trauma is a horrifying injury. Patients may present with sudden death, or life threatening injuries such as catastrophic haemorrhage, major vessel injury, injuries to the respiratory or digestive tract, neurological deficits, or bony injuries of the cervical spine. Other less life threatening symptoms may be associated with such injuries. We present here a case report of a 2-year-old child who sustained a transpharyngeal penetrating neck injury that occurred while playing with a wooden stick. He presented one month later with an abscess in the posterior triangle of the neck.

Simple repair is sufficient for most injuries to the duodenum - a case series of 23 patients

Duodenal injury is the most important hollow viscus injury in the abdomen. The study analysed the outcome of duodenal injuries at the unit. Prospectively collected data on a case series involving 23 patients over 3 years. It involved demographic details, part of duodenum injured, injury severity according to the AAST, injury-operation time lag, mode of repair, and the extent of significant associated injuries. M:F ratio was 4.75:1. Mean age 33yrs. Patients with non-perforating injury were excluded. All were operated by a senior registrar or senior. 7/23 were blunt, 13/23 firearm and 3/23 stab injuries. D2 was involved in 87%. Injury severity was graded according to AAST [American Association for Surgery of Trauma]. 17/23 were Grade II/III, 3 Grade IV and 3 Grade V injuries. Four had injury-operation lag of >18hrs. Two injuries were missed. All injuries up to Grade IV had simple repair. Two of them had T-tube duodenostomy. None had pyloric exclusion. Complex repairs wer e required for 3/23 patients. Five patients died, as a result of associated insults. One delayed repair developed duodenal fistula. Intra-abdominal abscess, septicaemia and wound dehiscence were seen in two patients each. Duodenum-related mortality was zero. Adverse prognostic factors towards morbidity were injury severity >GIII and injury-operation lag >18hrs. The mortality was related to associated injuries. Primary repair is sufficient for most non-resectional duodenal injuries

Colonic injuries: is primary repair a safe option?

This study was conducted at Mayo Hospital, Lahore from April 2004 to May 2005 to compare the results of primary repair and exteriorization in cases of large gut injuries. 80 patients, presenting in emergency between Jan. 2004 and December 2005, were selected out of which 63 were males and 17 were females. Colonic injuries were divided into five categories and were dealt accordingly. All colonic injuries presenting to emergency in study period except. Injuries requiring ileocolic anastomosis, repair and proximal fecal diversion and distal colonic injuries requiring Hartmann's procedure

Management of acute pancreatitis: an experience at Mayo hospital, Lahore

This is a retrospective as well as prospective study of 46 patients with acute pancreaitis who were managed in North Surgical Unit of Mayo Hospital, Lahore. This study was carried out with special emphasis on need of surgical treatment and its outcome. No age group or sex was found immune to this disease. It was more common in 3rd to 4th decade of life and female sex. The commonest etiology is gall stones [54%] followed by alcohol [8%] and idiopathic [15%]. Pain epigastrium is a constant symptom. Judicious use of serum amylase urinary amylase and ultrasonography can help in early diagnosis of the acute pancreatitis. Complications are best diagnosed on CT scan. Majority of patients were treated successfully by conservative measures [44%] but developed complications which carried high morbidity and mortality. Surgical treatment of associated gall stones has prevented recurrent attacks of acute pancreatitis. Hence cholecystectomy for associated gall stones is recommended during same admission for mild to moderate pancretitis after resolution of symptoms

Balanites herb potential remedy for HIV/AIDS and other ailments

The herbal medicines are used as alternative remedies worldwide for different ailments from ancient times. In these days herbal formulations are successfully used in the world against different diseases. It is a need to introduce herbal remedies to the health professionals that have a promising effect on the recent ailments, like HIV/AIDS. Balanites herb [Balanites aegyptica] is used as complimentary therapies in medicine for different diseases in African sub-continent and other countries. Recently its therapeutic use for HIV/AIDS has been investigated and found to be very promising

Extremity vascular trauma-the continuing challenge

A retrospective study of 36 consecutive patients with extremity vascular trauma managed by the South Surgical Ward trauma team between February 1998 to January 2000. All our patients were men with a mean age of 27 years. The commonest clinical presentation.was with haemorrhage [75%] or ischemia [58.4%]. The mode of injury was gunshot wounds [75%], blunt trauma [20%] and iatrogenic injuries [5%]. The most commonly injured arteries were the superficial femoral [27.5%], the popliteal [24%] and the brachial [24%]. The techniques utilized for.repair of the arterial injuries were autogenous reverse vein grafting [51.7%], end-to-end anastomosis [27.6%].and lateral repair [3.4%]. 17.2% of the arterial injuries were ligated. 43% of the venous injuries underwent lateral venorrhaphy while 57% were ligated. Tri-compartment leg fasciotomies were carried out in 14 patients The commonest complication was vein graft thrombosis [16.7%]. Our amputation rate and mortality were both at 6.9%. Early transport of the patient to a good surgical facility, good surgical judgement and the liberal use of. vein grafts improves the outcome in vascular injuries of the extremities

Fulminant hepatic failure in multan: five years experience

Four hundred sixteen patients of fulminant hepatic failure [FHF] with a prevalence of 31.39% out of AVH patients were studied, who were admitted in Medical Unit II, Nishtar Hospital, Multan during January, 1987 to December, 1991. There were 323 male [77.64%] and 93 [22.36%] female patients. A progressive rise in number of FHF patients were noted during this period. Mean age was 40.31 +/- 16.84 years, male pts. Higher than female patients [42.33 +/- 17.18 and 35.35 +/- 15.51 years respectively]. In FHF patients hospital stay was shorter [6.18 +/- 6.06 V 7.95 +/- 1.65 days], disease was more acute [16.71 +/- 13.05 V 23.45 +/- 14.54 days], temperature higher [99.02 +/- 1.52 V 98.63 +/- 1.15 F], vomiting less frequent [12.73% V 17.82%], HbsAg positive rate higher [76.36% V 69.31%], serum bilirubin higher [9.67 +/- 5.87 V 5.7 +/- 4.83mg/dl], SALT higher [439.16 +/- 377.91 V 192.55 +/- 172.66 u/l], prothrombin time more prolonged [26.2 +/- 11.43 V 21.03 +/- 7.34sec.] and serum potassium lower [3.73 +/- 0.75 V 4.05 +/- 0.57 mmol/l] than in Non-FHF patients. Complications like ascites, hepatorenal syndrome and hypoprothrombinemia were more common in FHF [P<0.001]. Extremes of age [female<30years, P<0.001; male>60 years, P<0.01], short hospital stay [P<0.001] acute illness [P<0.001], higher temperature [P<0.001], serum bilirubin >10mg/dl [P<0.001], SALT>400u/l [P<0.01 in male, P<0.001 in female], were associated more frequently with FHF patients than Non-FHF patients. Overall mortality rate in FHF patients was very high [in total 61.3 V 4.5%, in male 53.5% V 6.9%, in female 88.2% V zero] as compared to Non-FHF patients. In male patients older age, short hospital stay, acute illness [all with P<0.001], high serum alkaline phosphatase, hypoglycemia, hypokalemia, prolonged prothrombin time and coma grade V [all with P<0.01] were associated with higher mortality and can be considered as poor prognostic factors. While coma grade I in both sexes [P<0.001] was associated with better survival. Such prognostic factors were of no value in female patients

Acute hepatitis B in adults 5-years experience

Total 946 patients were HBs Ag positive, out of 1325 patients admitted with Acute Viral Hepatitis, in Medical Unit II, Nishtar Hospital, Multan during Jan. 1987 to Dec. 1991, with an incidence of 71.4%. There were 632 males [66.8%] and 314 females [32.2%] patients. Mean age was 40.73 +/- 15.49 years, with male of slightly older age than female patients [41.29 +/- 15.50 and 38.93 +/- 15.68 years]. Clinical and laboratory features were unable to differentiate between HbsAg positive and negative patients. Serum bilirubin [7.31 +/- 5.71 V 6.77 +/- 5.00] SGPT [285.51 +/- 203.97 V 263.11 +/- 202.55], serum alkaline phosphatase [262.37 +/- 167.06 V 244.39 +/- 149.55] and fasting blood sugar [100.35 +/- 56.09 V 95.09 +/- 35.09] were slightly higher in HbsAg positive as compared to HbsAg negative patients. Various complications noted like bleeding [P<0.0001] ascites [P<0.0001 in males P<0.001 in females], hepatorenal syndrome [P<0.001] in males and deaths [P<0.0001 in females] were significantly more common in HbsAg positive patients. Hepatic encephalopathy was more common in female patients [P<0.01] only. Similarly extremes of ages, high temperature, small liver, very high s. bilirubin and enzymes, hypoglycemia, hypokalemia and prolonged prothrombin time [P<0.01 to <0.0001] were commonly seen in female patients. While high temperature, high serum enzymes hypokalemia and prolonged prothrombin time [P<0.01 to P<0.0001] were more common in male HbsAg positive patients. There were total 19.13% deaths, while in male patients death rate was 22.15% and in female HbsAg positive patients deaths were 13.05%. Excluding patients with hepatic encephalopathy, total death rate was just 3.80% and in male HbsAg positive patients death rate was 6.22%. There was no death in female HbsAg positive non-comatosed patients. Overall death rate was higher in HbsAg negative [30.34%] patients as compared to HBs Ag positive [19.13%] patients

Acute viral hepatitis in pregnancy

Total 91 pregnant women with AVH were admitted in Medical Unit II, Nishtar Hospital, Multan from January 1987 to December 1991. Incidence of female AVH patients was 22.3%, while hospital-based frequency was1: 3540. Mean age was 27.5 +/- 5.01 in pregnant women in contrast to 43.07 +/- 15.43 years in non-pregnant females. Younger age, short hospital stay brief illness, high temperature, high serum bilirubin, high serum ALT, hypoglycemia, hypokalemia [all with P<0.0001], high serum phosphatase [P<0.001], and small liver [P<0.01], were significantly more requent in pregnant women than in non-pregnant women. Bleeding from GIT [P<0.001] and ascites [P<0.001] were significantly more common in non-pregnant patients. While higher death rate, prolonged prothrombin time and hepatic encephalopathy [all with P<0.0001] were more frequently noted in pregnant AVH patients. The death rate in pregnant AVH patients was 58.24% in contrast to 9.15% in non-pregnant AVH patients. Out of pregnant AVH patients pregnancy was associated with 68% death rate and abortion / delivery was associated with 32% death rate. Poor prognosis was associated with short hospital stay [P<0.01], small liver [P<0.02], HBsAg positive [P<0.02], high serum alkaline phosphatase [P<0.001], pregnant AVH patients

Solitary cold nodule of the thyroid gland

Cold Solitary Nodule of the thyroid was found in 25% patients who had thyroidectomy over a period of three years. Goiter was the presenting symptom and solitary nodule was palpable in all the patients. Diagnosis of cold nodule was confirmed on scintigraphy. Unilateral lobectomy was the surgical procedure performed. The incidence of complications was very low. There was no the mortality in this series. Histopathologically colloid nodule was found in the majority of cases followed by adenoma, thyroid cyst, malignancy, tuberculosis, Hashimoto's Thydroiditis and pyogenic thyroiditis in descending order. The incidence of malignancy was 6.6% in this series

Pseudo-Hypo-Parathyroidism [PHP] and Albright's Hereditary Osteodystrophy[AHO], review and two case reports

Pseudo-hypo-parathyroidism and Albright's hereditary osteodystrophy are rare but important diseases as they represent the only human disease states in which G protein function is disrupted. Decreased function of Gs alpha of adenylate cyclase results in receptor resistance to not only to PTH but to some other hormones as well. Case reports of two young females are reported. One had PHP-Ia along with a rare manifestation of the oligomenorrhea; while the other has PPHP with spinal cord compression, again a rare complication

Neonatal mortality in Pakistan-a hospital based study

Various factors leading to neonatal deaths were studied in 150 cases. Poor socio-economic status, short birth interval, lack of antenatal care, home deliveries by TBAs, various customs regarding the feeding of neonates and treatment of sick babies by non-qualified persons and late referral to the hospital, were the major contributing factors. Septicemia was the most common cause of neonatal death and was observed in 37.3% of cases. Tetanus neonatorum was observed in 8.0% of cases. Other causes were respiratory tract infection 26.7%, GIT infection 33.3%, CNS infection 8.7%, umbilical sepsis 5.6%, birth trauma 5.3% and congenital mal-formations 1.3%. The total neonates admitted were 496 in the period of study. Septicemia was observed in 36.9%, tetanus 7.7%, respiratory tract infection 8.5%, GIT infection 16.5%, CNS infection 2.6%, Umbilical sepsis 5.8%, birth trauma 2.8%, and congenital malformation 1.2% of total admission

Cardiovascular anomalies in conjoined twins

Cardiovascular anomalies have been studied in two cases of conjoined twins. In case I, there was a single fused heart with 3 ventricles and 4 auricles. In case II, there were two ventricles and two auricles of which one was larger than the other. Both cases had separate arches of aorta for each of the pair. In both, persistance of sinus venosus was a feature. The truncus arteriosus was not differentiated in one of the pair, in case I. Two cases of conjoined female twins were received from the Mosul Obstetric Hospital. During labour, the head of one of the pair in Case I and lower abdomen with both legs in one of the pair in case II were severed to save the mothers. Both specimens were dissected to study the vital viscera and their anomalies. A variety of abnormal features were observed and the following is the account of such anomalies in the cardiovascular system. The other variations are being described in a separate communication

Anomalies of the alimentary canal in conjoined twins

Two cases of conjoined female [Siamese] twins are being reported with special reference to the anomalies of the alimentary system. This is for the first time that conjoined twins have been reported from Mosul area. In case I there was one liver, two gall bladders, two stomachs but a common duodenum. There was no pancreas. The duodenum continued as small intestine which divided into two canals, and joined separately with the large intestine of each fetus. In case II pharynx of each fetus fused below the chin to form a single larynx and oesophagus. The larynx continued as a single trachea which, after a short distance, bifurcated to go to two pairs of lungs. The oesophagus was traced to the abdominal cavity where it entered a common stomach which in turn continued as a duodenum and small intestine. The latter bifurcated to join the colon of each fetus separately. Gall bladder and pancreas were absent in case II but the stomach showed three diverticula on its posterior aspect