Minimal access awake craniotomy for drainage of cerebral abscess in a patient with severe complex cardiac defects in resource-limited country: A case report.

INTRODUCTION AND IMPORTANCE: Brain abscess is an uncommon but potentially fatal infection of the brain parenchyma that can affect 5 % to 18.7 % of people with uncorrected complex congenital heart defects. In management of patients with complex cardiac defects, the main concern is that they are prone to develop perioperative complications. Hence such cases are a real challenge for surgeons and anesthesiologists. In this study we have reported a well-managed awake craniotomy (Awake-Asleep-Awake) for drainage of cerebral abscess in a patient with complex cardiac defect. CASE PRESENTATION: We present a case of a 13-year-old male patient with untreated cyanotic CHD-TOF with complete AV canal defect, who complained of right-side paralysis since 2 weeks; and has been suffering from headache, fever and vomiting for 25 days. Brain CT scan showed a large abscess in the left fronto-temporal lobes. Minimal access awake craniotomy with regional scalp nerve block and sedation was done and about 100-120 cc thick pus was drained. The patient's paralysis improved significantly and neurological deficit ceased on 3rd postoperative day. CLINICAL DISCUSSION: Pediatric population itself is a challenge for anesthesiologists and this manifolds when associated with complex cardiac defects and neurosurgery cases. CONCLUSION: Brain abscess is expected to be more common in patients following uncorrected complex congenital heart disease in developing countries. Physicians must hold a high index of suspicion for early diagnosis and well-management of these patients with multidisciplinary approach. Minimal access awake craniotomy with or without sedation for patients with large brain abscess is a safe surgical approach.

Primary cervical hydatid cyst: A rare case report.

INTRODUCTION AND IMPORTANCE: Hydatid cyst is a zoonotic parasitic disease caused by Echinococcus granulosis. Occurrence in the head and neck is quite uncommon even in endemic areas. The diagnosis of an isolated cystic neck mass is still a challenge due to the presence of similar congenital cystic lesions and benign tumors in the neck. Imaging is useful, but sometimes they cannot identify a definitive diagnosis. The treatment of choice is exclusively surgical excision, combined with chemotherapy. Histopathology confirms the definitive diagnosis. CASE PRESENTATION: We present a case of an 8-year-old boy with no history of surgery or trauma, who complained of an isolated left posterior neck mass since one year. All radiological items lead to suspect a cystic lymphangioma. Excisional biopsy under general anesthesia was done. The cystic mass was totally resected and the diagnosis was further confirmed by histopathology. CLINICAL DISCUSSION: Cervical hydatid cyst is mostly a misdiagnosed condition, majority of hydatid cyst cases are asymptomatic and vary on the basis of their locations. The differential diagnosis includes cystic lymphangioma, branchial cleft cyst, bronchogenic, thoracic duct, esophageal duplication cysts, pseudocysts and benign tumors. CONCLUSION: Isolated cervical hydatid cyst is rarely reported yet, it must be considered in any cases of cystic cervical mass, particularly in endemic areas. Imaging modalities are sensitive in diagnosing cystic lesions, yet sometimes they cannot identify the exact etiology of the lesion. Furthermore, Prevention of hydatid disease is more favorable than surgical excision.

Sclerotherapy for the management of venous malformations: Experience from a single institution in Afghanistan.

Sclerotherapy is a convenient modality for the treatment of venous malformation. Ethanol as a sclerosing agent is easily available and cheap. Sclerotherapy for venous malformations has both functional as well as aesthetic outcome.

Successfully separated conjoined twins at French Medical Institute for Mothers and Children Kabul Afghanistan.

Conjoined twins are a rare malformation and few cases have been reported in the literature. There are different types of conjoined twins and the most common type is the thoracopagus. Prognosis is related to the type of conjoined twins and the organs they share. We are reporting an Omphalopagus, in which there was sharing of the liver, sternum, and abdominal wall. The complications in this kind of cases are Bleeding, Bile leakage, and infection.

Surgical outcomes and socio-demographic pattern of hypospadias patients treated in a tertiary care center in Kabul, Afghanistan.

INTRODUCTION: Hypospadias is a congenital anomaly of male external genitalia and is the second most common congenital anomaly of male newborns after cryptorchidism. Although its prevalence in Afghanistan is unknown, anecdotal evidence shows that hypospadias is an important clinical and psychosocial problem in Afghanistan. There is no data available regarding the socio-demographic pattern of the disease and age at the time of surgery in Afghanistan context. OBJECTIVE: The aims of this study were to identify socio-demographic pattern of hypospadias among patients and to determine surgical outcomes of hypospadias patients operated in a tertiary care center in Kabul. METHODS: A descriptive case series design and non-probability consecutive sampling were used. Study population was 86 patients undergone urethroplasty during January 2018 to September 2019. A structured questionnaire was used to assess the dependent and independent variables. Follow up notes of patients' medical record files were reviewed to assess post-operative condition of the patients along with presence of any post-operative complications. RESULTS: The mean age at the time of repair was 6.2 years. Family history was positive in 16.3% and consanguinity in almost 56% of the patients. The most common type of hypospadias was distal shaft type (30.2%), penile chordae was present in 25.6% and pinhole meatus in 32.6% of the cases. The most common associated anomaly was cryptorchidism (9.3%) followed by inguinal hernia (2.3%). Peno-scrotal transposition was the most common sexual differentiation disorder (11.6%), however majority didn't have any disorder of sexual differentiation (83.7%) The most common complication was urethral stricture and meatal stenosis (9.3% each) followed by urethra-cutaneous fistula (7%) in this study, although remarkable majority (74.4%) was complication free. Urethral advancement procedure was more practiced in distal type (94.7%) and 2-stage repair for the proximal type (70%) of hypospadias. CONCLUSION: Findings showed that the age at repair for hypospadias in our center is much higher than the recommended age. Different than the literature, the most common complication was meatal stenosis. Majority of patients were result of consanguineous marriages. Procedure choice was different according to the type of hypospadias and preference of the surgeon.