Neurosurgeons and electrocautery

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Role of surgery in cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis (CVST) usually is taken care of by medical management or neuro-interventional vascular techniques. Some cases of CVST may take a malignant course if the intracranial pressure increases excessively. This increase in pressure is because of oedema in brain tissue due to impediment in venous return and/or intracerebral haemorrhage. Neurosurgical experience has shown remarkable recovery in these moribund patients if appropriate surgical intervention is done within reasonable time. Emergent decompressive craniotomy or other neurosurgical interventions are the only appropriate treatment in these malignant forms of CVST to prevent mortality and severe morbidity

B-cell lymphoma of the brainstem with central neurogenic hyperventilation

Non-Hodgkin\u27s lymphoma of the brainstem is a rare entity. Central Neurogenic Hyperventilation (CNH), an associated manifestation of this disease, is an even rarer event. We report a case of an immunocompetent individual who presented to us with tachypnea and facial nerve palsy. Neuroimaging showed a Cerebellopontine angle tumour which on histopathology showed feature consistent with a Non-Hodgkin\u27s B-Cell Lymphoma. The patient went on to develop severe respiratory alkalosis with findings consistent with CNH. Chemotherapy with Methotrexate was started and high dose Dexamethasone was added to the regimen a month later. Radiologically, the tumour size decreased by 50% but the patient\u27s clinical condition deteriorated. He eventually expired due to cardiopulmonary arrest. Some common clinical presentations of this disease and various diagnostic modalities and treatment options available to such patients are discussed

Prevalence of perceived heavy postpartum hemorrhage and its associated factors among married mothers in squatter settlements of Karachi

Objectives; To estimate the prevalence of postpartum hemorrhage (PPH) and identify its associated factors among the married women of 15-49 years, residingin the Karachi, Pakistan. Methodology: This cross-sectional survey was carried out in five squatter settlements of Karachi during 2000-2001. Information was collected regarding age, gravida, education, antenatal, natal and postnatal care, with perceived puerperal morbidities from 525 mothers, who were in their 42nd to 56th post delivery day. Univariate and multivariate analyses were computed using multiple logistic regression method. Results: The estimated prevalence for perceived PPH was 7.24%. Three hundred and ninety six (75.4 %) women received ante-natal care with 273 (52%) consulting skilled health professionals and 268 (51%) gave birth to their babies at a health facility. Eighty nine (16.9%) women who delivered at a health facility were advised for the post partum routine care and only 127 (24.2%) women followed the instructions. Two hundred and seventy eight (53%) mothers reported at least one perceived puerperal morbidity and among them 38 (7.24%) women perceived PPH. On multivariate analysis, the factors associated with PPH were older age (aOR=1.10, 95% CI:1.04-1.1), longer duration of labor (aOR=1.08,95% CI :1.02-1.2) and restricted fluid intake (aOR=2.1, 95% CI :1.05-4.0).Conclusion: Older age group, longer duration of labor and restricted fluid in take were found to be the common factors associated with PPH. Women need to be educated regarding family planning program, safe and timely delivery by skilled medical personnel and intake of extra fluid during post partum period

Associations of controlling behavior, physical and sexual violence with health symptoms

Controlling behavior is often manifested as monitoring, coercing or threatening the partner. Globally, it has been experienced by the women (in range of 5.2% to 56.6%) and often results in their physical and mental ill health. To the best of our knowledge there is no published research on controlling behaviors. Therefore, a cross sectional study was conducted to measure the magnitude of the controlling behaviors and its association to some physical stress symptoms of women. The study was conducted in urban settings of Karachi, Pakistan, using simple random sampling technique. The data was collected by trained midwifes from the 759 married women of aged 25 to 60 years. The data was entered in Epi Info version 6 and analyzed on SPSS version 11. The study showed that the prevalence of pastyear physical and sexual violence is 68% while controlling behavior was experienced by 51.6% of the women. Among the different types of controlling behavior, refusal of the husband to give money for the household chores was the most common. The results of the bi-variate analysis showed that there was a significant association between women who had past-year physical or sexual violence experience with shoulder and neck pain, feeling worthlessness and suicidal thoughts. This study identified that most women in middle and lower socioeconomic groups are exposed to physical, sexual and psychological violence. Furthermore, we found that in addition to exposure to violence, women face controlling behaviors from their partner which restrict their decisions making toward their health

Endoscopic laser-ablation for the treatment of orthotopic and ectopic ureteroceles in dogs: 13 cases (2008-2017).

BACKGROUND: Ureteroceles are a rare condition in dogs in which conventional treatments can result in substantial morbidity. Cystoscopic and fluoroscopic-guided laser ablation (CLA) of ureteroceles can successfully relieve obstruction. OBJECTIVES: To describe the technique and outcomes of attempting CLA for treatment of ureteroceles in dogs. ANIMALS: Thirteen client-owned dogs that underwent CLA for treatment of ureteroceles. METHODS: Retrospective multicentered study. Medical records were reviewed in all dogs that underwent CLA for ureterocele(s). A laser was used to extend the opening of the ureteral orifice (UO) unless surgical conversion was necessary. Data collected included signalment, clinicopathologic data, imaging, procedural findings, complications, and short- and long-term outcome. RESULTS: Thirteen dogs with 13 ureteroceles associated with 14 UOs resulting in ureteral obstruction were included. One ureterocele extended bilaterally. Treatment was initiated via retrograde cystoscopy (7 females), percutaneous perineal urethrocystoscopy (4 males), or percutaneous antegrade cystoscopy (2 males). Surgical conversion was necessary in 2 males. Ten of 14 (71%) UOs associated with the ureteroceles were ectopic. Thirteen of 14 had stenotic or imperforate UOs. No postoperative complications were noted. Preoperative incontinence or pollakiuria was present in 9 of 13 and 3 of 13 dogs and resolved in 8 of 9 and 3 of 3 dogs, respectively. Follow-up imaging showed resolution of all ureteroceles and improved ureteral/renal pelvic dilatation. Median follow-up time was 27 months (range, 3-96 months). CONCLUSIONS AND CLINICAL IMPORTANCE: Cystoscopic-guided laser ablation was effective for the treatment of ureteroceles(s) in 11 of 13 dogs