Pakistan’s Trade Performance vis-à-vis Its Major Trading Partners

In contrast to earlier empirical research that documents the import and export price elasticities at an aggregate level, this article estimates bilateral price and income impacts on Pakistan’s trade performance with its four major trading partners, i.e., USA, UK, Germany, and Japan. Using quarterly data for the period 1982-I–1996-IV and the Three-stage Least Square technique, the study documents the impact of real devaluation, real income, export incentives, and domestic inflation on trade performance with respect to each of the four trading partners.

Pakistan’s Trade Performance vis-à-vis Its Major Trading Partners

In contrast to earlier empirical research that documents the import and export price elasticities at an aggregate level, this article estimates bilateral price and income impacts on Pakistan’s trade performance with its four major trading partners, i.e., USA, UK, Germany, and Japan. Using quarterly data for the period 1982-I-1996-IV and the Three-stage Least Square technique, the study documents the impact of real devaluation, real income, export incentives, and domestic inflation on trade performance with respect to each of the four trading partners

Efficacy of Ventriculoperitoneal Shunt For The Management of Cerebellar Haematomas

Object:  To determine the role of ventriculoperitoneal shunt in the management of cerebellar haemotoma with obstructive hydrocephalus. Result:  A total of 10 cases were included in the study. Six (60%) were male and 4 (40%) were female. Age range was from 35 – 63 years. The clinical presentation was sudden severe headache, vomiting, loss of consciousness. Glasscow coma score was 6/15 to 13/15.. C T Scan brain revealed cerebellar haematoma compressing the fourth ventricle with obstructive hydrocephalus. The range of volume of cerebellar haemotoma was from 20 ml to a maximum of 80 ml. Various management plan were offered, decision was done case to case basis. Three (30%) patients with mean cerebellar haemotoma volume of 30 ml (range 20-40) obstructive hydrocephalus were managed by a ventriculoperitoneal shunt (V.P. Shunt) alone. All three patients had excellent post operative recovery within a period of 2 to 4 weeks. Seven (70%) patients were operated for removal of cerebellar haematoma alongwith external ventricular drain (EVD.), which was removed on 5th – 7th day but in one case V.P. shunt was inserted post operatively. Result were good in 3 cases, excellent in 2 cases, fair in one case due to persistant hydrocephalus and mortality in one case. The patient who died was operated for removal of cerebellar haematoma and external ventricular drain was passed He died due to chest infection post operatively. Thus out of 10 cases V.P. shunt was done in 4 cases

Insular Glioma Esoteric Precinct

Background and Objective:  The complex insular anatomy and its proximity to eloquent areas make this area almost inaccessible for safe surgical resection of Glioma. Aim of our study is to determine outcome assessment after surgical resection. Materials & Methods:  This was a retrospective analysis of 59 patients over a period of 5 years from July 2013 till June 2018. All patients of insular Glioma were included in our study irrespective of age and sex. Degree of surgical resection, Post-operative neurological deficits and complications were assessed. They were followed in the outpatient department at 3, 6 and 12 months. Results:  Total 59 patients were included 38 (64.40%) male and 21 (35.59%) females. 36 (61%) patients had right sided insular Glioma and 23 (38.98%) have left sided. Seizures were main presentation in 46(77.96%) patients. Trans-sylvian route adopted in 34 (57.6%) patients followed by transcortical route. Near total Resection was Possible in 30 (50.84%) patients and partial in 29 (49.15%) patients. Focal neurological deficits the motor weakness & dysphasia were main post-operative complications in 18 (30.5%) patients. Three (5.08%) patients died. In all grade II and grade III Gliomas no increase in size was discovered on MRI Brain at 6 and 12 months. Conclusion:  Maximum safe resection of insular Glioma with acceptable morbidity is possible with improved overall survival and disease free interval

Clinical Presentation and Surgical Outcomes of Chronic Subdural Hematoma

Objective: The aim of this study was to access clinical presentation of chronic subdural hematoma and to evaluate the surgical outcome of evacuation of chronic subdural hematoma after single burrhole craniotomy with a close drainage system under local anesthesia. Material & Methods:  A descriptive study conducted in the Neurosurgery Department of Khairpur Medical College Sindh. 30 patients of chronic subdural hematoma were included. Patients prepared for evacuation of chronic subdural hematoma through single burr hole followed by closed drainage system for two days. Results:  The most common feature was gait disturbance followed by Hemiparesis and headache. Coexisting diseases were hypertension, Diabetes mellitus and Chronic Liver Disease, etc. and causes of CSDH were head injury (trivial trauma) and anticoagulant. Surgical decisions were taken on the bases of clinical presentation and radiological findings of patients. Surgical procedure single burrhole craniotomy followed by irrigation with normal saline and close drainage system for two days. On post-operative follow-up, a recurrence of CSDH occurred in two patients. Conclusion:  Single burrhole craniotomy with close drainage system is a simple and safe procedure under local anesthesia for treatment of chronic subdural hematoma. Keywords:  CSDH (chronic subdural hematoma), GCS (Glasgow coma score), Burrhole craniotomy, Neurosurgery & Subdural drain

Brain Death Islamic Perspective

Western world has well defined criteria for declaring the patient brain dead and discontinuation of life support treatment. However in the Muslim world these methods and practices are seen with skepticism as to their acceptance from Islamic and Sharia point op view, which in fact is incorrect and is due to lack of knowledge and absence of Institutional guidelines on this matter. Islamic law permits the withdrawal of futile treatment, including life support, from brain dead patients allowing death to take its natural course. “Do not resuscitate” is permitted in Islamic law in brain dead patients. Euthenesia is however unacceptable in Islam. Although debate continues about the details of brain death criteria within Islamic scholars, brain death is accepted as true death by the majority of Mulim scholars and there is concensus on discontinuation of life support treatment in brain dead patients

Extensive Surgical Exposures for Enormous Skull Base Meningiomas: A Single Institutional Experience

Background: Huge, sizeable, anterior skull base meningioms are relatively common in tertiary care hospitals. Here, a single institutional experience dealing with such lesions is presented.Material and Methods: A retrospective review of 30 consecutive patients was done, who were treated for a variety of anterior skull base meningioms at Department of Neurosurgery, Lahore General Hospital, Lahore. Management and outcome were noted and analyzed.Results: In this study, thirty skull lesions were identified in 21 female (70%) and 9 male (30%) patients, with a mean age at diagnosis was 39.7 years. These benign lesions commonly presented with headache (n = 19), visual deterioration (n = 9) & seizures (n = 5). Olfactory groove (n = 15) was the most frequent site encountered in this study followed by planum (n = 5), tuberculum sallae (n = 4) and clinoidal area (n = 2). Gross total resection achieved in all patients by fronto-orbital craniotomy (n = 15), while frontal craniotomy alone or with temporal extension performed in other patients (n = 13 + 2). Complications observed more in frontal craniotomy patients, than fronto-orbital craniotomy patients.Conclusions: Majority of the extensive anterior skull meningiomas can be addressed by enormous fronal exposure including supraorbital rim to reduce the intraoperative brain retraction, with wide surgical exposure & great surgical freedom for gross total excision with ease. Recurrence is uncommon after gross total resection

Craniovertebral Junctional Injuries and Management

Objective: Craniocervical junction injuries are less common. They are unique in their presentation and need specialized management. The objective was to determine diagnosis initial management and ultimate surgical procedures performed and efficacy of these procedures.Materials and Methods: A five year study from April 2003 to Oct. 2008 was conducted at department of neurosurgery unit II Lahore general hospital Lahore. A total of fifteen patients were included. All patients with upper cervical trauma with all modes of injuries were included irrespective of their age and sex. All patients were evaluated with routine X-rays cervical spine, anterioposterior, lateral and open mouth views. While dynamic views were advised only in those having osodontoideum. C.T with saggital reconstruction and MRI were performed in all patients to further augment and detect bony and soft tissue details. In all modes of injuries we maintain their airway breathing and circulation.Clinical Presentation: Out of total fifteen patients mostly were young in their twenties and thirtees, only two patients (13.33%) were below twenty and one patient (6.66%) was above fourty years. The main culprit was road traffic accident in most of patients (thirteen patients 80%) followed by fall in two patients (13.33%) and assault in one patient (6.66%). The odontoid fracture with reductable atlantoaxial instability was appeared to the most common problem in five patients (33.33%). In two patients (13.33%) transverse ligament found to be intact. In two other cases (13.33%) atlas fracture was simultaneously found. Osodontoideum detected in two patients (13.33%) while basilar invagination seen in one patient (6.66%). Irreducable atlantoaxial instability was seen in three patients (20%). Out of fifteen patients, three patients (20%) were neurologically intact, while one patient (6.66%) had complete injury. Eleven patients (73%) had partial injury.Surgical Procedures: In order to achieve stability, we performed posterior instrumentation and bony fusion in all nine reducible injury patients (60%). Atlanto axial fusion performed in seven patients (46.66%), while in two patients (13.33%) having concomitant C1 injury occipitocervical fusion was done. Initial transoral decompres-sion, prior to posterior fusion was done in all four (26.66%) non reducible injury patients. Transodontoid screw fixation was done in two patients (13.33%) having intact transverse ligament.Outcome: Overall 07 (46.66%) cases revealed excellent results all recovered without any complication. Four (26.66%) cases had some complication but recovered within 02 weeks and result was labeled as good. Two cases who had neurological deterioration, recovered slowly within 03 months. Recovery was labeled as fair. One patient who suffered neurological deterioration did not recovered and result was labeled as poor.Complications: One patient (6.66%) died after severe chest infection, although severe chest infection observed in three patients (20%). Mild wound infection and wound dehiscence seen in one patient (6.66%) each. These patients managed conservatively successfully. Neurological deterioration observed in three patients (20%), out of them two patients (13.66%) improved with 3 months

Out Come of Surgical Management of Tethered Cord Syndrome

Objective: To determine neurological outcome after surgical management of tethered cord syndrome. Material and Methods: This descriptive study was conducted in the department of Neurosurgery, Lahore General Hospital Lahore. Over a period of Three Years From 2012 to 2014. Study Comprised of Fifty Patients after fulfilling the inclusion and exclusion criteria. Results: The mean age of the patients was 36 ± 10 Years There were 30 (60.0%) male and 20 (40.0%) female patients. There was improvement in neurological status. The distribution of improvement in neurological status, revealed 35 (70.0%) patients had improvement in back pain, 18 (36.0%) improved motor function and 17 (34.0%) improved urinary incontinence. Conclusion: It is concluded from this study that back pain, motor function and urinary incontinence improve postoperatively in the majority of patients. The rate of symptomatic improvement was greatest for back pain, followed by motor, and then urinary improvement. Abbreviations: TCS: Tethered Cord Syndrome. ATCS: Adult Tethered Cord Syndrome