Leaking pseudoaneurysm of hepatic artery: A potentially life-threatening complication of a common procedure

We report a case of leaking pseudoaneurysm of right hepatic artery in a 54-year old female after laparoscopic cholecystectomy who presented with massive gastrointestinal haemorrhage and was successfully managed with angiography and coil embolization

Association of chronic viral hepatitis with ABO blood groups and rhesus (Rh) factor

Background: Chronic viral hepatitis includes hepatitis B and hepatitis C and is responsible for causing the deaths of millions of people all across the world each year. Although there are small studies in literature about association between ABO blood groups and chronic viral hepatitis, only few studies found relation between them. The objective of this case control study is to establish a relation between the host factors and these viral infections.Methods: This is a case control study on patients diagnosed with CVHB and CVHC. The study was conducted on 508 patients reported to Nishtar Hospital, Multan and Sheikh Zayd Hospital, Rahim Yar Khan, Pakistan.709 healthy blood donors were selected as a control group from Nishtar Hospital blood bank during December 2016 and December 2017.The results were subjected to SPSS v.20 for analysis using the chi square test. The patients and blood donors were also asked about certain demographic factors like age, sex and blood transfusions.Results: Among CVHB patients,173(100%), the distribution of blood groups was following: Group A, 38 (21.96%), B, 57 (32.94%), AB, 11 (6.35%), O, 67 (38.72%). 158 (91.32%) were Rh positive and 15 (8.67%) Rh negative. In CVHC patients, 335 (100%), the distribution was following: Group A, 69 (20.59%), B, 123 (36.71%), AB, 24 (7.16%), O, 119 (35.52%). 303 (90.44%) were Rh positive while 32 (9.55%) were Rh negative. In healthy blood donors, 167 (23.55%) were group A, 225 (31.73%) group B, 41(5.78%) group AB, 276 (38.92%) group O.632 (89.13%) were Rh positive and 77 (10.86%) Rh negative.Conclusions: There was no significant difference between blood groups(p>0.5) and Rh(p>0.5) with chronic viral hepatitis. However, it was also observed that the infections of HCV increase among (26-45) years old patients while the HBV infections increase with progression of age. Association of chronic viral hepatitis infection with blood group types needs more studies to get more knowledge about this aspect

An institutional review of transarterial embolization in haemorrhagic urological emergencies

OBJECTIVE: To review the effectiveness of therapeutic transarterial embolization in controlling phagic urological emergencies irrespective of the cause of emergencies. METHODS: Thirty-seven vascular angiographies were performed in 32 patients (19 males and 13 females, age range 19-70 years) who were referred with haemorrhagic urological emergencies to Aga Khan University Hospital\u27s angiography suite from July 2005 to June 2010. Embolization was performed with coils, polyvinyl alcohol particles, N-Butyl cyanoacrylate glue and gel foam according to the clinical indication. Data on clinical indication, technique, site and type of bleeding lesions were obtained from a retrospective review of medical records. Success rate, clinical outcome and complications of the procedure were analysed. RESULTS: Indications of procedure included iatrogenic injury (16), Renal mass on clinical examination and imaging (4), haematuria with pseudoaneurysm on examination (3), haematuria with no known cause (3), post traumatic renovascular injury (2) Renal arteriovenous fistulas (2), Carcinoma of prostate (1) and pelvic arteriovenous (AV) fistula (1). Twenty four patients underwent successful endovascular control of bleeding. Eight examinations were negative for active extravasation, two of whom showed haemorrhage in second session and were embolized. Two sessions were needed in two patients at different time intervals. Complication as dislodgement of coil in distal profunda femoris artery was seen in one patient with no significant obstruction to flow. CONCLUSION: Transarterial renal angioembolisation is a safe and effective therapeutic tool for managing haematuria or haemorrhage in urological emergencies. Wherever and whenever indicated it should be the first preferred treatment modality

Diagnostic accuracy of digital mammography in the detection of breast cancer

Introduction Breast cancer has a high prevalence in the community and places very high demands on resources. Digital mammography provides a good quality image with reduced radiation dose and can detect breast carcinoma in its earlier stages, resulting in good prognosis and improved patient survival. Objective To calculate the diagnostic accuracy of digital mammography in the detection of breast cancer, using histopathology as a gold standard in women aged over 30 years, who are undergoing mammography for screening and diagnostic purposes. Materials and methods This was a cross-sectional analytical study, conducted in the department of radiology, for a total duration of 10 months. A total of 122 patients of age above 30 years, referred for digital mammography for the evaluation of different symptoms related to breast diseases, followed by biopsy/surgery and histopathology, were included in the study. Result Our data confirmed that digital mammography is a highly accurate tool for breast cancer detection having a sensitivity of 97%, a specificity of 64.5%, a positive predictive value of 89%, and a negative predictive value of 90.9%, with a diagnostic accuracy of 89.3%. Conclusion Considering our results, we recommend that digital mammography should replace screen-film mammography as a basic tool to detect breast cancer for both screening and diagnostic purpose

Politics of Nawab of Kalabagh Malik Amir Muhammad Khan (1910-1967)

Political ideology of Nawab of Kalabagh Malik Amir Muhammad Khan (1910-67) was based on the perception of a highly educated but conservative feudal. He advocated status quo in almost all the matters including foreign relations. He advised Ayub Khan not to switch over to China because it would antagonise U.S.A. He was not so optimist about the solution of Kashmir issue. His pragmatic approach favoured the peaceful method of negotiation instead of confrontation. General perception portrays him as a typical landlord who was averse to education and freedom of press. Evidences from history reveal that there is a partial truth in it. He liked a responsible press which should not be left unbridled. Bengalis of East Pakistan made the bigger chunk of the total population of Pakistan. He, as a non-Bengali of West Pakistan, was apprehensive of their strength in numbers. Anti-One Unit politicians were secessionists in the eyes of Nawab so were dealt severely. He treated his political rivals according to their strength and ambitions. He was suspicious of Zulfiqar Ali Bhutto because he (Bhutto) was too ambitious to be trusted. He allegedly victimized Chaudhri Zahoor Elahi because Chaudhri had desired to replace him. Mawlana A. Sattar Niazi, Habibullah Paracha and Pir of Makhad Sharif used to challenge his supremacy in his native area so Nawab had to deal them harshly. It can be derived that his political outlook reflected the mindset of a typical feudal lord

Treatment of nonvariceal gastrointestinal hemorrhage by transcatheter embolization

Purpose. To investigate the sensitivity of mesenteric angiography, technical success of hemostasis, clinical success rate, and complications of transcatheter embolization for the treatment of acute nonvariceal gastrointestinal hemorrhage. Material and Methods. A retrospective review of 200 consecutive patients who underwent mesenteric arteriography for acute nonvariceal gastrointestinal hemorrhage between February 2004 and February 2011 was done. Results. Of 200 angiographic studies, 114 correctly revealed the bleeding site with mesenteric angiography. 47 (41%) patients had upper gastrointestinal hemorrhage and 67 (59%) patients had lower gastrointestinal hemorrhage. Out of these 114, in 112 patients (98%) technical success was achieved with immediate cessation of bleeding. 81 patients could be followed for one month. Clinical success was achieved in 72 out of these 81 patients (89%). Seven patients rebled. 2 patients developed bowel ischemia. Four patients underwent surgery for bowel ischemia or rebleeding. Conclusion. The use of therapeutic transcatheter embolization for treatment of acute gastrointestinal hemorrhage is highly successful and relatively safe with 98% technical success and 2.4% postembolization ischemia in our series. In 89% of cases it was definitive without any further intervention

Angioembolisation for the treatment of pseudo-aneurysm of internal maxillary artery

Pseudo-aneurysm of internal maxillary artery, following a road traffic accident, is a rare clinical scenario. The consequence of pseudo-aneurysm may be spontaneous rupture of the arterial wall, which may eventually lead to life-threatening hemorrhage. We report a case of a 20-year male who presented with recurrent epistaxis. CT scan was performed, which revealed a pseudo-aneurysm of the internal maxillary artery; this was successfully treated by angioembolisation. Similar cases of traumatic pseudo-aneurysms have been reported, however, none presented with recurrent epistaxis after management of pan-facial fractures. Key Words: Epistaxis, Pseudo-aneurysm, Angioembolisation, Pan-facial fracture

Ultrasonographic optic nerve sheath diameter measurement for raised intracranial pressure in a Tertiary care centre of a developing country

Background: Intracranial hypertension is not an uncommon life-threatening syndrome, caused by a variety of non-neurological and neurological illnesses, and quick diagnosis, timely treatment of Raised Intracranial Pressure (ICP) is associated with improved outcome. Our aim of study was to determine ultrasonographic measurement of Optic nerve sheath diameter (ONSD) for raised ICP. Method: Prospective case series done in Emergency and Paediatric critical care unit of Aga Khan University Hospital. ONSD measurement in millimetres was done by placing linear probe of ultrasound on eye ball. Result: Forty-eight patients were included in study with mean age of 7.5±5.0 years with 21/48 (43.8%) between 1-8 years and 19/48 (39.6%) \u3e8 years with 32/48 (66.7%) were male. Non-traumatic coma was most common diagnosis 41/48 (85.4%) with infectious cause being most common while Traumatic brain injury constitutes 7/48 (14.6%). Ct scan brain was done in 39/48 (81.3%) while MRI brain in rest of patients. Raised ICP was found in 83.33% (40/48) patients with Ultrasonographic ONSD measurement as compared to CT scan/MRI 14/48 (29.2%). 85% of patients, showed ultrasonographic ONSD measurement suggestive of Raised ICP with GCS ≤12. Mean ONSD with signs of raised ICP in infants 4.64 (±0.48), in 1-10 years 6.44 (±0.65), and in adolescent \u3e10 years 6.28 (±0.62) ONSD respectively with ROC Curve showing Area Under Curve (AUC) 0.814 ( 95% CI, 0.692-0.936). Conclusion: We identified threshold of Ultrasonographic ONSD measurement in infants \u3e4.0 mm, in children 1-10 yrs \u3e4.71 mm, in adolescent \u3e10 yrs \u3e5.43 mm for raised ICP with sensitivity and specificity of 100% and 60-66.7% respectively. 85% of patients showed raised ICP with Ultrasonographic ONSD measurement with GCS ≤12

The descriptive study of anxiety levels among diabetics: insulin users versus non-insulin users

Background: Anxiety is an emotion characterized by an unpleasant state of turmoil often accompanied by nervous behaviours such as pacing back and forth, somatic complaints and rumination. Diabetes is the most metabolically active disease which can influence the psychological state. This study evaluates the anxiety levels among diabetics (Insulin users versus non-insulin users) along with its relation to certain demographic factors like age, sex, education, type of medication and medication compliance.Methods: Hamilton anxiety rating scale (HAM-A) was used to test the anxiety levels in 187 diabetic patients visiting the diabetic clinic and research centre, Nishtar Hospital, Multan and other diabetic clinics in the area. 97 (51.87%) patients of the total sample are males and 90 (48.12%) patients are females.Results: In this study, 170 (91%) had type 2 diabetes while 17 (9%) suffered from Type 1 Diabetes. 66.66% of the patients in the sample were insulin users while 34.34% were non-insulin users. The overall mean anxiety level in insulin users is 24.55 and in non-insulin users is 23.92.Conclusions: Our study showed a high prevalence of anxiety levels in insulin users as compared to non-insulin users. Certain symptoms like anxious mood, tension, fears, depressed mood, cardiovascular and gastrointestinal symptoms appeared with mild anxiety levels while other symptoms like insomnia, somatic symptoms, autonomic symptoms, respiratory and genitourinary symptoms appeared with high severity levels. The presence of risk factors for anxiety among patients of diabetes predicts a causal relationship and deserves attention from clinicians

Image-guided percutaneous radiofrequency ablation for osteoid osteoma: experience from a developing nation

Objective The purpose of this study is to report our experience in using image-guided percutaneous radiofrequency ablation (RFA) for the treatment of osteoid osteoma (OO) and the subsequent duration of pain relief over a period of about six years (May 2013-March 2019; 70 months) at a tertiary-care hospital in a developing nation. Methods A retrospective study was performed at the radiology department of Aga Khan University, Karachi, Pakistan. All patients who had undergone image-guided percutaneous RFA for OO between May 2013-March 2019 were included. All cases had been performed with CT-guidance under general anesthesia, with an additional local anesthesia injection also administered to the patients. A soloist needle had been used for RFA. The primary success rates, complications, symptom-free intervals, and follow-ups were evaluated. Results In total, 15 patients (11 males, 4 females) of a mean age of 13.93 years (range: 5-25 years; median age: 14.5 years) with OO underwent image-guided percutaneous RFA during a period of 70 months. Eleven lesions were located in the femur, three in the tibia, and one in the humerus. The mean nidus size was 8.1 x 5.73 mm [range: (4.9-11.5) x (3.8-9.1) mm]. All patients were successfully treated and experienced resolution of pain in 2.36 months (range: 1-4 months). During the follow-up period (range: 3-40 months; mean: 13.85 months; median: nine months), none of the patients experienced any relapse or persistent symptoms. No major complications were reported. Conclusion Image-guided percutaneous RFA is a minimally invasive and safe treatment option with high efficiency and a high rate of technical success for the treatment of OO. The risk of recurrence is remote with all patients achieving independent recovery