The present study was performed in patients with EDH in order to define the clinical outcome of EDH evacuated through a single burr hole. █ MATERIAl and METhODSThis descriptive study was performed in the Department of Neurosurgery, Ayub Teaching Hospital (ATH), Abbottabad, Pakistan from 8 th October to 12 th October 2005, during the earthquake. ATH is 1000-bed hospital with a well-established unit and serving about 7 million population. We had two qualified neurosurgeons at the time of the earthquake. On the first day of the earthquake 18 patients were operated for EDH, followed by 13 patients on the second day and 6 patients on the third day. █ INTRODUCTIONHead injury is a major health problem. It is reported that 1% of all deaths and 15% of deaths occurring between 15 and 24 years are secondary to head injury (12,16). The major cause of preventable deaths in head injuries is a delay in diagnosis and treatment of intracranial hematomas (16,20).Deterioration of conscious level and developing focal neurological signs signify a rapidly growing extradural hematoma (EDH) (16). In these cases, an urgent computed tomography (CT) scan will reveal biconvex hyperdense EDH causing effacement of the ventricle and midline shift. Craniotomy/craniectomy and evacuation of the hematoma is the treatment of choise to save the life of these patients (16). AIM:To observe the outcome of burr hole evacuation of extradural hematoma (EDH) in mass head injury. MATERIAl and METhODS:This study included patients of any age who sustained head injury in the earthquake of October 8, 2005, were diagnosed as EDH on computed tomography (CT) scan and were admitted in the neurosurgery ward over a period of 3 days. All patients were followed by serial CT scans and neurological assessments. RESUlTS:A total of 36 patients were included in this study. There were 25 male and 11 female patients and the age range was from 5 years to 50 years. All cases were the victim of the earthquake. All patients underwent surgery for evacuation of EDH through a single burr hole. One patient required craniotomy for EDH due to neurological deterioration on the second postoperative day, and 1 patient died. CONClUSION:As EDH is potentially fatal lesion, evacuation of EDH through a single burr hole has good outcome with less chances of recurrence and complications in mass head injured patients as seen with earthquakes.
Objectives: Bilateral tympanic membrane perforation closure is usually performed by otosurgeons in two sittings. However, in this study, transperforation myringoplasty was performed alongside contralateral tympanoplasty in a single sitting. The effectiveness of transperforation myringoplasty procedure and the benefits of single sitting bilateral surgery were evaluated.Methods: A prospective study of 50 selected patients with mucosal-type bilateral chronic otitis media was conducted. All patients underwent transperforation myringoplasty on the side that met the inclusion criteria and tympanoplasty on the contralateral side. Graft uptake and hearing improvement were evaluated after 6 months.Results: At the 6-month follow up, the graft uptake rate was 82 per cent, the hearing gain was 11.5 dB and the air-bone gap gain was 11.6 dB.Conclusion: This procedure offers perforation closure in a single sitting to patients with bilateral chronic otitis media who meet the inclusion criteria.
<p class="abstract"><strong>Background:</strong> Chronic otitis media (COM) implies a permanent abnormality in the tympanic membrane characterized by irreversible changes in the mucosa of middle ear and mastoid cavity. Diseases of the nose and para nasal sinuses have been implicated in the development of the disease. Hence the present study aims at identifying the risk factors involved and the importance of its management in treating the disease. The objective was to study the correlation between COM and Sino nasal and nasopharyngeal pathology.</p><p class="abstract"><strong>Methods:</strong> A total of 100 patients with chronic otitis media were included in the study. A Detailed history and clinical examination was done using a pre-prepared questionnaire. Diagnostic nasal endoscopy was done in all cases to assess the nasal cavity and nasopharynx along with bacteriological study of ear and corresponding side of nasopharynx. </p><p class="abstract"><strong>Results:</strong> Symptomatic, clinical and diagnostic profile proved the evidence of sinonasal pathology in 82% of patients with COM. The comparative study of the microbiological flora of both ear and corresponding side of nasopharynx showed 77 % of ear swabs and 91% of nasopharyngeal swabs to be sterile. The results were statistically significant with a p value of 0.003.</p><p class="abstract"><strong>Conclusions:</strong> This study emphasises on a thorough evaluation of nose and paranasal sinuses in all cases of COM for comprehensive management of the disease. Its detection and management is equally important as the ear surgery per se.</p>
Background/Objectives: Chronic subdural hematoma commonly reported in neurosurgical practices. Variations are reported in neurosurgical practices regarding the treatment of chronic subdural hematoma (SDH). This study determined the outcomes of SDH with Drain and without Drain in terms of recurrence and effectiveness. Material and Methods: A randomized control trial was conducted in the Department of Neurosurgery Ayub Teaching Hospital Abbottabad. Group-A patients were subjected to drainage of chronic subdural hematoma without drain and Group-B patients were subjected to drainage with drain. All patients were followed up to one month for recurrence of subdural hematoma like on CT-scan. Results: Overall, the recurrence of chronic subdural hematoma in both groups was seen in 16.7% of patients and the procedures were effective in 83.3% of patients. In Group A, 79.6% of patients were successfully treated through burr hole with irrigation, while 20.4% of patients had recurrent chronic SDH. In Group B, only 13% of patients had a recurrence, while 87% of patients were successfully treated with burr with the closed continuous drainage system. An insignificant difference (p-value: 0.302) existed between groups for both types of procedures. Conclusion: The patients who were treated with burr hole and irrigation of the subdural space with normal saline had high recurrence incidence than those with burr hole with closed continuous drainage system.
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