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.
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.
BACKGROUND: The first appendectomy was performed by Claudius Amyand in 1736 when he wasoperating on a boy for hernia and found appendix lying in hernial sac. Reginald Fitz introduced the wordappendicitis in 1886 and before that it was called typhlitis or perityphlitis.Frederick Treves performedthe lstappendicle surgery in England for the new disease ‘appendicitis’ in 1887.OBJECTIVE: To study the accuracy of modified Alvarado scorning system in diagnosis of acuteappendicitis.MATERIAL & METHODS: This descriptive cross sectional study was conducted at DHQ HospitalTimergara Dir lower from January 2015 to July 2015 to find out the accuracy of Alvarado Scoringsystem in the diagnoses of acute appendicitis. A total of 50 patients admitted in surgical ward from OPDand Casualty with suspected appendicitis were included in the study. Patients less than 7 years andpatients with mass right iliac fossa were excluded. Every patient was evaluated with modified Alvaradoscoring system on a standard Proforma. Patients with Alvarado score of > 6 underwent appendectomy.The removed appendices were sent for histopathology to confirm or otherwise the provisional diagnosisof acute appendicitis and hence the accuracy of Alvarado scoring system.RESULTS: Out of 50 patients, 20 were male &30 were female with a male to female ratio of 1:1.5. Themean age of the patients was 19.7 ± 9.6years. The mean Alvarado score was 7.92 ± 1.383. TheHistopathology reports of the specimens of 37 patients were confirmative of acute appendicitis whereasthe rest of the (13 patients) removed appendices were reported normal by histopathalogist. So thesensitivity is 74%.CONCLUSION: Our study shows that Alvarado scoring system is a simple and quick tool in theevaluation and management of suspected cases of acute appendicitis. Its accuracy increases if used inpatients above 14 years of age.KEYWORD: Alvarado scoring system, Appendicitis, Accuracy.
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