Background: Median nerve compression in hand at the level of transverse ligament leads to numbness and pain in the hands, which results in discomfort in daily routine work has a psychological impact. The objective of the present study was to evaluate the modified mini-incision at the transverse crease in carpal tunnel syndrome.
Methodology: A prospective descriptive study was conducted at Neurospinal & cancer care Institute, Karachi, from January 2012 – February 2020. Patients who were diagnosed with clinical symptoms, positive Phalen and Tinel test and confirmed with EMG finding of carpal tunnel syndrome were included in the study. Patients were operated through modified mini-incision at the transverse crease. The outcome was recorded in the form of pain relief, healing time with restoration of daily life activity and scar adhesion on follow-up.
Results: A total of 97 patients were included. The male to female ratio was 1:7.8. The mean age was 40 ± 19.5 years. The right hand was 72.2%, the left hand was 13.4%, and the bilateral was 14.4%. VAS score improved 2 grades in 96%, and pinch grip improved in 98% of patients in one month. Only 2% of patients had stiffness after surgery
Conclusion: Minimal incision carpal tunnel release has shown positive outcome in median nerve compression, having limited skin incision, safe, feasible and minimizing the scar assist help in early return to work.
Objective: The objective of this present study was to assess the accuracy, result, and safety measures of stereotactic biopsy. The study was conducted at the Neurospinal & Cancer Care Institute Karachi.
Material and Methods: After the approval from the ethical hospital committee, the study was conducted on 34 patients, in which 9 (26.4%) were females, and 25 (73.5%) were males. 34 consecutive patients with biopsy inclusion deep seated lesion, mid line pathology, eloquent area and operated surgery, previous radiation treatment were excluded, and after that, the biopsy report based surgery or radiotherapy treatment was decided.
Result: The biopsy underwent histopathological diagnosis proving Astrocytoma in 7 (20.5%) patients out of which four were in the Eloquent area, tuberculosis diagnosed in 5 (14.7%) patient, Oligodendroglioma diagnosed in 3 (8.8%) patients, metastasis in 5 (14.7%), Abscess in 4 (11.7%) patient which was aspirated to maximum and sent for culture, Malignant tumor (grade 3 & 4) 5 (14.7%), Lymphoma in 2 (5.8%) patient both were given radiation therapy Tumor necrosis 1 (2.9%) case, and No tissue obtained in 2 (5.8%) which was repeated later. No major complication or side effects were observed in the patient.
Conclusion: Stereotactic Framed biopsy is safe and accurate and can be used in deep seated lesions with high success rate, minimal complication and decrease surgical morbidity for patients, and it is comparable to updated methods
Objective: To assess the outcomes of the transcranial approach in traumatic cerebrospinal fluid rhinorrhea. Study Design: Descriptive study. Setting: J.P.M.C, Karachi. Period: 15-1-2017 to 17-7- 2019. Material & Method: Total of 57 patient were included. Including criteria were patient with a history of trauma, fall, assault, and delayed onset, however, patients presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhea, brain abscess, brain space-occupying lesion, skull base surgery operated elsewhere were excluded. fasia lata, Pericranial flaps were used for the surgical repair. Data were analyzed on SPSS version 22.0. Result: Patients gone through the surgical approach having intradural repair in all patients, 25 (43.85%) patients with fasia lata graft while pericranium in 32 (56.1%) and the defect was filled with small bone pieces. In 38(66.6%) unilateral sub frontal approach was done while in 19 patients (33.3 %%) bicoronal craniotomy was carried out. All patient had dura defected, 37 patients (64.9%) had a fractured cribriform plate, 9 (15%) patient had fovea ethmoidal fracture. 30(52.63%) had right side leak, 20 had left side leak (35%), 7(12.28%) had bilateral from both nasals leakage. No reoperation was done. 93% procedure showed successfully. Conclusions: This method is effective with the low rate of morbidity in patients, it can be preferred for traumatic cerebrospinal fluid (CSF) leaks with the injuries associated with the brain, recurrent leak cases with a success rate of > 93%
Background: Magnetic Resonance Spectroscopy (MRS) combined Magnetic Resonance Spectroscopic Imaging (MRSI) can diagnose brain lesions and help manage several diseases. It has the advantage of differentiating neoplastic brain lesions from non-neoplastic brain lesions based on metabolic changes of the brain. The present study focuses on Magnetic Resonance Spectroscopy (MRS) assessment accuracy in the diagnosis of brain lesions.
Methodology: A prospective, non-probability, consecutive sampling study was conducted at the Neurospinal & Cancer care institute, Karachi-Pakistan, from June 2017 to September 2020. A total of 161 patients with brain space-occupying lesions shown on MRI brain contrast and associated with clinical symptoms of headache, fits, or limb weakness was included in the study. The single voxel method was used for MRS; after contrast. MRI was used to localize the pathology in the brain, and the voxel was used in the area of heed interest.
Results Spectroscopy interpretation showed that 114(70.8%) patients were diagnosed with a brain tumour, 41 (25.46%) had a non-neoplastic entity, and 6 (3.72%) were reported as non-specified. MR Spectroscopy reported non-neoplastic entities in 41 (25.46%) patients by spectroscopy. among them, 39(95.12%) patients had decreased choline, NAA and creatinine peaks, raised lactate peak 16(39.02%), lipid peaks 20(48.78%), while in 4 (9.75%) patients the peaks were absent.
Conclusion: This study recommends that MR spectroscopy has a high accuracy for the diagnostic purpose of neoplastic and non-neoplastic, which is 91.33% which can affect the course of the treatment plan and it can help to avoid unnecessary delay in management.
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