Pseudoaneurysms of the superficial temporal artery are an uncommon vascular lesion of the external carotid system and most often the result of blunt head trauma. The frequency of pseudoaneurysms of the superficial temporal artery developing after craniotomy is exceedingly low and only a few cases have been reported. We present a case of pseudoaneurysm of this type in a 45-year-old male who underwent craniotomy for excision of meningioma. One month postoperatively, the craniotomy flap exhibited an enormous diffuse pulsate swelling. The suspected diagnosis of pseudoaneurysm arising from superficial temporal artery was confirmed on angiography. Surgical excision was done and no recurrences of the tumor or aneurysm were noted on subsequent follow up.
Aims:The aim of the study was to compare the efficacy of phenytoin and levetiracetam for seizure prophylaxis in patients with severe traumatic brain injury (TBI).Subjects and Methods:A randomized controlled trial was conducted over a period of 6 months, at a tertiary health care center in Karachi, Pakistan. Patients with TBI were divided into two groups. Patients in Group A were given phenytoin, whereas Group B patients received levetiracetam. The first dose of the drugs was given within 24 h of injury and continued for 7 days. Data were collected using a predesigned pro forma. All the patients who were in a state of persistent coma, had altered mental status, or had clinical signs of seizures underwent a 1-h electroencephalographic (EEG) recording to observe the seizures, the first EEG was done on the 1st day posttrauma and a second one was done on day 7 of drug use, both the EEGs were compared for changes. We also analyzed the patients according to their duration of antiepileptic drug therapy, length of hospital stay, and complications during therapy.Results:One hundred and forty (117 males and 23 females) patients who presented with TBI having a mean age of 29.48 ± 16.24 years were part of the study. The most prevalent cause of brain injury was road traffic accidents in 72.85% patients. There was no significant relationship between the antiepileptic drug used with the initial EEG (P = 0.313) and seizure activity (P = 0.502). However, a significant correlation of the antiepileptic drug used was found with EEG (P = 0.002) and seizure activity (P = 0.014) on follow-up. Patients who took levetiracetam had decreased the incidence of abnormal EEG and seizure activity on follow-up. There was not any correlation between GCS both initially (P = 0.845) and on follow-up (P = 0.104) with the antiepileptic drug used.Conclusion:The incidence of abnormal EEGs and seizure activity in patients with TBI is the same for both levetiracetam and phenytoin for the initial 7 days post-TBI; however, the incidence of seizures is lower for patients who used levetiracetam on the subsequent follow-up.
Introduction: Postoperative inguinal pain is one of the most significantcomplications following inguinal hernia repair. Routine ilioinguinal nerve excision has beenproposed as a means to avoid this complication. Objectives: To compare the postoperative painafter preservation and elective division of ilioinguinal nerve during inguinal hernioplasty.Methods: This was a Randomized Controlled Trial conducted at the department of generalsurgery at KVSS Site Hospital for a period of 6 months from Jun 2011 to Nov 2011. 84 patientswho underwent mesh hernioplasty for unilateral inguinal hernia, were randomly assigned into twogroups (A and B), 42 in each group. Ilioinguinal nerve was preserved in group A patients, whereaselective division was carried out in patients of group B. Mean postoperative pain scores wererecorded using numerical analogue scale on first and third postoperative day, and one monthafter surgery. The SPSS version 16 was applied to the data. Results: Mean±SD age was38.46±14.36 years. Seventy four (88.1%) patients were male whereas ten (11.9%) were female,with male to female ratio being 7:1. Using the numerical analogue scale to detect pain severity onpostsurgical day 1 and 3, mean scores±SD in the nerve-preservation and nerve-excision groupswere 2.88±0.43 versus 2.04±0.39, and 1.95±0.39 versus 1.43±0.44, respectively (p<0.05). At 1month after surgery, these scores were 1.73±0.62 versus 0.98±0.25, respectively (p<0.05).Conclusions: Postoperative pain after inguinal hernioplasty significantly decreases in electivedivision of ilioinguinal nerve as compared to nerve preservation.
Objective: To determine the differences in post-operative pain experienced by patients undergoing emergency versus elective craniotomies. Study Design: Cross-sectional study. Setting: General Hospital, Karachi. Period: January 2017 to December 2019. Material & Methods: We included all the patients who underwent craniotomy at our institute and we measured their pain assessment levels. Further we excluded patients whose data was missing any variable of interest or whose measurements could not be taken at the time they were admitted to the hospital. All the data was analyzed using SPSS statistical software. Results: We included 152 patients in our study population. The mean age of the patients in our study group was 50 years of age and there were 81 males and 71 females included in our study. The combined pain scores for patients undergoing elective and emergency procedures was found to be 5.5 (Standard deviation= 2.6 for day one, 4.8 (Standard deviation= 2.6) for day two and 4.5 (Standard deviation=2.9) for day three post-operation respectively. When analysis was done to compare the differences in the VAS score for patients of the two categories we found no significant difference between the groups for day one having a p value of 0.485, for day two there was no significant difference as well having a p value of 0.957. Conclusion: We did not find any statistical difference in the two groups under study. The postoperative pain experience was similar in patients who underwent elective as compared to emergency craniotomies.
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