Use of 'trocar site closure device' for frontalis brow suspension

Ptosis correction by Fox Pentagon technique of frontalis brow suspension, using 'trocar site closure device' for placement of banked fascia lata is presented. The use of this device was found to be safe, secure, smooth, and stable. It has a gently tapered cutting upper edge and a blunt front, and is less traumatic as compared to the conventional Wright's fascia needle or the 18 gauge needle which are sharper and could cause an inadvertent and relatively more damage to the eyelids' delicate tissues. The surgery can be performed quickly with this single-use device and it provides a good grasp for holding the fascia lata during the manoeuvres, forming the desired pentagon

Peripheral ulcerative keratitis our challenging experience

A 52 year old male presented with peripheral ulcerative keratitis in the right eye. Patient's history included retinitis pigmentosa, pseu-dophakia [right eye], cataract [left eye], bilateral partial deafness, ischemic heart disease, hypertension, type 1 diabetes mellitus, depression, hyperparathyroidism, hypertriglycemia and renal failure. The patient was on weekly hemodialysis. The peripheral corneal ulceration remained stable until he developed sudden and rapid thinning after eight months of regular follow up and management. Laboratory investigations including immunological studies were negative and we had to rely on treatment based on clinical signs, including the visual acuity, size, depth and staining of the ulcer and perilimbal, episcleral, scleral, corneal and anterior chamber reactions. The patient was treated with medical and conservative approaches and the eye was protected with a plastic shield to avoid injury. Despite our efforts, the patient perforated his eye due to a trivial trauma during sleep. He was managed successfully with cyanoacrylate glue and a bandage contact lens. The anterior chamber reformed after the perforation was sealed and the patient is on a regular follow up with a multidisciplinary approach

Surgical management of missile trauma to thoraco -lumbar spine

To evaluate the optimum treatment for Spinal Missile Injury with respect to missile trajectory, functional outcome, surgical indications, and timing of surgical intervention. Analysis of the patients with spinal missile injury. This study was conducted in the Emergency Department of Assir Central Hospital Abha Kingdom of Saudi Arabia over a period of three years from June 2001 - May 2004. A prospective series of Nineteen Missile trauma patients to the Thoraco-lumbar spine is presented. A total of 20 patients [13 in the surgical group A, 7 in the conservative group B] were monitored for functional recovery. One female patient died preoperatively. Twelve were treated surgically, of whom 9 [75%] had incomplete injuries [Frankel scores B, C, and D],6 [66.66%] showed improvement, 2 [22.22%] showed no change, and 1 [11.11%] worsened[Table3] . In the conservative group, five [71.42%] had incomplete injuries, 3[60%] improved, one [20.0%] remained unchanged and one [20%] worsened. Five patients [including both groups] were with complete injury [Frankel scores A]. Mean postoperative hospital stay was 18 days. The wounds were caused by splinters in 12 [71.4%] and bullets in 7 [28.7%]. Eight patients received more than one shrapnel. Associated injuries were present in eleven patients. The best results were obtained by the patients who received operations because of rapid neurologic deterioration cauda equina compression. If spinal cord is not injured by the trajectory, the best approach is conservative. It was concluded that surgical intervention is essential for spinal gunshot injury patients with instability or rapid neurological deterioration and beneficial for patients with CSF fistula, infections and compressing foreign bodies in the injury site. The initial neurological grade was found to be the best prognostic indicator. Most of the management revolves around consequences of the neurological deficit

Subdural empyema: how effective is the burr hole drainage?

Subdural empyema is a collection of pus between the dura mater and the arachnoid mater, usually unilateral and spreads rapidly through the subdural space until limited by specific boundaries [eg, falx cerebri, tentorium cerebelli, base of the brain, and foramen magnum]. It is present in about 20% of all cases of intracranial abscesses. The aim was to identify the best mode of surgical treatment for SDE Experimental study. This is a personal long term study of seventeen emergency patients of subdural Empyema admitted in Frontier Medical college/Women medical College Abbottabad and Private clinics at Abbottabad over seven years period from September 2006 to August 2013. All were operated soon after stabilization and proper investigations. There were 10 male and 7 female ratio [1.3:1]. The majority of patients were between 10 and 20 years of age. The most common clinical presentation was headache, fever, neck stiffness, seizures or peri-orbital swelling; only seven patients had status epilepticus, While the erythrocyte sedimentation rate and white blood cell count were invariably elevated, the cerebrospinal fluid showed nonspecific pleocytosis in the patients who underwent lumbar puncture. The definitive per-operative diagnosis was made by contrast enchanced CT in all cases. Surgical treatment was by multiple burr holes in 8 patients, burr holes and small craniectomy in one, burr holes with catheter drainage in seven, and a large craniotomy in one. The Success rate was 86% while 76% making an excellent recovery. These results compare favorably with those reported in other studies using craniotomy alone, and suggest that burr holes drainage is equally good a method treating subdural empyema

Tuberculoma brain: diagnostic criteria and conservative management

There is evidence that medically treated Tuberculoma patients have a significantly better functional recovery than those having surgical excision. This would not be possible theoretically unless strict diagnostic criteria are applied and if there is still doubt, resort to surgical excision or biopsy so that patient' health is not jeopardized. To evaluate the Effectiveness of Conservative management of Tuberculoma of Brain based on strict Diagnostic Criteria. Prospective Study. This study was conducted at Assir Central Hospital Abha KSA from March 2001 to August 2003. Out of total thirteen patients, Eight Patients presented with signs of raised intracranial tension [Headache, Vomiting], Two with localizing symptoms or signs [Hemiparesis and Diplopia], Two with history of Fever, Night sweats, Cough, and had been receiving immunosuppressive agents. One pregnant patient presented with history of convulsions on term. Three patients had Solitary and Ten patients Multiple Lesions. Maximum number of Lesions in our cases were Eleven and minimum was one. Patients were diagnosed based on Strict Criteria like Blood Smears, ESR, CRP, Acid-fast Bacillus in Sputum smears, CSF serology X-ray Chest, Contrast- enhanced CT and MRI. Failure of medical treatment occurred in two patient. One pregnant patient was operated due to intractable Epilepsy following caesarian section on term. The patients were followed for six months to Two years without recurrence. Diagnostic Criteria helped us to filter out TB Positive cases as against Bacterial, fungal and actinomycotic infections of brain. Conservative management alone was successful in the Treatment of Tuberculoma of Brain

Nocardia canaliculitis presenting as pouted punctum

A rare case of culture-positive Nocardia canaliculitis is reported that presented with a history of chronic conjunctivitis and epiphora for the last 1.4 years, refractory to multiple treatment courses. Chronic conjunctivitis and a pouted punctum were observed in the right lower eyelid. Probing and sac syringing was performed. The "Sulfur granules" were expressed and subjected to various microbiological analyses. Nocardia sp was grown on culture. The patient was successfully managed with surgical removal of concretions and topical/systemic antibiotics

Sliding conjunctival flap in the surgical management of pterygium: a better approach

To note the frequency of recurrence of pterygium after surgical management using "Sliding Conjunctival Flap Technique" and "Bare Sclera Technique" thereby finding out a better technique where least recurrence occurs. Prospective interventional study. Study was carried out between February 2003 and February 2005 at Department of Ophthalmology, Military Hospital Rawalpindi initially and completed at Eye Department CMH Khuzdar, Balochistan. Surgical intervention was carried out on ninety patients with virgin pterygium; who had no other ocular pathology. Patients were selected from routine OPD using non randomized convenience sampling and were divided into two groups; Group A and Group B. Group A included 42 patients and were managed using "bare sclera technique, while Group B comprised of 48 patients and were managed using "sliding conjunctival flap technique". Patients were followed up for 1 year post-surgically at regular intervals. All patients were prescribed a standard treatment and results were documented. It was found that at the end of 1 year, 9 [21.42%] patients in Group A developed recurrence and only 3 [6.25%] patients in Group B developed recurrence. The results were found to be statistically significant [P-value <0.05]. Patients operated upon using sliding conjunctival flap technique had less frequency of recurrence of pterygium than those operated upon using bare sclera technique