Management of a giant lymphocele following varicose vein surgery: a case report.

Background: A lymphocele or lymphocyst is formed when lymphatic fluid accumulates in a space, following disruption of lymphatic channels. Here, we report a case of a giant lymphocele in a middle-aged female, who underwent Trendelenburg operation (saphenofemoral junction ligation) for varicose veins of her right lower limb.

Case Presentation: A 48-year-old Pakistani Punjabi female presented to the plastic surgery outpatient department with a history of painful, progressive swelling of the right groin and medial aspect of the right thigh for 4 months.

Sphenoid Wing Dysplasia: Report Of 3 Cases.

Sphenoidal Dysplasia is the absence of complete or a part of sphenoid bone, most commonly the greater wing of sphenoid. It can occur as an isolated deformity or in Neurofibromatosis-1 (NF1). Features of NF1 include café au lait spots, inguinal or axillary freckling, neurofibromas, optic gliomas, scoliosis and tibial deformity.

Increased inpatient mortality in patients hospitalized for atrial fibrillation and atrial flutter with concomitant amyloidosis: Insight from National Inpatient Sample (NIS) 2016-2017.

Purpose: Using National Inpatient Database (NIS), comparison of clinical outcomes for patients primarily admitted for atrial fibrillation/flutter with and without a secondary diagnosis of amyloidosis was done. Inpatient mortality was the primary outcome and hospital length of stay (LOS), mean total hospital charges, odds of undergoing cardiac ablation, pharmacologic cardioversion, having a secondary discharge diagnosis of heart block, cardiogenic shock and cardiac arrest were secondary outcomes.

Methods: NIS database of 2016, 2017 was used for only adult hospitalizations with atrial fibrillation/flutter as principal diagnosis with and without amyloidosis as secondary diagnosis using ICD-10 codes.

Nasolabial and extended nasolabial flaps for reconstruction in oral submucous fibrosis.

Objectives: The objective of the study was to evaluate the results of nasolabial/extended nasolabial flaps as a modality for treatment of oral submucous fibrosis.

Materials And Methods: Eleven patients of Stage III or IVa maximum interincisal opening were selected to be operated. Nasolabial/extended nasolabial flaps were done for both the sides.

Caspase-1 inhibition by VX-765 administered at reperfusion in P2Y receptor antagonist-treated rats provides long-term reduction in myocardial infarct size and preservation of ventricular function.

Patients with acute myocardial infarction receive a P2Y receptor antagonist prior to reperfusion, a treatment that has reduced, but not eliminated, mortality, or heart failure. We tested whether the caspase-1 inhibitor VX-765 given at reperfusion (a requirement for clinical use) can provide sustained reduction of infarction and long-term preservation of ventricular function in a pre-clinical model of ischemia/reperfusion that had been treated with a P2Y receptor antagonist. To address, the hypothesis open-chest rats were subjected to 60-min left coronary artery branch occlusion/120-min reperfusion.

Surgical correction of grade III hypertelorism.

Orbital hypertelorism is an increased distance between the bony orbits and can be caused by frontonasal malformations, craniofacial clefts, frontoethmoidal encephaloceles, glial tumors or dermoid cysts of the root of the nose, and various syndromic or chromosomal disorders. We report a series of 7 cases of hypertelorism that were treated in our hospital. The underlying causes in our series were craniofacial clefts 0 to 14 (4 cases), craniofacial clefts 1 to 12 (1 case), and frontonasal encephalocele (2 cases), all congenital.

Increasing mortality from ischaemic heart disease in China from 2004 to 2010: disproportionate rise in rural areas and elderly subjects. 438 million person-years follow-up.

Aims: We sought to ascertain the changes in mortality from ischaemic heart disease (IHD) from 2004 to 2010 in China as the sheer size of China's population makes disease patterns relevant globally.

Methods And Results: Data on IHD mortality were obtained from the Chinese Centre for Disease Control and Prevention National Disease Surveillance Point System, which includes 161 counties and a population of over 73 million-a representative sample of over 6% of the entire population of China. Both crude and World Health Organization (WHO)-standardized IHD mortality increased, in both men and women and in both urban and rural locations, during the study period, demonstrating the effect of urbanization, economic growth, and epidemiological transition on cardiovascular health.

Coronary-Cameral Fistula Connecting the Left Anterior Descending Artery and the First Obtuse Marginal Artery to the Left Ventricle: A Rare Finding.

Coronary-cameral fistulas are rare congenital malformations, often incidentally found during cardiac catheterizations. The majority of these fistulas are congenital in nature but can be acquired secondary to trauma or invasive cardiac procedures. These fistulas most commonly originate in the right coronary artery and terminate into the right ventricle and least frequently drain into the left ventricle.

Giant Thoracic Aneurysm Following Valve Replacement for Bicuspid Aortic Valve.

Bicuspid aortic valve is a common congenital anomaly associated with aortopathy, which can cause aortic root dilatation, necessitating regular screening if the aortic root is > 4.0 cm. Despite the low absolute incidence of aortic complications associated with bicuspid aortic valve in the general population, the consequences of such complications for an individual patient can be devastating.

Speckle Tracking Echocardiography of the Right Atrium: The Neglected Chamber.

The right atrium (RA) plays a pivotal role in electromechanical and endocrine regulation of the heart. Its peculiar anatomical features and phasic mechanical function make it distinct from ventricles. Various invasive and noninvasive techniques have been used to elucidate RA structure and function.

THORACODORSAL ARTERY PERFORATOR FLAP FOR UPPER LIMB RECONSTRUCTION.

Background: Thoracodorsal artery perforator flap (TAP) is a feasible option to reconstruct defects in upper limb where only skin and subcutaneous tissue is required.

Methods: This case series was carried out at department of Plastic and Reconstructive Surgery Combined Military Hospital Rawalpindi. A total of 5 patients with upper limb defects were reconstructed with thoracodorsal artery musculocutaneous perforator flaps.

Painful palpitations: chest pain associated with postextrasystolic ST depression.

Postextrasystolic T-wave changes have been described as early as 1915. The significance and mechanism of such changes remain controversial. Because postextrasystolic ST changes are rare, much of the ensuing discussion concentrates on the closely related and more commonly reported phenomenon of postextrasystolic T-wave inversion.

Traumatic Tension Pneumothorax as a Cause of ICD Failure: A Case Report and Review of the Literature.

Background. Tension pneumothorax can infrequently cause ventricular arrhythmias and increase the threshold of defibrillation. It should be suspected whenever there is difficulty in defibrillation for a ventricular arrhythmia.

Fronto-orbital advancement and total calvarial remodelling for craniosynostosis.

Objective: To describe the results of fronto-orbital advancement and remodelling for craniosynostosis in children.

Study Design: Case series.

Place And Duration Of Study: Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from June 2009 to June 2012.

Use of vascularised free fibula in limb reconstruction (for non-malignant defects).

The case series was conducted at the Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from June 2009 to May 2011, and comprised 19 patients in whom free fibula flap was performed for upper and lower limb reconstruction, using SPSS 16. Results showed that flap survival was 100%. One (5.

Benign paediatric mandibular tumours: experience in reconstruction using vascularised fibula.

The majority of the paediatric oral and maxillofacial tumours are benign and the mandible is involved in one-third of these cases. A review of the literature reveals only a handful of studies pertaining exclusively to benign paediatric mandibular tumours. The basis of this study was to fulfil the need to assess the suitability of major mandibular reconstructions using a vascularised fibular graft in cases of benign tumours in children.

Grebe syndrome: a rare association with congenital heart disease.

Grebe syndrome is a very rare form of short-limbed dwarfism. It is a genetic condition, passed by autosomal recessive inheritance. It is characterized by marked acromesomelic shortening of all the four limbs.

Free anterolateral thigh flap raised on musculocutaneous perforators of rectus femoris muscle.

The anterolateral thigh flap (ALTF) has been in wide clinical use for the last two decades, its major disadvantage has been its variable anatomy. We are presenting a case in which no substantial perforators were found to be arising from either the lateral septum of thigh or Vastus Laterlis muscle. In this case, instead of raising another flap, we used the same skin paddle raised on the musculocutaneous perforators of rectus femoris muscle.

Clinical applications of the pedicled anterolateral thigh flap in penile reconstruction.

Background: Penile reconstruction remains a major challenge in plastic surgery and, over the years, a myriad of techniques has been employed to achieve a functional phalloplasty. Unfortunately, the more commonly used forearm free flaps also have significant drawbacks. The pedicled anterolateral thigh flap (ALTF) has numerous attributes, which make it a comparable, if not a better option, for penile reconstruction.

Has the anterolateral thigh flap replaced the latissimus dorsi flap as the workhorse for lower limb reconstructions?

Objective: To compare the applicability and reliability of free Anterolateral thigh flap (ALTF) with Latissimus Dorsi free flap (LD) in different reconstructive scenarios of lower limb. To compare flap elevation time, vessel diameters, pedicle lengths, total operative time, peri-operative blood requirement, number of secondary procedures and complications between the two types of flaps.

Methods: Patients of all age groups with lower limb soft tissue defects requiring free tissue transfer, reporting to Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from November 2005 to November 2008, were included in the study.

Rotation-transposition correction of nasal deformity in Tessier number 1 and 2 clefts.

Objective: To formulate a standardized procedure for repair of the nasal component of Tessier number 1 and 2 clefts.

Patients And Methods: The procedure was performed from 1998 to 2007 in 13 patients with congenital nasal clefts of different degrees of expression corresponding to Tessier 1 and 2. The patients' ages ranged from 3 months to 28 years.

Reoperation for intracranial hypertension in TWIST1-confirmed Saethre-Chotzen syndrome: a 15-year review.

Background: Saethre-Chotzen syndrome is a syndromic craniosynostosis defined by a genetic mutation affecting the TWIST1 gene on chromosome 7p21. It is typically associated with unicoronal or bicoronal synostosis, eyelid ptosis, dysmorphic external ears, and other variable facial and limb abnormalities. Surgical management of the craniosynostosis addresses the calvarial deformity and may relieve or reduce the risk of intracranial hypertension.

Quality of life assessment in patients with locally advanced head and neck malignancy after ablative surgery and reconstruction with microvascular free flaps.

Objective: To assess the improvement in Quality Of Life (QOL) after ablative surgery in locally advanced head and neck malignancies by microvascular free flaps reconstruction.

Study Design: Quasi-experimental.

Place And Duration Of Study: Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from September 2005 to February 2007.

Tuberculous tenosynovitis: a cause of Carpal Tunnel Syndrome.

Objective: To highlight the presentation of tuberculous tenosynovitis as Carpal Tunnel Syndrome (CTS).

Methods: A descriptive study conducted with purposive sampling on the patients presenting between April 2004 to January 2005 to the department of Plastic Surgery, CMH Rawalpindi, with the clinical picture of CTS. Symptoms and signs were recorded.