Bioprosthetic aortic valve replacement on a mechanical valve ring.

Mechanical valve failure is a known but rare occurrence in cardiac surgery. A 71-year-old lady underwent surgery for failure of her mechanical aortic valve. It was replaced with another mechanical valve.

Unique presentation of a primary pleomorphic sarcoma of the left atrium.

This report describes an extremely rare cause of a common presentation. A 59-year-old man who presented with symptoms of progressive cardiac failure, was demonstrated to have a large left intraatrial mass on computed tomography pulmonary angiography and an echocardiogram. He proceeded to urgent surgery under cardiopulmonary bypass.

Thoracic melioidosis: a diagnostic dilemma.

The diagnosis of melioidosis can be difficult, and it is frequently described as "the great mimicker". We report a case of thoracic melioidosis presenting as a mediastinal mass with impending superior vena cava obstruction. With the presumptive diagnosis of mediastinal tumor, the patient underwent surgery for tissue sampling, and a purulent collection was found.

Carotid cavernous fistula in a patient with coronary artery disease.

Carotid cavernous fistulas are abnormal communications between the carotid and cavernous vasculature, with potential for serious neurological and ocular sequelae. There is considerable literature on the neuro-radiological management of carotico-cavernous fistula depending upon their flow status. The coronary artery bypass grafting (CABG) for coronary artery disease (CAD) is a well established method of revascularization.

Foreign body in the esophagus: a review.

Foreign body in the esophagus is a common emergency presentation. The approach towards a patient with a foreign body in the esophagus comprises a thorough history and systematic examination followed by relevant investigations. However, there is considerable debate over the most appropriate treatment option for such patients.

Endovascular stenting of a leaking thoracic aortic pseudoaneurysm.

Rupture of an aortic aneurysm is a major cause of early mortality during the course of disease. A less invasive approach with fewer complications is sought. A case of leaking thoracic aortic aneurysm is presented, where endovascular approach was adapted owing to ongoing sepsis.

Role of focused appendiceal computed tomography in clinically equivocal acute appendicitis.

Objective: To determine the accuracy of FACT (focused appendiceal computed tomography) in evaluation of acute appendicitis.

Methods: The study was conducted in Aga Khan University Hospital, Karachi, over a period of one year. Sixty-three patients with clinically equivocal acute appendicitis underwent thin-section non-enhanced helical CT.

Psoas abscess secondary to Pott's disease--an unusual presentation in a young child.

Psoas abscess in neonates and infants are rare. Primary psoas abscesses are said to be more common in young children. Limping, fever and abdominal pain has been described to be the way psoas abscesses usually present.

Colorectal carcinoma, preoperative evaluation by spiral computed tomography.

Objectives: To assess the capability of spiral computed tomography (CT) scan in preoperative evaluation of colorectal carcinoma (CRC).

Methods: A cross sectional study on 52 patients with recent histopathologic diagnosis of CRC was conducted over a period of one year at the Aga Khan University Hospital, Karachi. All these patients underwent spiral CT with oral and intravenous contrast administration.

Life threatening mediastinal haematoma: a complication of central venous catheterization.

Central venous catheterization (CVC) has established risks and benefits in its application as a vascular access source, particularly in situations involving temporary cannulation. We present a rare case of life-threatening mediastinal haematoma resulting from CVC usage. Even though aggressive intervention yielded survival, the patient was left with permanent vocal compromise owing to traumatic palsy of the right recurrent laryngeal nerve.

Coronary artery bypass surgery in Guillain Barre syndrome.

Guillain Barre Syndrome (GBS) is a rare autoimmune inflammatory polyneuropathy with established acute phase morbidity and mortality. Despite the positive outcome in majority of cases, there is hesitance in subjecting these patients to major surgical interventions under general anaesthesia. This case documents the successful undertaking of major coronary artery grafting under cardiopulmonary bypass and general anaesthesia, in a GBS patient.

A case of transient diabetes insipidus following cardiopulmonary bypass.

Cardiopulmonary bypass surgery has been linked with a number of postoperative complications. One of the frequently reported physiological alterations is the relative diuresis seen in the immediate post-op period. Rarely reported though is the development of full-blown diabetes insipidus in such patients.

Hemoptysis, a developing world perspective.

Background: Hemoptysis is a significant clinical presentation in respiratory medicine. Often a life threatening emergency, it mandates prompt assessment and intervention. Various investigations and management protocols are proposed globally, to advocate a standardized approach towards patients presenting with hemoptysis.

Coronary artery bypass grafting and sensorineural hearing loss, a cohort study.

Background: Sudden sensorineural hearing loss is routinely encountered by the otologist. The etiology is varied and often identifiable. One of the relatively less frequent causes is surgery.

Attitude toward organ donation: a survey in Pakistan.

This study was conducted to get an insight into the knowledge, attitude, and practices of the people of Pakistan regarding organ donation (OD), and to understand the various factors that influence these. Systematic sampling was used to generate a sample size of 357. Data collection was carried out via a questionnaire in the outpatient units of our hospital.