Inflammatory myofibroblastic tumor of the lung in an adolescent boy

Inflammatory myofibroblastic tumors of the lung are rare, here, an unusual case is described. A 14-year-old boy presented with a history of weight loss and clubbing and was found to have a solitary circumscribed mass in right lower lobe treated with lobectomy. This case indicates the need for early and complete removal of the inflammatory myofibroblastic tumor of the lung

Bidirectional cavopulmonary shunt for cyanotic heart disease: surgical experience from a developing country

Objective: The importance of bidirectional cavopulmonary anastomosis for palliation of complex cyanotic con-genital heart disease is widely recognized. This study was conducted to highlight our surgical experience withthis procedure in a developing country.Methods: A retrospective study was conducted using medical records at the Aga Khan University Hospital,Karachi, Pakistan. Clinical findings at presentation, anatomical defects seen on transthoracic echocardiography,pre-operative McGoon index, cardiopulmonary bypass time, use of cardioplegia,post-procedure oxygen satura-tions and complications were evaluated. Results: A total of 8 patients underwent bidirectional cavopulmonary anastomosis. There were 6 males (75%)and 2 females (25%). Ages and weights atoperation averaged 5.7 ± 3.7 years (range 2-14 years) and 18.6 ±10.4 kg (range 8.5-35.5 kg) respectively. The most common symptoms were the presence of cyanosis in all(100%) patients followed by recurrent respiratory tract infections in 3 (37.5%) patients. Transthoracic echocar-diography revealed 6 (75%) patients with atrial septal defects, 5 (62.5%) with tricuspid atresia, 3 (37.5%) with ventricular septal defects, 3 (37.5%) with malposition of great vessels, 2 (25%) with pulmonary stenosis and 2(25%) with double inlet left ventricles. The mean pre-procedure McGoon index was 2.1 ± 0.5 (range 1.37-2.80).All patients received cardioplegia. Cardiopulmonary bypass was used in all patients for a mean time of 154.1 ± 83.6 minutes (range 60-298 minutes). All patients were ventilated for a mean period of 1.5 ± 0.7 days (range 1-3 days). The ICU stay was 3.0 ± 0.6 days (range 2-5 days) with a total hospital stay of 9.8 ± 3.8 days (range 7-18 days). The mean post-procedure oxygen saturation was 82.6 ± 3.5% (range 76-86%). The most commonpost-operative complication was supraventricular arrhythmia in 2 (25.0%) patients. There were no intra-opera- tive or early (within 7 days of procedure) deaths. One patient developed pulmonary artery hypertension and died 23 months later due to cardiac arrest. Conclusion: Patients tolerated the procedure well. After a mean follow-up of 10 months, 6 patients were assessed to be in New York Heart Association (NYHA) functional class I and one patient in NYHA class II.Clinical and post-procedural data gathered from our experience confirms the safety of bidirectional cavopul-monary anastomosi

Rare relapsed extrapulmonary hydatid disease

Hydatid cysts are rarely seen at the extrapulmonary sites. We report relapsed hydatid cysts with abdominal origin in a 25 years old woman. Over 1000 Hydatid cysts were removed through right posterolateral thoracotomy without any complications. Only very few cases are reported in the literature

Outcome and factors associated with hospital mortality in patients with impaired left ventricular function undergoing coronary artery bypass grafting: where do we stand?

Objective: Impaired ventricular function is a known risk factor for mortality after coronary artery bypass grafting however increasingly more patients with impaired ventricular function are referred for surgery. Currently no large data is available from Pakistan regarding this aspect of coronary surgery. Our objectives were to find out the hospital mortality and mid term functional improvement in patients with impaired ventricular function undergoing coronary artery by pass grafting and identify the risk factors for mortality. Methodology: Retrospective analysis of preoperative, operative and postoperative variables of patients with impaired ventricular function who were operated for isolated first time coronary artery bypass between October 2006 to April 2009. Results: Total 190 patients with impaired ventricular function underwent isolated first time coronary artery bypass grafting during this period with a male predominance (82.6%). Mean ejection fraction of the group was 25.4±5.3%. Mean predicted mortality on logistic Euro score was 10.9±2.7%. Actual in hospital mortality of the group was 4.7% which is comparable to contemporary published results. Multivariate analysis identified use of intra aortic balloon pump, non use of internal mammary artery and preoperative NYHA functional class as factors associated with mortality. Conclusion: Coronary artery bypass grafting can be performed in patients with impaired ventricular function with acceptable hospital mortality and mid term functional improvement

Peer-taught virtual research workshops for surgical residents: Protocol for a novel and sustainable solution to improving surgical research in Pakistan

Objective: To generate a protocol describing the methodology for a study assessing the effectiveness of a comprehensive series of peer-taught online research workshops for surgical residents across Pakistan in terms of improving research-related knowledge and skills, and long-term research involvement and output.Methods: The quasi-experimental study will consist of a series of six online research workshops conducted over Zoom for surgical residents across Pakistan. An online sign-up form will be circulated on social media to current surgical residents throughout Pakistan. Curricular content covered in the workshops will be developed in collaboration with experienced research faculty at the Departments of Surgery and Community Health Sciences at the Aga Khan University Hospital, Karachi. Facilitators of the workshops will be current surgical residents with a solid track record of research involvement at the hospital. Improvement in research-related knowledge and skills will be assessed through pre- and post-tests for each workshop. A post-series feedback form will assess satisfaction with the organisation, content relevance, peer-teaching and online delivery of the workshops. Long-term research involvement and output will be assessed by follow-up surveys at 6 months and 1 year post-workshop. All data-collection will be done via Google Forms. For ethical purposes, informed consent will be taken from participants prior to enrolment; data will be collected using a unique identifier number to maintain anonymity; and the only incentive provided to participants will be a Certificate of Completion for the research workshop series.Results: We expect that surgical trainees participating in the series of six research workshops will demonstrate a highly significant percentage improvement (p80%) to rate the overall organisation, effectiveness of online mode of instruction, and relevance to surgical training of the workshops as excellent/good. We also expect that most participants (\u3e80%) would strongly agree/agree that peer-education is an effective model of teaching in research workshops. Finally, we expect statistically significant improvement (pConclusions: In light of the ever-growing need for academic surgeons in Pakistan, this research protocol details a comprehensive strategy for research capacity-building among surgical trainees across the country. By equipping trainees with the knowledge and skills to conduct high-quality research, virtual research workshops provide a novel, grassroots-level and sustainable solution for addressing the surgical research crisis in Pakistan

Semiconductor Nanowires Biosensors for Highly Selective and Multiplexed Detection of Biomolecules

The surface modification of Nano-structure has allowed specific and selective detection to be made on nano structures devices. Current study, a nanowire was surface engineered with the potential of silicon nanowires biosensors (SiO2) which enhance the biosensor activity especially identifying single-stranded bio-molecular such as E.coli DNA. The device's capabilities were studied based on it response n electrochemical activities of the terminal group of the surface modification agent. NH2 -terminated APTES) to provide rigid chemistry between the DNA organic and Si inorganic link of a biomolecule single_stranded ssDNA probe and SiO2_APTES link nanostructure. Thus, the study demonstrates that silicon nanowire sensing capability to discriminate molecular probe to that of molecule target of supra-genome 21 mers salmonella due to sensitive surface chemistries that made distinguishing the two species. The device captured the molecule precisely; the approach took the advantages of strong binding chemistry created between APTES and biomolecule. The results indicated how modifications of the nanowires provide sensing capability with strong surface chemistries that can lead to specific and selective target detection

Burkitt lymphoma masquerading as cardiac tamponade

A 61 year old man presented with diffuse large B cell lymphoma of the skin of the back of the shoulder which was excised and treated with chemotherapy (CHOP regime) in 1998. He was in complete remission till he presented in 2002 with extranodal marginal zone lymphoma of the parotid gland for which he underwent superficial parotidectomy and radiotherapy. He continued in remission till 2006 when he presented with recurrent pericardial effusion and tamponade. At median sternotomy, pericardial effusion was drained, an anterior pericardiectomy was done and a left posterior pericardial window made, and an enlarged hard paraaortic lymph node excised. Histology, immunocytochemistry and chromosome analysis revealed Burkitt lymphoma. Patient underwent chemotherapy with CODOX-M regime and continues in remission. This report is unusual on account of the highly atypical presentation of Burkitt lymphoma as cardiac tamponade, only a few cases having been reported previously, the occurrence of three lymphomas of different pathological and genomic profiles in one patient over a period of eight years and the relatively slow rate of growth of an otherwise fulminant tumour with high tumour doubling time. A review of literature with special emphasis on chromosomal diagnosis, transformation of other lymphomas into Burkitt lymphoma and mediastinal and cardiac involvement with Burkitt lymphoma is presented

Large thymic carcinoma presenting with right ventricular failure: a case report.

Thymic carcinoma is an overall rare tumour with variable clinical manifestations. Right ventricular failure remains an uncommon occurrence and has not been reported in literature so far. A 40-year-old lady presented with the complaints of progressively worsening retrosternal chest pain, shortness of breath, easy fatigability and cough since 1 year. Computed tomography scan of the thorax revealed a mass measuring 12 x 10 cm in the anterior mediastinum. This mass appeared to be adherent to both lungs and pericardium and was impinging on the right atrium and right ventricle. It appeared to be infiltrating the ascending aorta, pulmonary arteries and superior vena cava. Ultrasound of the abdomen showed hepatomegaly and moderate ascites. Echocardiography showed evidence of right ventricular dysfunction as well as elevated right ventricular systolic pressures secondary to extrinsic compression. Percutaneous biopsy of the thymus was performed showing a malignant thymoma. Radical thymectomy with resection of pericardium was planned. Intra-operatively, the tumour was separated from the right and left lungs, pulmonary artery and aortic arch. Morphologically, immunochemically and clinically, the features were consistent with those seen in Masoka stage III thymic carcinoma. She also received six cycles of chemotherapy (PAC regimen) including cisplatin (50 mg/m(2)), doxorubicin (50 mg/m(2)) and cyclophosphamide (500 mg/m(2)). Radiation therapy in the adjuvant setting was planned but the Patient was lost to follow-up after 4 months. Although right ventricular failure is a very rare presentation of thymic carcinoma, clinicians should be aware of this presentation to appreciate the complete clinical spectrum of presentation of this neoplasm