Hakeem Zubair Ashraf

Vascular injuries after bear attacks: Incidence, surgical challenges and outcome

Background: Bear mauling is rarely reported in medical literature due to its rare occurrence. Present study was undertaken to describe the pattern and management of bear maul vascular injuries in Kashmir. Patients and Methods: Study of patients with bear maul vascular injury from 1st Jan 2004 to 31st Dec. 2008. Fifteen patients with bear maul vascular injury were studied. All patients of bear maul without vascular injury were excluded from the study. Results: Most of the patients were treated by reverse saphenous vein graft or end to end anastomosis. Most common complication was wound infection (20%) followed by graft occlusion (13.33%). There was no operative death. Conclusion: Bear attacks are very common in Kashmir. Vascular injury due to bear maul needs prompt resuscitation and revascularization. Results are very good provided timely intervention for revascularization is done.

Popliteal artery pseudoaneurysm due to femur exostosis

Vascular complications of femur exostoses are rare, with popliteal pseudoaneurysm being the most common. After establishing the diagnosis, surgical treatment is mandatory. A 35-year-old woman presented with a painful pulsatile swelling in the lower medial aspect of the left thigh. Investigations revealed a pseudoaneurysm arising from the left popliteal artery adjacent to femur exostoses. Skeletal survey revealed multiple exostoses involving the upper and lower limbs. Surgical excision of the pseudoaneurysm was followed by ePTFE patch repair of the defect and excision of the exostoses. The patient was discharged after 5 days and followed up for 6 months with excellent results.

Minimally invasive thoracotomy approach for double valve replacement for valvular heart diseases

Background: Double valve replacement (DVR) is usually done through median sternotomy. However, right anterolateral thoracotomy is an alternative approach. Aim: The aim of this study was to analyze the results of right anterolateral thoracotomy for DVR. Patients and Methods: This was a prospective study conducted on during the period from January 2009 to January 2012. This study consists of 56 patients who had a concomitant mitral and aortic valve disease and were subjected to DVR. Patients were studied according to their age and sex, New York Heart Association (NYHA) class, valve pathology, concomitant procedures, urgent/elective, length of incision, surgical exposure, mean bypass time, operating time, hospital stay, and cosmesis. Results: Majority of the patients were in 3 rd and 4 th decade (61%). Postoperative length of stay was 7-12 days, 70% of patients were discharged by the 7 th day. The average size of incision in males was 7.5 cm and in females the size of incision was 7.25 cm with a mean of 7.3 cm in both genders. Rheumatic heart disease was responsible for 89.28% of cardiac valvular lesions, degenerative disease in 7.14% and endocarditis in 3.5%. Postoperatively at 2 months, there was a statistically significant improvement in the NYHA class with 94% of the survivors in class I-II. There was a statistically significant difference in the outcome in patients having higher ejection fraction as compared to those who had low ejection fraction preoperatively. Thirty days mortality was 1.78%. Over the first 24 postoperative hours, only about 30% of patients were pain free, and this proportion increased to about 50% by day 2, 60% by day 3, 70% by day 4, 75% by day 5 and stabilized. Postoperative length of stay was 7-12 days, 70% of patients were discharged by the 7 th day. Conclusion: DVR via thoracotomy appears to be associated with faster recover, early discharge and reduced use of rehabilitation facilities that translate into a shorter hospital stay and cost. In addition to early benefits of thoracotomy approach, late cosmetic results are also better than conventional sternotomy.

Mediastinal bronchogenic cyst compressing left recurrent laryngeal nerve.

A 15-year-old boy developed recurrent laryngeal nerve compression by a bronchogenic cyst, causing recurrent choking. Bronchogenic cyst compressing the recurrent laryngeal nerve is unusual. The patient had a normal voice and occasional choking with periods of normalcy in between. A left posterolateral thoracotomy was performed and cyst was excised. Histopathology revealed bronchogenic cyst.