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Khan FW, Fatima B, Lahr BD, Greason KL, Schaff HV, Dearani JA, Daly RC, Stulak JM, Crestanello JA. Hyponatremia: An Overlooked Risk Factor Associated With Adverse Outcomes After Cardiac Surgery. Ann Thorac Surg 2020; 112:91-98. [PMID: 33080237 DOI: 10.1016/j.athoracsur.2020.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 07/29/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hyponatremia is an unrecognized risk factor for adverse outcomes after cardiac surgery. We sought to study the prevalence of preoperative hyponatremia and its impact on short-term and long-term outcomes after cardiac surgery. METHODS Patients who had coronary artery bypass graft, valve, or coronary artery bypass graft and valve procedures from 2000 to 2016 and available preoperative serum sodium values within 30 days of the index procedure were included in the study. The effect of preoperative sodium on short-term and long-term outcomes was analyzed as a continuous and binary (hyponatremia [Na+ <135 mEq/L] versus no hyponatremia) predictor variable in multivariable regression models. RESULTS Preoperative hyponatremia was present in 9.9% of 16,238 patients with available sodium levels. Comorbidities were more common in patients with hyponatremia. Hyponatremia was independently associated with operative mortality (odds ratio [OR] = 1.80; 95% confidence interval [CI], 1.38-2.34; P < .001), long-term mortality (hazard ratio = 1.31; 95% CI, 1.21-1.40; P < .001), longer postoperative length of stay (hazard ratio = 1.35; 95% CI, 1.28-1.43; P < .001), renal failure (OR = 1.52; 95% CI, 1.20-1.93; P < .001), prolonged ventilation use (OR = 1.52; 95% CI, 1.30-1.78; P < .001), and stroke or transient ischemic attack (OR = 1.48; 95% CI, 1.09-2.02; P = .013). Severity of hyponatremia, as measured by sodium level, was similarly associated with increased risk for death and postoperative complications. CONCLUSIONS Preoperative hyponatremia is relatively common and is associated with adverse short-term and long-term outcomes after cardiac surgery. Preoperative hyponatremia can be used independently from standard risk factors to identify high-risk patients for cardiac surgery.
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Affiliation(s)
- Fazal Wahab Khan
- Department of Cardiovascular Surgery, Mayo Clinic Rochester, Minnesota
| | - Benish Fatima
- Department of Cardiovascular Surgery, Mayo Clinic Rochester, Minnesota
| | - Brian D Lahr
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic Rochester, Minnesota
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic Rochester, Minnesota
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic Rochester, Minnesota
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Khan FW, Said SM. Konno-Rastan Combined with Manougiaun Root Enlargement for Small Aortic Root with Coronary Anomaly in a Young Woman. Heart Views 2019; 20:172-174. [PMID: 31803375 PMCID: PMC6881867 DOI: 10.4103/heartviews.heartviews_108_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 09/15/2019] [Indexed: 12/05/2022] Open
Abstract
Aortic root enlargement (ARE) is an established procedure to deal with small aortic annulus. It becomes very important to place adequate size prosthesis to prevent patient–prosthesis mismatch (PPM). Aortic root enlargement procedures procedures are technically demanding operations, particularly in obese patients. The presence of coronary artery anomalies adds more complexity to the procedure. We present an interesting case of a 22-year-old obese female with symptomatic severe aortic valve stenosis and anomalous coronary arteries. We successfully performed aortic valve replacement using the combined Konno aortoventriculoplasty and Manouguian posterior aortic root enlargement. Combined aortic root enlargement techniques techniques should be considered in the presence of major coronary anomalies.
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Affiliation(s)
- Fazal Wahab Khan
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sameh M Said
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Amanullah M, Razzaq S, Siddiqui AH, Khan FW. Minimally invasive technique of placing a dual chamber permanent pacemaker in children. J PAK MED ASSOC 2019; 69:1119-1123. [PMID: 31431764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To share the experience of a minimally invasive technique in the implantation of a dual chamber permanent pacemaker in paediatric population. METHODS The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients aged up to 16 years who underwent epicardial dual chamber permanent pacemaker insertion via xiphisternal incision between April 2011 and August 2016. Demographic data included age, weight and gender of the patient. Indications for pacemaker insertion, electrocardiography findings, concomitant cardiac procedures and procedural complications were reviewed. Pacemaker thresholds and impedance at the time of implantation and throughout the course of follow-up were extracted from the clinical data. RESULTS Of the 10 patients, 5(50%) were males and 5(50%)were females. The overall mean age was 3.4}3.8 years (range: 1 month - 13 years). The mean weight at the time of operation was 11.4}6.8 kg (range: 4.3-27kg). Indications for permanent pacemaker insertion included postoperative advanced or complete atrioventricular block in 7(70%) and complete congenital heart block in 3(30%). There was no reported morbidity. CONCLUSIONS Dual chamber permanent pacemaker insertion via xiphisternal incision was found to be of benefit to the patients and the surgeons alike.
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Affiliation(s)
| | - Somia Razzaq
- Jinnah Sindh Medical University, Karachi,Pakistan
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Abstract
Chondrosarcoma is a cancer of cartilage cells, and despite being a common primary bone tumor, tracheal chondrosarcoma is rare with only 18 cases reported in the literature prior to mid-2016. A 60-year-old gentleman presented with progressively increasing cough, severe stridor, and production of phlegm for approximately 2 years. On admission to our tertiary care hospital, he developed complete obstructive apnea within an hour, and was intubated. A tracheal biopsy was performed, followed by resection. Histopathology confirmed chondrosarcoma of the trachea. The patient tolerated the procedure very well and is currently symptom-free on follow-up, with no signs of recurrence.
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Affiliation(s)
| | - Ibrahim Zahid
- Dow University of Health Sciences, Karachi, Pakistan
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Samad MA, Rahim Khan HA, Urooj F, Hyder UA, Khan FW, Fatimi SH, Khan JK. Management Of Penetrating Injury To Thoracic Inlet And Lower Neck With Retained Foreign Body Using Video Assisted Thoracoscopic Surgery. J Ayub Med Coll Abbottabad 2017; 29:486-488. [PMID: 29076689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Penetrating neck and chest injuries are a common form of occupational injuries. We hereby report a unique case in which a metallic rod had penetrated the left chest and neck of a plastic factory worker. The patient was vitally stable when he presented to Emergency Room. Chest X-ray was performed and the patient was rushed to the operating room. VATS (video assisted thoracoscopic surgery) and neck dissection was done for retrieval of the metallic rod. On table, endoscopy was also done to rule out injury to oesophagus. No injury to vital structures was found and the subsequent recovery was uneventful.
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Affiliation(s)
| | | | - Faiza Urooj
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Usman Ali Hyder
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Fazal Wahab Khan
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | | | - Jamal Kabeer Khan
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
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Khan HAR, Khan FW, Fatimi SH. Giant Ganglioneuroma in a 5-Year Child. J Coll Physicians Surg Pak 2017; 27:S16-S17. [PMID: 28302232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 10/27/2016] [Indexed: 06/06/2023]
Abstract
We report a 5-year boy presenting with pain in the lower chest and upper abdomen. On evaluation with computed tomography scan of the chest, he was found to have a large 16 x 14 cm posterior mediastinal mass compressing the inferior vena cava and liver, and shifting the heart to the opposite side. Tumor was approached via right postero-lateral thoracotomy and dissected off from esophagus, heart, inferior vena cava and lungs. The entire tumor was resected without any complications. Postoperative course was unremarkable. Resection of the tumor was successful. The histopathology showed it to be giant ganglioneuroma with no evidence of malignancy.
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Affiliation(s)
| | - Fazal Wahab Khan
- Department of Surgery, The Aga Khan University Hospital, Karachi
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Zahid I, Rahim Khan HA, Irfan O, Fatima B, Tahir M, Tariq M, Khan FW, Fatimi S. Retrograde bullet migration from inferior vena cava into right common iliac vein following gunshot: A case report. J PAK MED ASSOC 2016; 66:1673-1675. [PMID: 28179710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Bullet embolization cases are rare and even rarer are its retrograde migration in the veins. We report the case of a 14 year old male with a gunshot wound to the left side of his chest. CT scan revealed bilateral haemothorax and foreign body in the right common iliac vein. The patient was immediately taken to the operating theatre and median sternotomy performed. Bullet entry tear was found in the inferior vena cava however, the bullet was found lodged in the right common iliac vein and slipped down against the flow of blood. The bullet was left in situ and after the necessary repair the chest was closed and the patient shifted to the CICU and discharged after 4 days in stable condition. Patient was followed after 1 week and reassured and advised for one year follow-up.
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Affiliation(s)
- Ibrahim Zahid
- Dow University of Health Sciences, Aga Khan Hospital, Karachi, Pakistan
| | | | - Omar Irfan
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Benish Fatima
- Medical College, Liaquat National Hospital, Aga Khan Hospital, Karachi, Pakistan
| | - Maha Tahir
- Medical College, Dow International, Aga Khan Hospital, Karachi, Pakistan
| | - Muhammad Tariq
- Department of Cardiothoracic Surgery, Aga Khan Hospital, Karachi, Pakistan
| | - Fazal Wahab Khan
- Department of Cardiothoracic Surgery, Aga Khan Hospital, Karachi, Pakistan
| | - Saulat Fatimi
- Department of Cardiothoracic Surgery, Aga Khan Hospital, Karachi, Pakistan
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Khan HAR, Batool S, Khan FW, Fatimi SH. Successful Treatment of Giant Left Subclavian Artery Pseudoaneurysm Abutting the Arch of the Aorta and Descending Aorta. Heart Views 2016; 17:106-108. [PMID: 27867459 PMCID: PMC5105221 DOI: 10.4103/1995-705x.192560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 28-year-old woman presented with 3-month history of fever of unknown origin and progressively increasing cough. She was diagnosed with pulmonary tuberculosis on bronchial lavage cultures. A chest X-ray performed on follow-up showed a new opacity in the left apical area of the chest. Computed tomography scan of chest showed a large 10 cm pseudoaneurysm of the left subclavian artery 1 cm from its take off from the arch of the aorta. The pseudoaneurysm was approached through a left posterolateral thoracotomy and opened following a proximal and distal control. A 3 cm longitudinal defect was identified in the subclavian artery within its intrathoracic portion. This was debrided and repaired with an autologous pericardial patch. The patient had an uneventful recovery and remained well on follow-up.
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Affiliation(s)
| | | | - Fazal Wahab Khan
- Department of Surgery, Division of Cardiothoracic Surgery, Aga Khan University, Karachi, Pakistan
| | - Saulat Hasnain Fatimi
- Department of Surgery, Division of Cardiothoracic Surgery, Aga Khan University, Karachi, Pakistan
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Hasan SB, Khan FW, Hashmi S, Ehtesham A, Magsi RA, Shahabuddin S. Cervical mediastinoscopy in the diagnosis of lymphadenopathy in South Asia. J PAK MED ASSOC 2016; 66(Suppl 3):S16-S18. [PMID: 27895343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We planned to determine the clinical utility and safety of mediastinoscopy in the pathologic diagnosis of mediastinal lymphadenopathy and to determine disease patterns in a tertiary care setting in Karachi. The retrospective review comprised record of patients who underwent mediastinoscopy over 25 years between July, 1990 and August, 2015. Of the 122 patients, records were complete for 88(72%). Mean age was 42.5±12.9 years and 55(62.5%) were male. Overall, 60(68.2%) patients had benign inflammatory diseases; 25 (28.4%) had lymphoma or lung cancer which was accurately staged; 26(29.5%) had tuberculosis; 13(14.8%) sarcoidosis; and 11 (12.5%) had concomitant tuberculosis and sarcoidosis. No mortality or significant morbidity was recorded. Mediastinoscopy was useful in staging bronchogenic carcinoma and influenced the management in this series. It was found to be accurate in the diagnosis of other malignant as well as benign mediastinal pathologies, all of which were treatable.
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Affiliation(s)
- Sulaiman Bashir Hasan
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi
| | - Fazal Wahab Khan
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi
| | - Shiraz Hashmi
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi
| | | | | | - Syed Shahabuddin
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi
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Khan FW, Muhammad A, Abbas M, Bin Mahmood SU, Fatima B, Fatimi SH. Delayed Presentation of Forgotten Thyroid Goiter - 25 Years After Thyroidectomy. J Coll Physicians Surg Pak 2016; 26:858-860. [PMID: 27806818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 03/04/2016] [Indexed: 06/06/2023]
Abstract
Forgotten goiter is a rare occurrence (2 - 16% of retrosternal thyroid cases) that depicts recurrence of retrosternal thyroid mass due to growth of remnant thyroid tissue overlooked during an initial thyroidectomy. The patient is a 59-year female who presented with dyspnea and stridor 25 years after total thyroidectomy. She was diagnosed as having a mediastinal mass on radiographic imaging. There were only localized pressure symptoms due to mass effect. The mass was excised employing an extra-cervical approach and using a partial sternotomy. The profuse extension of thyroid tissue, adherent to vital structures in the thorax and the extra-cervical thyroidectomy was a novel experience. The mass was completely excised and the patient's symptoms alleviated after the surgery. The patient recovered without any complications and there was no recurrence at 1 year of follow-up.
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Affiliation(s)
- Fazal Wahab Khan
- Section of Cardiothoracic Surgery, The Aga Khan University Hospital, Karachi
| | - Ayesha Muhammad
- Florez Lab, Massachusetts General Hospital, Yale University, USA
| | - Mohsin Abbas
- Section of Cardiothoracic Surgery, Ziauddin University Hospital, Karachi
| | | | - Benish Fatima
- Department of Biochemistry, Liaquat National Hospital, Karachi
| | - Saulat H Fatimi
- Section of Cardiothoracic Surgery, The Aga Khan University Hospital, Karachi
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Khan FW, Hashmi S, Naeem SS, Fatima B, Hanif H, Zareen M, Fatimi SH. Peri-operative determinants of prolonged CICU stay after coronary artery bypass graft surgery in elderly at a private tertiary care hospital: A case control study. J PAK MED ASSOC 2016; 66(Suppl 3):S19-S23. [PMID: 27895344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To explore peri-operative risk factors associated with prolonged stay in cardiac intensive care unit among patients undergoing isolated coronary artery bypass grafting. METHODS This retrospective case control study was conducted at the Aga Khan University Hospital, Karachi, comprised medical records of patients who had undergone cardiothoracic revascularisation surgery from January 2006 to December 2013. The patients were grouped into cases and controls at a ratio of 1:2 on the basis of length of stay at cardiac intensive care unit, i.e. >72 hours and <72 hours. Independent risk factors for prolonged cardiac intensive care unitstay were evaluated. SPSS 20 was used for data analysis. RESULTS Of the 999 patients, 333(33.3%) were cases and 666(66.6%) were controls. The mean age of cases was 62.5±9.7 years and that of controls was 60.8±9.6 years (p=0.007). The number of males was 280(84.1%) among the cases and 489(73.4%)among the controls. Adjusted odds ratio and 95% confidence interval for age and male gender were 1.02 (1.0,1.03) and [1.90 (1.32,2.74)]; diabetics were at high risk of staying longer [1.51 (1.13,2.02)]; previous cardiovascular interventions [1.65 (1.05,2.59)], intra-aortic balloon pump insertion [1.45 (1.01,2.08)], initial ventilation time and post-operative bleeding tamponade were independently associated with prolonged cardiac intensive care unit stay [1.01 (1.00, 1.01)] and [1.9 (1.13,3.2)], respectively. The risk of dying among the cases was three times more after adjusting for all covariates in the model [3.1 (1.52,6.31)]. CONCLUSION Advanced age, male gender, diabetes, previous cardiovascular interventions, post-operative intra-aortic balloon pump insertion, initial ventilation support and post-op bleeding tamponade were found to be the independent risk factors for prolonged cardiac intensive care unit stay.
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Affiliation(s)
- Fazal Wahab Khan
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi. )
| | - Shiraz Hashmi
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi
| | - Syed Saeed Naeem
- Interns, Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi
| | - Benish Fatima
- Interns, Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi
| | - Hashim Hanif
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi
| | - Mubashir Zareen
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi
| | - Saulat Hasnain Fatimi
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi
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Mahmood UB, Khan FW, Fatima B, Tariq MU, Fatimi SH. Primary Melanotic Schwannoma with Typical Histology. J Coll Physicians Surg Pak 2016; 26:707-709. [PMID: 27539769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/11/2015] [Indexed: 06/06/2023]
Abstract
We present a case of a 17-year male with a soft tissue density spreading from the neural foramina (T3) of the spinal cord and involving the right upper thoracic cavity. We managed the patient through surgical intervention and resected the complete tumor. Gross definition and microscopic findings of the resected tissue revealed the definitive diagnosis of melanotic schwannoma. The histological characteristics in this case were very specific and harbour an important diagnostic clue for this rare disease. Malignant melanoma was ruled out on the basis of histological findings. The patient recovered completely and was healthy on one-year follow-up.
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Affiliation(s)
| | - Fazal Wahab Khan
- Department of Surgery, The Aga Khan University Hospital, Karachi
| | - Benish Fatima
- Department of Biochemistry, The Aga Khan University Hospital, Karachi
| | | | - Saulat H Fatimi
- Department of Surgery, The Aga Khan University Hospital, Karachi
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Khan FW, Fatima B, Bukhari N, Ali TA, Fatimi SH. Right atrial rupture after road traffic accident. ANZ J Surg 2015; 87:734-735. [PMID: 25765630 DOI: 10.1111/ans.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Fazal Wahab Khan
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Benish Fatima
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Nashrah Bukhari
- Department of Surgery, Medical College, Aga Khan University, Karachi, Pakistan
| | - Taimur Asif Ali
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Saulat H Fatimi
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
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Sami SA, Shahabuddin S, Khan FW. A selection of cases of direct cannulation in surgery for type A dissection. Asian Cardiovasc Thorac Ann 2014; 22:887. [PMID: 24899046 DOI: 10.1177/0218492314538845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shahid Ahmed Sami
- Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Shahabuddin
- Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Fazal Wahab Khan
- Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Moosa FA, Khan FW, Rao MH. Comparison of complications of circumcision by 'Plastibell device technique' in male neonates and infants. J PAK MED ASSOC 2010; 60:664-667. [PMID: 20726200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To determine the effectiveness of the circumcision by Plastibell technique with comparison of complications among neonate and infant age groups. METHODS A retrospective, descriptive study was conducted in all the plastibell circumcisions performed by the first author, during the period October 2006 to December 2008 at a private hospital Karachi. The record of all the cases fulfilling the inclusion criteria were obtained and analyzed for determining the outcome and complications if any in neonates and infants and to compare it with in these two groups. RESULTS Overall 245 cases of neonates and infants were selected. Mean age of neonates and infants was 14 +/- 2 days and 3 +/- 0.5 months respectively. The plastibell circumcision was done in all the cases i.e. 90 neonates and 155 infants. Out of these, the successful rate of plastibell circumcision without any complication was recorded as 196 cases (80.00%) whereas, 49 cases (20.00%) developed complications. In neonates it was recorded as 04.44% cases, whereas this ratio was 29.03% in infants. Most common complications were delayed separation of the ring in 17 cases (6.93%), bleeding in 12 cases (4.89%), localized superficial infection in 12 cases (4.89%), and proximal migration of ring in 07 cases (2.85%). CONCLUSION The ratio of complications of circumcision by plastibell is significantly higher in infants as compared to neonates. However it is an easy, quick and safe technique. Outcome of this procedure is encouraging while infants are more prone to develop post operative complications than neonates.
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Affiliation(s)
- Foad Ali Moosa
- Surgical Unit-I, Dow University of Health Sciences, Civil Hospital, Karachi
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