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S A Sami

Publications and source records attributed to S A Sami.

6 recordsLinked to original sources
PubMed2000

Non-small cell lung cancer: disease spectrum and management in a tertiary care hospital.

OBJECTIVES: To review the spectrum of presentation and the surgical management of Non Small Cell Lung Cancer (NSCLC) and the role of various diagnostic modalities in predicting the post-operative stage and the correlation of the post-operative stage with the chances of recurrence. SETTINGS: The Aga Khan University Hospital, Karachi--a tertiary care referral center in Paksitan. METHODS: This is a retrospective study of medical records of all the patients who were managed at the Aga Khan University Hospital (AKUH) between 1988 and 1998. The patients with a diagnosis of lung cancer were identified using the ICD-9-CM coding system and the data was analyzed for patients with NSCLC only. RESULTS: A total of 773 patients were admitted with a diagnosis of lung cancer at AKUH over 10 years period. Out of these 21 (2.71%) underwent staging mediastinoscopy and 20 (2.58%) patients underwent exploratory thoracotomy and biopsy without any resection, as the disease was found to be unresectable. Only 18 (2.32%) patients underwent surgical resection. There were 15 males and 3 females and the mean age was 53 years. Mean duration of symptoms was 12 months and cough and haemoptysis were the main presenting symptoms. Most of the tumors were located on the right side. CT scan and mediastinoscopy were mainly used to stage the disease. Complete surgical resection including en-bloc resection of adjacent structures was attempted, when possible. Median follow up was 24 months and the recurrence rate was 39%. There was no significant correlation between post-op stage and recurrence. CONCLUSION: It is concluded that most of the patients present at the advanced stage and resection is possible only in a small number of patients. The size of primary tumor and local extension should not contra-indicate surgery in patients with negative mediastinal nodes and without distant metastasis as it can be performed safely. All pulmonary lesion in the adults must be thoroughly investigated as early diagnosis and complete resection is the only key to cure and long term survival.

Adult↗
PubMed1998

Should coronary artery bypass grafting be performed at the same time as repair of a post-infarct ventricular septal defect?

OBJECTIVE: The value of coronary artery bypass grafting (CABG) at the time of repair of a post-infarct ventricular septal defect (VSD) remains controversial. The aim of this study was to analyse the effect of CABG on early mortality and survival following repair of an acquired VSD. METHODS: Over 23 years, 179 patients, 118 male, 61 female, mean age 66 years (range 43-80), have undergone repair of a post-related VSD in our unit. A total of 29 patients, who predominantly form the earlier part of the series, were operated on greater than 1 month after the infarct and are, therefore, excluded. Coronary angiography was performed in 98 (65.3%) of the remaining 150 patients. Of these, 41 had coronary artery disease (CAD) limited to the infarct-related vessel and 57 had additional significant CAD. Those with CAD limited to the infarct-related vessel were not grafted (Group A). Of those, 40 with significant CAD underwent CABG at the time of VSD repair (Group B) and 17 did not (Group C). In 52 patients the coronary anatomy was not documented (Group D). Risk factors for early mortality were evaluated using logistic regression. Actuarial survival was compared using log rank and Wilcoxon tests. Cox's proportional hazards method was used to determine factors affecting survival. RESULTS: Overall, 30 day mortality was 32%. CABG did not significantly decrease operative mortality (logistic regression). There was no statistically significant difference in early mortality or actuarial survival between the four groups. CABG was not associated with an increased survival (Cox's method). CONCLUSIONS: Concomitant CABG at the time of VSD repair does not affect early mortality nor confer survival benefits. There seems to be no demonstrable benefit in revascularisation at the time of repair and, therefore, it may be unnecessary to perform CABG or coronary angiography in these patients.

Adult↗