Gastric outlet obstruction: change in etiology

To assess the results of the management of Acute Pancreatitis. Retrospective descriptive study from Jan. 2003 to Dec. 2005. Surgical Ward-2, Jinnah Postgraduate Medical Centre, Karachi. 62 patients with the diagnosis of Acute Pancreatitis. The demographic variables, cause and outcome of the cases were observed and recorded. Out of the total 62 patients, 37 had cholelithiasis; other causes were alcoholism, abdominal trauma, worms, instrumentation [ERCP] and drugs. All patients were classified according to APACHE-II scoring system into acute oedematous pancreatitis, severe acute pancreatitis and acute necrotizing pancreatitis. Forty eight patients developed complications including ARDS, anuria, hypotension, paralytic ileus and pseudocyst formation. Four cases died due to multiorgan failure. Current recommended principles in the management of Acute Pancreatitis are based on identification of patients having severe disease and the group at risk for the development of complications. APACHE-II is a helpful scoring system and CT scan is an effective diagnostic tool in difficult cases

Marinum hand infection a case report of an atypical mycobacterium

A 50 year old lady presented with 7 months history of an ulcerating, cutaneous lesion on the dorsum of middle finger, extending on to the dorsum of her left hand,on May 1999. There was no associated functional deformity or systemic manifestation. This lesion started as a small ulcer, which developed following a minor trauma on the dorsum of the right middle finger about 7 months back. The lesion continued to grow slowly and she visited various clinics and received multiple antibiotics. She was a housewife and used to regularly wash her clothes at home. She does give a history of a pond in her locality where fishing was done, however she denies any direct contact with aquatic life. She was seen in our department, where a high suspicion of an atypical mycobacterium marinum infection was aroused. Subsequently a tissue was taken from the lesion under local anaesthesia and sent for culture after informing the department of microbiology for specific cultures. The tissue showed growth of Mycobacterium marinum for which a successful therapy of combination of ciprofloxacin and rifampicin was started