Utility of a modified components separation for abdominal wall reconstruction in the liver and kidney transplant population

BACKGROUND: Incisional hernia is a common complication following visceral organ transplantation. Transplant patients are at increased risk of primary and recurrent hernias due to chronic immune suppression and large incisions. We conducted a retrospective review of patients with a history of liver or kidney transplantation who underwent hernia repair to analyze outcomes and hernia recurrence. METHODS: This is a single center, retrospective review of 19 patients who received kidney and/or liver transplantation prior to presenting with an incisional hernia from 2011 to 2017. All hernias were repaired with open component separation technique (CST) with biologic mesh underlay. RESULTS: The mean age of patients was 61.0±8.3 years old, with a mean body mass index of 28.4±4.8 kg/m², 15 males (78.9%), and four females (21.1%). There were seven kidney, 11 liver, and one combined liver and kidney transplant patients. The most common comorbidities were hypertension (16 patients, 84.2%), diabetes (9 patients, 47.4%), and tobacco use (8 patients, 42.1%). Complications occurred in six patients (31.6%) including hematoma (1/19), abscess (1/19), seroma (2/19), and hernia recurrence (3/19) at mean follow-up of 28.7±22.8 months. With the exception of two patients with incomplete follow-up, all patients healed at a median time of 27 days. CONCLUSIONS: This small, retrospective series of complex open CST in transplant patients shows acceptable rates of long-term hernia recurrence and healing. By using a multidisciplinary approach for abdominal wall reconstruction, we believe that modified open CST with biologic mesh is a safe and effective technique in the transplant population with complex abdominal hernias.

Metabolic evaluation for pediatric renal stones: a stitch in time

Objectives: To evaluate the pediatric patients with renal calculi in terms of bio-metabolic profile

Study Design: Cross sectional study

Place and Duration of Study: Department of pediatric nephrology the Children's Hospital and the Institute of Child Health Lahore over a period of 10 months from Nov 2016 to Sep 2017

Material and Methods: A total 85 patients with urolithiasis up to the age of 14 years were enrolled for study. Structured history and tailored investigations were collected from all the patients. Results of the physical examination, blood chemistry, and urinary excretion of metabolites [urinary calcium, citrate, magnesium and oxalate] were recorded

Results: Out of 85 patients; 65 percent were males and 35 percent were females [2:1]; mean age at presentation was 8.15 +/- 5.04 years. Hypertension was documented in 57 percent patients. Mean level of urea and creatinine was 73.02 +/- 59mg/dl and 4.435 +/- 4.024mg/dl respectively. Vitamin D level was 37 +/- 15.6ng/ml while serum PTH level was 51.2941 +/- 26.067pg/l. Serum calcium and phosphorus was 8.54 +/- 1.18 and 5.0224 +/- 0.885 respectively. Among all patients, 95 percent were found to have metabolic abnormalities. The most common was hypercalciuria [54 percent] followed by hyperoxaluria in 28 percent patients. Hypocitraturia was seen in 21 percent patients. Distal renal tubular acidosis was found in 6 percent children. Only 5 percent children were having low magnesium level in their urine

Conclusion: Majority of the children with stone disease had underlying metabolic risk factor and in our setting, hypercalciuria is the most common one

Not all asymptomatic carotid plaques are equal: some require intervention

Ischemic stroke represents a major health hazard around the world, which has a severe impact on society and the health-care systems. Roughly, 15% of all strokes can be attributed to significant atherosclerotic disease of the carotid arteries. Some patients presenting with disabling strokes for the first time cannot benefit from carotid revascularization having lost the opportunity of prevention. We know that all symptomatic patients were once asymptomatic. Hence, after identifying high risk carotid plaques and patient's characteristics suitable for interventions, they should be offered carotid revascularization at specialized centers [with low perioperative stroke and death rates] to prevent stroke and cognitive function decline in long term

Clinicopathological analysis of odontogenic cysts in a selected Pakistani population

The cysts of the jaw are broadly classified as odontogenic and non-odontogenic. The odontogenic cysts are pathological fluid filled cavities lined by odontogenic epithelium and further sub-classified as inflammatory and developmental. The objective was to determine the types, frequency, distribution, and demographic characteristics of odontogenic cysts in our setup. This 8 years retrospective study [from January 2003 to December 2010] was conducted at Histopathology department of Armed Forces Institute of Pathology, Rawalpindi [Pakistan]. The histopathology record of odontogenic cysts were reviewed for age, gender, site, associated tooth and histopathological diagnosis. The data was analysed by using SPSS soft ware package version 17. The data revealed that periapical, dentigerous and odontogenic keratocysts were the most commonly reported odontogenic cysts which reported in the age range of 4 to 72 years [mean 29.09 +/- 13.53 years]. Amongst them 67.7% were males and 32.3% females with peak incidence in the 2[nd] and 3[rd] decades. The association of age and teeth with different type of cysts was statistically significant while gender association was insignificant although having predilection for males. None of the case of odontogenic keratocyst was found in deciduous teeth. The statistically significant association of different types of Odontogenic cysts with the age, site, teeth and male prevalence reveals that demographic knowledge can be helpful in early diagnosis and their prompt treatment

Clinicopathalogical analysis of benign salivary gland tumours: a study of 242 cases at AFlP Rawalpindi [Pakistan]

Objective: to analyze the clinicopathological aspects of benign salivary gland tumors. Materials and Methods: This descriptive case series study was carried out from Jan 2003 to Dec 2009 at Armed Forces Institute of Pathology Rawalpindi, [Pakistan]. All cases of benign salivary gland tumors were reviewed and their diagnoses were reconfirmed. The data regarding all the major and minor salivary gland tumor was analyzed using computer soft ware program SPSS [version 17]. The descriptive statistics and frequency was calculated for type of tumors, age, gender, site and size. Association of these parameters with the type of tumor was calculated by using chi square test. Results: the most common histological tumor type found was pleomorphic adenoma, followed by Myoepithelioma. All these cases presented between 12 and 85 years of age [mean 39.7 +- 16.91] mostly in the 3rd and 4th decades of life with 48.7% males and 51.3% females respectively. The most frequent site involved by these tumors were parotid gland [66.5%]. Submandibular gland, minor salivary glands of palate and lip were the other sites involved, but none of the tumor was found in sublingual gland. The tumor size ranged between 0.4 to 18 cm with maximum variation in Pleomorphic adenoma and myoepithelioma. Conclusion: benign salivary gland neoplasm are more common than their malignant counterparts. They occur mostly in 3rd and 4th decade. Parotid gland is the most common site and pleomorphic adenoma remains the most common bengin salivary gland neoplasm followed by myoepithelioma.

Acute limb ischemia due to ergotism

Acute ischemia of an extremity potentially threatens limb loss and occasionally the life of the patient. We are reporting two cases of extremity ischemia secondary to ergot poisoning. The first patient was a 60 years old woman, who presented with a 15 days history of ischemia of the left arm with gangrene of the fingers and pain in the resting right hand for one day. Right brachial artery catheterization showed severe spasm of the artery which was resolved by passage of the inflated balloon catheter. She underwent amputation for gangrene of the left hand. The second patient presented with bilateral symmetrical ischemia of the lower extremities which improved upon withdrawal of the ergot containing medicine. She responded to nifedipine

Cerebral embolism Distal subclavian disease as a rare etiology

Subclavian artery occlusive disease is usually secondary to persistent compression caused by thoracic outlet syndrome [TOS] and rarely due to focal atherosclerosis. Emboli from diseased vessel can flow retrograde to the vertebral or carotid arteries to produce ischemic infarct with or without neurological deficit. We are reporting two cases of distal subclavian artery disease presenting with cerebral embolization, an unusual manifestation. Such surgically correctable lesions producing cerebral emboli and stroke needs consideration while evaluating patients with unusual presentation to prevent further occurrence of stroke