Cystic duct anomalies and their surgical implications in patients undergoing laparoscopic cholecystectomy

Background: During cholecystectomy, to avoid common bile duct injury or other per operative complication, the knowledge of cystic cyst anomalies is imperative. This study aimed to highlight cystic duct anomalies identified during laparoscopic cholecystectomy and report their implications

Methods: This prospective study was conducted at Liaquat University of Medical and Health Sciences, Jamshoro over a period of six years [2009-2014] in the department of Surgery. Over this specified period a total of 775 patients underwent cholecystectomy and were included in this study

Results: Among 775 patients who underwent laparoscopic cholecystectomy, abnormal confluence was found in 7.22%, short cystic duct in 26.78%, long cystic duct in 17.86% and double cystic duct in 12.50%. Surgical problems encountered due to these variations were cystic duct avulsion, common bile duct injury, bleeding and bile leak

Conclusion: During laparoscopic cholecystectomy, unidentified anatomical variations of cystic duct may cause drastic complications including ductal injuries which significantly increase morbidity and may raise mortality

Role of vitamin E in mastalgia in young women

Background: Vitamin E is a fat soluble vitamin and plays key role in many body systems. It has been in clinical practice for mastalgia for decades, however there is still limited literature defining its precise role

Methods: This case series was retrospectively collected from a prospectively established database of a dedicated breast clinic for a period of 16 months. A total of 100 patients came with a complaint of breast pain; 20 patients excluded as 17 were having palpable lump while 3 were post menopausal. Eventually 80 patients were included in this study. They were given Vitamin E 400 mg a day for six months. They were followed up at six weeks then at three months and finally after six months. Patients were given a pain chart to mark severity of pain on daily basis

Results: Follow up initially at six weeks, three and six months suggested significant improvement in the symptoms of cyclical mastalgia [p<0.001]

Conclusion: Vitamin E is relatively safe supplement with a better compliance, therefore can be safely considered as first line management of mastalgia in premenopausal young patients

Role of shearwave elastography in the search of unknown primary cancer in breast and abdominopelvis

Objevtices: Shearwave elastography has recently got approval for its use in clinical imaging. It has got its established accuracy in assessing liver fibrosis, where biopsy for the staging of cirrhosis has been minimized. There is emerging data showing its superiority in detecting breast and other cancers as compared to conventional imaging methods. This study aimed to analyse role of shearwave elastography in detection of primary impalpable lesions in breast and abdomino-pelvic regions and those missed on conventional imaging modalities

Setting: Shearwave Elastography Unit, Liaquat University of Medical and Heath Sciences, Jamshoro, Pakistan

Design and methods: The study is an observational pilot project including the patients presented to surgery and oncology departments with metastatic cancer suggested on conventional imaging or cytology of the metastatic site but primary sites were not known and suspected to be in the region of breast, abdomen or pelvis. Shearwave elastography was applied as supplementary tool to re-do B-mode ultrasound. Aixplorer Ultrasound System Multiwave version 8.2.0 [Supersonic Imagine S.A., Aix-en-Provence, France] was used in this study. This study selectively includes the patients who were called on experimental basis to see the effectiveness of the system on trial basis, the calculation of the sensitivity, specificity, positive predictive value and negative predictive values were not determined

Results: There were seven patients including four with axillary lymph nodes and three having liver metastases. In patients with axillary lymph nodes mammogram and conventional ultrasound failed to show primary breast lesions, histopathology of the axillary lymph nodes suggested infiltrating ductal carcinoma. In patients with liver metastases conventional ultrasound abdomen and CT scan failed to reveal primary lesions. Shearwave assisted B- mode ultrasound suggested a solid mass in a complex cyst in the kidney in one patient and in the other there were multiple benign cysts and a solid mass however the third patient with liver mass found to have primary from gall bladder. These findings were later confirmed on histopathology or cytology

Conclusion: Shearwave elastography is an emerging non invasive technology showing potential role to supplement B-mode ultrasound in detecting unknown primary cancerin breast and abdomino-pelvic region

incidence, pattern and outcome of stray bullet injuries: a growing challenge for surgeons

Objective: To study the incidence, pattern of injuries, presentation and management of stray bullet injuries

Methods: All patients presented and admitted with stray bullet injuries during a period of 4 years from January 2006 to December 2010 were included in this prospective study which was conducted at Liaquat University of Medical and Health Sciences Hospital Hyderabad/Jamshoro. All of the study subjects were admitted through casualty and were initially thoroughly examined and resuscitated. The pattern of injuries was noted and requisite investigations performed. Patients who sustained injuries demanding surgery were prepared accordingly and were submitted for laparotomy or other procedures depending upon the severity of injuries. The data collected on individual basis and variables studied including demographics, pattern of injuries, time since injury occurred and management

Results: A total number of 165 patients with a mean age of 17.1 years, SD 13.807 and range of 74[2-76] presented with stray bullet injuries during study period. The study population comprised 117[70.90%] males and 48[29.09%] females. Majority of the patients were brought late because of delay in diagnosis or delay in transportation. The commonest victims were young children in their teens and comprised 78% of the study population. Haemothorax/ pneumothorax or peritonitis was the common presentations occurring in 11% and 61.81% of the study population respectively. Of the total number, 92 [55.75%] patients underwent laparotomy while remaining patients either had chest intubation or some other procedures done accordingly. Nine [5.45%] patients developed permanent disabilities while 13[7.87%] patients died either immediately after arrival or later on in the hospital during or after the operative treatment. Mortality was related to the time of arrival in hospital since the injury and thus was highest among those brought 4 or more hours after the shot [P < 0.001]. Patients who did not sustain major injuries were kept under observation and were subsequently discharged

Conclusion: Stray bullet injuries are an ever increasing challenge in our society. Unlawful and jubilant use of weapons in celebrations, weddings and similar occasions are causing a lot of morbidity and mortality in the society