Frequency of raised urinary trypsinogen-2 in acute pancreatitis

Objectives To determine the frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis

Methodology Settings Patients in emergency refer to General Surgery ward-3 Jinnah Post Graduate and Medical Centre Karachi. Duration Six months, started from 20-01-2012 to 19-07-2012. Study Design Cross sectional descriptive study. Subjects and Methods All cases of Acute Pancreatitis diagnosed by Upper Abdominal Pain, Raised Serum Amylase and/or Serum Lipase and Abdominal CT Scan findings, were included in the study. Urinary Trypsinogen-2 dipstick test was done. All patient related data including age, gender, sex and raised Urinary Trypsinogen-2 or normal, was recorded. Data analysis was done on SPSS version 10. Frequency and percentage was calculated for gender and raised trypsinogen-2. Age and gender wise stratification was done to see the effect of these variables on outcome

Results Mean age of the patients was 38.14 +/-7.42 years. The minimum age was 24 years, while the maximum age was 63 years. Raised urinary trypsinogen-2 level was present in 55 [65.5%] patients. Stratification of age group shows, that 40 [66.7%] patients in age group

Conclusion The frequency of raised Urinary Trypsinogen-2 in diagnosed patients of acute pancreatitis was found to be high

Comparative results of repair of ischemic mitral regurgitation [IMR]: conventional against trans-septal approach

Objective Ischemic mitral regurgitation is common and increases mortality, even when mild. [American Heart Association] AHA and European association have both stressed the need of mitral valve repair in patients with moderate or more regurgitation. The aim of this study was to compare the results with the conventional and right atrial trans-septal approach of mitral valve repair in Ischemic Mitral Regurgitation [IMR]

Methodology A total of 308 consecutive patients underwent mitral valve repair for IMR, between January 2012 and December 2013 at Tabba Heart Institute. Patients who had at least moderate mitral regurgitation or more mitral regurgitation underwent mitral regurgitation repair. The final decision of mitral valve repair was taken after the intra operative trans-esophageal echocardiography [TEE]

Result Total number of patients included in study was222, out of those 153 [69.9%] patients underwent conventional approach and 69 [31.1] patients underwent trans-septal approach. Total 88.2% patients got off bypass in normal sinus rhythm in conventional approach group, as compared to 82.1% in transseptal group. 11.8% and 17.9% patients got off by pass on pacing in conventional and transseptal approach respectively. 3 patients developed junctional rhythm and 5 patients developed complete heart block in post-operative period in trans-septal approach

Conclusion Right Atrial Trans-septal technique is a good alternative approach that can be used in relatively small atria. It not only provides an excellent exposure to the mitral valve, there also seems to be no associated rhythm disturbances encountered as well

Acute sub dural hematoma with extra dural hematoma evacuation in ventricular septal defect patient using conventional craniotomy under local anesthesia following peer regimen

Background: extradural hematoma [EDH], and acute subdural hematoma [ASDH] are common pathologies encountered in neurosurgical emergencies following traumatic injuries usually secondary to road traffic accident, assault and fall. Both extradural hematoma and acute subdural hematoma have dreadful effects on patient's health if not managed properly and timely and even lead to death. The standard treatment for such problems is conventional large craniotomy under general anesthesia to prevent fatal outcomes

Method: we have presented a case of ASDH with EDH in a patient having history of large ventricular septal defect and due to large ventricular septal defect patient had delay in getting fitness and alongside patient had fallen Glasgow Coma Scale [GCS] which encouraged surgeon to perform the surgery under local anesthesia by following Peer Regimen

Results: the outcome of case turned fruitful and providing possibility of Local anesthesia [Peer Regimen] as an alternate in case of critical emergency to save life of patient

Conclusion: acute Subdural hematoma with either concomitant ventricular septal defect or alone can evacuated safely under local anesthesia using Peer regimen. Further studies should be carried to know the more benefits of procedure and potential hazards of procedure and to improve outcome from this lethal type of brain injury