Pattern of peripheral vascular disease in troops and troop families in armed forces

Objective: To delineate pattern of peripheral vascular disease [PAD] [upper or lower limb vessels] among troops and their families in the Armed Forces. Study Design: Cross sectional descriptive study. Place and Duration of Study: Armed Forces Institute of Cardiology [AFIC] and National Institute of Heart Diseases [NIHD] Rawalpindi and Combined Military Hospital [CMH] Rawalpindi over a 3 year period, from Aug 2012 to Aug 2015

Material and Methods: All serving and retired army personnel and their families were included in the study. Method of sampling was non probability convenience sampling. The total number of patients was 156. All referrals were from CMH vascular surgery department. All arteriograms were performed on Siemens angiography equipment without facility of DSA [digital subtraction angiography]. The lesions were placed in one of the following categories: normal category in whom either the vessels were normal or minimally diseased without any flow limitation, short and long segment stenoses, and short and long segment occlusions and diffusely diseased vessels. The arteriogram of infra inguinal region was divided into femoropopliteal segment and infra popliteal segment. SPSS version 14 was used to calculate the frequency and percentage of various disease patterns

Results: The pattern of peripheral vascular disease was divided in the lower limb in infra inguinal region into femoropopliteal disease and infra popliteal disease. The predominant pattern of disease in the femoro popliteal segment was long segment occlusion and the disease pattern in the infra popliteal segment was diffuse disease of the involved vessels. The predominant pattern of disease in upper limb was long segment blockage

Conclusion: Peripheral vascular disease among soldiers and families show advanced disease pattern at presentation

Laparoscopic surgery; incidence of intra operative and early post operative complications

Objective: To observe the rate of complications during elective laparoscopic cholecystectomies. Design and study duration: It was a prospective study and was carried out from July 2011 to June 2012. Setting: The study was conducted at PAF Hospital Islamabad. Patients: 105 patients with gall stone disease who underwent elective laparoscopic cholecystectomy

Material and Methods: 105 patients ranging in age from 23 yrs to 81yrs were operated. 12 were males and 93 were females. History, clinical examination and ultrasonography were used to diagnose the presence of gall stones. Patients with acute symptoms were excluded from the study

Results: The main complications encountered were iatrogenic perforation of the gall bladder [8], haemorrhage [7], post-operative bile leakage [4], and large gut injury [1]. Conversion to open surgery was done in three cases due to difficulty in identifying anatomy and in case of large gut injury. There was one death

Conclusions: Laparoscopic cholecystectomy [LC] has become the preferred method of treatment in surgery for gall stone disease. A sound knowledge of the complications and their management makes this a safe procedure

Fat embolism and fat embolism syndrome; management trends

Fat Embolism and the associated Fat Embolism Syndrome is a serious and potentially life threatening condition. It tends to occur usually after fractures or intramedullary instrumentation of long bones. Non-traumatic conditions such as Diabetes Mellitus severe Burns, SLE, sickle cell disease and Pancreatitis can also lead to Fat Embolic syndrome. Young adults are commonly affected. Presentation consists of an asymptomatic interval followed by pulmonary and neurological manifestations combined with petechial haemorrhages. The diagnosis largely depends on high index of suspicion and exclusion of other conditions. Treatment of this condition remains supportive. Mortality associated with this condition is significant, ranging from 10-20%