Outcome of Longitudinal Pancreatico-Jejunostomy on Pain Control and Pancreatic Function in Chronic Pancreatitis

Background: Outcome of drainage operation for chronic pancreatitis are variable. The present study is taken to observe effect of longitudinal pancreatico-jejunostomy (LPJ) on pain control and pancreatic function in chronic pancreatitis in our setting.Material & Methods:Thirty-three patients who underwent LPJ for symptomatic chronic pancreatitis for one year period presented with abdominal pain (100%), steatorrhoea (30.3%), diabetes (66.7%) and weight loss (78.8%). Definitive diagnosis was made on the basis of ultrasonography and MRCP findings. LPJ (Partingtong-Rochelle) operation was done in all patients. Pain (using visual analoge scale), glycemic status (using FBS, 2hABF, HbA1c), body weight, serum zinc levels (as a marker of exocrine function), and serum insulin level (as a marker of endocrine function) were measured immediately after admission and 3 months after operation.Results:Three months after operation pain was completely disappeared in 23 (69.7%) patients, it persisted in different grade in 10 (30.3%) patients and the pain reduction rate was significant. Twenty two patients who had diabetes prior to surgery, their glycemic status significantly decreased and serum insulin level significantly increased (preoperative; 7.1�1 礥/L, postoperative; 14.3�礥/L) in 22 patients with DM after surgery. Serum zinc level increased (preoperative; 80.8�.5 礸/dl, postoperative; 85.3�.7 礸/dl) 3 months after surgery but the difference was not significant (p=0.571). However the body weight of all patients were significantly increased after operation.Conclusions:LPJ reduces abdominal pain and improves both exocrine and endocrine function in patient with chronic pancreatitis. Serum zinc levels can be considered as a tool of exocrine function.

Evaluation of stentangioplasty in university cardiac center.

In this ongoing prospective study conducted in University Cardiac Center, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2004 to January 2006. Fifty (50) patients (mean age 56+/-7.2 years) underwent stentangioplasty were evaluated. The study group of 50 patients consisted of 42 (84%) men and 08 (16%) women. The aim of this study was to evaluate in-hospital success, failure and complications during the procedures. About risk factors 19(38%) had hypertension, 13(26%) were smoker, 11(22%) suffered from diabetes mellitus, 05(10%) had family history of ischaemic heart disease. Average left ventricular ejection fraction was 54+/-7. Target vessel percutaneous coronary angioplasty (PTCA) were done in 61 vessel, intracoronary stent implanted in 58 vessels, direct stenting were done in 35 cases, failed PTCA were in 03(6%) cases and two had dissection. The native vessels had a mean reference diameter of 2.91 mm and their luminal diameter increased significantly after percutaneous coronary intervention (PCI). All the patients were discharged by one to three days of the procedure with improvement of their clinical condition. In conclusion, intracoronary stent deployment in coronary artery stenosis following balloon angioplasty is a valid and beneficial strategy with good in-hospital results.

Preoperative discrimination of benign and malignant ovarian tumors using color Doppler sonography and its correlation with histopathology.

A total of forty clinically diagnosed ovarian tumors were studied over a period of one year. The study aimed at evaluating the efficacy of trans-vaginal color Doppler sonography (TV-CDS) in preoperative discrimination of benign and malignant ovarian tumors and to correlate the imaging findings with postoperative histopathological findings. The pulsatility Index (PI) and Resistive Index (RI) were studied as primary effecacy variables of TV-CDS. In the present study, using TV-CDS, 72.5% of the ovarian tumors were found benign and 22.8% were malignant which were significantly correlated with postoperative histopathological findings. The average PI for benign and malignant tumors were 1.98 and 0.77 respectively and RI for benign and malignant tumors were 0.62 and 0.41 respectively. The low PI and RI values in malignant tumors as compared to benign ones were statistically highly significant (p < 0.001). The validity tests for TV-CDS were found to be 90% sensitive, 100% specific and 97% accurate. The study concludes that TV-CDS is a useful imaging diagnostic modality in preoperative discrimination of benign and malignant ovarian tumors due to its excellent characterization of tumors neo-vascularization.

Comparison and outcome of commissurotomy by metallic valvotome and balloon commissurotomy.

The purpose of this study was to compare the echocardiographic outcome of percutaneous transvenous metallic mitral commissurotomy (PMMC) and Percutaneous transvenous balloon mitral commissurotomy (PTMC). This prospective comparative study was carried out during the period of January 1999 to June 2000 in the department of Cardiology, National Institute of cardiovascular diseases (NICVD) and national heart foundation hospital, Dhaka Bangladesh. Two dimension, M-mode, spectral and colour Doppler studies were done to all patient of mitral stenosis both before and after PMMC and PTMC. The increased in mitral valve area in PMMC was statistically significant than PTMC. (P<0.047).

Bilateral giant angiomyolipoma of kidneys: a case report and review of literature.

Angiomyolipoma is uncommon benign tumor of the kidney. Bilateral and multiple lesions are associated with tuberous sclerosis. We report a case with bilateral giant angiomyolipomas in a patient who had no other features of tuberous sclerosis. In this case, the involvement of the kidneys was diffuse rather than usual well-circumscribed lesions.

Renal artery involvement in patients of coronary artery disease undergoing coronary angiography--a prospective study.

METHODS: We prospectively studied the angiographic incidence of renal artery stenosis in 1000 consecutive patients who underwent coronary angiography for clinically suspected coronary artery disease since December, 1998. Selective renal arteriography was performed in all the patients (mean age 57 years, 74.6% males) after coronary angiography. RESULTS: Systemic arterial hypertension was present in 52%, 29.1% were smokers, 21% had diabetes and 31.2% had hypercholesterolemia. Significant coronary artery diseases was found in 849 (84.9%) patients. Of the total patient cohort, 103 (10.3%) patients had renal artery disease; 78 (7.8%) had insignificant stenosis (> 50%) and significant renal artery stenosis (< 50%) was identified in 25 (2.5%) patients. Three had bilateral renal artery stenosis. Comparisons were made between renal artery stenosis and risk factor profile. There was no statistically significant association between renal artery stenosis and parameters like diabetes mellitus, hypertension, smoking, lipid levels and serum creatinine. CONCLUSION: In our study, the absolute number of cases with significant renal artery stenosis is small, so no statistical analysis could be performed to demonstrate the relationship of presence of renal artery stenosis with severity of CAD. However patients with severe coronary artery disease or having multiple risk factor showed a trend towards increased prevalence of renal artery stenosis, hence renal angiography should be done for this subset of patients.

Carotid artery involvement in patients of atherosclerotic coronary artery disease undergoing coronary artery bypass grafting.

BACKGROUND: Patients with concomitant critical carotid and coronary artery disease are at risk of major neurological events while undergoing coronary artery bypass grafting. The presence of carotid artery stenosis increases the stroke rate in the perioperative period. In an effort to reduce the stroke rate, many institutions perform routine preoperative noninvasive assessment of the carotid arteries. METHODS AND RESULTS: We analyzed the clinical and laboratory data of 1,200 patients who underwent coronary artery bypass surgery in the last 2 years. Carotid Doppler was normal in 186 patients (15.5%), and showed <30% stenosis in 796 (66.3%), 30%-50% in 110 (9.2%), 50%-70% stenosis in 64 (5.3%) and critical (>70%) stenosis in 44 (3.7%) patients. Conventional risk factors such as hypercholesterolemia, hypertension, smoking and family history were not independent predictors of carotid artery stenosis. However, diabetes as a risk factor had a significant association with carotid artery disease (79.6% v. 43.8%, p<0.02). There was a trend towards increased prevalence of carotid artery stenosis in patients with > or = 2 risk factors (84.3% v. 68.8%). Patients with significant carotid artery stenosis had severe coronary artery disease (triple-vessel disease 93.3%, left main coronary artery disease 12.0%). Out of 44 patients with critical carotid artery stenosis, 27 were subjected to carotid angiography. Doppler findings correlated well with angiography. Seventeen patients underwent carotid artery intervention. None had any perioperative neurological events. A total of 5 (0.4%) patients had a major stroke. Coronary artery bypass grafting was done in 27 patients with critical stenosis without any intervention. The stroke rate (11.1%) was higher in these patients compared to patients with < 70% carotid artery disease or post-carotid intervention (2.5%) patients. Thus, untreated >70% carotid artery stenosis was associated with a higher stroke rate. CONCLUSIONS: Doppler screening of the carotid artery is helpful in detecting the subgroup of patients at increased risk of stroke. Patients with critical carotid artery stenosis should be subjected to angiography. Prophylactic intervention may reduce the occurrence of stroke in the perioperative period.

Myoglobinuria: evaluation of methods in the clinical diagnosis acute renal failure.

Patients with red--brown urine which may be a sign of myoglobinuria, can develop acute renal failure. We assayed serum creatinine, blood urea nitrogen (BUN) and creatine kinase activity in a total of 33 patients of equal groups, A (automobile accident), B (trauma) and C (undergoing rhabdomyolysis). In addition we tested 132 urine samples for the presence of myoglobin using a dipstick assay. Only five patients in group A showed any sign of myoglobinuria with increased creatine kinase activity upto 7 times the normal value but their serum creatinine level and BUN were within the normal range. In contrast, all 22 patients in group B and C showed myoglobinuria and above normal concentrations of serum creatinine and BUN, with significantly increased (p < 0.0001) creatine kinase activity upto 150 times the normal range. Four of the most seriously ill patients in group C developed acute renal failure. Supplementation of routine determinations of serum creatinine and BUN and serum creatine kinase activity with a rapid test for myoglobinuria provides an extra indication of impending renal dysfunction. It may be beneficial in the emergency management of these patients.

Hypomagnesemia and clinical implications in children and neonates.

The prevalence of hypomagnesemia was studied in neonates and children. The specimens were selected randomly from those submitted to the clinical chemical laboratory for blood test. A serum magnesium concentration less than 0.74 mmol/L was considered hypomagnesemic. A total serum magnesium determinations of 910 patients showed that 188 (21.7% prevalence rate) patients contained low serum magnesium levels. Frequently encountered hypomagnesemia was found among neonates with clinical conditions as diarrhea 41 (21.8%), premature births 24 (12.8%), neonatal hepatitis 20 (10.6%) and respiratory distress syndrome 5 (2.7%). In children the clinical conditions most frequently encountered with low serum magnesium were seizure 30 (16%), renal disease 26 (13.8%), metabolic acidosis 18 (9.6%), ideopathic apnea 14 (7.4%) and tachycardia 10 (5.3%). The statistical analysis of low serum magnesium values of patients in various clinical groups showed a significant difference (p < 0.0001) upon using homogeneity of variances but this was insignificant with the application of Kruskal-Wallis 1-Way ANOVA since Chi-square = 12.5748.

Dyslipidemia: clinical approaches, evaluation of methods and strategies for standardization.

Disorders in lipid metabolism (dyslipidemia) can result to the chronic heart disease. The low density lipoprotein (LDL) is a critical subfraction of total cholesterol present in serum because it is directly linked to coronary heart disease (CHD). The growing awareness of the risks of CHD stipulates the need for more accurate and precise measurement of LDL cholesterol. Current approaches in diagnosing and monitoring CHD is largely dependent on calculated LDL (CLDL) value due to the inherent complexity of ultracentrifugation method. While friedwald's calculated formula may provide comparable values with ultracentrifugation method, it may provide a result which is different. This difference may be of clinical significance. The lipoprotein electrophoresis may be useful in measuring LDL cholesterol, in the diagnosis of type III hyperlipidemia (broad beta band) and when the triglyceride level exceeds 400 mg/dl. The result that compares the CLDL with that obtained by the electrophoresis showed a significant difference (P > or = 0.000) for LDL and insignificant difference (P = 0.068) for high density lipoprotein (HDL) cholesterol.

Metabolism of magnesium in health and disease.

Magnesium (Mg) is an intracellular cation. It is an essential element which catalyses more than 300 enzymatic reactions, in particular those involving ATP. Approximately half of the total Mg in the body is present intracellularly in soft tissues, and the other half is present in bone. Serum Mg determination represents only 1% of total body's Mg concentration. Modern instruments will soon be available to determine physiologically active intracellular ionised Mg. Despite the ubiquitous nature of Mg, low serum Mg occurs either from decreased absorption or due to increased excretion. Hypomagnesaemia is surprisingly common in hospital populations and is more prevalent in acute than in chronic cases but often remains undetected or overlooked. Magnesium deficiency may result in hypokalaemia and hypocalcaemia. Myocardial Mg depletion may result in influx of Na+ and Ca+2 into the mitochondria which may lead to myocardial cell death. Hence, low Mg concentration may be a factor for a wide variety of clinical conditions.