Role of deliberate creation of control enterocutaneous fistula in patients of abdominal tuberculosis with perforation of small bowel and matted small intestine

To study the results after forming the controlled enterocutaneous fistula in the patient of abdominal tuberculosis with matted and perforated small bowel. Design, place and duration of study This study based on therapeutic trial and conducted in one and half years from january1999 to june2001 at Mayo Hospital, Lahore. All these 20 patients either operated in emergency or on elective list were malnourished, toxic and their operative findings were almost the same, these patients had extensively matted, friable and perforated gut. In these patients it was technically not possible to perform some definite procedure like right haemecolectomy or ileostomy with out increasing the morbidity or mortality. Under these circumstances, minimal surgical procedure which can be life saving is to oppose the anterior abdominal wall to the perforation and thus create a controlled enterocutaneous fistula. In 11 patients fistula closed on its own and in eight patients fistula remained patient and needed re-exploration and repair. This new method of treatment has yielded excellent results. We were able to cure the disease with no mortality. It is recommended that in cases of TB peritonitis with perforation and matted gut making of a controlled enterocutaneous fistula saves the life of the patient

Insulin requirement in diabetic patients with chronic renal failure due to diabetic nephropathy [DN]

This study was performed in the Department of Medicine, Postgraduate Medical Institute and Lahore General Hospital, Lahore. One hundred patients of type 1 and type 2 diabetes with diabetic nephropathy induced chronic renal failure, of either sex; the ages above 18 years were included in the study. Patients, recruited, were investigated to rule out any other cause of renal failure. Data was collected on a questionnaire regarding duration of diabetes, previous diabetic treatment and compliance. Patients were put on insulin and their daily blood glucose charts were maintained. When the patients achieved optimal glycaemic control, total amount of insulin per day was recorded. This study included a total of 100 diabetics, 12 [7 men, 5 women] had type 1 and 88 [41 men, 47 women] had type 2 disease. Duration of diabetes was higher in type 1 [15.6 +/- 3.2 years] than in type 2 diabetes [9.7 +/- 5.0 years]. All patients with type 1 diabetes required insulin but there was reduction of 28.2%-60.0 % as compared to maximum units taken prior to renal impairment. About 35.2% patients of type 2 diabetes did not require any insulin. Mean insulin requirement was lower in type 2 diabetics [14.8 +/- 14.6 units/day] than in type 1 diabetics [34.3 +/- 9.9 units/day]. The Pearson correlation [2-tailed] between serum creatinine and 24 hour insulin requirement was significant [P=0.01]. The purpose of this study was to find out the requirement of insulin for optimal glycaemic control in diabetics with impaired renal function due to diabetic nephropathy. It was concluded that the patients with impaired renal function due to DN had lower requirement of insulin than before the development of DN. Type 1 diabetic patients had significant reduction in insulin compared to the requirement prior to DN. Some type 2 diabetic patients did not require any treatment

Effect of exogenous melatonin on gonadal functions in mature male rats

To study the effect of melatonin on the gonads, seminal vesicles and prostates, melatonin was injected subcutaneously [at 3 p.m] into mature male rats in a dose of 50, 100 and 500 ug. daily for 20 days. A significant decrease [P < 0.01] in the average weight of the testes occurred in the groups treated with the second and third dose of melatonin. A moderate inhibition of spermatogenesis and spermatocytogenesis in most tubules of the testes in the groups treated with lowest dose was observed. Drastic inhibition of spermatogenesis and spermatocytogenesis in the tests of treated groups with the second and third doses was noticed. The number of leydig cells and the diameter of seminiferous tubules were significantly decreased [P < 0.01] in first dose] and [P 0.001 in the second and third doses.] A highly significant decrease [P < 0.001] in the average weights, drastic hypoactive and atrophy of seminal vesicles and prostates in all treated groups was noticed. A significant decrease [P < 0.01] in serum testosterone of the group treated with the lowest dose, and the results of moderate and highest doses were below the sensitivity of the curve [less than 0.3 ng/ml]. From this work, it is clear that the suppressive effects of melatonin on gonadal functions was dose dependant. A maximum inhibitory action resulted from injection of the moderate dose. The suppressive effects of melatonin on gonadal functions may be due to a direct effect on the gonods. Also, may be due to suppression of the gonadotrophin hormone or reduction of the gonadotrophin releasing hormone from the hypothalamus by endorphin. May be also, due to decrease of the prolactin hormone which decreased the sensitivity of LH and FSH receptors in the testes