Paraplegia Following Spinal Cord Contusion from an Indirect Gunshot Injury / 대한신경손상학회지

Spinal cord injuries are debilitating and life threatening. Paraplegia due to direct traumatic gunshot injury to the spinal cord is common. The most common cause of spinal cord injury is road traffic accidents. This is followed by spinal cord injury due to a fall from a height. Most of the spinal cord injuries due to gunshot wounds occur as a result of direct traumatic effects. We present a rare case of a 49-year-old male with trauma. He developed paraplegia after a gunshot wound injury to the neck and contusion to the spinal cord, with no direct trauma. Paraplegia due to direct gunshot injury can have many different outcomes. In our case, the patient was managed conservatively, and the outcome was favorable.

Routine or selective histopathology of gallbladder specimen after cholecystectomy for gallstone diseases

Objectives: To determine the incidence of incidental gallbladder cancer [IGBC] and to assess the need of routine histopathological examination of all gallbladder specimens after cholecystectomy for benign gallstone diseases Design: Retrospective study Setting: Department of Surgery, College of Medicine, King Saud University, KSA

Subjects: This study included all the patients who underwent elective or emergency cholecystectomy for gallstone disease at King Saud Medical City, Riyadh, Saudi Arabia between January 2012 and September 2015. Patients with preoperative suspicion of gallbladder cancer on imaging, or underwent cholecystectomy for gallbladder polyps or porcelain gallbladder were excluded from the study. Medical record of all the selected patients was reviewed and the data were collected. Interventions: Histopathological examination of gallbladder Main outcome measures: IGBC, routine histopathological examination of all gallbladder

Results: A total of 2396 patients underwent cholecystectomy for gallstones disease. All gallbladder specimens were sent for histopathological examination. IGBC was detected in nine gallbladder specimens [0.4%]. Out of 2396 patients, morphologic abnormalities were observed in 518 specimens [22.6%]. There was no reported case of IGBC with normal appearance of gallbladder specimen. Five patients underwent simple cholecystectomy for stage T1b, three patients of stage T2 tumor had further liver resection and one patient received only palliative care

Conclusions: The incidence of IGBC was 0.38%. All cases of IGBC were detected in abnormal looking thick wall gall bladder. Therefore, selective histopathology of abnormally looking specimen is recommended to reduce the cost and work load of pathologists

experience of laparoscopic modified heller cardiomyotomy for achalasia cardia

Objective: The study was carried out to ascertain the outcome of laparoscopic modified Heller's myotomy for achalasia cardia and to determine the morbidity associated with it

Study Design: Descriptive cross sectional study

Place and Duration of Study: The study was conducted in Combined Military Hospital [CMH] Rawalpindi over a period of 4 years, from Jan 2010 to Aug 2014

Material and Methods: This study was carried out on patients undergoing surgical repair of laparoscopic Heller myotomy for cardiac achalasia at Combined Military Hospital Rawalpindi over a period of four years [2010-2014]. Patients undergoing laparoscopic-modified Heller myotomy at a thoracic referral and surgical training center. Eighteen cases of achalasia cardia based on clinical, barium and endoscopic findings were included in the sample using non probability purposive sampling technique. Pseudo achalasia, sigmoid esophagus were excluded. Laparoscopic modified Heller myotomy was done in all patients. Data were analyzed with the help of SPSS 20.0

Results: Age ranged between 14 years to 40 years with mean age of 28 years. The most frequent symptom was dysphagia [95%], followed by regurgitation of ingested food [60%], weight loss [40%] and chest pain [20%]. Mean operating time was forty minutes. There was no perioperative mortality. We applied Dor patch in 4 patients. Three patients had mucosal tear on large myotomy, diagnosed per operatively and repaired. There was no conversion to open procedure. There was marked improvement in symptoms especially dysphagia and there was no post operative reflux

Conclusion: Modified Heller myotomy by laparoscopic approach is a safe and effective procedure with acceptable results. It is easy to perform and improves the symptoms of the suffering individual

Is chest tube clamping necessary before removal? an experience with 2661 cases of tube thoracostomies

Objective: The aim of this study was to evaluate outcome of chest tube removal without clamping and relying only on clinical or radiological status for removal

Study Design: Retrospective descriptive study

Place and Duration of Study: The study was conducted in CMH Rawalpindi over a period of four years

Material and Methods: All patients of tube thoracostomies during Jan 2010 to Dec 2013 were included. Sample size was 2661. 1061 intubations were done for trauma, effusions and pneumothoraces, 905 in thoracostomies, 443 in VATS procedures like decortications, apical staplings, pleural biopsies and thymectomies and 252 in miscellaneous procedures such as open pleural biopsies, thoracoplasties and chest wall resections and reconstructions. Chest tube removal was based on absence of air bubbling in chest bottle, clinically or radiologically expanded lung, less than 6 cm excursion of column of chest tube and fluid output of <50ml [pus] and <100ml [clear fluid]. It was ensured in all cases that chest tube was not blocked and all tubes were removed by a thoracic surgery trainee. Chest tube was not clamped in any patient before removal to see respiratory distress

Results: Tube thoracostomies were performed in a vast variety of procedures. 1940 [72.9%] were males and 721 [27.1%] were females. Mean age was 37 years. In 1529 [57.4%] intubation was done on the right side. In 34 [1.27%] there was recurrent fluid collection. Recurrent pneumothorax was seen in 18 [0.67%] while tension pneumothorax was seen in 4 [0.15%]. Collective complication rate was in 56 [2.1%]. There was no mortality

Conclusion: Current worldwide practice of clamping chest tube before removal to judge respiratory distress can be challenged by our study. Emphasis is laid on clinical judgment, absence of air leak and minimal excursion sign of well expanded lung before removal of chest tube