Comparison of displaced patellar fracture treatment by two methods: cerclage circumferential wiring versus tension band wiring

There are a variety of methods for operative treatment of patellar fractures. The aim of this study was to compare the outcome of cerclage wiring [CW] versus Tension Band Wiring [TBW] for treatment of displaced fractures of the patella. In this retrospective study we reviewed the medical files of the patients who had displaced transverse or comminuted patella fractures treated at two trauma hospitals between 2004 to 2010. Forty four patients were found that had been operated with either of these two methods: TBW=24, CW=20. Outcome was evaluated by Bostman rating score, at a mean follow up time of 2.3 years. Mean age of all patients was 32.7 years. There was no significant difference regarding the mean age, gender, and mechanism of the fractures in patients treated by two methods of TBW and CW. Atrophy of quadriceps muscle was [1.146 cm +/- 0.9cm] in 19 patients with TBW, and [2.3 +/- 0.6cm] in all patients with CW, which shows significant difference. No case of infection or nonunion had occurred. Good to excellent results in TBW and CW were found in 83.4% and 80% of patients respectively that reveals no major difference. Hardware removal due to pin irritation was performed in 66.6% of TBW and 10% of CW group. There was no significant difference between two groups with respect of PF osteoarthritis. Despite less secure fixation with CW, both TBW and CW methods had comparable outcome with a high rate of good to excellent results in the treatment of displaced patella fractures. Individualized treatment plan based on the type and pattern of the fracture is suggested.

Effect of treatment with metformin on omentin-1, ghrelin and other biochemical, clinical features in PCOS patients

Polycystic ovary syndrome is associated with insulin resistance and obesity. Previous studies suggest that metformin by reducing hyperinsulinemia is clinically useful in the treatment of polycystic ovary syndrome. This study's Objective is to observe the role of metformin in omentin1, ghrelin, and other biochemical, clinical features within three months in hyperinsulinemic women with polycystic ovary syndrome. Another aim is to assess the decrease in hyperinsulinemia and body weight by metformin in the population. This study was carried out at the Kamal AL Samarai Hospital between June 2007 and March 2008. 60 women fulfilling the clinical and biochemical criteria for polycystic ovary syndrome and hyperinsulinemia were enrolled. Metformin was started at an oral dose of 850 mg/day for 3 months. Besides Body Mass Index [BMI], Waist Hip Ratio [WHR], serum omentin1, ghrelin, fasting insulin, fasting blood sugar and lipid profile levels were performed. After three months, all these parameters were assessed. Omentin1, ghrelin and insulin were measured by enzyme-linked immunosorbent assay, fasting blood glucose and lipid profile were measured by colorimetric methods. Mean Body Mass Index and Waist Hip Ratio had significantly decreased in the 60 polycystic ovary syndrome patients after three months of Metformin therapy. Serum levels of omentin1, ghrelin and HDL-cholesterol were increased while the total cholesterol/HDL cholesterol ratio was decreased significantly. Serum concentrations of insulin, Homeostatic Model Assessment [HOMA] and HOMA beta -cell% were also decreased significantly, the present study showed a significant increase in omentin1: insulin ratio, omentin1: HOMA ratio and omentin1: HOMA beta -cell% ratio. There was a significant an increase in omentin1: insulin ratio, omentin1: HOMA ratio and omentin1: HOMA beta-cell% ratio. These results in the present study are shown the first time, these factors may be useful in following improvements in insulin sensitivity in subjects with polycystic ovary syndrome or obesity treated with insulin sensitizers. Further studies are needed to certify these factors in other populations with these treatment or with other insulin sensitizers or when treated with diet and exercise

Pseudocyst of the pancreas.

1. Early diagnosis of pseudocyst of the pancreas. 2. Determination of the incidence of various etiological factors in Faisalabad area. 3. Evaluation of the various management options. DESIGN: Retrospective study. SETTING: Department of Surgery Punjab Medical College, Faisalabad. PERIOD: April 1993-1996. PATIENTS AND METHODS: Fifteen patients. 13 males [86.67%], 2 females [13.33%]. Age ranging between 6 to 50 years [Mean age=28 years]. 11 cases [73.33%] secondary to blunt abdominal trauma, 2 cases 13.33% secondary to Choledocholithiasis and 2 cases 13.33% secondary to alcoholic pancreatitis. 13 patients [86.67%] underwent Cystogastrostomy [CG] and 2 patients [13.33%] underwent External drainage [ED]. One patient [6.67%] with a history of alcoholism died secondary to recurrence of pseudocyst and bleeding during postoperative period

Surgical treatment of carcinoma of the pancreas

1. To highlight the surgical treatment of carcinoma of the pancreas. 2. To discuss its various treatment modalities. DESIGN: Case study PERIOD: June 1994 to June 1996. SUBJECTS: A total of 30 patients [09 females [30%] and 21 males [70%]. Age ranged between 24 to 80 years [mean being 52 years]. SETTING: Allied Hospital Faisalabad DIAGNOSTIC CRITERIA: Ultrasound, CT scan, operative findings and biopsy. PATIENTS AND METHODS: Nineteen patients [63.33%] had cholecysto jejunostomy [C.J]. Nine patients [30.00%] had choledocho duodenostomy [CDD] and two patients [6.66%] had Hepatico jejunostomy [HJ]. All had prophylactic antecolic Gastro jejunostomy [GJ]. All were T3 or higher stage tumours. 1. None of the patients underwent curative resection. 2. All underwent various types of palliative surgical bypass. CONCLUSIONS: Palliative surgery for carcinoma pancreas has tow advantages; 1. It gives long term relief of symptoms. 2. Only surgical explorations offers potential for curative resection