Diaphragmatic perforation without penetration into the peritoneum in sharp thoracoabdominal injury

In diaphragm injuries, especially those which are left sided, it is recommended to repair diaphragm perforation to prevent complications. However, we found two cases of diaphragm injuries including two 27 and 31 years old men who were injured with stab but they were not repaired at thoracoscopy. Both patients were haemodynically stable. Chest X-ray and CT-scan were not in favor of diaphragm perforation in both cases. The thoracoscopic finding was a 1.5 [case 1] and 1 cm teasing on the left diaphragm on the left muscular past of the diaphragm without penetrating into the abdominal cavity and with an intact peritoneum documented by probing. Due to intact peritoneum and absence of peritoneal signs, no further thoracotomy was performed. The patients were followed for 6 months with CXR and also physical examination. They did not develop any complication on the follow-up. In conclusion, in spite of diaphragm injuries, since peritoneum was intact in both cases, neither underwent thoracotomy which is invasive. They were asymptomatic during the 6 months of the follow up

Necrotizing pancreatitis as an unusual cause of severe abdominal pain during pregnancy

Acute pancreatitis is an uncommon cause of abdominal pain during pregnancy that may become severe and rarely progresses to a necrotizing form with a high maternofetal mortality even in young patients[1, 2]. A small number of pregnant women with acute pancreatitis have an associated hyperlipidemia, usually hypertriglyceridemia while in all these cases, pancreatitis is mild in severity and is responsive to conservative medical management[2.3]. We present a case of necrotizing pancreatitis in a 25 years old pregnant woman at 34 weeks of gestation, who presented with acute abdominal pain, nausea and vomiting that required operative management

Metabolic and clinical effects of Ramadan fasting in patients with type 2 diabetes

To evaluate the effects of fasting on anthropometric indices and carbohydrate and lipid metabolism in patients with type II diabetes. Design: Observational non-interventional study. Place and Duration of Study:: Diabetes clinic, Shariati Hospital, Tehran, Iran during Ramadan 1419 [winter 1998-99]. Patients and Fifty-seven volunteers with type II diabetes underwent anthropometric and biochemical evaluation before and on the 14th and 28th days of Ramadan. Biochemical markers were measured by standard laboratory methods and anthropometric indices by WHO criteria. Statistical analysis was done by ANOVA for repeated measurements and Friedman's two-way ANOVA using SPSSv6 software. Daily cholesterol intake increased in all subjects [p<0.03]. Body mass index increased in women [p<0.03], but BMI and waist-hip ratio both decreased in men [p<0.01]. Blood pressure, fasting blood glucose and serum fructosamine did not change during the study. Plasma insulin [p<0.05], C-peptide [p<0.01] and insulin resistance [p<0.01] decreased only in men. Total and LDL cholesterol increased significantly in all subjects during the study. Ramadan fasting does not alter carbohydrate metabolism or tissue insulin sensitivity in patients with type II diabetes given appropriate dietary education and rescheduling of oral hypoglycaemic medication. Lipid profile is unfavourably altered due to changes in both diet and biochemical response to starvation