Left-sided appendicitis in a 14-year girl with midgut malrotation

We present a case of 14-year girl with left-sided acute appendicitis who presented with lower abdominal pain. Midgut malrotation occurs at a rate of 1 in 500 live births. The condition is incidentally diagnosed during various radiological investigations done for other purposes. However, such patients may present with conditions like acute appendicitis, which poses a diagnostic dilemma if a high index of suspicion is not kept. The purpose of this case report is to increase awareness in the emergency physicians and young surgeons of this rare presentation; and the importance of radiological investigations in the diagnosis of left-sided appendicitis, to decrease morbidity and mortality

Fascial slings: a new adjunct to Brachiobasilic Fistula Elevation fascial slings

Objective: To introduce a new technique of fascial slings created from fascia over biceps muscle as an adjunct to Brachiobasilic fistula elevation contributing in the ease of cannulation and position of arm for both nursing staff and the patient

Study Design: Retrospective study

Place and Duration of Study: This study was carried out in Combined Military Hospital Rawalpindi, form Jan 2016 to Apr 2017

Patients and Methods: The demographic and outcome data of the patients, who underwent Brachiobasilic Elevation using fascial slings, were collected and analyzed retrospectively

Results: A total of 89 [60 males, mean age 44.2 +/- 14 years and 29 females mean age 42.6 +/- 12 years] patients underwent brachiobasilic fistula elevation. The distance of fistula vein from skin incision at mid arm was found to be consistent from the per op measurement till the last assessment at 6 months. In our study it was 5 +/- 0.7 cm. Slinged vein was found to be easy to cannulate in first prick as per dialysis nursing staff. Fistula maturation rate was 91 Percent. A total of eight [9 Percent] fistulae were never put on dialysis because of thrombosis. The mean maturation time was 40 +/- 14 days. Fifteen [16 Percent] patients had arm edema, and twelve [13 Percent] had infections. Patients had similar ease of arm position as of brachiocephalic AVF during dialysis

Conclusion: Considering the consistent post op distance of fistula vein from scar site, ease of cannulation for the dialysis staff and comfort of arm position for the patient during dialysis after fascial slings it is concluded that fascial slings are good adjunct to basilic vein elevation technique

Accuracy of Ca-125 concentration as predictor of peritoneal dissemination of colo-rectal carcinoma

Objective: To determine the association of CA-125 levels with the peritoneal dissemination among the patients of colo-rectal carcinoma at a tertiary care surgical oncology unit of Pakistan

Study Design: Observational study

Place and Duration of Study: Department of Surgical Oncology, Combined Military Hospital Rawalpindi. Duration of ten months, from Jan 2018 to Oct 2018

Patients and Methods: A total of 83 cases of colorectal carcinoma were included in the study, which were diagnosed by consultant oncologist after relevant histological and radiological investigations. Peritoneal dissemination was confirmed during the surgery. CA-125 levels were assessed before the surgery and cut off of 35U/mL was used. Relationship of age, gender, raised CA-125, tumor metastasis and tumor differentiation was assessed with the presence of peritoneal dissemination among the patients suffering from colo-rectal cancer

Results: Fifty nine patients were males and 24 were females. Mean age of the patients was 51.17 [+/-3.395]. Out of 83 patients of colo-rectal cancer, 37.3 percent showed the presence of peritoneal dissemination while 62.7 percent had no peritoneal dissemination at the time of surgery. Forty one patients had raised levels of CA-125 while 42 had levels within the normal range. After applying the logistic regression we found that raised levels of CA-125 and metastatic illness had significant association with the presence of peritoneal dissemination among the patients of colo-rectal cancer

Conclusion: CA-125 concentration emerged as a strong predictor of peritoneal dissemination of colo-rectal cancer in our study analysis. Routine checking of levels of this marker among the patients of Colon cancer may help in early recognition of the advancement of disease and help the surgical oncologists to manage it in a more effective way