Spectrum and outcome of pancreatic trauma.

BACKGROUND AND AIMS: Pancreatic trauma is associated with high morbidity and mortality. Diagnosis is often difficult and surgery poses a formidable challenge. METHOD: Data from 17 patients of pancreatic trauma gathered from a prospectively maintained database were analysed and the following parameters were considered: mode of injury, diagnostic modalities, associated injury, grade of pancreatic trauma and management. Pancreatic trauma was graded from I through IV, as per Modified Lucas Classification. RESULTS: The median age was 39 years (range 19-61). The aetiology of pancreatic trauma was blunt abdominal trauma in 14 patients and penetrating injury in 3. Associated bowel injury was present in 4 cases (3 penetrating injury and 1 blunt trauma) and 1 case had associated vascular injury. 5 patients had grade I, 3 had grade II, 7 had grade III and 2 had grade IV pancreatic trauma. Contrast enhanced computed tomography scan was used to diagnose pancreatic trauma in all patients with blunt abdominal injury. Immediate diagnosis could be reached in only 4 (28.5%) patients. 7 patients responded to conservative treatment. Of the 10 patients who underwent surgery, 6 required it for the pancreas and the duodenum. (distal pancreatectomy with splenectomy-3, pylorus preserving pancreatoduodenectomy-1, debridement with external drainage-1, associated injuries-duodenum-1). Pancreatic fistula, recurrent pancreatitis and pseudocyst formation were seen in 3 (17.05%), 2 (11.7%) and 1 (5.4%) patient respectively. Death occurred in 4 cases (23.5%), 2 each in grades III and IV pancreatic trauma. CONCLUSIONS: Contrast enhanced computed tomography scan is a useful modality for diagnosing, grading and following up patients with pancreatic trauma. Although a majority of cases with pancreatic trauma respond to conservative treatment, patients with penetrating trauma, and associated bowel injury and higher grade pancreatic trauma require surgical intervention and are also associated with higher morbidity and mortality.

Coronary calcium scoring in asymptomatic Indian population: correlation with age, gender and risk factors--a prospective study on 500 subjects.

BACKGROUND: The present study was conducted with an objective to assess, quantify and describe a reference value (percentile) of coronary calcium score for the asymptomatic adult Indian population and its correlation with gender, age and risk factors and to review the same with the available literature. METHODS AND RESULTS: Five hundred asymptomatic subjects/volunteers were taken from the general population for this study. Calcium scoring was done based on modified Agatston scoring on a four-row multidetector CT scanner with ECG gating. Findings revealed that with increasing age there was increase in the calcium score. Males had a little higher CACS (not significant) compared to females for any defined age group. There was a significant continuous graded relation between the calcium scores and prevalence of CAC deposits with the number of risk factors. Subjects without any risk factors (n = 340) showed absence of coronary calcium in 85.3 and with the presence of two or more risk factors (n = 72) the absence of coronary calcification was seen in 13.9% The percentile reference values of CACS as obtained from this study (please see table in text) CONCLUSION: This study provides a reference percentile of CACS for Indian population which can be utilized to screen and stratify risk of coronary events in asymptomatic individuals using a non invasive method and thus individuals can be subjected to necessary investigations and risk factor intervention. Limitations in our study - Non availability of lipid profiles, comparison and correlation with angiographic studies and follow up of subjects to evaluate the prospective outcome.

Ileal polyposis as manifestation of neurofibromatosis syndrome.

A 13-year-old girl presented with features of intestinal obstruction. At surgery, the terminal 25 cm of ileum, which was resected along with the right colon, showed plexiform neurofibromatosis of the serosa and mesentery, hyperplastic submucosal and myenteric nerve plexuses and proliferation of neural tissue in the lamina propria, which manifested as diffuse polyposis of the ileal mucosa. The patient had a single inconspicuous external neurofibroma and a few café-au-lait spots on the back.