Estimation of some vital trace elements in patients with acute pancreatitis: A case-control study

Abstract Trace elements have an important influence on the living system and play a major role in a variety of processes necessary for life. This case study was conducted as an attempt to expand our knowledge of the relationship between trace elements and their effect on acute pancreatitis. Sixty-five patients diagnosed with acute pancreatitis with mean age 43.6 years, along with sixty-five healthy volunteers with a mean age 45.7 years, were included in this study. The obtained results indicated a significant increase in the Cu, Ni and Cr levels, and a significant decrease in the Zn, Mg and Fe levels for acute pancreatitis patients compared with the control group (p <0.001). In addition, a remarkable increase in the Cu/Zn ratio was observed in patients. The current work provides important evidence of correlation between changes in copper and zinc levels and the risk of acute pancreatitis. Also, an increased Cu/Zn ratio may be a useful indication for the diagnosis and monitoring of acute pancreatitis. Moreover, the current study concluded that there is a possible relationship of Mg, Fe, Ni and Cr with acute pancreatitis. Thus, it can be suggested that these elements are reliable to provide indications for warning of the risk of acute pancreatitis.

Awareness of medical ethics in undergraduate medical students- a literature review

Medical ethics is a core issue for all specialties and is encompassed in professionalism. It is a presumption that not dealt appropriately in the undergraduate teaching curriculum. There is a paucity of awareness lectures and seminar workshops in teaching setups for medical ethics for undergraduates in developing countries. The current policy of PMDC does not provide a centralized curriculum for teaching of medical ethics in medical colleges, which results in lack of logical ethical reasoning among students. There is a need to develop a medical ethics curriculum taught by medical ethics department in every medical college in collaboration with the clinicians with real life case scenarios. Students should be evaluated through examinations at the end of every year with fixed hours dedicated to the teaching of the curriculum. Only, through these measures patient satisfaction will improve and medicine can achieve its lost glory and nobility in our part of the world

Emergency tracheal surgery for adenoid cystic carcinoma: a rare entity

Primary tumours of the trachea are rare. Adenoid cystic carcinoma [ACC] constitutes less than 1% of these tumours. They occasionally masquerade as asthma. We are presenting a case of a young female, who had been treated for 3 years as asthma. She presented in emergency with severe respiratory difficulty, stridor and decreasing saturation of 85% on room air. Two weeks back, she had a CT scan in a local hospital, but they did not notify the tracheal mass. Her clinical picture and CT scan helped us diagnose the case. She was treated in emergency with primary resection of tracheal mass and anastomosis. The tumor was diagnosed as ACC. Postoperative recovery was uneventful. Continuity of the trachea was restored and adjuvant radiotherapy was given

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

Clinical assessment compared with chest-x-ray after removal of chest tube to diagnose pneumothorax

Objective: To evaluate clinical judgment in ruling out pneumothorax during the removal of the chest tube by auscultating the chest before removal and after the extubation of the chest tube in comparison to x ray radiological results

Study Design: Descriptive cross sectional study

Place and Duration of Study: Combined Military Hospital [CMH] Lahore Pakistan, from August 2015 to March 2016

Material and Methods: A sample size of 100 was calculated. Patients were selected via non probability purposive sampling. Children under 14 years were not included. The patients with mal-positioned chest tube, surgical site infection, air leak and the patients with more than one chest tube on one side were excluded. A proforma was made and filled by one person. Chest tubes were removed by two trained senior registrars according to a protocol devised. It was ensured that there was no air leak present before removal clinically and radiologically. Another chest x-ray was done within 24 hours of extubation to detect any pathology that might have occurred during the process. Any complication in the patient clinically was observed till the x-ray film became available. Two sets of readings were obtained. Set A included auscultation findings and set B included x ray results

Results: Out of 100 patients, 60 [60%] were males and 40 [40%] females. The ages of the patients ranged between 17-77 years. Mean age of the patient was 43.27 +/- 17.05 years. In set A out of 100 [100%] no pneumothorax developed clinically. In set B out of 100 patients 99 [99%] showed no pneumothorax on chest x ray, only 1 [1%] showed pneumothorax which was not significant [less than 15% on X ray]. However, the patient remained asymptomatic clinically and there was no need of reinsertion of the chest tube

Conclusion: Auscultatory findings in diagnosing a significant pneumothorax are justified. Hence, if the chest tube is removed according to the protocol, clinically by auscultation we can be sure that no significant pneumothorax developed during extubation, thus there is no need of x-ray after wards

experience of corrective surgery of 37 cases of chest deformity

The study was carried out to ascertain the cosmetic outcome of corrective surgery for pectus deformity and to determine the morbidity associated with it. Quasi-experimental study. The study conducted in CMH Rawalpindi and CMH Quetta from 2007 to 2012. Total number of cases operated for chest deformity was 37. Modified Welch procedure with sub perichondrial resection was done with a strut of prolene mesh in a majority of exacavatum repairs and k wires in few. Pectoroplasty was subsequently carried out in all patients. Midline incision was made in a majority of patients. Subjmammary incision was made in some female patients with a lower deformity due to better cosmetic outcome. Inclusion criterion was patients with chest deformity without any cardiac and spinal deformity. Age range was between 4 years to 12 years with mean age of 8 +/- 2.3 years. twenty four [65%] deformities were of excavatum and 9 [24%] were of carinatum type. Four [11%] cases were of unilateral asymmetrical deformity. Mean operating time was 95 +/- 11 minutes. Transfusion was required in only 1 [3%] o the cases. There was no perioperative mortality. Four [11%] patients had formation of seroma and 3 [8%] developed pneumothorax which was aspirated without placement of chest tube. Two [5%] had surgical site infection. Fifteen [41%] patients were satisfied and 21 [57%] reported excellent results. Chest deformity correction is safe and effective procedure with acceptable cosmetic results. It is easy to perform and improves self image of the suffering individual

Determinants of success of decortication

Background: To find out different factors which lead to failed decortication and to evaluate their management and outcome

Study Design: Retrospective observational descriptive study

Place of Study: Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January 2003 to Sep 2006

Materials and Methods: Clinical record of 300 patients who underwent decortication tor chronic empyema during the last 3.9 years was retrospectively analyzed and their results evaluated. Detailed scrutiny of the computerized clinical record was carried out to analyze the aetiology of failure of the operation. The variables studied were persistent broncho- pleural fistula, poor postoperative efforts by the patients, wound infection, old chest drain site infection, technical failure and nutritional state of the patient

Results: Of the 300 deoortications performed over the period of 3.9 years, 260 patients had a successful outcome in terms of lung expansion and improved pulmonary functions. In thirty patients [19 males, 11 females with age range of 12 to 70 years] decortications failed to achieve the desired results. These patients had to undergo space obliteration procedures for persistent infected space. Twenty three patients had history of tuberculosis and seven patients had nontuberculous empyema. All patients had chronic empyema with duration of more then 12 weeks before the first operation. All patients were nutritionally compromised. Thoracoplasty [compete or partial] was performed in 25 patients to obliterate the persistent infected space. Five patients with recurrent broncho-pleural fistula had an additional procedure of intercostal muscle reinforcement over the fistulae, in addition to thoracoplasty. All patients had successful obliteration of the persistent space with no mortality and minor wound infection in only three patients

Conclusion: Early referral, old drain site infection control, meticulous closure of broncho pleural fistula and space obliteration procedure in combination primarily instead of secondarily, lead to a successful outcome

Management of postoperative chylothorax

To evaluate treatment modalities of iatrogenic post operative chylothorax and describe our current approach this study was conducted at CMH/AFIC Rawalpindi from Aug 2001 to Aug 2003. It included the causative evaluation and management modalities. 11 patients were operated for cardiac and thoracic pathology, which resulted in chylothorax. Chylothorax was diagnosed based on clinical appearance and chemical analysis of pleural fluid. Out of 11 patients, 9 had cardiac procedures while 2 had thoracic operations. All Patients had chest intubation. 9 had drainage within 24 hours, 1 at 48 hours, and 1 after 72 hrs. Initial tube thoracostomy drainage was 1000 to 2500 ml/day. S patients responded to conservative tube thoracostomy and TPN. 2 were operated with in 48 hours with ligation of the leaking site. 4 had to undergo the supra-diaphragmatic enmass ligation via right thoracotomy