Laparoscopic colorectal surgery; district general hospital experience

The aim of this study was to assess the outcome of laparoscopic colorectal procedures performed in a district general hospital within 5 years period and to compare it with patients who had an open procedure during the same period. Data were collected retrospectively from patient's case notes retrieved from hospital medical records. One hundred consecutive cases of laparoscopic colonic resection including both benign and malignant diseases between 2005 and 2010 were analysed for perioperative and long term outcome and were compared with consecutive one hundred cases of open colectomies. Overall conversion rate was 6% for laparoscopic group. The mean major complication rates in laparoscopic group were 5% [3% in open group] and minor complications occurred in 18% [28% in open group]. There was no mortality in either group. The overall morbidity rate was 23% in laparoscopic group as compared to 31% in open colectomy group. In 64 cases, curative laparoscopic resections were performed for colorectal malignancy while 72 patients had resections for cancer in open group. The mean lymph node harvest in laparoscopic group was 13.2 nodes as compared to 12.4 in open group; no port-site recurrence was documented at a mean follow-up of 26 months. Average duration of surgery was 180 minutes as compared to 140 minutes in open group. Mean postoperative hospital stay was reduced from 13 days to 7 days. [Open Vs. Lap]. There was no statistically significant difference in major complication rates and mortality. Laparoscopic colorectal surgery is safe and feasible in elective colorectal cases and reduces the hospital stay without any added morbidity

Rapunzel syndrome

A trichobezoar may be confined to the stomach or unusually it may extend from stomach to the small intestine or beyond when it is labelled as Rapunzel syndrome. Bezoars are concretions in the gastrointestinal tract that increase in size by continuous accumulation of non-absorbable food or fibre. Most bezoars in children are trichobezoars from swallowed hair. Repunzal syndrome is an uncommon condition in children with less than 40 cases reported. We present a case of an 8 year old girl with Rapunzel syndrome. She presented with vague abdominal pain and epigastric fullness of one year duration. On investigation she was found to have a trichobezoar. At laparotomy a large dark foul smelling trichobezoar that occupied the stomach, duodenum and proximal jejunum was removed via gastrostomy

Microalbuminuria and associated risk factors in type II diabetics

To determine the frequency of microalbuminuria [MA] and its associated medical risk factors in type II diabetic patients. Place and Duration of Study: This cross-sectional analytical study was conducted during Ist half of 2003 at Combined Military Hospital, Lahore. Non-probability purposive sampling was employed. Materials and Study population included 150 type II diabetic patients [70 women, 80 men] attending outpatient department of the hospital. Patients having clinical albuminuria and with other causes of proteinuria were excluded. Women and men were of comparable ages. Women [26.4 kg/m2] had higher body mass index [BMI] than men [24.3 kg/m2]. The frequency of MA was 46.7%, higher in males [50.6%] than females [41.5%]. Fasting plasma glucose and HbA1c levels were significantly higher in patients with MA compared to those with normoalbuminuria [p < 0.001]. The microalbuminuric patients had significantly decreased HDL-c levels compared to normoalbuminuric subjects [p< 0.001]. However, no relation of MA with age, gender, known duration of diabetes, BMI, history of smoking, hypertension and serum: total cholesterol, LDL-c, triglyceride, urea and creatinine was found. There is a strong association of poor glycaemic control and decreased HDL-c levels with the presence of microalbuminuria