RESUMO
Objective: To report the results in the surgical treatment of pancreatic and periampullary neoplasms with emphasis on surgical technique, short-term postoperative outcome and the lessons learnt
Study Design: Case series
Place and Duration of Study: This study was carried out at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, from October 2014 to May 2016
Methodology: Patients undergoing surgical treatment of pancreatic and periampullary neoplasms were selected. Patients' characteristics including demographics, surgical technique, and 30-day morbidity and mortality were recorded. International Study Group of Pancreatic Fistula [ISGPF] classification was used to define postoperative pancreatic fistula and Clavien-Dindo classification to grade complications
Results: A total number of 65 patients underwent the trial of dissection; 50 had pancreaticoduodenectomy and 15 patients underwent palliative bypass and were excluded from analysis. Sixty-four percent were males and 36% were females. The most common tumor was periampullary [n=29, 58%] followed by pancreatic head [14, 28%] and duodenal tumors [n=07, 14%]. Mean age was 52.92 +/- 13.27 years; mean operating time was 470 +/- 358.28 minutes and median blood loss was 400 [287-500] ml. Pancreaticogastrostomy [PG] was the preferred reconstruction technique in 37 [74%] verses pancreaticojejunostomy [PJ] in 13 [26%] patients. Four [08%] patients needed portal vein reconstruction and two [04%] replaced right hepatic artery resection and reconstruction due to tumor involvement. There were seven Grade A, and one Grade B and C pancreatic fistulae each. Three patients [06%] needed endoscopic therapy for gastrointestinal hemorrhage from pancreatic stump. There was one death in postoperative period
Conclusion: Pancreaticoduodenectomy is a safe procedure with excellent postoperative outcome, if carried out in a specialized hepato-pancreato-biliary unit. A PG reconstruction can be a safer alternative to PJ
RESUMO
Objectives: to see the pattern of rheumatic heart disease in local population
Setting department of Medicine, Medical Unit II and Cardiology Allied Hospital Punjab Medical College Faisalabad
Period: June 1997 to June 1999
Material and methods: total 60 patients of different age and sex groups with clinical diagnosis of rheumatic heart disease according to who were admitted in medical unit II were included in the study. Color Doppler echo cardiography was performed to see the evidence of cardiac involvement.23 patients [38.3%] were male and 37 female. Mean age was 14 years [range 7-27 years].The diagnosis of rheumatic fever was made on the basis of history, clinical examination, elevated ESR and ASO titre. Color Doppler echo-cardiography was performed to confirm and note the pattern of cardiac involvement
Results: most of the patients were having recurrence of rheumatic fever and only 10 patients [16.6%] had first attack of rheumatic fever. Forty patients [66.6%] belonged to rural population and low socioecnomic group. Majority of patients had evidence of carditis and five [8.3%] had no valvular involvement. Mitral valve most commonly involved .Isolated mitral regurgitation was seen in 25 patients [41.6%], Mitral regurgitation in combination with aortic regurgitation in 10 patients [16.6%] isolated mitral stenosis in 20 patients [33.3%] and mitral stenosis in combination with mitral regurgitation in 19 patients [31.6%]. Chest pain due to pericarditis and pericardial effusion was seen in 2 patients [3.3%]. Fever and migratory arthritis were seen in 21 patients [35.5%].Chorea was seen in one patient [1.6%] whereas erythema marginatum and erythema nodosum were not seen in any of the patients
Conclusion: there was a very high incidence of recurrence of rheumatic fever and rheumatic carditis