Acute pancreatitis; evaluation of modified glasgow scoring system [IMRIE]

To determine whether in our setup the Modified Glasgow Scoring System is still an accurate marker for the assessment of severity in acute pancreatitis. Observational study. Surgical Unit, CMH Peshawar. January 2005 to January 2008. It is an observational study of 50 male and female patients between ages of 1 5-75 years [Mean 43.3]. Male to female ratio was 1:1.3. They were graded mild, moderate and severe using the 8 variables / markers of Modified Glasgow Scoring System. Exclusion from this study were the patients with acute pancreatitis who were treated at the same institution but not admitted to the surgical ICU, those admitted after inter institutional transfer for tertiary care and patients admitted as sick transfer from other hospitals after 24 hours. On the basis of variables in the Modified Glasgow scoring system [Imrie], 18 patients were predicted with the severe outcome, but only 15 [83%] cases had an actual severe outcome. Whereas 3 cases [17%] did not follow the prediction and behaved as moderate pancreatitis. Similarly, 16 cases predicted as moderate pancreatitis, 14 [88%] followed the prediction and only 2 [12%] cases behaved as mild cases.16 cases were predicted mild, but 13 [81%] followed the prediction and only 3 [19%] switched to moderately severe group. Thus the overall accuracy of Modified Glasgow Scoring System was found in 42 [84%] cases. Bililary pathology remained the main aetiological factor. Two of the variables were significantly deranged in severe cases. These were age over 50 [4 cases], and WBC count > 20x 10[9]/l [12 cases]. Hospital stay varied between 4-21 days [Mean 9 days]. Conclusion: The Modified Glasgow Scoring System remains a valid predicting system for the outcome in patients with acute pancreatitis. It is simple, easy to apply with good predictive value and can be used in all hospital settings

hernia which repair? experience with pre-peritoneal Stoppa's repair

The objective is to evaluate an alternate hernia repair technique for complex, combined primary and recurrent groin hernias. Quasi - experimental study. Surgical unit II, Ward - III CMH Rawalpindi from Jan 2002 to Jan 2005. This study included forty patients having inguinal hernias with 31 to 70 years of age. Twenty patients having primary bilateral, 10 cases with recurrent hernia and 10 with complex hernias. Mean hospital stay ranged from 1-5 days with average 3 days. General anaesthesia was administered in 35 cases and spinal anaesthesia only in 5 cases. Mean operation time was 70 minutes [Range 45-110 min]. Recurrence was noted only in one case. There was no need of conversion to another technique where as no case had mesh infection. Minor wound complications such as seroma or erythema were noted in few cases without any peri operative death. Stoppa`s repair is safe, effective addition to surgeons armamentarium to treat complex, groin hernias. It provides facility for repair to three critical areas, such as direct, indirect and femoral hernia

Tuberculous splenic abscesses in an immunocompetent patient

A 39 years old presented with low grade off and on fever and pain in the left upper abdominal region for one month. There was no history of cough, altered bowel habits, weight loss or contact with a case of tuberculosis. The patient was a nonsmoker. He was afebrile, with tenderness on deep palpation in left hypochondrium, spleen was not palpable. There was no palpable lymphadenopathy or jaundice. Laboratory investigations revealed raised 74 mm1hr ESR. Montoux test [1-TU PPD] was positive after 48 hours. Sputum smear was negative. Ultrasonography abdomen revealed normal sized spleen with multiple hypo echoic areas of various sizes, the largest measuring 2.8 x 3.6 cm. CT scan of the abdomen showed multiple small focal hypo dense lesions, suggestive of abscesses. CT-guided FNAC of the splenic lesions yielded frank pus. Smears showed epithelial cell granulomas, Langhan`s giant cells and few lymphoid cells with a necrotic background. Ziehl-Neelson stain revealed AFB. Mycobacterial culture and sensitivity testing of the pus that was aspirated showed a growth of M. tuberculosis after six weeks and the isolate was sensitive to first line of anti-Tuberculous drugs. The patient was found to be HIV negative by ELISA [Enzyme linked immunosorbent assay]. He was diagnosed to have Tuberculous multiple splenic abscesses

Management of inguinal hernias

This cohort comparative non-randomized study was done at CMH Pano Aqil from Jan 2000 to Jun 2001. Main objective was to evaluate technique related postoperative complications in inguinal hernia surgery. A total 100 patients with various types of inguinal hernia were admitted. They were divided in two groups with 50 patients in each group. Lichtenstien repair was done in group one and modified Shouldice repair in group two. However another current method i.e. laparoscopic herniorraphy was not included in this study due to non-availability of equipment and expertise for this technique. As longterm complications e.g. recurrence are claimed to be negligible in these methods so, only short term complications were considered in this study. Their incidence was found less in Liechtenstein technique than in modified Shouldice repair

Evaluation of extra mucosal single layer intestinal anastomosis technique

An insecure intestinal anastomosis is an unacceptable iatrogenic hazard. The breakdown of suture line or anastomosis may result into hemorrhage, leakage, Stenosis, diverticular formation and ultimately faecal fistula with serous faecal and septic complications. The sound haeling of process of anastomosis depends mainly on anastomosis technique, which is the most important determinant. Therefore the main objective of this study was to assess/evaluate anastomotic technique. This cohort study with 50 cases necessitating intestinal anastomosis was designed at CMH Pano Aqil from January 2001 to August 2002. This comprised of 40 [80%] males, 10 [20%] females, which were mainly young adults. Patients with gunshot, sharp and blunt object trauma to the abdomen/gun were 35[70%] alongwith 15 [30%] patients in whom intestinal perforation was non traumatic in origin. Only one case showed minor anastomotic leak, which settled without surgical intervention. It is concluded that extramucosal single layer intestinal anastomosis is simple, safe, easy and logical technique