CLINICAL FEATURES AND OUTCOME ANALYSIS OF INTRACRANIAL HYDATID CYSTS.

BACKGROUND: Hydatid cyst of the brain is serious zoonotic parasitic infections which have profound health consequences if left untreated. The surgical excisions of the cysts are rewarding for both the patient the neurosurgeon. METHODS: The study was conducted prospectively at Department of Neurosurgery Hayatabad Medical Complex Peshawar from January 2013 to December 2014. Patients with a diagnosis of intracranial hydatid cysts were included, clinical and radiological features recorded, intervention and postoperative outcome were analysed. RESULTS: Eleven patients with a male to female ratio of 1.7:1. Mean age was 12.4 (SD ± 6.5) years with median GCS on arrival of 10 (SD ± 2.5). Clinical features were headache (81.8%), vomiting (90.9%), seizures (36.4%), focal deficits (54.5%) and papilloedema (72.7%). The median GCS on discharge was 13 (SD ± 1.1) while GOS at 1 month follow up was 4 (SD ± 0.7). The bivariate analysis showed inverse correlation (R² = -0.68; p = 0.02) between duration of symptoms and outcome while GCS on admission was positively correlated (r(s) = 0.75; p = 0.007) with the outcome. There was no mortality. CONCLUSION: Despite its rarity the clinical features are non-specific while radiological features help in establishing diagnosis. Earlier diagnosis and prompt intervention is the key to favourable outcome.

Role of simplified admission criteria for predicting severe complications of gall stone pancreatitis.

BACKGROUND: Gallstone Pancreatitis (GP) is not an uncommon disease in our country and is associated with large number of morbidity and mortality especially if severe complications develop. Different criteria have been developed to predict the complications of GP. Simple admission criteria are better predictors of severe complications of GP than an APACHE II score of 5 or greater, a modified Imrie (Glasgow) score of 3 or greater, and a Biliary Ranson score of 3 or greater. The purpose of this study was to determine the role of simplified admission criteria in predicting severe complications of Gallstone Pancreatitis. METHODS: This was a descriptive study conducted in Surgical 'A' Unit, Khyber Teaching Hospital Peshawar between July 16th 2007 to November 30th 2008. Total 52 patients (42 women and 10 men, aged range from 18 to 76 years, with mean age, 39 years) who presented to our unit with gallstone pancreatitis were included in the study through technique of non-probability convenient sampling. The main outcome measures were major local and systemic complications requiring intensive care unit care, and death. Physiological factors and laboratory data were collected on admission and recorded daily. RESULTS: Seven patients (14%) had severe complications with mortality of 2%. On univariate analysis, a white blood cell count of 14500/dL or more (p = 0.03), a serum glucose level of or more > or = 150 mg/dL (8.3 mmol/L) (p < 0.001), an APACHE II score of 5 or greater (p = 0.008), a modified Imrie score of 3 or greater (p < 0.001), and a biliary Ranson score of 3 or greater (p = 0.03) were statistically associated with the development of severe complications. On multivariate analysis, only a serum glucose level of > or = 150 mg/dL or more (8.3 mmol/L) was predictive of adverse events (p < 0.001). CONCLUSIONS: Glucose level (> or = 150 mg/dL) is the best single admission predictor of severe complications of Gallstone Pancreatitis and is superior to an APACHE II score of 5 or greater, a modified Imrie score of 3 or greater, and a biliary Ranson score of 3 or greater.