Outcome of Surgical Drainage of the Pancreatic Duct in Chronic Pancreatitis.

Abdominal pain, one of the major symptoms of chronic pancreatitis, is believed to be caused by obstruction of the pancreatic duct system by stones or strictures. This results in increased intraductal pressure and parenchymal ischemia. Surgical decompression of the duct and ductal drainage can achieve best pain relieve and slow the progression of the disease. We want to share our experience of surgical drainage of pancreatic duct in chronic pancreatitis in our hospital. We studied 20 cases operated in our hospital between January 2010 and October 2015. Patients were selected with pre-operative ultrasonography. Dilatation of the main pancreatic duct by at least 7 mm proximal to the obstruction were recruited for operation. We did Roux-Y lateral pancreato-jejunostomy (LPJ) for patients with obstruction of the pancreatic duct due to stricture or intraductal stones or both. We did additional distal pancreatectomy in case of stone in the tail area.We did one Frey's operation for stone and fibro-calcification of the head. We evaluated their symptoms, their duration, post-operative hospital stay and complications following surgery. We studied their pain control, recurrence and mortality during this period. We followed these patients for more than 5 years. We found 16 out of 20 patients got complete remission of the abdominal pain with no progression of their disease. Ultrasonic evidence of chronic pancreatitis have improved or resolved. Ductal diameter has decreased. They did not develop diabetes or malabsorbtion. One had a recurrence of stone in the head within a year. Three died during this follow-up period. One died three months after LPJ due to massive gangrene of the small intestine distal to LPJ and jejuno-jejunostomy and subsequent short bowel syndrome. Other two developed carcinoma of the pancreas within one year and six months after LPJ respectively. Rate of pain free survival is about 75% and recurrence is 5%. Mortality during this follow up period is 15%. In this small series, we found that surgery if done early, can have good remission of abdominal pain and can slow the progression of chronic pancreatitis in majority of patient. Patient with chronic calcific pancreatitis and diabetes are likely to have unfavorable outcome even after decompressive surgery.

Testicular tumour - a review article.

Painless scrotal masses must be investigated with ultrasound imaging and tumour marker assay before being treated with radical inguinal orchidectomy. For unknown reasons, the incidence of this cancer increased in Caucasian population. The incidence of testicular germ cell tumour has doubled in past 40 years. An annual increase of 3-6% is reported in Caucasian population. But the mortality rate has been stable or decreasing due to improvement in treatment. In the past, metastatic testicular cancer was usually fatal, but recent advances in treatment, including high-dose chemotherapy and stem cell rescue, have considerably improved the prognosis. Indeed, testicular cancer is a bright spot in the oncological landscape and is now considered the model for the treatment of solid tumors. We looked into the epidemiology, presentation, classification, work up, staging, various treatment modalities and prognosis of testicular tumour in this article.

A case of ileo-caecal Crohn's disease presenting as acute intestinal obstruction.

We report a case of 42 year old man who presented with one month history of weight loss, gradual abdominal distension and constipation. X-ray of the abdomen showed features of small gut obstruction. A tight stricture at the ileoceacal junction was found to be the cause of obstruction on laparotomy. Distal ileum was found to be severely inflammed with enlarged regional lymph nodes. Right hemicolectomy with resection of distal ileum was done. Histology revealed non caseating granuloma of Chroh's disease. Crohn's disease is relatively rare in Bangladesh. Recent data suggests rising incidence of Crohn's disease (CD) in the Indian sub-continent.

Mammography is the most effective method of breast cancer screening.

Screening is defined as identification of individuals within an asymptomatic population who have specified disease at a time when intervention may result in improvement of prognosis of the disease. Identification of the disease at the earlier phases of progression improves prognosis. All kinds of cancer screening may not have same benefit. Screening for breast cancer has been found to be beneficial. Randomized controlled trials and meta-analysis have shown that screening by mammography reduces breast cancer by 25% and can significantly reduce mortality from breast cancer. This article reviews methodology and bias, modalities, benefits, problems, results and current guidelines of breast cancer screening.