Traumatic pancreatic injury--an elusive diagnosis: experience from a developing country urban trauma referral centre.

OBJECTIVE: To determine the frequency of pancreatic injury in patients presenting with trauma and to review the mechanism of injury, management, subsequent complications and in-hospital mortality rate associated with these patients. METHODS: The retrospective study included all patients over 18 years of age presenting with pancreatic injury due to trauma at the Aga Khan University Hospital, Karachi, between January 1990 and December 2009. Patients with iatrogenic pancreatic injury were excluded. The severity of the injury was assessed using the Injury Severity Score, while it was graded according to the scale defined by the American Association for the Surgery of Trauma. SPSS 17 was used for statistical analysis. RESULTS: A total of 30 patients were identified representing just 1.5% of the total adult abdominal trauma patients. The mean age of the patients was 28 +/- 9.7 years. There were 28 (93.3%) males and just 2 (6.6%) females. The complication rate was 80% (n = 24) and the mortality rate was 23.3% (n = 7). Of the 30 patients, 19 (63%) had been transferred from some other medical facility.The mean length of hospital stay was 16.4 +/- 20.6 days (range 5-97 days). CONCLUSION: Surgical management in pancreatic trauma patients should be dictated by the degree and location of pancreatic injury, associated injuries and time from event to presentation. Mortality was primarily determined by associated life-threatening injuries.

Portal hypertensive biliopathy: review of pathophysiology and management.

Portal hypertensive biliopathy is described as abnormalities of the walls of the biliary tree secondary to portal hypertension. In literature it has also been named as "Cholangiopathy associated with portal hypertension", "Portal biliopathy" and "Portal cavernoma associated cholangiopathy". It is usually asymptomatic and found incidentally, but rarely patients do present with symptoms of abdominal pain, jaundice, asthenia and fever. Treatment is warranted in symptomatic cases only, and is dictated by the clinical manifestations and complications of the disease process. Due to presence of underlying severe portal hypertension, endoscopic biliary intervention is usually the first line of management, and is relatively safe and often sufficient. When surgery is resorted to, a porto-systemic shunt prior to biliary bypass procedure provides early relief of obstructive biliary symptoms and often precludes the need for a biliary bypass surgery. This review describes the pathophysiology, presentation, progression and management approaches to portal biliopathy.

Early complications after biliary enteric anastomosis for benign diseases: a retrospective analysis.

BACKGROUND: Biliary-enteric anastomosis (BEA) is a common surgical procedure performed for the management of biliary obstruction or leakage that results from a variety of benign and malignant diseases. Complications following BEA are not rare. We aimed to determine the incidence and the factors associated with early complications occurring after BEA for benign diseases. METHODS: We reviewed the medical records of all patients who underwent BEA for benign diseases at our institution between January 1988 and December 2009. The primary outcome was early post operative complication. Logistic regression analysis was done to identify factors predicting the occurrence of complications. RESULTS: Records of 79 patients were reviewed. There were 34 (43%) males and 45 (57% females). Majority (53%) had choledocholithiasis with impacted stone or distal stricture, followed by traumatic injury to the biliary system (33%). Thirty-four patients (43%) underwent a hepaticojejunostomy, 19 patients (24%) underwent a choledochojejunostomy, and choledochoduodenostomy was performed in 26 patients (33%). Early complications occurred in 39 (49%) patients - 41% had local complications and 25% had systemic complications. Most frequent complications were wound infection (23%) and bile leak (10%). Four (5%) patients died. On multivariate analysis, low serum albumin level (odds ratio = 16, 95% CI = 1.14-234.6) and higher ASA levels (odds ratio = 7, 95% CI: 1.22-33.34) were the independent factors predicting the early complications following BEA. CONCLUSIONS: Half of the patients who underwent BEA for benign diseases had complications in our population. This high incidence may be explained by the high incidence of hypoalbuminemia and the high-risk group who underwent operation.

Primary non-functioning paraganglioma of liver: a rare tumour at an unusual location.

Pheochromocytomas are rare tumours, 22% of which are extra-adrenal and are known as paragangliomas. We report a case of a young male with non-functioning paraganglioma of the liver; a very uncommon primary site. A CT scan with contrast showed a huge, highly vascular mass lesion in the right lobe of the liver and a core biopsy confirmed it to be a paraganglioma. Whole body study with iodine-131-meta-iodobenzylguanidine (MIBG) tracer highlighted the liver tumour but was negative for any other active lesions depicting that the tumour was confined to the liver. The lesion was completely resected by extended right hepatectomy and the patient had an uneventful recovery. There is no evidence of disease recurrence at 3 years of follow up.

Knowledge and practice of healthy lifestyle and dietary habits in medical and non-medical students of Karachi, Pakistan.

OBJECTIVE: To objectively compare the differences in knowledge and practices regarding healthy lifestyle among medical and non-medical students of Karachi along with assessment of any perceived barriers. METHODS: This cross-sectional study included 350 students between ages 17-24 years from 6 private universities of Karachi--three medical and three non-medical Institutions. A self-reported questionnaire was employed to assess attitude and barriers to healthy practices among the simple random selection of students. RESULTS: On a 10-point scale, the average knowledge score of students on general and clinical nutritional knowledge was 5.7 +/- 1.51 and 4.4 +/- 1.77, respectively and the difference was statistically significant (p < 0.01). Conversely the diet and lifestyle score (85-point scale) among medical (41.3) and non medical students (40.8) was not significant (p = 0.646). There was no difference between the perception of medical and non-medical students regarding 'work-related stress' in their life. 'Lack of time' was cited as the most important reason for skipping meals and as a barrier to exercising regularly among both groups. CONCLUSION: The knowledge, attitudes and practices of medical students in Karachi suggest that superior knowledge about healthy lifestyle does not necessarily result into better practices.