Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
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J Coll Physicians Surg Pak · Mar 2021
Observational StudyEarly Surgical Management of Appendicular Mass in Pediatric Patients.
To find out the feasibility and safety of early surgery in pediatric patients who presented with appendicular mass. ⋯ This study was conducted on 60 children, who were diagnosed with appendicular mass. Patients were operated after initial stabilisation and investigations. Variables analysed included demographic characteristics, clinical presentation, intraoperative surgical difficulties and postoperative complications. Data were entered into SPSS version 22. Chi-square test and Fisher Exact test were used for finding statistical significance among variables. A p-value of <0.05 was considered as significant. Results: There were 41 (68.4%) male and 19 (31.6%) female patients with the mean age of 8.3 + 2.9 year. Mean duration of pain was 3.8 + 1.8 days. In 41 (68.4%) patients, mass was composed of appendix with adherent ileal loops and omentum, while in 19 (31.6%) patients frank pus was also found within the mass. Thirty-four (56.6%) patients had suppurative appendix without gross perforation, while in 26 (43.4%) patients partially sloughed / gangrenous perforated appendix found. Intraoperative difficulties were more in patients with complex mass (p=0.004). Postoperative complications were observed in 14 (23.3%) patients. These were more frequent in female patients (p=0.001), with sloughed, gangrenous perforated appendix (p=0.034) and complex mass (p=0.008). Superficial wound infection was the most common complication noted in 9 (15%) patients. In 5 (8.3%) children, deep seated intra-abdominal collections were found. The mean hospital stay was 3.4 + 1.5 days. Conclusion: Early surgery in pediatric patients with appendicular mass was found feasible with minimal complications. This obviated the need of prolonged follow-up and interval appendectomy with its inherent risks. Key Words: Appendicular mass, Appendicular lump, Appendectomy, Child.
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J Coll Physicians Surg Pak · Mar 2021
Dehydroepiandrosterone Sulfate (DHEAS) Levels in Polycystic Ovarian Syndrome (PCOS).
To compare DHEAS levels among subjects with and without PCOS, evaluating differences between lean-PCOS or obese-PCOS phenotype for insulin resistance, anthropometric indices, glycemic and lipid parameters. ⋯ DHEAS levels were high in lean-PCOS in comparison to obese-PCOS and non-PCOS females. However, receiver operating curve (ROC) analysis showed DHEAS as a weaker marker for diagnosing PCOS than FAI and modified FG score. Key Words: DHEAS, Polycystic ovarian syndrome (PCOS), Homeostasis model assessment for insulin resistance (HOMAIR), Rotterdam criteria, Free androgen index.
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J Coll Physicians Surg Pak · Mar 2021
Case ReportsNon-operative Treatment of Gastric Fistula after Splenectomy Combined with Pericardial Devascularisation in Portal Hypertension.
Portal hypertension may gradually lead to esophagogastric varices and splenomegaly in the decompensated stage of liver cirrhosis, which requires surgical treatment, if the disease worsens. Splenectomy with pericardial devascularisation is the routine surgery. One complex complication after splenectomy is upper gastric fistula which can seriously affect the perioperative recovery. ⋯ The occurrence of gastric fistula may be strongly related to preoperative preparation, intra-operative procedure and postoperative management. Therefore, personalised management is important for avoiding gastric fistula. Key Words: Gastric fistula, Splenectomy, Pericardial devascularisation, Portal hypertension.
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J Coll Physicians Surg Pak · Mar 2021
Observational StudyDalteparin and Rivaroxaban Sequential Use in Cancer Patients with Venous Thromboembolism.
To determine the effect and safety of sequential treatment with the low-molecular-weight heparin dalteparin and the direct oral anticoagulants rivaroxaban in patients with cancer- associated venous thromboembolism (VTE). ⋯ Maintenance of rivaroxaban after initial dalteparin treatment could effectively reduce the risk of VTE recurrence and was well tolerated by patients with cancer-associated VTE. However, in the clinical practice, the treatment duration is often insufficient, so it is essential to follow-up these patients to ensure sufficient treatment time. Key Words: Venous thromboembolism, Low-molecular-weight heparins, Directly oral anticoagulants, Cancer.