Articles: ninos.
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J Coll Physicians Surg Pak · Mar 2021
Case ReportsHenoch-Schönlein Purpura Presenting with Acute Abdomen.
Henoch-Schönlein Purpura (HSP) is an autoimmune, systemic, non-granulomatous vasculitis characterised by self-limiting clinical course, and leukocytoclastic vasculitis of small vessels. Deposition of immune complexes that contain IgA is the hallmark of vascular involvement. Adults with HSP have a higher incidence of complications and death. ⋯ Although corticosteroids do not prevent recurrences, evidence in literature suggests that these are beneficial in resolution of the arthritis and abdominal pain. Aggressive therapy with corticosteroids or cyclophosphamide is not successful in reducing renal damage, except in patients with crescentic nephritis. Key Words: Henoch-Schönlein purpura, Gastrointestinal complications, Steroids, Surgery.
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J Coll Physicians Surg Pak · Mar 2021
Incidence of Silent Ischemic Infarct after Diagnostic Conventional Cerebral Angiogram.
This study was carried out to determine the risk of new ischemic events, demonstrated by diffusion weighted magnetic resonance imaging (DW-MRI) in patients undergoing diagnostic conventional cerebral angiogram. MEDLINE, EMBASE, Current Contents, Cochrane Central, Expert Files, and bibliographies of included articles were systematically searched to identify prospective studies that reported MRI findings after diagnostic angiogram. Eligibility criteria included the following elements: manuscripts published between 1999 and 2019; prospective design; only diagnostic angiogram imaging performed prior to the MRI; DW-MRI done before and after the angiogram procedure; and number of new diffusion weighted lesions documented after each procedure. ⋯ DWI lesions were associated with diagnostic angiograms in 106 (24.65%) of total procedures. Mean time fluoroscopy, procedure by resident operator, and vascular risk factors were the recognised independent risk factors for silent cerebral ischemia after diagnostic angiogram. Key Words: Stroke, Diffusion magnetic resonance imaging, Cerebral infarction, Angiography, Brain ischemia.
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J Coll Physicians Surg Pak · Mar 2021
Review Case ReportsCervical HSIL Involving the Endometrium and Adenomyosis: A Case Report and Literature Review.
Cervical squamous cell carcinoma (SCC) spreading superficially to the inner surface of the uterus and replacing the endometrial lining cells with carcinoma cells is called superficial spreading SCC. We, hereby report a 53-year postmenopausal woman who had a history of cervical SCC in situ/high grade squamous intraepithelial lesion (HSIL). ⋯ This a very rare phenomenon, as the endometrial involvement may be caused by direct extension of the cervical lesion, and occur mainly in postmenopausal women, and should be deligently searched during pathological examination. Key Words: HSIL, Cervix, Endometrium, Adenomyosis.
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Tuberculosis (TB) of pancreas is a rare presentation in both immune-competent and immune-suppressed patients. Its presenting clinical features are usually vague and non-specific, while radiological features mimic other common pancreatic conditions such as malignancy, so it is often misdiagnosed. It commonly involves the head and the uncinate process of the pancreas. We report a middle-aged immune-compromised man who presented with left-sided tubercular pleural effusion and later was diagnosed as pancreatitis by clinical presentation and TB of pancreas on computed tomography of the abdomen.
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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.