S. Siminkovitch, B. Vladimirov1 , M. K ovacheva-Slavova1 ,J. Genov , R. Mitova B. Golemanov, P. Gecov, D. Svinarov
Vitamin D Deficiency In Chronic Pancreatitis
S. Siminkovitch, B. Vladimirov1 , M. K ovacheva-Slavova1 ,J. Genov , R. Mitova B. Golemanov, P....
The main objective of this study was to determine the prevalence of 25OHD deficiency in patients with chronic CP, and to assess its relations to the contributing factors. Study encompassed 93 patients in two subgroups: 72 patients with proven CP (52% males; group mean-aged 52.7 years) and 21 matched control subjects (43% males, mean-aged 54.2 yrs) who consented to participate. CP patients were subdivided according to Cambridge classification for CT/MRCP (grade 1–4). 25-Hydroxyvitamin D (25OHD, sum of 25OHD3 and 25OHD2) was analyzed by a ID-LC-MS/MS method. Results: Vitamin D (25OHD) levels in CP patients were found lower than in the control subjects, p 0.036. Absolute 25OHD deficiency (values under 25nmol/L) was observed in 37.5% (27) of patients with CP, while the absence of deficiency (25OHD >80nmol/L) was found only in 8.3% (6). The mean 25OHD levels were found lower in patients with diabetes (vs non-diabetic) and those presented with Pancreatic Exocrine Insufficiency, p
<0.05. We found a difference between 25OHD mean values for subgroups 1- 4 by CT/MRCP, p><0.001. Seasonal difference in 25OHD status was significant for patients with Cambridge 1 and 2 grade (mild changes) and in the control subjects. In the opposite, the lowest 25OHD levels were registered for patients with severe imaging data Cambridge 3 and 4, without effect of season; p><0.005, odd Ratio 10.37. Conclusion: Most of our CP patients were with vitamin D deficiency and insufficiency and there was a strong relationship between 25OHD levels and severity of morphological imaging data with increased risk for 25OHD deficiency. >
Transthoracic Penetration of Shrapnel to Liver-A Specific War Injury Demanding Awareness for Optimal Management
Author as a trauma surgeon with Sri Lanka army has treated 21 soldiers during December 1999 to May 2001 at Military Hospital, Palaly, Jaffna who only sustained shrapnel injuries reaching liver substance through lower part of right thorax. Injuries were a result of soldier anticipating enemy with gun pointing forward when shrapnel from above ground blasts enter chest wall through weaker flanks of flak jackets. During ATLS assessment they had insertion of a chest drain to right side performed. This 21 patients qualified for thoracotomy on grounds of initial drainage or ongoing drainage as per ATLS guidelines. The group in study did not have abdominal distension and had only mild right hypochondrial tenderness. Chest X-ray revealed right haemothorax and some shrapnel in the liver substance which was confirmed on abdominal X-Ray. Although qualified for thoracotomy these patients underwent exploratory laparotomy first. After control of bleeding and mobilization of liver, diaphragmatic lacerations were repaired and liver lacerations managed with gelfoarm packs and sutures. Three of the patients had large liver lacerations and required damage control surgeries which were successful. Thoracotomy was not required in any. Understanding of exact mechanism of injury through knowledge of the profession is vital for effective assessment in trauma. Awareness and accurate assessment of described thoraco-abdominal injuries contributed to optimum management with exploratory laparotomy and avoid thoracotomy, a second major operation.
Over time, the animals lose organ regeneration capacity, which remains in invertebrates and vertebrates turbellarians such as fish, amphibians and some reptiles. However, understanding of the molecular and cellular mechanisms of regeneration on these groups is interesting because this knowledge can be applied in the future treatment of diseases in mammals, including humans. Laser therapy is used in the medical clinic for varying purposes, including repair of damaged tissues.Are scarce in the literature, studies have examined the action of the laser on the regeneration processes of animal organs which are characterized by the formation of blastema.This study evaluated the possible actions of the visible laser diode in the regeneration of tail gecko (Hemidactylus flaviviridis) considering the kinetics of the process.In Methodology two groups of 14 adult animals were submitted to tail induced amputation, one of them received laser treatment and the other does not. The treated and not treated groups were divided in two subgroups according to the day of sacrifice, being killed on the 11th and 21st day.It was evaluated parameters as the measure of the macroscopic length of the regenerated at different times after amputation of tail. With the obtained data was calculated: the avarage variation of the regenerated length in gecko, 11 and 22 days after the amputation of the tail, the reduction percentage of the regenerated, the moment that there were the different stages of regeneration in each group and subgroup and the percentage of subjects who achieved the growth phase of the blastema.It was also documented by photographs each stage of the regeneration process of the tail in the experimental groups. The laser therapy model used in this experiment had inhibitory action on the growth and differentiation of epimorphic regeneration of the tail gecko, Hemidactylusflaviviridis, similar to the action of other anti-inflammatory therapies.
Loss of anterior tooth due to any reason like root resorption, trauma, periodontal disease or endodontic failure can be a deeply traumatic situation for most patients & needs immediate attention. An immediate replacement is necessary in order to avoid aesthetic, masticatory & phonetic difficulties. This paper describes the immediate replacement of lateral incisor using composite resin with the natural tooth crown as pontics. It is a simple and economical method. It requires minimal or no tooth preparation tooth & also it is a reversible technique with no additional lab costs
Effect Of Therapeutic Ultrasound In The Management Of Shoulder Calcific Tendinopathy-Case Study
Mr. Nezar Al-Toriri
Introduction: Ultrasound therapy is used to treat calcific tendinitis of the shoulder; its efficacy has not been rigorously evaluated. In this case report patient with symptomatic calcific tendinitis is verified by radiography. Patient received continuous ultrasound (frequency, 1 MHz; intensity, 1.5 W per square centimeter; 7-minute period for 10 sessions of ultrasound (five times in a week for two week) to the area over the calcification. Case Report: A 60-year-old man was presented with complaints of acute left-shoulder pain. patient underwent a course of therapeutic ultrasound. The outcome measures were the Visual analog scale (VAS) and patient perceived improvement (PPI). Following treatment, the patient reported improvements in both pain and function as measured by the VAS and PPI. Conclusion: In this case report, therapeutic ultrasound for the treatment of shoulder calfication resulted in improvement in all recorded measures of pain and function. The promising outcome of this single case report highlights the need to further evaluate through more structured controlled trials the efficacy of therapeutic ultrasound in the treatment of shoulder calcification.
Intra-Operative Triage- A Novel Technique In Doing The Best For The Most In Disasters
RW S eneviratne
Introduction: Disaster triage involves categorizing casualties according to the need of medical care in a disaster situation when number of casualties overwhelm the capacity of medical services available . Triage is a continuous process and done at different levels. They are done initially at the site of disaster at the site of transport to hospital and on arrival at accident and emergency department to determine priority for resuscitation again. This is followed by triage performed to send patient to operating theatre .Currently available literature does not describe a triage concept beyond this level although many agree that triage should be done periodically. Aim: Aim of this article is to describe a new concept termed intraoperative triage which is an extension of general principals governing disaster triage in to the operating theatre. Description of the concept: In a mass casualty situation a forward hospital may find available specialist surgical cover scarce compared to that of middle grade doctors and opened-up theater beds. Simpler components of operations as well as anesthesia can be performed by middle grade doctors but complex injuries need advice and often manual input of experienced surgeons who are in short supply. The surgeon need to shift between patients performing the specialized and urgent components only leaving less experienced to complete the rest. Conclusion: Intraoperative Triage stretches the primary concepts governing triage further in to intraoperative delivery of health care in a mass casualty situation. It is a process which is required to be discussed, formalized and disseminated among trauma surgical community in order to save more lives of disaster victims.