Spinal epidural haematoma is a rare condition, which may be due to trauma, surgery, epidural catheterisation or disorders of coagulation. We report a case of 60 year old lady who was on warfarin for Atrial fibrillation (AF) presented with history of non-traumatic sudden onset pain in both legs and difficulty in walking. Magnetic resonance imaging (MRI) spine demonstrated epidural haematoma which was treated conservatively. Another dilemma was anticoagulation for AF. We examine the options to manage such case.
Background: Pancreatic cancer is a fatal disease with high mortality rate. Imaging has a significant and decisive interplay in the diagnosis process and in staging of the patients with carcinoma. Thus MRI detection of linear metastasis in patients with pancreatic carcinoma is of great importance. Objective: The purpose of the study was to find out the diagnostic accuracy of MRI in the detection of linear metastasis in patients with pancreatic carcinoma Methodology: Systematic literature search was conducted by the help of following search engines: Google scholar, PubMed, NCBI, Medline and Medscape databases from 1999 up to 2020 for names or pancreatic carcinoma, MRI, diagnostic accuracy of MRI in carcinoma, management of motion artifact in MRI, RADAR sequence for motion compensation in MRI. Only those studies were included in this review study which showed the role MRI detection in the patients with pancreatic carcinoma. Total 33 studies were selected and evaluated for the current study. All data extracted from them was further analyzed through meta-analysis. Results: According to literature MRI detection technique is responsible in the detection of linear metastasis in pancreatic carcinoma. The diagnostic accuracy of the test was high with four out of five studies indicating diagnostic accuracy greater than 90%. Moreover, the sensitivity and specificity of the technique is high i.e. above 0.80 and 0.78 respectively. Thus MRI stands as the significant and accurate marker for the detection of metastasis especially in the case of pancreatic adenocarcinoma. Conclusion: The reviewed literature indicated that MRI possesses high diagnostic accuracy for detection of pancreatic carcinoma. The sensitivity and specificity of MRI was also high. The results indicated that the use of MRI may help in early detection of Pancreatic Cancer. Key words: Pancreatic carcinoma, Linear metastasis, Magnetic Resonance Imaging
Objective: To assess the superficial surgical site infection after primary closure versus delayed primary closure of wound in perforated appendicitis. Study Design and Setting: This was an observational study conducted at Darul Sehat Hospital & Civil Hospital Karachi during March 2019 to August 2019 Methodology: All patients of either gender between 18-50 years of age undergoing open Appendectomy through standard gridiron incision in emergency having consented for participation in the study prior to surgery and with per-operative finding of perforated appendix in emergency were included. Patients on steroids or immunosuppressive agents, smoker staking 5 or more cigarettes per day, patients with history of Diabetes Mellitus, chronic liver disease and chronic renal failure were excluded from the study. Patients with perforated appendix were randomly allocated into two Groups. Group A received delayed primary closure at 3rd post-operative day while in Group B primary closure was done immediately after appendectomy. All patients were examined for signs and symptoms of superficial surgical site infection at the 5th postoperative day before discharge from the hospital. SPSS version 13 was used for data analysis. Chi square test was applied to compare the outcome (superficial surgical site infection) in both groups. P-value <0.05 was considered as significant. Results: A total sixty patients were allocated in each group. Wound infection was very high among patients with immediate closure (40%) as compared to group which received delayed primary closure (15%) (p=0.020). Conclusion: The superficial surgical site infection was significantly higher after primary closure versus delayed primary closure of wound in perforated appendicitis.
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