Management of perforated peptic ulcer in Al-Gamhouria teaching hospital, Aden

We aimed to explore and analyze the current status in management of patients with perforated peptic ulcers. The study was carried out at the surgical department of Al-Gamhouria Teaching Hospital, Aden-Yemen. Patients, admitted with perforated benign peptic ulcers, during the period January 1997 to December 2006, were retrospectively evaluated. The total number of enrolled patients was 156; 138 [88.46%] men and 18 [11.54%] women. Overall mean age was 39.08 years [range 14-75 years] and the higher frequency of PPU was in patients of age group 21-40 years [58.34%]. The PDU/PGU ratio was [4.38:1]. The mean time of presentation was 16.5 hours and of the operative intervention after admission was 525 hours. Simple perforation closure was used in [91.67%] of the patients. Postoperative complications rate was 41.03% [statistically significant in cases admitted later than 12 hours], wound sepsis making the majority-55.24%; died 6 patients [3.85%]-correlation with presentation time was not significant. The overall mean post-operative hospitalization period was 12.76 days; 14.74% of the patients stayed more than 3 weeks. Emphasis should be placed on shortening the time to surgery. Simple closure remains the selected treatment in the majority of patients. Improving the surgical skills, wound care, administrative regulations, hospital environment and equipments is needed to reduce the high rate of complications

Awareness of intra-abdominal pressure and abdominal compartment syndrome

This study is carried out to assess current understanding and management of intra-abdominal hypertension [TAFT] and abdominal compartment syndrome [ACS] among clinicians. A questionnaire study was carried out in 7 hospitals of 3 Governorates in Southern-Western part of Yemen. It included clinicians in most of the specialties with different experience categories. The 12-question survey explored awareness, knowledge, and practice regarding intra-abdominal pressure [IAP], IAH, and ACS. The response rate was 91.7%-254 of 277 respondents, of which 3.2% [9] were excluded due to improper filling, and the remaining 245 [88.5%] were enrolled in the study. Most of the participants were from general surgery [66-26.9%], obstetrics [63-25.7%], and medicine [54-22%]. Unaware [140-57.1%] were more than aware respondents, whereas less respondents have knowledge in TAP, TAFT, and ACS. TAP had been measured only by 7 respondents [2.9%], most of whom were general surgeons-85.7%, whereas decompression was performed only by 4 surgeons [57.1%]. A significant percentage of the clinicians are unaware of presence and current approaches to diagnosis and management of TAFT and ACS. Education is necessary for diagnostic methods as well as standards for treatment of this unusual and lethal condition

Awareness of intra-abdominal pressure and abdominal compartment syndrome

To assess current understanding and management of intra-abdominal hypertension [IAH] and abdominal compartment syndrome [ACS] among clinicians. A questionnaire study was carried out in 7 hospitals of 3 Governorates in Southern-Western part of Yemen. It included clinicians in most of the specialties with different experience categories. The 12-questions survey explored awareness, knowledge, and practice regarding intra-abdominal pressure [IAP], IAH, and ACS. The response rate was 91.7% - 254 of 277 respondents, of which 3.2% [9] were excluded due to improper filling, and the remaining 245 [88.5%] were enrolled in the study. Most of the participants were from general surgery [66 - 26.9%], obstetrics [63 -25.7%], and medicine [54 - 22%]. Unaware [140 - 57.1%] were more than aware respondents, whereas less respondents had knowledge about IAP, IAH and ACS. IAP had been measured only by 7 respondents [2.9%], most of whom were general surgeons - 85.7%, whereas decompression was performed only by 4 surgeons [57.1%]. A significant percentage of the clinicians are unaware of presence and current approaches to diagnosis and management of IAH and ACS. Education is necessary for diagnostic methods and standards for treatment of this unusual and lethal condition

Role of magnesium sulphate in ischaemic stroke

To evaluate the role of magnesium sulphate in patients presenting with ischaemic stroke. This experimental type of interventional study was carried out at Mayo Hospital, Lahore. Within 24 hours of onset of clinically diagnosed stroke, which was later confirmed by CT scan, patients were randomized to receive either magnesium sulphate [16mmol IV over 15 minutes and 65mmol over 24 hours] or placebo. Their disability was measured by Barthel score at presentation and outcome measured after three months by death and disability and the results were compared between the two groups. Those patients who had a Barthel score of = 12 at three months were considered independent and those with a score of < 12 were considered disabled. The results were analyzed by SPSS. Fifty patients were recruited in the study. 25 patients were randomized to receive MgSO[4] and 25 received placebo. The Barthel score improved from 5.1 +/- 3.3 at presentation to 13.5 +/- 3.4 after three months in all the patients so the re was improvement whether MgSO[4] was given or not. Patients who were randomized to receive MgSO[4] had a lower Barthel score of 4.2 +/- 2.9 as compared to controls 5.9 +/- 3.5, but after three months they improved more than the controls gaining a score of 15.7 +/- 1.9 versus 11.3 +/- 3.2 [p=0.000]. The mortality rate was not statistically different in the two groups. 88% patients had a Barthel score of > 12 at three months in the MgSO[4] and 30% in the control/placebo group. Combined death and disability was 8% in MgSO[4] group and 60% in the control group. Moreover MgSO[4] was well tolerated. Magnesium sulphate therapy was safe in patients presenting with ischaemic stroke irrespective of the site of infarct. It improves prognosis regarding Barthel score at three months as well as the difference in the Barthel score at presentation and at three months. A greater percentage of magnesium treated patients led independent lives after three months

Complications of streptokinase during infusion in acute myocardial infarction

Myocardial infarction is one of the most common causes of death worldwide. The cornerstone of therapy is thrombolytic therapy. Coronary thrombolysis helps restore coronary patency, preserves left ventricular function and improves survival. The most common thrombolytic agent used is streptokinase. But thrombolytic therapy is at times associated with some complications. This comparative study was aimed to find out the complications occurring during streptokinase infusion in patients presenting with acute myocardial infarction in Mayo Hospital, Lahore. Two hundred patients with definite diagnosis of acute myocardial infraction, who presented to East Medical Ward, Mayo Hospital, Lahore, were included in this study. All patients presenting with AMI were considered for SK therapy. Those who were actually given SK constituted the SK group and those who were not fit for SK, but otherwise SK was indicated, constituted the control group. In SK group 100 patients were given standard t reatment of acute myocardial infarction including streptokinase. In control group 100 patients were given standard treatment of acute myocardial infarction except streptokinase due to non-eligibility. Patients with typical chest pain of at least 30 minutes duration, serial ECG changes and serial cardiac enzyme changes were entered in the study. Comparative / interventional Post SK changes in blood pressure were significant [p= 0.011]. There was post SK hypotension in 48 [24%] and post SK hypertension in 20 [10%] patients. Allergic reaction was present in 4 [2%] only [p=0.044]. Arrhythmias were significantly less prominent in SK group [p=0.000]. Post SK bleeding occurred in 3 [1.5%] only [p=0.082]. 37 patients died [18.5%] in total, out of which 5 [2.55] patients died in SK group and 32 in control group [p=0.000]. CVA occurred in 1 SK group patient only, which was found to be hemorrhagic on CT scan [p= 0.31]. Early administration of SK lowers in-hospital mortality [p= 0.00 0]. Major complications during SK therapy are Hypotension [p= 0.011], Arrhythmias [p= 0.000], Allergic reactions [p= 0.044]

Surgery for prolactinomas

A large proportion of prolactin secreting tumours of the pituitary gland are treatable by dopamine agonist drugs. However certain subgroups of these patients are better managed by surgical excision. The indications for surgery in prolactinomas remain controversial and this paper attempts to clarify these with illustrative cases. The factors favouring a surgical approach include poor tolerance of long term medical therapy, progression of visual deficits or recurrence while on medical treatment, cystic change in the tumour with pressure effects, CSF fistula secondary to tumour shrinkage and prophylactic surgery in tumours anticipated to cause CSF leak following medical therapy. The size and invasiveness of the tumour and the prolactin level are also important determinants of treatment planning. The indications for surgery in prolactinomas are discussed and illustrative cases are presented

Atrial fibrillation in mitral stenosis and its correlation with age, sex and clinical symptoms

The objective of the study was to calculate the frequency of atrial fibrillation of MS and its correlation with age, sex and clinical symptoms. A prospective descriptive study. Mayo Hospital and Punjab Institute of Cardiology, Lahore. 112 patients of mitral stenosis were investigated with an ECG and an echocardiography to confirm mitral stenosis and to measure anteroposterior left atrial dimensions on M-mode. All patients who were suffering from AF due to causes other than mitral stenosis were excluded. The significance of findings were tested through standard "t"test. Atrial fibrillation is more in female patient and has a linear correlation with age. More common symptoms of shortness of breath followed by palpitation

Ct and mr imaging in young stroke patients

This study investigates the role of CT and MR imaging in the diagnosis and management of young stroke patients. CT scan findings of 108 patients and MR findings of 30 patients between 15-45 years of age were reviewed retrospectively. The variables included the territory of infarct on CT and MR imaging, the cortical distribution and size of infarct. About 80% of the patients had infarcts of the carotid territory and 20% the vertebro-basilar distribution. More than half of the infarcts were cortical [56%]. The yield of MR imaging was much higher for deeper structures such as basal ganglia, thalamus and brainstem. In half the cases, the infarct size was more than 3 cm. The ratio of carotid to vertebro-basilar infarcts was similar to that reported previously. A large proportion of the carotid territory infarcts were cortical. Deeper infarcts were better imaged with MR scan. There was a high proportion of large infarcts