outcome of darning method of inguinal hernia repair using polypropylene in Sir Ganga Ram Hospital, Lahore

To valuate the darning method of inguinal hernia repair with polypropylene. 300 patients of unilateral inguinal hernia were admitted. After thorough investigations, all patients were operated for hernia repair by standard procedure using No.1 polypropylene. Patients were operated under, spinal or general anesthesia. Patients were followed up at one week, six weeks and six months after operation for wound healing and complications. Out of 300 patients, ranging in age from 20 to 70 years, 250 patients were given spinal anaesthesia, 45 patients [20%] were operated under local anesthesia. 196 patients were discharged from the hospital on the following day. 3 patients went into urinary retention and one patient had large haemotoma requiring exploration. Recurrence rate was 1% [n=3]. Darning method of inguinal repair with polypropylene is a safe and cheaper method of hernia repair

Indicators of early outcome in neonatal sepsis

The purpose of this study was to evaluate different parameters predicting outcome of neonatal sepsis. It was carried out at the neonatal unit of Ghurki Trust Teaching Hospital, Lahore from February 2004 to May 2005. This was an analytical comparative study performed prospectively. A total of 100 culture proven cases of neonatal sepsis were included. Complete data including birth weight and time interval between onset of symptoms and arrival at hospital was recorded. Complete blood counts and arterial blood gas analysis were performed in all cases. Overall mortality was 37%. Among the total of 100 cases 51% [n=51] were low birth weight [LBW] while 49% [n=49] were of normal birth weight, 40.7% [n=24] expired from LBW group, while 26.5% [n=13] from those with normal birth weight. Mortality was higher [P<0.05] in LBW babies. Among them 29.03% [n=18] expired from those who reached within 24 hrs of onset of symptoms [n=62] whereas 50% [n=19] expired from those who reached after 24 hrs [n=38]. This difference was also significant [P<0.05]. Hypothermia affected 39% of the cases. Mortality was significantly higher [P<0.05] in cases who developed hypothermia. Among laboratory parameters, leukopaenia, thrombocytopaenia, and acidosis were individually associated with high mortality [P<0.05], while leukocytosis was not significantly [P>0.05] associated with neonatal mortality. It was concluded that neonatal sepsis has high mortality. Some of the clinical and laboratory parameters are useful to recognize high-risk cases. Early referral can reduce mortality. Long-term follow-up of the survivors is indicated

Carotid endarterectomy at Punjab institute of cardiology, Lahore: Mid term postoperative results

This study was designed to review postoperative results of the carotid endarterectomy [CABG/CEA] performed at the Punjab Institute of Cardiology, Lahore. Cconsecutive 10 patients with coexisting severe ischemic cardiac and carotid artery disease were operated on during 1-year period ending December 2003 at Punjab Institute of Cardiology, Lahore. The mean age of the study population was 60.20 +/- 7.56 years, among theses 9 were male and 1 female patient. Four [40%] patients with carotid artery stenosis were asymptomatic. Previous stroke occurred in 2 [20%] patients: two [20%] patients presented with a history of blackouts and two [20%] with a transient ischemic attack. The mid term results with regard to 30-day postoperative mortality, stroke and major postoperative complications were significantly low in terms of post operative infection as only one [10%] patient had chest infection and there was no in-hospital mortality. Combined interventions of CE and CABG can be performed with an acceptable morbidity and mortality when severe carotid stenosis is associated with advanced, symptomatic ischemic heart disease. The introduction of routine preoperative carotid duplex scanning resulted in higher diagnostic rate for asymptomatic carotid artery disease among the patients scheduled for combined CABG/CE procedure

Free radial artery as an alternate conduit in CABG

This study was under taken to explore the potential of the Free Radial Graft as a safe efficient and suitable alternative conduit in coronary artery bypass grafting incase of in availability of the more established conduits like the IMA and Great Saphenous Vein graft especially in redo surgery. This prospective randomized single center trial was conducted on three groups of patients under going CABG. The study was conducted from 1st January 1999 to December 2002.The first group A [n=15 with mean age of 47.05'8.35years] Radial artery was used for grafting in Right and Left sided grafts except the LAD. In the second group B [n=15 with a mean age of 54.80'11.14 years] Great Saphenous Vein was used for grafting in Right and Left sided grafts except the LAD. In the third group C [n=20 with a mean age of 55.93' 11.14 years] IMA was only grafted to LAD. Proximal ends of both the GSV and the Radial Artery were anastomosed to the Aorta. All patients were male. Follow up was done in these patien ts both by non invasive and invasive methods such as ETT, Thallium scan, Angiography. Comparison was mainly done between the Radial artery and the Great Saphenous Vein taking as granted that the IMA g the best graft for the LAD in all cases. IMA was always applied to LAD in all patients in the three groups. In group [A] Radial Artery was grafted to RCA in 5 [33.3%] pts. Diagonal in 4 [26.7%]pts. Obtuse Marginal 12[80%] pts. And PDA 3 [20%] pts. In group [B] Great Saphenous Vein was grafted to RCA in 6[40%]pts. Circumflex 1[6.7%]pts. Diagonals 2 [13.3%] pts. Obtuse marginals 6 [40%] pts. And on PDA 4[20%] pts. All patients were regularly followed up for 18 months to 24 months. Post operative angina was reported in 2 [13.3%]pts. in group A and 5[33.3%] pts. In group B [p=0549]. ETT was done in all these pts. Was positive in 1[6.7%] in group A and 2 [13.3%] in group B [p=0.309]. Thallium scan was done in all the study population and was found positive in 4 [26.7%] in group A and 5 [33.3%] in group B Patients[p=0.265]. Coronary angiograms were done on 10 patients out of each group. In group A the grafts were patent in 9 patients [90%]. In the group B the grafts were found patent in 8 [86%] patients.[p=0.543]. Moderate Graft stenosis was found in 01 patient in group B and none in group A [p=0.35]. Totally blocked grafts were found in 01 patients in each group [p=1.00]. On the basis of this study early results suggest that Radial Artery graft is a suitable, safe, and potentially effective alternative in CABG patients. Early graft patency in patients receiving RADIAL ARTERY grafts is comparable to those receiving Saphenous Vein grafts, It may prove an excellent alternative for those who do not have the traditional conduits available due to any reason. However this short follow up period is not sufficient to come to a firmly conclusive result. A long term study with graft angiography is required to prove the efficacy of this conduit for future use

Electrophysiological assessment in paint workers with chronic exposure to organic solvents

Exposure to organic solvents has been associated with many neurological deficits. However, not all solvents are equally neurotoxic. The association of clinically significant polyneuropathy with long term occupational exposure to organic solvents, alone or in combination, is controversial. The aim of this study was to assess the effects of chronic occupational exposure to a mixture of certain organic solvents upon the peripheral nervous system [PNS] in exposed painting workers and detection of sub-clinical affection. The population of this cross-sectional study included two groups. The exposed group comprised 40 male workers recruited from a paint factory. Twenty male workers, age matched, with no contact with the exposure environment, from the same factory were eligible as a control group. The exposed workers were further divided into two groups group [I] and group [II] according to frequency and the pattern of usage of personal protective equipment [PPE]. The materials frequently used in painting process were included; epoxy, calcium carbonate, barium sulfate, n-butanol, titanium dioxide, xylene and zinc oxide. All workers were subjected to a structured interview questionnaire about their exposure and medical history as well as complete general and neurological examinations. Bilateral nerve conduction studies [NCSs] for motor [common peroneal, median and ulnar] nerves and sensory [sural, median and ulnar] nerves were performed for all the study population using a standardized protocol. The diagnosis and classification of neuropathy was established using a combination of symptoms, signs, and NC measures consistent with standard clinical practice. Potential confounders of NC measures were examined. Mean values for nerve conduction velocities [NCVs] for all studied motor and sensory nerves were highly significantly slower in exposed workers compared to control group [p<0.01]. The same results were recorded for the mean values for SNAP amplitudes. Regarding motor nerves CMAP amplitudes, there was significant difference only for tibial nerve. There was no significant difference of distal latencies for any estimated nerve either sensory or motor. For whole exposed group [n=40], 19 workers [47.5%] had at least one abnormal NC measure in two or more of evaluated nerves; 11 workers [27.5%] fulfilled criteria for confirmed clinical neuropathy whereas 8 workers [20%] fulfilled the criteria for sub-clinical neuropathy. The results NCSs of exposed workers with regular and complete protection [group I], exposed workers with partial protection [group II] and controls demonstrated significant differences regarding all parameters of all studied nerves except sensory latency of ulnar sensory nerve and motor amplitudes of median motor and tibial motor nerve. Regarding the inter-group comparisons, there were significant differences between the three groups for all SNCVs and only the MNCV of tibial nerve [p<0.01]. Other evaluated parameters of both motor and sensory nerves were affected with different significant degrees except distal latency of ulnar sensory nerve and motor amplitudes of median motor and tibial motor nerves[p>0.05]. The median sensory nerve was the only nerve which showed highly significant differences between the 3 groups regarding all its evaluated parameters [p<0.05]. Also only ulnar motor nerve showed highly significant differences between workers of group I and workers in group II regarding its all evaluated parameters of [p<0.05]. In the studied population [n=60], exposure, age and smoking were found to have significant effects on some NC measurements on logistic regression analysis. In the exposed group [n=40] using of PPE, type of job [regarding the spray painters] and duration of exposure, in years, had significant effects on certain NC parameters based on the same model of logistic regression analysis. Chronic exposure to the mentioned organic solvents was associated with solvent induced toxic polyneuropathy [SITP] as proved by the results of abnormal electrophysiological parameters of the evaluated peripheral nerves for all exposed workers group. Appropriate medical strategies to reduce such morbidity as periodic medical evaluation and electrophysiological assessment should be implemented

Cardiovascular health - behaviour of medical students in Karachi

To assess the health behaviour and perceptions of medical students towards cardiovascular disease. This descriptive cross-sectional survey was conducted on 203 Pakistani medical students enrolled in a private medical college in Karachi, Pakistan using systematic random sampling. It was based on a self-administered questionnaire. Eight% smoked, 9% were overweight, 33% had a family history of coronary artery disease, 32% regulated dietary fat intake, 28% exercised regularly, 62.1% knew personal blood pressure and 5.4% personal cholesterol levels. Regarding developing cardiovascular disease in the future, 62% showed concern but only 54% of these adopted preventive practices. About 46% believed medical college life had a harmful effect on their health. Gender, family history and personal health status perception were behavior modifying influences [p<0.05]. Reasons reported for their behavior were: no need of prevention at their age [38.3%] and never thinking about these issues [37.0%]. Conclusions: The study shows a high prevalence of coronary artery disease family history, inappropriate dietary intake, physical inactivity; poor screening practices and lack of awareness. The results underscore the urgent need to promote preventive knowledge and practices among medical students, if they are to become prevention oriented physicians and counsel patients on preventive strategies to counter the rapidly increasing burden of cardiovascular diseases effectively

Ruptured aneurysm of sinus of valsalva: clinical manifestations and surgical treatment in eighteen patients

Eighteen patients with ruptured aneurysms of sinus of valsalva were operated in the cardiac surgery department of a large tertiary care teaching hospital between January 1991 and December 1996. Male to Female ratio was 8:1. Age range was 18-40 years with mean of 24. Majority of aneurysms originated from right coronary cusp [67%] and rest from non-coronary cusp [33%]. All right coronary sinus aneurysms opened into right ventricular outflow tract and all non-coronary aneurysms ruptured into right atrium. Associated anomalies were present in eleven cases [61%] comprising VSD in 3 [16.6%], Aortic incompetence in 5 [28%], Sub-aortic membrane in 2 [11%], and Coarctation of Aorta in one [5.5%]. Surgical correction was performed in all patients to close both the defect and the associated lesion. A standard cardio-pulmonary bypass with single aortic and bi-caval cannulation was established. Prolapsing portion of the sinus was excised and repaired simultaneously through aorta and the involved chamber. There were no perioperative deaths. Follow-up ranged from 4 months to 5 years with an average of 3.5. None of the patients required re-operation. We conclude that in patients with ruptured aneurysm of Sinus of Valsalva, dual approach is a better surgical option with minimal operative risk and excellent long term results

Intracardiac myxomas: a review of clinical and operative findings in 24 cases

Twenty four patients were referred for operative removal of intracardiac myxomas to the cardiac surgical department at Mayo Hospital, Lahore during the period 1986-1996. Out of these, 21 patients were operated while the rest refused operation. The age range of the patients was 15-65 years with a mean of 29 years. There were 16 female and 5 male patients. Presenting symptoms were varied including general and constitutional symptoms 15[62%], dyspnea and palpitations 14[58%] and embolic episodes 10 [40%]. All patients had preoperative 2-D echocardiography which suggested the diagnosis and described the location and size of the tumour. All the patients were successfully operated with no perioperative mortality. The size of the tumour ranged from 2-6 cm with an average of 4cm. Eighteen tumours were pedunculated and the rest were sessile. Eighteen patients had left atrial myxoma, 2 right atrial and one right ventricular myxoma. All the tumours were solitary and there were no reported recurrences