Enteric ileal perforation primary repair versus loop ileostomy

Objectives: The aim of this study was to record the outcome of enteric ileal perforation, managed by primary repair versus ileostomy in terms of post-operative complications, mortality rate and hospital stay

Design and Duration: Quasi experimental study from January, 2009 to August, 2010

Setting: Surgical Unit-V, District Headquarters [Teaching] Hospital, Punjab Medical College, Faisalabad

Methodology: During the period of study 46 patients of enteric ileal perforation were divided in two groups on consecutive sampling basis. Detailed data of each patient including presentation, operative findings, procedures performed, post-operative outcome and histopathology was entered on a specially designed proforma. The main outcome measures found significant were post-operative complications, hospital stay and mortality rate. The data was compiled and analyzed by using SPSS-1B

Results: 46 Patients of enteric ileal perforation were studied during the period of 20 months, divided equally in 2 groups, Group A [loop ileostomy] and Group B [primary repair]. An increased rate of post-operative complications was seen in Group B [primary repair] when compared with Group A [loop ileostomy] with 21.74% patients landed up in peritonitis secondary to leakage from primary repair and 17.39% ended up with controlled feacal fistula formation. Mortality rate was twice higher in Group B [primary repair] when compared with Group A [loop ileostomy]. A ratio of 1:2.75 days was observed between hospital stay of Group A [loop ileostomy] to Group B [primary repair]

Conclusion: Enteric ileal perforation still represents a disastrous complication of enteric fever and constitutes a good number of patients presenting in surgical emergency with acute abdomen. Exteriorization of perforation in the form of loop ileostomy is more appropriate option for such patients as compared to primary repair of the perforation when compared in terms of postoperative complications, hospital stay and mortality rate

Pharmacokinetics for dose proportion; estimation of 250 mg cefaclor tablet in male volunteers

To estimate dose proportion for male volunteers by calculating pharmacokinetics following oral administration of Cefaclor [CCL] 250mg Tablet and to check the relative susceptibility of four bacterial strains. Randomized Clinical Trial, case series. Department of Chemistry and Biochemistry, University of Agriculture, Faisalabad. From Mar 2006 to Feb 2007. Blood samples were collected for the period of 12 hours in heparinized tubes. Collected samples were centrifuged at 3000xg and plasma thus separated was stored at -10°C until further analysis. The CCL plasma concentration was determined via bioassay using disc diffusion method. Pharmacokinetics parameters were calculated using American Pharmacology Organization [APO] computer software. Renal Clearance [CL], volume of distribution [VD], time of Peak [T[max]], maximum plasma concentration [C[max], mean residence time [MRT], absorption half life, elimination half life and the Area Under plasma Concentration [AUC [t0tot12h] showed that the four bacterial strains have different susceptibility against cefaclor and administration of cefaclor at rate of 250 mg as tablet orally thrice daily maintained considerable concentration [>MIC] that prove it to be very effective for the treatment of specific infections in male volunteers

In hospital outcome of patients undergoing coronary endarterectomy: comparison between off-pump vs on pump CABG

Due to advancement of non-surgical methods of coronary revascularization the patients referred for surgery have extensive and complex coronary anatomy. Patients with diffuse atheromatous coronary artery disease required coronary artery reconstruction or coronary endarterectomy [CE]. Coronary endarterectomy on beating heart needs skill and better surgical technique. Coronary endarterectomy along with coronary artery bypass grafting [CABG] done on beating heart is compared with coronary endarterectomy done by using conventional CABG technique. Seven hundred and ninety five consecutive patients underwent CABG from January 2006 to March 2007 in a prospective randomized trial at cardiac surgery department, Punjab Institute of Cardiology, Lahore; out of these 115 patients underwent coronary endarterectomy [CE] and were included in this study. Coronary artery bypass grafting was performed in 115 patients. Seventy two [62.6%] were in group A on-pump and 43 [37.39%] were in group B off-pump. Mean age in group A was 55.68 +/- 1.06 and 52.63 +/- 1.40 in group B. Sixty six male and 6 female were included in group A, 40 male and 3 female patients were in group B. In-hospital mortality among patients undergoing CABG was 5.6% in on-pump group and 2.3% in offpump group [p=0.649], the duration of post-operative mechanical ventilation in on-pump was 6.78 +/- 9.34 hours and 5 +/- 4.0 hours in off-pump group [p=0.060], 66.7% patients in on-pump and 58.1% patients in off-pump group required blood transfusions, Intra-aortic balloon pump [IABP] was required in 5.6% of the patients in on-pump group. Other factors included, smoking 26.4% in on-pump and 41.9% in offpump group [p=0.01], Intensive care unit [ICU] stay was statistically significant 4 +/- 3 in on-pump group and 4 +/- 2 in off-pump group [p=0.02], and drain in on-pump group was 455 +/- 208 ml and 540 +/- 370 ml in off-pump group [p=0.01]. Coronary endarterectomy [CE] has higher post-operative morbidity and mortality but the post-operative outcome after the procedure on either technique is comparable and CE is feasible on off-pump technique as well

Early vascular complications of intraaortic balloon counterpulsation in patients undergoing open heart surgery

The use of IABP is helpful for haemodynamic stability of patients with low cardiac output and compromised left ventricular function in patients who undergo coronary artery bypass grafting. This procedure is also associated with some vascular complications due to the insertion of IABP. The objective of this research was to study the vascular complications in patients with IABP counterpulsation. We observed the clinical outcome of these patients with special reference to post IABP complications in our research. One hundred and six consecutive patients were included in this study from August 2005 to February 2007. Mean age of patients was 58.08 +/- 1.814 years. Seventy nine patients [74.5%] were male and 29 [25.5%] were females. Out of these 106 patients, 101 were operated for CABG, one for angina due to aortic stenosis, two patients had ischemic mitral regurgitation and one patient had post infarct VSD. In 102 [96.2%] patients IABP was inserted percutaneously, one patient received transthoracic and in three patients IABP was inserted with open technique. Thirteen [12.3%] patients received IABP with sheath and 93 [87.7%] received IABP without sheath. Ten patients [9.4%] out of 106 developed vascular complications due to insertion of IABP. Seven patients [6.6%] had the major complications and 3 [2.8%] patients developed minor vascular complications. Mortality due to vascular complications in 106 patients was 8.49% with p<0.005. IABP has remarkable beneficial effects in patients with haemodynamic instability due to myocardial ischemia and low cardiac output syndrome. At the same time IABP is related to significant morbidity and mortality related to vascular complications due to its insertion which include limb ischemia, limb loss and even mortality

Cardiac mortality trends in the emergency department of a tertiary care cardiac centre

Limited information is available on trends in mortality from cardiovascular diseases in Pakistan. The objective of this study was to examine the various cardiac causes of early deaths and asses the treatment strategies in emergency department of a tertiary care cardiac centre. We conducted a prospective observational study of early deaths over an eight months period. Data of emergency admissions from June 2006 to January 2007 was analyzed. There were 357 early deaths; median age 60 years, and median survival time 1.55 hours. There were 6221 emergency admissions, with 4.6% of men and 9.4% of women having early mortality in emergency department. Only 14 were non-cardiac deaths and 314 [88%] were cardiac related deaths. Valvular heart disease comprised 6% of cardiac deaths. There were 373 cases received dead in emergency and assumed to be sudden cardiac deaths. Cardiogenic shock [CS] was the leading cause [265, 74%] of cardiac deaths and ST elevation myocardial infarction [STEMI] comprised nearly half of those deaths [130, 49%]. Only 39% [51/130] of STEMI patients were thrombolysed and there was only marginal difference in the survival time of patients with or without lytic therapy. ST depression was seen in 17% of CS patients. Ventricular fibrillation and ventricular tachycardia constituted only 20% of cardiac deaths. Complete heart block [CHB] was seen in a quarter of CS patients and emergency transvenous pacing was successful in 67% [42/63]. The survival time was shorter in patients with failure to pace acutely; men [0.50 vs. 1.30 hrs], women [1.00 vs. 2.15 hrs]. A very large number of early deaths were cardiac and cardiogenic shock was the major cause. Only half of cardiogenic shock patients had diagnostic ECG changes of ST segment elevation and less than half of these were thrombolysed

Early left ventricular remodeling after aortic valve replacement

Aortic valve disease is associated with eccentric or concentric left ventricular [LV] hypertrophy and changes in the LV mass. The relationship between LV mass and function and the effect of LV remodeling after aortic valve replacement [AVR], in patients with aortic valve disease needs evaluation, that is largely unknown in our population. The aim of this study was to evaluate the effect of AVR on LV remodeling, in patients with aortic valve disease. Fifty patients with aortic valve disease were studied using transthoracic echocardiography to assess LV mass before AVR and compared with early postoperative changes in the LV dimensions and function. LV mass was studied preoperatively and before discharge in 50 consecutive patients undergoing isolated aortic valve replacement. Out of fifty patients, 47[94%] were male and 03[6%] were female. Mean age of the patients was 40.42 years. 22 [44%] had isolated aortic stenosis [AS], 16 [32%] patients had isolated aortic regurgitation [AR] and 12 [24%] patients had mixed aortic valve disease [MAVD]. 02 [4%] patients died. LV mass regression was studied in all the patients. In group A, with aortic stenosis, LV regressed to 69.88 gm [mean] with maximum of 156.88 gms and minimum of 0.00 gms [SD 43.67 gms, p value=0.001]. In group B, with aortic regurgitation, LV mass regressed to 203.96 gms [mean] with maximum 453.79 gms and minimum of 45.65 gms [SD 95.33, p value=<0.001]. In group C, with mixed aortic valve disease, postoperatively LV mass regressed to 122.94 gms [mean] with minimum 9.57 and maximum of 224.75 gms [SD 69.53, p value=0.524]. There was significant early LV mass regression after aortic valve replacement in patients with pre existing aortic valve disease. However, it was noticed that LV mass regressed in all patients except no significant changes in LV wall thickness [hypertrophy]

In hospital outcome of acute myocardial infarction [ST segment elevation type] in diabetics and non diabetics

To evaluate the in-hospital mortality and complications of acute myocardial infarction in diabetic and nondiabetic patients. Descriptive study. Coronary Care Unit and Cardiology Ward of Nishtar Hospital, Multan from 1st October 2002 till 15th May 2003. Four hundred and forty-eight [448] consecutive patients who fulfilled the inclusion criteria were studied while they were admitted to the hospital. Patients were divided into two groups of diabetics and non-diabetics depending on the presence of diabetes mellitus. In-hospital mortality and complications were compared between the two groups by Chi-square method. Diabetic patients presented in more advanced Killip class as 32[26.7%] patients presented in Killip class II, 13[10.8%] patients presented in Killip class III and 6[5%] patients presented in Killip class IV. In the non-diabetic group, 68[20.7%], 24[7.3%] and 11[3.4%] patients presented in these Killip classes respectively [p<0.042]. The total in-hospital mortality was 17%. Mortality was 28[23.3%] in diabetics and 48[14.6%] in non-diabetics [p<0.03]. In-hospital mortality was almost double in diabetics as compared to non-diabetics. Mechanical complications were observed in 42[35%] patients in diabetic group and 80[24.4%] patients in non-diabetic group. Left ventricular failure was the most commonly observed mechanical complication. Electrical complications were observed in 84[70%] diabetic and 162[49.4%] non-diabetic patients [p<0.205]. In patients with acute myocardial infarction, presence of diabetes mellitus was associated with worse inhospital outcome leading to increased mortality and complications as compared to non-diabetic patients