profile of patients with ischaemic heart disease

It is generally believed that the lschaemic Heart Disease is a disease of the affluent people. The findings of this study, however, suggest that less well to do sections of the society are equally prone to coronary heart disease rather with a higher mortality. Sixty patients [76.92%] had at least one risk factor, while only 33.33% patients had multiple risk factors. Hypertension was the most common risk factor, present in 39.74% of the patients, diabetes mellitus in 35.89% and cigarette smoking in 30.75% cases. The percentage of patients, who smoked was higher among patients below 50 years of age [43.7%] as compared to those aged over 50 years [27.41%]. The distribution of risk factors was, however, almost equal among both groups

Congenital diaphragmatic hernia in the adult

Diaphragmatic hernia through pleuroperitoneal canal of Bochdalek in the adult is a rare surgical occurrance. Two adult males 26 and 43 years of age with left sided hernia of the foramen of Bochdalek with abdominal viscera in the thoracic cavity were treated in North Surgical Unit. The major part of the contents in both cases consisted of greater omentum and transverse colon whereas in one patient the thoracic cavity also contained portions of stomach and jejunum. These patients were admitted as emergency with acute upper abdominal symptoms and respiratory embarrassment which was more marked in one patient who had been misdiagnosed as a case of tension pneumothorax and treated by an intercostal drainage tube at a peripheral hospital before he was referred to us. This patient in fact was later found to have a perforation in the transverse colon which was lying in the chest cavity. In the adults these invariably present us emergency due to strangulations of the herniated contents. The diagnosis is often missed because of the rarity of the condition, although the need for an urgent and accurate diagnosis is imperative for correct management. The chest X-Rays in these patients tell the whole story provided they are looked at carefully

Sutureless skin closure: a comparative study with conventional stitching

Sutureless skin closure employing a new product 'Polyurethane membrane' [opsite] was evaluated in North Surgical Unit, Mayo Hospital, Lahore in Comparison with the standard technique of skin closure using interrupted silk stitches. The trial was conducted on 120 patients undergoing elective and emergency surgery. The results were comparable in both cases. Polyurethane skin closure yielded equally sound wound healing as the conventional method of skin closure with the added advantages that it was easier and quicker to apply, produced superior cosmetic results, the final scar being limited to a fine line devoid of the cross marks of suturing. It was also associated with lower incidence of infection and greater patient satisfaction

Perioperative single dose antibiotic therapy in elective surgery

A placebo controlled study was undertaken to evaluate the role of antimicrobials as a single 24 hours cover peri-operatively. Patients matching in proposed surgery, age, sex, diagnosis and built were divided into three groups. Group 'A' was on placebo, group 'B' received full dose of antibiotics by conventional method and group 'C' received antibiotics as a single 24 hour cover perioperatively. The post operative incidence of complications was 27% in placebo, 13% in group 'B' and 7% in group 'C'. The perioperative use of antibiotics has been found to be comparatively more effective, safe and economical

review of surgical amputations

A critical review of the pattern ofamputations performed in our general surgical unit at Mayo Hospital, Lahore is presented in this article. The unit admits all emergencies including trauma and orthopaedics. 172 amputations were performed during 1981 and 1993 on 152 patients needing more than one amputation. The indications for these amputations in order of incidence were trauma, peripheral occlusive vascular disease, malignancy, congenital malformation, burns, puerperal sepsis and maduromycosis. Major amputations of the limbs were necessitated in cases of trauma and occlusive disease, whereas minor amputations of digits and toes were performed on patients of younger age group ranging from 6-20 years for congenital and traumatic reasons. Regretfully poor training facilities of young workers and employment of untrained labour especially young children in heavy mechanical work lead to numerous accidents needing amputations. This review is confined to the amputations of the extremities only

Fat embolism

Multiple injuries including fracture of the bones and crush injuries of the limbs pose many problems in their management. Fat Embolism, a mere 2.5% of the total number of cases presented here, remains a dreaded complication. Early diagnosis and management has a significant effect on the eventual morbidity and mortality. In the present study we have tried to standardize the diagnosis and management of these cases in the light of present knowledge. This series also highlights the fact that it is not a common complication but one must always be on the look in relevant cases

Minocycline HCL in urinary tract infection - a clinical trial

Minocycline HCL was tried in 100 patients with urinary tract infection. It was highly effective in patients with E. coli and Strep faecalis infections. A convenient dose schedule, low recurrence and relatively low cost make it attractive in terms of patient compliance

Role of polyurethane membrane in postoperative wound management

The role of polyurethane adhesive transparent film dressing was studied in fifty patients against the conventional gauze dressing. "Polyurethane membrane" was found to be a superior form of dressing since it allowed frequent wound observation without disturbance of normal healing process due to change of dressings. It was also found to reduce the wound infection rate. It is moisture, vapour permeable non-irritant membrane, more economical than the conventional gauze dressing. Its role therefore as a wound dressing is well established