Acute appendicectomy is better choice for appendicular mass

To compare the cost effectiveness, hospital stay and morbidity in each type of management of appendicular mass i.e. early surgical intervention and conservative management. A randomized comparative study. South Surgical Ward, Mayo Hospital Lahore from July, 1999 to January, 2001. 40 patients were included dividing in two equal groups. Group A patients were explored early and group B patients were managed conservatively. Cost effectiveness, hospital stay and morbidity were determined in each group. Mean hospital stay was 2.85 days [2-4 days] in group A and 6.25 days [5-8 days] in group B [p value< 0.001]. Mean expenditure in group A was Rs.1255 and Rs. 2183.75 in group B [p value < 0.001]. 100% patients in group A got complete pain relief within three days while it took 7 days for 90% of patients in group B [p value<0.001]. Oral fluids were started earlier in group A as compared to group B [p value<0.05]

Bacterial infections in paediatric patients with chemotherapy induced neutropenia

To determine the pattern of bacterial infections, isolate and identify the pathogenic bacteria and their sensitivity to different antibiotics during febrile episodes in paediatric patients with chemotherapy induced neutropenia from January to June 2000 at the Paediatric OncologyUunit of Combined Military Hospital, Rawalpindi [CMH RWP]. Patients and The study material comprised of 62 febrile episodes occurring in 50 neutropenic children aged less than 12 years with various malignancies. All the episodes were worked up in detail including history, physical examination and relevant investigations. Total 29 bacteria were cultured in 62 febrile episodes. Fifty five% organisms were isolated from blood and 45% from other sites, 15 [51.7%] were Gram-positive and 14 [48.3%] were Gram-negative. S. aureus was the most frequent Gram positive isolate and E. coli was the most common Gram negative isolate. The standard empiric antibiotic regimens for [combination of amikacin and ceftazidime] showed an overall response rate of 61.3%. The infection related mortality in this series was 22%. Fever is the commonest symptom of infection in neutropenic children with malignancy and demands an urgent empirical antibiotic therapy after the onset of fever. Based on this study we recommend a combination of ceftazidime and amikacin for use as empiric antibiotic therapy in these children