Acute abdomen, causes and outcome - experience at DHQ hospital Abbottabad

Acute abdominal pain is one of the most frequently encountered symptoms in patients seeking emergency treatment. Acute and severe abdominal pain, however, is almost always a symptom of intra-abdominal disease. Abdominal pain in neonates, infants, and young children has numerous causes not encountered in adults. Evaluation of mild and severe pain follows the same process, although with severe abdominal pain, therapy sometimes proceeds simultaneously and involves early consultation with a surgeon. History and physical examination usually exclude all but a few possible causes, with final diagnosis confirmed by judicious use of laboratory and imaging tests. To find out the most common causes of acute abdomen in the region. Retrospective study. This study was conducted at DHQ Teaching Hospital Abbottabad from April 2011 to March 2012. Total 1056 patients were admitted with pain abdomen during this period. Patients of all ages were included. Patients with blunt and penetrating trauma to the abdomen were excluded. The patients were divided into 05 age groups. Patients were investigated with physical examination, ultrasonography, X-ray abdomen and blood complete picture, serum amylase and serum LFT's. Preoperative diagnosis and post operative findings were compared and evaluated. The most common age group was 16-30 yrs [42.5%] and 2[nd] most common group was 1-15 yrs [28.5%]. The most common cause found was acute appendicitis [48.2%]. The 2[nd] common cause was non-specific abdominal pain [16.15%]. Total of 645 [61%] out of 1056 patients reported with acute abdomen were operated while 411 [39%] patients were managed conservatively. Acute appendicitis was the most common cause of pain abdomen in patients of ages 5-30 years followed by non-specific abdominal pain. Life-threatening causes should always be ruled out before focusing on less serious diagnosis. Ultrasonography of abdomen and pelvis should be done routinely in every female patient with acute lower abdominal pain to rule out gynaecological causes of acute abdomen

Role of nitric oxide in the effect of nebivolol on isolated tracheal muscle of guinea pig

The use of beta blockers is limited by their ability to produce bronchospasm in asthmatics. Third generation beta-blockers like Nebivolol may show better tolerability because they may augment the release of nitric oxide [NO] from endothelial cells. However the involvement of NO in the respiratory effect of Nebivolol remains controversial. The present study, carried out on isolated tracheal muscle strips of guinea pigs, was designed to explore this controversy. Varying concentration of histamine ranging from 10[-7] M to 10[-3] M were used to plot a concentration response curve on the isolated tracheal muscle strips of guinea pig and was used as a control. The same concentration response curve was plotted in presence of a fixed concentration of Nebivolol 10[-6] M and then again in presence of a fixed concentration of L-Nitro Arginine Methyl Ester [L-NAME] 10[-4] M and Nebivolol 10[-6] M together in a series of experiments using six sets of isolated tracheal muscle strips in each case. Nebivolol did not produce any significant shift in the concentration response curve while in the presence of L-NAME, Nebivolol shifted the histamine concentration response curve upwards and to the left. Nebivolol does not augment the histamine induced contraction of respiratory smooth muscle of guinea pig but in the presence of Nitric Oxide inhibitor L-NAME a significant augmentation of the same curve occurs, indicating a role of NO in the sparing of respiratory smooth muscle by Nebivolol

Serum homocysteine as a risk factor for coronary heart disease

Homocysteine [Hcy] is an intermediate formed during the catabolism of sulphur containing essential amino acid, methionine and Less than one percent of tHcy is found as the free form. Development of atherosclerotic changes and thrombo-embolism are common features in patients with homocysteinuria. This study was conducted to assess the relationship of Hcy and coronary heart disease [CHD] in our population. The cross-sectional analytical study was carried out at the Department of Biochemistry, Hazara University Mansehra and Ayub Medical College, Abbottabad. A total of 80 subjects were included in this study and were divided into 2 groups. Cases Group consisted of 40 patients who had confirmed Myocardial Infarction [MI] coming for routine follow-up [first re-visit] after the acute attack. Control Group consisted of 40 matching healthy individuals. Demographic data including age, gender, dietary habits, height and weight as documented in preformed proforma. Blood pressure was taken in sitting posture. Serum total Hcy were measured. Data was entered into computer using SPSS 16.0 for analysis. The mean age of the cases was 59.68 +/- 8.06 [30-70] years and that of the controls was 58.93 +/- 6.93 [48-76] years. The average BMI of cases was 27.70 +/- 3.61 Kg/m[2] and of the controls was 25.66 +/- 2.98 Kg/m[2]. This increase of BMI from controls to cases was statistically significant [p<0.050]. The mean systolic BP of the cases was 153.88 +/- 11.90 mmHg in comparison with 142.62 +/- 11.65 mmHg for the controls. This difference was statistically significant [p<0.001]. Mean tHcy level of the cases was 17.15 +/- 4.45 micromol/l while that of controls was 12.20 +/- 2.53 micromol/l. There is a statistically significant difference between cases and controls with respect to Hcy levels [p<0.001]. Plasma tHcy level has a powerful predictor value of CHD and routine screening for elevated Hcy concentrations is advisable especially for individuals who manifest atherothrombotic disease without their traditional risk factors.

Management of gastric carcinoma; comparative analysis of various treatment modalities

To find the best treatment modality for carcinoma stomach. Case series study. Combined Military Hospital Rawalpindi. From January 1996 to December 1999. 42 cases of gastric carcinoma are included in this study. The mode of treatment predominantly remained surgical with the aim to cure the patient of this disease. The disease occurred mostly above the age of 50 years. Common clinical features were unexplained weight-loss, malnourishment and anaemia, respiratory tract infections. No specific etiological factor was detected except that, out of 42 patients 35 were smokers or had quit smoking during the past six years. Nearly all were having at least 8-10 cups of hot tea per day. Adenocarcinoma was the most frequently encountered histological type. 03 patients could not be operated upon because of extremely poor prognosis due to multi-organ failure. 12 patients were selected for surgery curative resection was carried out, whereas the remaining 27 were subjected to palliative resections. Five patients died during or within one month of surgical intervention. Out of the remaining 34, only 21 patients reported for follow up. In most of the patients in whom curative resection was performed, the quality of life was reasonably good. At the end of one year, another eight patients had died of tumour dissemination and cachexia, three patients developed tumour recurrence at the anastomotic site, and one patient developed stricture at anastomotic site. Patients with recurrence were sent for radiotherapy. It is concluded that for carcinoma of stomach the only possible treatment is surgery either alone or in combination with radiation and chemotherapy, the most common, preventable etiological factor is smoking, probably in combination with hot beverages in excess. The most common presentation remains weight loss with dyspepsia or weakness and anorexia, commonly effected age group is middle and old age, preoperative nutritional build-up achieves good postoperative results, palliative surgical procedures made the quality of life of the patient better. The prognosis remains extremely poor, in terms of morbidity and mortality