Predictive value of euroscopre in Pakistani cardiac surgical patients

To evaluate the predictive value of European System for Cardiac Operative Risk Evaluation [EuroSCORE] of early mortality in Pakistani cardiac surgical population in a single cardiac center. A prospective, single institution, observational cohort study. Department of Cardiac Surgery AFIC Rawalpindi from 1st January, 2009 to 31st December 2009. A total of 1064 consecutive adult patients undergoing cardiac surgical intervention at department of adult cardiac surgery from 1st January 2009 to 31st December 2009 were included in the study. The logistic EuroSCORE score was estimated for all the patients and compared with the observed 30 day mortality. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow goodness-of-fit test was applied to assess the calibration of the EuroSCORE model and the area under the receiver operating characteristic [ROC] curve was measured to analyse the EuroSCORE discriminative power on individual death prediction. Expected mortality was compared to observed or actual mortality. Mortality was defined as death from any cause within 30 days of operation or within the same hospital admission. The Hosmer-Lemeshow test revealed a good calibration power [p = 0.73] and the area under the ROC curve was 0.753, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients [18.18%] was very high as compared to predicted mortality [8.14%]. EuroSCORE is a reasonably good relevant predictor of immediate post-operative mortality in low and intermediate risk groups after cardiac surgery in Pakistani population, but is less predictive for high-risk patients

Open extraperitoneal mesh repair for abdominal wall hernias in females

To determine the outcome of treatment in terms of infection and recurrence using open extraperitoneal mesh repair technique. Quasi-experimental study. The department of General Surgery, Combined Military Hospital, Bahawal Nagar Cantonment, from February 2006 to November 2008. Female patients with abdominal wall hernias with defect of 4 cm or more were studied. A history of previous surgery along with clinical findings on examination like size of defect and previous scar were noted. At surgery, hernial sacs were carefully opened and omental and intestinal adhesions were carefully separated. Polypropylene mesh was placed over extraperitoneal space and secured with interrupted vicryl 2/0 sutures. Redivac drains were placed over the mesh and the fascial repair. The patients were discharged on the 3rd - 4th postoperative day and were followed-up at 3 monthly intervals for postoperative sequelae like seroma, haematoma, infection and recurrence. There were 32 cases with a mean age of 41.25 +/- 10.79 years. The mean follow-up period was 15.78 +/- 9.02 months. Previous abdominal surgical intervention was found in 16 [50%] cases. Out of those, 14 [43.7%] had defects through the previous scar. A history of multiple caesarean sections alone, or in combination with either hysterectomy or laparotomy in the last 5 years was present in 7 patients. There were 12 [37.5%] cases of paraumbilical hernia, 4 [12.5%] of a recurrent paraumbilical hernia, 5 [15.6%] epigastric hernia, 2 [6.2%] mix hernia, 7 [21.8%] incisional hernia and 1 [3.1%] each of Spigelian hernia and postlaparoscopic cholecystectomy portal [paraumbilical] hernia. The mean size of the defect was 4.9 cm in primary paraumbilical hernias and 7.2 cm in recurrent paraumbilical hernias. The mean size of the defect in incisional hernias was 9.4 cm, larger than all other types. Superficial wound infection was seen in only 1 morbidly obese [BMI > 30] patient. No case of seroma, haematoma, deep seated abscess or recurrence was noted in the follow-up period. Abdominal wall hernias are common in female patients, especially those with previous surgical intervention. Open extraperitoneal mesh repair with placement of redivac drains is an effective method for the management of abdominal wall hernias with a smaller complication rate and less recurrence

Comparison between delayed-absorbable polydioxanone and non-absorbable [prolene] suture material in abdominal wound closure

The objective of this study was to compare Polydioxanone [PDS] and Prolene suture material for abdominal fascial closure regarding morbidity in terms of post-operative wound complications. Cohort comparative ramdomized study. Dept of surgery Combined Military Hospital Rawalpindi from January 2002 to December 2003. A series of 100 patients presenting in the General Surgical OPD and requiring midline laparotomy were studied. In group "A" all the midline abdominal wounds were closed with Prolene 1 and in group "B" PDS 1 was used. In both the groups the data was collected, based on post-operative wound complications including post-operative wound pain, wound infection, wound dehiscence, suture sinus formation, stitch granuloma and incisional hernia. All the post-operative wound complications were then compared between the two groups. Our results show that the post-operative wound infection, wound dehiscence, suture sinus formation, stitch granuloma and chronic wound pain were significantly lower with PDS 1 as compared to Prolene 1, without any significant increase in incisional hernia formation. Slowly absorbable suture material [PDS] appears to be superior than non-absorbable suture material [Prolene] in midline abdominal fascial closure

Retroperitoneal masses: different clinical scenarios

We present two cases of retroperitoneal masses with different presentations and outcomes. The first case was a 22 years old primigravida lady who underwent emergency caesarean section for preterm premature rupture of membranes with breach. On the operating table, a large retroperitoneal mass was identified and the biopsy confirmed Burkitt's lymphoma. Post operative chemotherapy did not have a favourable result and the patient had a fatal outcome. The other case was a 15 years old boy who had a progressively increasing retroperitoneal mass. Exploratory laparotomy revealed a hard, fixed, unresectable tumour extending into the mesentery of the small gut, biopsies were taken which showed tuberculosis. Post operative antituberculosis treatment had a marked response and the tumour disappeared after 6 months

Combined urethrolithotomy with vesicolithotomy in an 18-months old boy

We present a case of 18 months old male child who reported with acute urinary retention. He had a urethral calculus along with a vesical calculus. He was subjected to combined external urethrotomy and open vesicolithotomy in one sitting. The patient made a smooth post operative recovery and was followed up for 6 months

Torsion of appendix of testis

An case of torsion of the appendix of testis is described in a 10 years old boy. He presented with sudden onset of severe pain in the left testis of 3 days duration. Emergency exploration of the left testis revealed a gangrenous appendix of the left testis. The appendix of the testis was excised and the wound was closed. The patient made a smooth post-operative recovery