Optimal dose of adenosine effective for supraventricular tachycardia in children

To determine the optimal adenosine dose effective in supraventricular tachycardia [SVT] and underlying conditions affecting the effective dose in children. Experimental study. Department of Cardiology, The Children's Hospital and Institute of Child Health, Lahore, from July 2008 to June 2011. All children presenting with SVT were administered adenosine in rapid boluses according to PALS guidelines using incremental doses of 100, 200 and 300 micro g/kg. The response was recorded on 12 lead ECG. Preexcitation was documented and echocardiography performed on all children after attaining sinus rhythm. Mann Whitney test and Kruskal-Wallis test were used as a test of significance to determine any difference in effective adenosine dose between normal heart and various underlying conditions, taking p < 0.05 as significant. Eighty five patients were treated for 110 episodes of SVT with adenosine. M:F ratio was 2.2:1. Their age ranged from 6 days to 14 years with mean age of 27.9 months. Adenosine was effective in reverting 97 episodes of SVT to sinus rhythm [88.2%]. A dose of upto 100 micro g/kg was only effective in 36.4% episodes of SVT. Two hundred micro g/kg was effective in 44.3% of those not responding to 100 micro g/kg dose [n = 31/70, cumulative 64.5%]. A dose of 300 micro g/kg was effective in further 25 patients not responding to lower doses [n = 25/38, 65.8%; cumulative 88.2%]. Mean effective dose of adenosine was 185.3 +/- 81.0 micro g/kg with median effective dose of 200 micro g/kg. Significantly higher dose of adenosine was required in children with underlying pre-excitation, n = 18/97 [220.8 +/- 67.6 micro g/kg vs. 177.2 +/- 81.9 micro g/kg, p = 0.039]. Adenosine is an effective medicine in treating SVT in children. A higher dose of 200 micro g/kg may be used as first bolus particularly in children with pre-excitation

Exposed skin grafting in various surgical conditions

Background: A descriptive study was conducted at SIMS from December. 2002 to November 2005 to see the results of exposed skin grafting in various surgical conditions

Method: One hundred patients underwent exposed skin grafting. Most of the patients had surgical wound after excision of carbuncle, diabetic foot debridement, due to trauma and due to burn these wounds are dressed daily until they became clean, red granulation. We applied split thickness skin graft

Results: In this study 56 were male and 44 were female with a median age 42.6 years in male and 43.3 years in females. Thirty five percent [35%] had surgical wound after excision of carbuncle. Twenty five percent [25%] had surgical wound after debridement of diabetic foot and 25% had wound after trauma. Eleven percent [11%] had wound after burn. In all these patient we performed delayed exposed grafting and results are alright without any rejection. Early exposed skin grafting performed in 3% of cases after release of contracture and after mastectomy in 1 male patient. One patient after mastectomy had partial rejection

Conclusion: Exposed skin grafting is a simple and cheap method and can be done in both de/aye granulating wound and early surgical wound

Effect of pamidronate on pain control in breast cancer patients

One of the common complaints in advanced breast cancer is pain. This is due to osseous metastasis. Analgesics, along with chemotherapy and hormonal therapy, are the mainstay of treatment. Multifocal bone disease that is refractory to above routine treatments can benefit from a series of agents like pamidronate. Design: Prospective comparative study. Place and Duration of Study: Study was carried out from February 1998 to January 2001 in the Department of Radiotherapy / Oncology, Services Hospital, Lahore. Subjects and Sixty patients suffering from metastatic breast cancer [mainly to bones] initially treated with chemotherapy or hormonal therapy and analgesics were treated with 60-90 mg of injection pamidronate by 4-hour intravenous infusion once a month for three or more months. The intensity of pain was assessed by the memorial symptom assessment scale and marked on the pain control performa according to frequency of pain, severity of pain or interference in daily activities due to pain at the start and after six months time of incluson in the study. Difference in frequency of pain, severity or interference in daily routine was measured for each patient individually. Marked pain relief was reported by 60% of patients who were additionally taking Pamidronate as compared to 43.3% patients who were not taking pamidronate. Reduction in pain and analgesic demand is noted more in chemotherapy group with pamidronate as compared to hormonal therapy group. Pamidronate can be additionally used in resistant cases for pain control

Study of risk factors for carcinoma breast in adult female general population in Lahore

To evaluate some of the established risk factors for the breast cancer in adult female population. Design: It was a prospective study. Place and Duration: This study was conducted in Oncology Department, Services Hospital, Lahore, from August, 1999 to August, 2000. Subject and One hundred breast cancer patients and 100 control subjects enrolled for interview and the percentage of positives was analyzed. Proforma containing demographic characteristics and established risk factors for breast cancer was established. All the female subjects, above 15 years of age, were subjected to the questions in this proforma. To keep uniformity medical officers were briefed for filling this proforma. The data gathered was analyzed statistically. Out of established risk factors, family history of breast cancer and use of oral contraceptive pills were proved significantly positive with a value of p<0.001, infertility and history of early menarche was positive with statistically significant difference of p<0.05. Menstrual disturbance, late menopause, history of pregnancy after 30 years of age and history of breast-feeding had no statistically significant difference [p>0.05]. This study showed that there is a family tendency for breast cancer and estrogenic hormones are playing some role. More possibility of breast cancer was found in infertile and those having early menarche

Study of risk factors for carcinoma breast in adult female general pouplation in Lahore

To evaluate some of the established risk factors for the breast cancer in adult female population. Design: It was a prospective study. Place and Duration: This study was conducted in Oncology Department, Services Hospital, Lahore, from August, 1999 to August, 2000. Subject and One hundred breast cancer patients and 100 control subjects enrolled for interview and the percentage of positives was analyzed. Proforma containing demographic characteristics and established risk factors for breast cancer was established. All the female subjects, above 15 years of age, were subjected to the questions in this proforma. To keep uniformity medical officers were briefed for filling this proforma. The data gathered was analyzed statistically. Out of established risk factors, family history of breast cancer and use of oral contraceptive pills were proved significantly positive with a value of p<0.001, infertility and history of early menarche was positive with statistically significant difference of p<0.05. Menstrual disturbance, late menopause, history of pregnancy after 30 years of age and history of breast-feeding had no statistically significant difference [p>0.05]. This study showed that there is a family tendency for breast cancer and estrogenic hormones are playing some role. More possibility of breast cancer was found in infertile and those having early menarche