Recombinant factor VII [rFVII] can be useful for massive hemorrhage during radical nephrectomy

Radical nephrectomy for renal tumors can be associated with serious complications, e.g. massive bleeding or even table deaths. Various regimens like normovolemic hemodilution, autologous transfusion, hypotensive anesthesia, etc have been used in anticipation of hemorrhage in these operations. In our case there was not only massive hemorrhage but also a failure to clot and disseminated intravascular coagulation. All the routine regimens failed to stop bleeding and the generalized ooze. Recombinant Factor VII [rFVIIa] was used and it saved the day

Clinico-pathological profile and outcome of inhalational burns

To determine clinico-pathological profile and outcome of inhalational burns in a specialized burns treatment unit. Case-series. The Department of Plastic Surgery and Burns Centre Unit, Combined Military Hospital, Kharian Cantonment in March 2005. Patients of inhalational burns were included and evacuated within 30 hours of accident to the specialized burns centre after immediate resuscitation. Total Body Surface Area [TBSA] involved in burns was calculated. Complete blood count and renal profile along with serum albumin and total proteins was obtained. Portable chest radiographs and bronchoscopic examination was conducted. Escarotomies were carried and wounds were covered with split thickess skin grafts. Ventilatory support was used as needed. Comparison of the clinico-pathological profile of surviving and fatal cases was done for significance using t-test. There were 19 patients of inhalational burns, 8 [42%] of whom expired. The mean percentage of TBSA in 11 surviving patients was 50 +/- 10.87 and 70 +/- 15.46 in fatal cases. The mean haemoglobin [Hb] on admission was 15.8 +/- 1.6 g/dL and after fluid resuscitation it became 11.4 +/- 1.5 g/dL. The mean Total Leucocyte Count [TLC] in surviving patients was 9.6 +/- 6.1x10[9]/L and 1.5 +/- 2.3x10[9]/L in fatal cases [p=0.001]. The mean platelet count of surviving patients was 205 +/- 63x10[12]/L while in fatal cases was 58 +/- 48x10[12]/L [p=0.05]. The serum urea levels in surviving patients was 4.3 +/- 2 mmol/L while in fatal cases was 8.6 +/- 0.9 mmol/L [p=0.05]. The serum creatinine levels were 98.2 +/- 16.5 micro mol/L in the survivor group and 249.5 +/- 76 micro mol/L in the mortality group [p=0.05]. The serum total protein in surviving patients was 63 +/- 8 g/dL while in mortality cases it was 57 +/- 7 g/L. Serum albumin in the survivor group was 36.7 +/- 5 g/L and 35 +/- 4 g/L in fatal cases. Significant in Hb, protein and albumin levels. All the expired patients had acute respiratory distress syndrome while acute renal failure with multi-organ failure co-existed in 6 patients. Inhalational burns injury cases multi-system injury with high mortality. Body area involvement, total leucocyte count, platelet count, serum area and serum creatinine are important indicators of survival

Incidence of post dural puncture headache [PDPH] with different gauge spinal needles in relation to age

To asses the incidence of PDPH in different gauges of spinal needle in relation to age. 1500. Comparative Study Armed Forces Institute of Urology [RWP], Railway General Hospital [RWP] and Waseema Talat PVT LTD, Multan. 15[th] Aug, 2007 to 14[th] Aug, 2008. 1500 patients were studied in 9 different groups [A1, B1, C1, A2, B2, C2, A3, B3, C3] with group A, B and C for 23G, 25G and 27G respectively and 1, 2 and 3 for 26-40yrs, 41-55 yrs, and 56-70yrs respectively. Al included younger age group with 23G spinal needles and C3 included older age group with 27G spinal needle. ASA II/III grade patients were selected. All groups were preloaded with 10ml/kg body weight ringers lactate. Routine urine examination and blood complete picture were done. 24hrs strict post-operative bed rest observed. The frequency of PDPH in A1[6%], B1[3%], C1[2%], A2[3%], B2[1.33%], C2[0%], A3[0%], B3[0%], C3[0%]. The study clearly shows that incidence is much higher in younger age group even with the finest needle of 27 gauges

Apgar score of neonate; comparison of thiopentone and propofol during c-section

A comparative study was conducted in CMH, Malir, CMH, Kharian and WT [Pvt] Ltd. Gynaecology and Obstetrics, Multan from April 2001 to March 2004. The Apgar score of neonate was compared for thiopentone or propofol in C-section patients. Two groups of patients were made. Group-A was induced with thiopentone and group-B was induced with propofol. Each group had 100 patients. In group-A 13 neonates required manipulation and 2 neonates in group-B also required manipulation like mask ventilation or endotracheal intubation and one of drugs like atropine to improve apgar score. 13% neonates in group-A and 1% neonates in group-B required manipulation. This clearly shows the superiority of propofol over thiopentone as an induction agent in C-section. The P value of group-A was 0.13 and for group B was 0.02 and had had a statistically significant difference