Myocardial damage in successful single vessel coronary angioplasty as assessed by creatinine kinase and its myocardium band lsoenzyme levels

To determine the frequency of myocardial damage in elective, successful, single vessel percutaneous coronary angioplasty by assessing myocardial band [MB], creatinine kinase levels and to find out the association of common modifiable risk factors with myocardial damage in patients undergoing single vessel coronary angioplasty. Descriptive. Armed Forces Institute of Cardiology / National Institute of Heart Disease, Rawalpindi, from September 2006 to September 2007. Fifty patients undergoing elective and successful single vessel percutaneous coronary angioplasty were evaluated with creatinine kinase and creatinine kinase MB levels before and after 8 hours and 1[st] day following coronary angioplasty. Studied variables included the length of stent deployed, maximum deployment pressure and total balloon inflation time, apart from hypertension, cholesterol level, smoking and diabetes mellitus. Out of 50 patients, 9 had raised creatinine kinase at 8 hours [18%] and 10 had raised creatinine kinase [20%] on 1[st] day following coronary angioplasty, 7 [14%] patients and 8 [16%] patients had raised creatinine kinase MB levels at 8 hours and 1st day following coronary angioplasty respectively. The rise of either was equal to or more than 3 times the normal limits. Modifiable risk factors, significantly associated with myocardial damage, were diabetes mellitus [p=0.006] and LDL levels [p=0.009] in patients undergoing single vessel coronary angioplasty. Successful elective, uncomplicated, single vessel coronary angioplasty resulted in some myocardial damage evident by mild rise in cardiac enzymes but rise of creatinine kinase MB above 3 times of normal, which signifies percutaneous coronary angioplasty-related myocardial infarction, was not seen. There was a significant association between diabetes mellitus, LDL levels and myocardial damage in patients undergoing coronary angioplasty but no significant association was found between hypertension, smoking and myocardial damage

Surgical treatment of carpal tunnel syndrome

Objective: the purpose of this study was to evaluate the clinical outcome of surgical treatment of carpal tunnel syndrome

Material and Methods: the study was conducted in Khyber Teaching Hospital from December 2001 to December 2002. Forty patients with carpal tunnel syndrome who did not respond to conservative treatment with analgesics, a splint age and local steroid injection were operated under local anesthesia and median nerve was decompressed with transverse carpal ligament release. The patients were followed for a minimum of 3 months to assess the clinical outcome of procedure

Results: female to male ratio was 7: 1. All females were housewives exposed to manual work. Four of them had rheumatoid arthritis. The age range was from 30-50 years with mean age of 38 years. The results of surgical treatment were excellent with 90% patients being completely relieved of symptoms

Conclusion: surgical release of carpal tunnel has excellent results in patients who do not respond to conservative treatment

Nonunion of fracture clavicle; Treatment by compression plate and bone graft

To evaluate the of surgical treatment of nonunion fracture clavicle by compression plate and bone graft. Material and This study was conducted in the department of orthopaedic and Trauma Khyber Teaching hospital Peshawar from December 2001 to December 2003. Fifteen cases of non-union of the clavicle fracture after conservative treatment were included in the study. Non-union of clavicle resulting from other mode of treatment like primary open reduction and internal fixation were excluded. The nonunion was excised and fixed with 3.5 mm dynamic compression plate. The site was grafted with cancellous bone graft. We have been successful in all 15 patients with early return to normal mobility of the joints. The consequent narrowing of the shoulder girdle is fully acceptable for appearance and activities of the shoulder girdle. We obtained bony union within 4 months in all these cases. We have found this method a useful treatment for the nonunion of clavicle after conservative treatment has failed. The technique is simple and does not require any special instrument. It facilitates an early return to normal activities of shoulder girdle and gives a quick recovery from non-union