Effect of aortic cross clamp time on renal function in patients undergoing coronary artery bypass grafting

Objective: the aim of the study is to see the effect of aortic cross clamp time on renal function post operatively

Material and Methods: in a prospective study 90 patients were selected for CABG first time with normal renal function. A questionnaire was made to see the effect of aortic cross clamp time on post-operative renal function. Demographic factors, pre-operative, intra operative and post-operative variables were evaluated. The patient were divided into two groups according to aortic cross clamp time, patient with aortic cross clamp time 50 minutes and patients with aortic cross clamp time > 50 minutes ultimately they were evaluated to see the occurrence of acute kidney injury [AKI]

Results: AKI was observed in 6 patients with aortic cross clamp time = 50 minutes and 36 patients with aortic cross clamp time > 50 minutes. The aortic cross clamp time was highly associated with blood urea post operatively at day 1 [p value 0.002], day 2 [p-value 0.000] and day 3 [p-value 0.000]. It had significant effects on serum creatinine postoperatively day 1 [p-value 0.000], day 2 [p-value 0.005] and day 3 [p-value 0.001]. It also had significant effect on reduction of GFR postoperatively day 1 [p-value 0.011], day 2 [p-value 0.003] and day 3 [p-value 0.001]

Conclusion: the greatest likelihood of developing acute kidney injury [AKI] after CABG was observed with prolonged aortic cross clamp time. The levels of blood urea and serum creatinine was increased in patients with aortic cross clamp time> 50 minutes. Glomerular filtration rate [GFR] was reduced with aortic cross clamp time> 50 minutes

Effect of aortic cross clamp time on renal function in patients undergoing coronary artery bypass grafting [CABG]

Objective: to see the effect of aortic cross clamp time on renal function in patients undergoing CABG post operatively

Material and Methods: in a prospective study 90 patients were selected for CABG first time with normal renal function. A questionnaire was made to see the effect of aortic cross clamp time on post-operative renal function. Demographic factors, pre-operative, intra-operative and post-operative variables were evaluated. The patient were divided into two groups according to aortic cross clamp time, patient with aortic cross clamp time 50 minutes and patients with aortic cross clamp time > 50 minutes; ultimately they were evaluated to see the occurrence of acute kidney injury [AKI]

Results: AKI was observed in 6 patients with aortic cross clamp time 50 minutes. The aortic cross clamp time was highly associated with blood urea post operatively at day 1 [p = 0.002], day 2 [p=0.000] and day 3 [p=0.000]. It had significant effects on serum creatinine postoperatively day 1 [p=0.000], day 2 [p=0.005] and day 3 [p=0.001]. It also had significant effect on reduction of GFR post operatively day1 [p=0.011], day2 [p=0.003] andday3 [p=0.001]

Conclusion: the greatest likelihood of developing acute kidney injury [AKI] after CABG was observed with prolonged aortic cross clamp time. The levels of blood urea and serum creatinine were increased in patients with aortic cross clamp time > 50 minutes. Glomerular filtration rate [GFR] was reduced with aortic cross clamp time of more than 50 minutes

Laparoscopic vs Lichtenstein hernia repair: a local experience

To compare the operative time, the postoperative pain scores, duration of hospital stay and wound infection rates between Lichtenstein and totally extra peritoneal [TEP] laparoscopic hernia repair for direct inguinal hernias. Comparative study. This study was conducted at surgical unit 1, Benazir Bhutto hospital and surgical unit 1, Holy Family hospital, Rawalpindi from 1[st] July 2007 to 31[st] December, 2010. A total of hundred patients were divided into open and laparoscopy groups and their age, sex, operative times, pain scores, duration of hospital stay and wound infections were compared and analyzed. Mean age was 60.7 [ +/- 9.2] years for open group and 59.7 [ +/- 9.3] for the laparoscopic group. Time for surgery was 48.9 minutes in open and 49.0 minutes in the laparoscopic group. Pain scores at 2 hours and 24 hours after surgery were significantly less in laparoscopic group as compared to open group. Hospital stay was 39.6 hours in open versus 31.4 hours in the laparoscopic group, which was also significant. There was no case of wound infection in either groups, requiring operative intervention or mesh removal. The laparoscopic approaches to hernia repair have clear advantages, including lesser post operative pain and shorter hospital stays

comparison of open and laparoscopic ventral hernia repairs

To compare the outcome of open versus laparoscopic ventral hernia repair in terms of duration of surgery, post operative pain and length of hospital stay. A comparative study was carried out at in-patients presenting at Surgical Departments of Benazir Bhutto Hospital, Holy Family Hospital and author's clinics. A total of 100 patients were included in the study and the patients were divided randomly in Group A and Group B, having 50 patients in each group, Group A representing open mesh repair group and Group B laparoscopic repair group. Patients of both groups were observed per-operatively for duration of surgery, postoperatively for length of hospital stay and intensity of postoperative pain. There was no statistically significant difference between two groups for duration of surgery [P >0.96]. Pain was calculated at 2 and 24 hour, using visual analogue scale. Less pain was noted in Group B. Difference of pain score was statistically significant at 2h and 24h [P0< .05]. Average duration of postoperative stay in hours was more in Group A [39.6 hrs] as compared to Group B [31.4 hrs] [P < 0.05]. Laparoscopic ventral hernia repair is beneficial due to less post operative pain and short duration of post operative hospital stay but duration of surgery remained same in both the settings

Appendicectomy; laparoscopic VS open

The objective of this study was to compare length of hospital stay, pain scores and the rate of wound infections between laparoscopic and open appendectomy. Randomized Controlled trial. This study was conducted in surgical unit I Holy Family hospital, Rawalpindi from 1st June 2009 to 31st May 2010. The patients were divided into open and laparoscopy groups and their age, sex, time of discharge, pain scores and wound infection rates were compared and analyzed. Total of 160 patients were included in the study, 80 in each group. There were 58% male and 42% female patients. Mean age was 22.78 years [ +/- 6.2]. Post operative pain scores were significantly less in the laparoscopic group [p<0.05]. The length of hospital stay in open group was 35.10 hrs [ +/- 5.4] hours and in the laparoscopic group was 38.70[4.8] hrs with a p value of 0.592. Wound infection was 0.037% in open and 0.025% in the laparoscopic group. Laparoscopic appendectomy is superior in terms of less morbidity and shorter post operative hospital stay in the setting of an overworked tertiary care surgical floor of a Pakistani hospital

Laparoscopic cholecystectomy at Rawalpindi General Hospital a clinical practice audit

To evaluate the practice audit of Laparoscopic cholecystectomy. A prospective, clinical practice audit At Surgical Unit-I, Rawalpindi General Hospital and at the author's Surgical Clinics from January 1998 to December 2007. There were 883 females and 117 males. Mean age was 45.0 +/- 11.0 years. Sixty six point six percent patients had chronic cholecystitis with cholelithiasis and were admitted through Out Patient Department whereas 33.4% were admitted through Accident and Emergency Department with acute cholecystitis. Abdominal ultrasound showed multiple calculi in 745 [74.5%] patients and 255 [25.5%] patients had single calculus preoperatively. Empyema was found in 60[6%] cases whereas adhesions were present in 403[40.3%] patients. In our study conversion rate was 4.8% and frequency of injury to common bile duct was 1.4%. Mean operating time was 40 minutes. Ninety two recent of the patients were discharged within 48 hrs of operation. There was no mortality while post-operative complications were seen in 6% patients. Laparoscopic Cholecystectomy in our set up proved to be a safe procedure having short duration of surgery and short hospital stay

Laparoscopy; indications in the diagnosis of abdominal pain

To identify the various acute and chronic abdominal conditions presenting as non specific abdominal pain in which diagnostic laparoscopy was indicated to establish a definite diagnosis and treatment. Descriptive study. Surgical unit-I of Rawalpindi General Hospital Rawalpindi. From February 2005 to February 2006. All patients who presented with non specific abdominal pain and fulfilled the inclusion criteria were included in the study. The sample size was 150 cases, out of which 71 [47%] were male and 79 [53%] were female. Mean age was 32.65_17 years. Fifty five [36%] patients were admitted through emergency department while 95 [63%] were admitted through OPD. Four main groups were identified who presented with nonspecific abdominal pain in which diagnostic laparoscopy was indicated. These were patients with acute or chronic inflammatory conditions [66%], acute or chronic intestinal obstruction [14%], patients with blunt/penetrating abdominal trauma [11%], and patients of intra abdominal tumor [9%]. Out of these 150 cases, 53 cases [35%] had laparoscopy to confirm the diagnosis [diagnostic laparoscopy] while the remaining 97 cases [65%] had both the diagnostic as well as therapeutic laparoscopy. Mean hospital stay was 1.7 Days. The study has demonstrated the various acute and chronic abdominal conditions in which laparoscopy in indicated and proved to have higher diagnostic and therapeutic yield, and hence improved the management of these patients

Post thyroidectomy hypocalcemia - does arterial ligation play a significant role?

The aim of this study was to determine if bilateral inferior thyroid artery [ITA] ligation is a causal factor for the occurrence of postoperative hypocalcaemia after subtotal thyroidectomy. Quasi experimental trial. One year study from Jan 2005 to Dec 2005 conducted at surgical department of Rawalpindi General Hospital [UNIT-I]. One hundred patients were included in the study who underwent subtotal thyroidectomy with and without truncal ligation of inferior thyroid artery and were prospectively analyzed comparing postoperative and late serum calcium levels A significant incidence of postoperative hypocalcaemia occurred: more in Group A [48%] as compared to Group B [22%]. This difference was statistically significant shown by the P value < 0.5 on the 1st postoperative day in patients with ligation of inferior thyroid artery. The ligation of the ITA tends to produce hypocalcaemia in patients undergoing subtotal Thyroidectomy

Pattern of intestinal obstruction a hospital based study

To determine the pattern of Intestinal Obstruction in local settings. This is a descriptive study of 100 cases of intestinal obstruction from January 2001 to December 2003. Rawalpindi Medical College, Rawalpindi. 100 cases of intestinal obstruction collected from Rawalpindi General Hospital from January 2001 to December 2003. The data of all patients was analyzed as regards to presentation, treatment and outcome. Total number of cases presented with intestinal obstruction requiring operative management was 100. Among them 81 were males and 19 were females. As far as the age distribution is concerned the age range was 5 months to 82 years. Mean age was 33 years. In our study commonest cause of intestinal obstruction was obstructed inguinal hernia followed by adhesions. Commonest postoperative complication encountered was postoperative fever and wound infection. In our study frequency of mortality was 7 [7%]. Despite all the improvements in the health care system, inguinal hernias are the commonest cause of intestinal obstruction in our setup

Response of plasma adrenocortical steroids to low doses adrenocorticotrophic hormone compared to standard dose in normal Egyptian subjects

The short ACTH stimulation test, using 250 micro g synthetic adrenocorticotropic hormone [ACTH], has been advocated as a safe alternative procedure to the dangerous insulin stress test, for assessment of the function of the hypothalamic-pituitary-adrenal [HPA] axis. However, it has been suggested that a maximal cortisol response can be achieved with a much lower ACTH dose, hinting at the possibility that reducing the dose might further enhance the sensitivity of the procedure. Aim of work: The aim of this study was to assess the potential role of the low dose ACTFI challenge in the evaluation of the HPA axis function, compared to the standard 250.micro g ACTH test in normal adults. Subjects and The study was conducted on 21 apparently healthy Egyptian adult volunteers, who underwent stimulation with three different doses [1 micro g, 5 micro g and 250 micro g] of synthetic ACTH [1-24]. Blood samples were obtained at 0, 15, 30 and 60mm for measurement of serum cortisol concentration and 0. 60min serum samples were also used to measure adrenal precursors Delta-4-androstendione [delta-4A], Dehydroepiandrosterone [DHEA] and 17- hydroxyprogesterone [17 OHP] levels, to investigate the efficiency of the low doses of ACTH for detection of late-onset congenital adrenal hyperplasia [LOCAH]. The study revealed no significant difference between mean cortisol level at 15, 30 and 60min in response to the three different doses. Using the 1 or 5 micro g doses, all subjects [100%] reached adequate cortisol response at 30min, while using 250 micro g dose, 90% of subjects reached adequate cortisol response at 60min. The steroid precursors showed no significant difference at 60min in response to the three doses. During the study, 4 cases, two males and two females, were accidentally found to have elevated steroid precursors in response to ACTH. These cases were found to have 21- hydroxylase deficiency, as evidenced by the elevated levels of stimulated 17 OHP, thus, were diagnosed as LOCAH. The low doses [1micro g and 5 micro g] ACTH test responses were found almost comparable to the 250 micro g doses on normal subjects, and can be used to induce adequate adrenal stimulation. They were also useful in detecting latent cases of congenital adrenal hyperplasia

Effect of squalamine on iris neovascularization in monkeys

The purpose of this study was to investigate the effect of squalamine, an antiangiogenic aminosterol, in an experimental model of iris neovascularization. Iris neovascularization was created in cynomolgus monkeys by occluding retinal veins with an argon laser and inducing persistent hypotony with a central corneal suture. Twenty-four eyes were treated in three groups. In group 1, 4 eyes were injected intravitreally with 3 mug/0.1 ml squalamine and four eyes with balanced saline solution [controls] immediately after vein occlusion [day 1]; injections were repeated every three days for three weeks. In group 2, 1 mg/kg squalamine was administered with intravenous infusion in dextrose 5% in four animals; 4 control animals received only dextrose. Infusions began on day 1 and were repeated every 3 days for 3 weeks. In group 3, after the development of iris neovascularization on day 7, 1 mg/kg squalamine was injected systematically in 4 animals; 4 animals received dextrose 5%. Monkeys were examined by slit-lamp biomicroscopy and underwent color photography and fluorescein angiography. The study concluded that intravitreally injected squalamine did not affect the development of iris revascularization; however, systemic squalamine injection inhibited the development of iris revascularization and caused a partial regression of new vessels in a primate model

Laparoscopic complications in the learning phase:our experience in the first 75 cases

To identify factors responsible for serious complications in learning phase of Laparoscopic surgery. Retrospective study of 75 patients undergoing Laparoscopic cholecystectomy. Surgical Units of D.H.Q. and Holy Family Hospital of Rawalpindi Medical College. Seventy five patients of cholelithiasis who had laparoscopic cholecystectomy done. Operative problems, conversion to open cholecystectomy, postoperative complications and hospital stay in patients having laparoscopic surgery. Overall conversion rate was 16% operative complications included one common bile duct injury and one case of duodenaI injury. Postoperative complications were infection of trocar site in 8%and subhepatic collection in 4% cases. Proper selection of patients, two or more experienced surgeons operating together and low threshold for conversion to open procedure reduces the risk of serious complications in the learning phase of laparoscopic surgery

Efficacy of non narcotic analgesia during first 24 post-operative hours

This study was conducted in 100 randomly selected hospitalized patients who underwent major surgical interventions during a period of 10 months. The objective was to evaluate the efficacy of non narcotic analgesia in relieving pain during first 24 hours after a major surgical procedure. The non narcotic analgesic diclofenac sodium was selected for the trial. For the efficacy assessment of the drug, the Pakistan Coin Pain Scale was selected. It was found that, in 87% of all patients included in the study, the pain was adequately relieved with non narcotic analgesia without any noticeable adverse effects

Transcutaneous electrical nerve stimulation [TENS] in chronic pain

Out of 2,780 cases of pain syndromes, we selected 156 patients with chronic pain. Three categories of patients having low back ache, osteoarthritis of knee and cervical spondylosis cases were studied. Their symptoms and duration of pain was more or less of similar nature. Fifteen days treatment was given to each patient. In one group [TENS group] electrodes were stimulated for 1/2 hour and to another group [Acupuncture group] needles were inserted on specific points and were stimulated with B.T 701 stimulator. Patients in the acupuncture group showed that needles were more effective and the effect persisted over a longer period. It was also observed that patients with pain of more than one year duration responded less well to TENS than acupuncture