Doubly committed subarterial ventricular septal defect repair: an experience of 51 cases

Objective: To review the surgical outcome of doubly committed subarterial [DCSA] ventricular septal defect repair

Method: Data of 51 patients of doubly committed sub arterial Ventricular septal defect from January 2012 to June 2017 that were referred to Chaudhary Pervaiz Elahi institute of Cardiology Multan was retrospectively reviewed using electronic database. All patients were operated by first author. In our study, we segregated patients into four main groups depending on presence or absence of aortic structural defect and degree of aortic valve regurgitation. Group-A comprised of nineteen [37%] patients who neither had aortic structural nor functional abnormality while GroupB had six [11.7%] patients, having aortic valve cusp prolapse without aortic regurgitation. Group-C and Group-D consists of seventeen [33.3%] and nine [17.6%] patients respectively depending upon degree of aortic regurgitation. Furthermore, six [11.7%] patients among these 51 had associated defects as well

Results: Group-A patients had no aortic valve regurgitation post operatively and at follow up of 22.6 months [1.8 years] as well. In Group-B, aortic valve was not addressed and aortic regurgitation was also not present post operatively or on follow up of 33.6 months [2.8 years]. Similarly, in Group-C aortic valve was not addressed, these patients also did not show progression of disease on regular follow up of 18 months [1.5 year]. While, in Group-D, eight patients underwent aortic valve repair and one patient had aortic valve replacement. Aortic regurgitation improved significantly in all patients of this group and remained, unchanged on follow up of 22.7 months [1.8 years]

Conclusion: Early closure of doubly committed subarterial ventricular septal defect with appropriati aortic valve disease caa halt the process of disease progression

Toxicity studies on herbal formulation used in diabetes mellitus

In current study herbal formulation was prepared for Diabetes mellitus [type 2]. It consists of the extracts of Salacia reticulate, Cinnamomum zeylanicum, Lagerstroemia speciosa, Camellia sinensis and Gymnema sylvester. Toxicity studies were carried out on heart, liver, kidney and blood of both male and female rabbits. Drug was administered in a dose of 15mg/kg body weight daily for 90 days. On 91[th] day, blood was drawn from animals and investigated for changes in biochemical and hematological levels. After that animals were sacrificed and their organs [liver, heart and kidney] were analyzed for histo-pathological changes. In biochemical tests for lipid profile, significant decreased [male-70.64 +/- 0.321; female-69.80 +/- 0.365] in triglycerides level were observed, no significant change was recorded in Cholesterol HDL ratio, LDL, VLDL level. A significant increase [male-16.00 +/- 1.418; female-10.00 +/- 0.709] was observed in HDL level. In liver function test significant decrease was observed in Gamma GT [male-10.08 +/- 0.862; female-7.00 +/- 0.709]. Alkaline phosphatase [male-79 +/- 0.838; female-51.1 +/- 1.810], SGPT [male-54 +/- 0.709; female- 43.04 +/- 2.060], direct bilirubin [male-0.024 +/- 0.005; female-0.014 +/- 0.002] and total bilirubin [male-0.109 +/- 0.003; 0.106 +/- 0.049] were observed. Non-significant changes were observed in serum total protein, globulins, albumin and A/G ratio. No significant changes were noticed in urea level and serum electrolytes. In cardiac enzymes significant decrease was observed in LDH [male-443 +/- 5.61; female-360 +/- 1.848] and SGOT [male-27 +/- 0.709; female-28 +/- 1.418] level and highly significant rise in CPK [male- 3128 +/- 8.478; female-1598 +/- 7.483] and CK[-]MB [male-446 +/- 2.308; female- 438 +/- 2.819]. In hematological profile, significant decrease was observed in Hb [male-12.3 +/- 0.392; female-12.4 +/- 0.1], RBC count [male-6.60 +/- 0.167; female-5.74 +/- 0.25] and Hematocrit [HCT/PCV] % in both male and female rabbits [male- 45.70 +/- 0.255; female-43.50 +/- 0.448] and significant [p<0.5] increased in WBC count [male-8.40 +/- 0.401; female- 9.10 +/- 0.054]. Significant [p<0.5] decrease in blood glucose level and HbA1c [male-3.36 +/- 0.113; female-3.16 +/- 0.076] was observed. In histopathological studies mild edema was observed in heart and there was no change in histo-architecture of liver and kidneys. It is concluded that formulation does not showed any chronic toxicity in adult dose

Hepatic artery aneurysm: a rare cause of obscure upper gastrointestinal bleeding

Hepatic artery aneurysms are rare and represent 0.01-0.2% of all arterial aneurysms. The patient may present with abdominal pain, which may be associated with a mass. More acutely, patients present with signs of hypovolemia secondary to rupture of the aneurysm. The patient reported here presented with right upper abdominal pain and gastrointestinal hemorrhage of unknown etiology. A CT angiogram showed presence of hepatic artery aneurysm. Aneurysm was excised at laparotomy.

Retroperitoneal lymphangioma

Retroperitoneal lymphangioma is a rare benign congenital malformation of lymphatic channels. This report is of a 35 years old male who presented with 1 month history of abdominal pain and swelling due to a large retroperitoneal cystic lymphangioma. The lesion was removed surgically with complete resection

Role of trabeculectomy in management of peseudoexfoliation glaucoma

Pseudoexfoliation syndrome is a relatively common but easily overlooked cause of chronic open angle glaucoma. When an eye with pseudoexfoliation develops secondary trabecular block glaucoma, the condition is referred to as pseudoexfoliation glaucoma. The response to medical treatment is generally not satisfactory and surgery has to be undertaken as a final resort. We conducted this study to find out the results of trabeculectomy in such cases. Fifty cases with pseudoexfoliation glaucoma presenting in the Dept of Ophthalmology, Military Hospital, Rawalpindi were initially treated with topical medications for three months. Twenty-nine cases that showed poor response to drugs were operated upon and a trabeculectomy was performed. Postoperative pressure readings were recorded twice weekly for the first two months and then once monthly for four months. After a follow-up of six months, twenty-one cases [72.41%] were effectively controlled without any added medications whereas eight cases [27.58%] required addition of a single drug to achieve the desired effect. Trabeculectomy seems a safe and effective operation in glaucoma associated with pseudoexfoliation of the lens capsule

effect of hyaluronidase on the quality of ocular akinesia in sub-tenons local anaesthesia in cataract surgery: a hospital based study

This prospective double blind study was conducted at Ophthalmology Department of Military Hospital Rawalpindi, to know the effect of hyaluronidase on the quality of ocular akinesia achived with sub Tenons local anaesthesia. A total of 200 patients scheduled for cataract surgery were randomized into study and control groups of 100 patients each. The study patients were given 3 ml 2% Lignocaine with adrenaline 1;200,000 and hyaluronidase 30 iv/ml, while the control group was given 3 ml Lignocaine 2% with adrenaline 1: 200,000 sub Tenons anaesthesia. Akinesia was measured 10 minutes after local anaesthetic injections were significantly better in the study group as compared to the control group. It shows that addition of hyaluronidse to local anaesthetic solution significantly improves the quality of ocular akinesia achieved with sub-Tenons local anaesthesia [p. less than 0.005]