Gamut of hepatocellular carcinoma at oncology department, Sheikh Zayed hospital, Rahim Yar Khan

Background: Hepatocellular carcinoma is ranked as third most cause of death from cancer in world

Objective: The objective of this study was to review predisposing factors among patients with Hepatocellular carcinoma [HCC] at a tertiary care centre in past two years

Material and Methods: This Descriptive study was conducted on patients who had proven HCC by histopathology or tumor marker were reviewed retrospectively and data for January 2009 to December 2010 was included. Demographic features were noted and positivity for hepatitis serology, presence of cirrhosis, level of alpha-fetoprotein, tumour size and distribution of liver lesions were noted

Results: A total of 192 patients were found to have histopathology and tumor marker proven HCC. Males were 149 [77.6%] vs females 43 [22.4%]. Hepatitis B surface antigen was noted to be positive in 27[14%] patients, and HCV was found to be positive in 138 [72%] patients. Patients with dual hepatitis [HBV+HCV] were 16 [08%] and in remaining 11 [06%] patients the etiology was unknown. Alpha fetoprotein level was highly elevated in 154 [84%] and Cirrhosis was noted in 134 [70%] patients. 117 [61%] patients had multicentric distribution

Conclusion: Hepatocellular carcinoma in this area, is related to hepatitis C virus infection in majority of the patients. A large number have underlying cirrhosis, multicentric and advanced disease at presentation. The disease is seen in the 5th and 6th decade and predominantly among males

Coronary artery by pass graftingearly morbidity and mortality in patients with tight glycaemic control versus standard control

Several studies have suggested superiority of tight glycaemic control in reducing the incidence of surgical site infection and mortality after cardiac surgery. To compare the frequency of post operative surgical site infections after CABG in patients with tight glycamic control and those with standard glycamic control. Shaikh Zayed Hospital, Lahore. June 2008 to March 2010. Total of 496 patients were included, they were randomized to tight glycaemic control group [TGC, n =248] or standard control group[SC, n=248].In TGC group blood glucose was maintained between 90 - 130 mg/dl, while in SC group blood glucose was maintained between 131- 190mg/dl for 48 hours post surgery. Results were prospectively evaluated. Demographic and surgical data was similar in both groups. Patients in TGC group showed significant reduction in post operative superficial sternal wound infection [4 vs 12, p < 0.05], deep sternal wound infection [1 vs 7, p <0.05] and leg wound infection [2vs 9, p<0.05].There was also non significant reduction in the incidence of post operative mediastinitis [1 vs 3], new myocardial infarction [2 vs 3],and atrial fibrillation [10 vs 12]. Mortality was equal in both groups [1 in each]. Significant reduction in SSI was observed in TGC group and no change was seen in other morbidities and short term mortality in the study