Monopolar cautery versus cold steel dissection for tonsillectomy in children. a randomized clinical trial

Objective: To compare monopolar cautery with cold steel dissection for tonsillectomy in pediatric age group

Study Design: A randomized clinical trial

Place and Duration of Study: Ear, nose and throat [ENT] department Combined Military Hospital Gujranwala, from Jan 2013 to Jan 2015

Material and Methods: A total of 220 consecutive pediatric patients undergoing tonsillectomy for recurrent or chronic tonsillitis between Jan 2013 to Jan 2015. Both groups were compared with regards to surgery time, intraoperative bleeding, post operative pain and complications

Results: A total of 20 patients were excluded from the study for various reasons while the data of the rest of the patients has been presented. Mean age of the study group was 8.82 years. A total of 58% of the patients were male. Average time of surgery for monopolar cautery was 29.33 [SD 2.77] min as compared to 18.53 min [SD 2.94] for dissection method which was significant [p<0.005]. Average blood loss for monopolar surgery was 11.66 ml and 29.04ml for dissection method [p<0.005]. Average pain scores were less for dissection method at 2nd post op day 3.59 vs. 5.51. Rates of primary and secondary hemorrhage were less for monopolar method although they were not statistically significant

Conclusion: Monopolar cautery though causes decreased intraoperative blood loss however requires longer anesthesia and causes significant post operative pain to the patient

Myocardial infarction; clinical predictors of in hospital complications in patients presenting with acute st segment elevation

To determine clinical predictors of in-hospital complications in patients presenting with acute ST elevation myocardial infarction. Descriptive Study. from October 2010 to January 2011. Faisalabad Institute of CardioIogy Faisalabad. A total 342 patients with AMI were recruited in this study. All patients presenting with acute ST elevation myocardial infarction and fulfilling inclusion and exclusion criteria were included in the study. A full history was taken, particularly age, sex occupation, address, history of smoking, diabetes mellitus, hypertension, ischemic heart disease and family history of ischemic heart diseases Primary end point was death while secondary end point were patients who had mechanical, ischemic or electrical complications or all of them Mean age of the study population was 56.3 +/- 12.7 years. There were 255[74.6%] males and 87[25.4%] females. There were 103[30.1%] diabetics, 137[40.1%] hypertensive and 174[50.9%] smokers. Family history of IHD was present in 34[9.9%]. Obesity was observed in 60[17.5%]. Dyslipidemia was observed in 45[13.2%]. Majority of patients 123[36%] presented between 4-8 hours after the onset of symptoms. Only 72[21.1%] patients presented to the hospital within 4 hours of onset of symptoms. Overall 194[56.7%] patients had anterior wall myocardial infarction followed by Inferior wall myocardial infarction 84[24.6%] patients. Streptokinase therapy for thrombolysis was given to 236[69%] patients. Overall in-hospital mortality was 28[8.2%]. Most frequent in-hospital complication was cardiogenic shock occurring in 38[11.1%] followed by lschemic complications [Post Ml angina and Re-MI] 37[10.8%], heart failure in 37[10.8%] and 1[st] and 2[nd] degree AV blocks in 36[10.5%] patients. In-hospital mortality was most significantly associated with site of Ml i.e. anterior wall myocardial infarction [X[2]=28.88, p=0.0001] followed by patients not receiving Streptokinase therapy [X[2]=18, p=0.001], Age [X[2]=10.13, p=0.006]. Site of Ml had the highest Contingency Coefficient value of 0.279 followed by Streptokinase therapy 0.195 and age 0.170. Cardiogenic shock was the most frequent complication. Major predictors of in-hospital mortality were anterior wall myocardial infarction, patients not receiving streptokinase therapy and old age