Risks and benefits of giving early aspirin within 6 hoursof CABG: a retrospective analysis

Background and Objective: Antiplatelet drugs are frequently used after coronary artery bypass graft [CABG] surgery to prevent venous graft occlusion. The fear of bleeding complications prevents them to be given early post operatively, which is the time when antiplatelets use confers maximum benefit. Our objective was to determine the effect and influence of early aspirin therapy on fatal and nonfatal bleeding complications and blood requirements after coronary bypass surgery [CABG]

Methods: The patients who only underwent coronary artery bypass surgery for the first time in the past three years and did not have any bleeding diathesis were retrospectively analyzed from the cardiac surgery database of CPEIC Multan. The patients either received aspirin within six hours of CABG or had it given after 12 hours. The patients were analyzed for mean blood loss and number of blood units transfused. SPSS was used for statistical analysis. P value < 0.05 was considered significant

Results: Total 281 patients received aspirin within six hours while 326 patients did not. Mean blood loss in early aspirin group was 727ml as compared to 767ml in the other group [p value 0.74]. The median number of blood units transfused was 2 [p value 0.98]. Our results did not show any statistical difference in both the groups

Conclusion: Aspirin can safely be given early after CABG without the fear of bleeding complications thus conferring the advantage of increased graft patency

Comparison of rubber B and ligation versus injection sclerotherapy in second degree haemorrhoids

The objective of this study was to compare the efficacy of rubber band ligation versus injection scierotherapy in second degree haemorrhoids. This randomized control study has been conducted at Surgical O.P.D Nishtar Hospital Multan from 3rd April 2008 to 3[rd] October 2008. The study included 70 patients divided randomly in two equal groups. Patients in group A were subjected to injection sclerotherapy while patients in group B were treated with rubber band ligation. The patients were followed up at two weeks after the treatment and history regarding bleeding and pain was taken and proctoscopy was done to see pile core sclerosis. No patient was below 20 years of age in each category. Males were affected more than females. Only 31.43% of patients complained of mild pain after RBL while 60% of the patients had no pain at all. 91.43% and 88.57% of patients were free from the cardinal symptoms of bleeding and prolapse respectively, after RBL, at the end of 2 weeks of follow up 62.86% and 65.71% of patients were free from the cardinal symptoms of bleeding and prolapse while 34.29% of patients complained of mild pain after injection scierotherapy at 2 weeks. Rubber band ligation showed better results and good efficacy as compared to injection scierotherapy and should be considered as a procedure of choice for outpatient treatment of second degree haemorrhoids

Criteria for Early Laparotomy in abdominal stab wound

Patients with an abdominal stab wound presenting with shock, peritonitis or eviscerarion are usually subjected to early laparotomy, although very few studies have been done to validate the criteria. To validate that early laparotomy for stab wounds is compulsory or other diagnostic methods may be helpful to prevent unnecessary laparotomy in certain cases. The study was carried out in surgical unit-1, Nishtar Hospital, Multan during the period from January 2003 to June 2008. A total of 110 patients with stab wounds of the anterior abdomen, flank or lower chest were evaluated for their accuracy in predicting the presence of significant abdominal organ injury. Overall, 47 patients had a significant abdominal injury [42.7%]. The signs of peritoneal penetration including omental evisceration, air under the diaphragm or free fluid in the abdomen were not the independent predictors of significant injury. Signs of major internal haemorrhage or generalized peritonitis are reliable criteria by themselves for early laparotomy. Peritoneal penetration is a poor indicator of significant organ injury and warrants direct organ specific evaluation, such as computed tomography or laproscopy, to identify, patients who can safely be treated without operation

Prevalence of verrucous carcinoma in laryngeal cancers and their metastatic potential

To study the frequency of: [1] Verrucous carcinoma in malignant laryngeal tumours [2] Lymph node metastasis in patients with laryngeal verrucous carcinoma. Descriptive study. Purposive type. Department of ENT and head and neck surgery, Pakistan institute of medical sciences, Islamabad. Period of study extended from 1St January 2001 to 31st December 2003. Frequency of verrucous carcinoma was evaluated among One hundred and twenty, [120] cases of malignant laryngeal tumours presented and primarily diagnosed in our ENT department. Cases of verrucous carcinoma were also evaluated for presence or absence of lymph node metastasis. Frequency of verrucous carcinoma in malignant laryngeal tumours was 2.5%. None of these patients had palpable lymph nodes at the time of presentation. Verrucous carcinoma in our population is relatively uncommon disease. Lymph node involvement is rare even with advanced t umours

Tympanoplasty: overlay versus underlay technique

To determine the rates of success of two different techniques of Tympanoplasty. Prospective comparison study. Department of ENT and head and neck surgery, Pakistan institute of medical sciences, Islamabad. Period of study extended from January 1999 to December 2000. This study included 30 patients that underwent tympanoplasty in the department of otolaryngology, head and neck surgery, Pakistan Institute of Medical Sciences Islamabad. Out of these 30 patients, 20 were males and 10 females. 15 cases underwent underlay technique and 15 patients were operated on by overlay technique. Outcome was measured for healing, post operative hearing and incidence of complications. According to this study, the success rate of tympanoplasty in graft uptake by underlay technique was 86% and by overlay technique was 70%. Hearing results were significantly different between overlay and underlay groups. Closure of Air Bone Gap with in 0 - 20 d B in underlay group was 86% while in overlay group it was 69%. The most significant finding in this study was high success rate with underlay technique with low incidence of complications. It was an ideal technique to repair perforations that are small and easily visualized in all quadrants, blunting and lateralization of the grafts were avoided