Outcome and factors associated with hospital mortality in patients with impaired left ventricular function undergoing coronary artery bypass grafting: where do we stand?

Impaired ventricular function is a known risk factor for mortality after coronary artery bypass grafting however increasingly more patients with impaired ventricular function are referred for surgery. Currently no large data is available from Pakistan regarding this aspect of coronary surgery. Our objectives were to find out the hospital mortality and mid term functional improvement in patients with impaired ventricular function undergoing coronary artery by pass grafting and identify the risk factors for mortality. Retrospective analysis of preoperative, operative and postoperative variables of patients with impaired ventricular function who were operated for isolated first time coronary artery bypass between October 2006 to April 2009. Total 190 patients with impaired ventricular function underwent isolated first time coronary artery bypass grafting during this period with a male predominance [82.6%]. Mean ejection fraction of the group was 25.4 +/- 5.3%. Mean predicted mortality on logistic Euro score was 10.9 +/- 2.7%. Actual in hospital mortality of the group was 4.7% which is comparable to contemporary published results. Multivariate analysis identified use of intra aortic balloon pump, non use of internal mammary artery and preoperative NYHA functional class as factors associated with mortality. Coronary artery bypass grafting can be performed in patients with impaired ventricular function with acceptable hospital mortality and mid term functional improvement

Traumatic pancreatitis and its complications

Injury to the pancreas occurs in about 5% of closed abdominal injuries, most of which follows road traffic accidents. The pancreatic injury may remain undiagnosed for some hours or days and may be overlooked in the presence of other more obvious injuries. A case of traumatic pancreatitis due to a fall, which was not apparent immediately after the injury, and which was followed by the development of pleural effusion, hyperglycaemia and pancreatic abscess is described. The literature as regards diagnosis, complications and management of pancreatic trauma has been briefly reviewed with special reference to the complication of pancreatic abscess