Outcome of cytomegalovirus colitis in inflammatory bowel disease with different regimes of ganciclovir

Background:Cytomegalovirus [CMV] infection is common in individuals with inflammatory bowel disease [IBD] and is responsible for relapse, increased severity, and poor outcome if left untreated. Ganciclovir is the mainstay of treatment but data regarding its use, mode of administration, and duration of treatment is poorly described. We reviewed the practice of treating CMV colitis with different regimes of ganciclovir at a district NHS hospital to compare the clinical outcome

Methods: 35 patients with IBD and concurrent diagnosis of CMV infection were evaluated. The parameters studied were clinical outcome in term of clinical response, length of hospital stay, readmission, or colectomy with three different regimes of ganciclovir, in addition to treatment for IBD

Results:35 patients with IBD [ulcerative colitis = 23, Crohn's disease = 5, Indeterminate colitis = 7] and positive diagnosis of CMV infection were studied. Clinical outcome with two weeks of intravenous [IV] ganciclovir regime was superior than one week of IV ganciclovir and two weeks of oral Valganciclovir in term of clinical response on day 15 [95.8% vs 74%, 24.3%, respectively p = 0.45] and colectomy rate within 3 months [6.25% vs 27.3%, vs 25%, respectively]

Conclusion CMV colitis is associated with poor outcome in patient with IBD if left untreated. 2 weeks IV ganciclovir was associated with a better outcome than 1 week of IV treatment or oral treatment

Best surgical treatment of pilonidal sinus natal cleft?

Objective: To assess the outcome of various surgical techniques applied for treatment of pilonidal sinus natal cleft

Study Design: Retrospective study. Place of Study: Zayed Military Hospital, Abu Dhabi, U.A.E. Period: Jan-2013 to Dec-2016

Methodology: Total cases operated 234, male 217 female 17, Surgical procedures performed, excision with primary closure, excision with marsupialization, excision with laying open and excision and closure with flaps. Age 14 to 49 years, median age 21 years, average BMI 33kg/m[2]

Results: Average healing time14 days, 43 days 56 days and 14 days from group one to four. Wound infection 3.4 %, bleeding 5.9 %. Recurrence rate of 12.3%. Marsupialization showed zero percent wound infection, bleeding of 4.6% and recurrence of 11.6 %

Conclusion: Excision and marsupialization is easy to perform, appears to have less complications, relatively shorter healing time and almost similar recurrence. In addition higher BMI showed higher recurrence rate

Laparoscopic assisted appendectomy in children. Our experience of first 50 cases at tertiary care hospital Rawalpindi

Objective: To present an experience of the first 50 cases of appendectomy performed via laparoscopy assisted open technique

Study Design: Descriptive case series

Place and Duration of Study: This study was carried out at Pediatric Surgery department, Pak Emirates Military Hospital Rawalpindi, from Jan 2016 to Apr 2018

Material and Methods: Fifty patients [<12 years old] diagnosed as cases of acute appendicitis were enrolled after ethical committee approval. The procedure was performed via three ports [4 ports if required]. Appendix was brought out through the right iliac fossa port and appendectomy was performed by extracorporeal knotting technique. Operative time, position of appendix and postoperative complications were recorded. Data was expressed as means and frequency percentages

Results: Out of 50 patients, 31 were male and 19 were females. The mean age of the patients was 7.99 +/- 3.34 years. Forty one patients had acute appendicitis while 9 patients were diagnosed as appendicular mass. The mean operative time was 24.9 +/- 7.42 minutes. There were no cases of surgical site infection. Thirty eight patients were operated via three ports while 12 patients required four ports. Three patients required conversion to open appendicectomy due to extensive adhesions or abscess. Post-operatively drain was placed in only 6 patients

Conclusion: Laparoscopic assisted open appendectomy is a safe, quick and easy to learn technique in children which combines all the advantages of minimal access surgery with open appendectomy while reducing the number of complications associated with it. The technique has the added advantage of diagnostic laparoscopy over open surgery

Comparison between Urethroplasty with and without stent for Hypospadias in terms of postoperative Urethrocutaneous Fistula formation

Objective: To compare the urethroplasty with and without stent for hypospadias in terms of frequency of postoperative urethrocutaneous fistula formation

Study Design: Randomized controlled trial

Place and Duration of Study: Department of Pediatric Surgery, Pak Emirates Military Hospital Rawalpindi, from Jan 2015 to Dec 2017

Patients and Methods: A total of 260 patients with diagnosis of hypospadias were selected from outpatient department after confirming their diagnosis by taking a detailed history and performing thorough clinical examination. Patients were divided randomly into two groups, group A and group B via lottery method. In group A, urethroplasty was done by using a stent while in group B, urethroplasty was done without a stent although stent was used in this group as a template preoperatively to form a neo urethra and then removed after 24 hours. The 6-8 FR nasogastric tube was used as stent. The follow up was after 2, 6 and 12 weeks to see the fistula formation in both types of procedures. All the data was recorded on the specially designed proforma attached as annexure A. Data was analyzed using SPSS version 22

Results:The overall incidence of urethrocutaneous fistula was 21 [8 percent] out of the total study population. In group-A there were 18 [13 percent] cases who developed fistula and in group-B 3 [2 percent] cases developed fistula. There was significantly higher no of cases in group-A, who developed fistula as compared to group-B, p-value = 0.001

Conclusion: Stents are routinely used in many centres after urethroplasty for hypospadias repair leading to higher incidence of urethrocutaneous fistula. If urethroplasty is done meticulously, stentless surgery may produce fewer fistulas

Comparison of Onlay versus Sublay mesh repair for ventral abdominal hernias. a randomized controlled trial

Objective: To compare onlay versus sublay mesh repair for ventral abdominal hernias in terms of mean operative team, frequency of post-operative wound infection, seroma formation and hematoma formation

Study Design: Randomized controlled trial

Place and Duration of Study: Department of General Surgery, Pak Emirates Military Hospital Rawalpindi, from Apr 2017 to Dec 2017

Material and Methods: A total of 78 patients [39 in each group] diagnosed as a case of ventral abdominal hernia meeting the inclusion and exclusion criteria were included in the study. Patients with complicated hernias, recurrent hernias and bleeding disorders were excluded. Group-A patients underwent mesh repair by the onlay method while group-B patients underwent mesh hernioplasty via the sublay technique. All patients were followed for wound infection, seroma formation and hematoma formation. Data was analyzed by SPSS ver. 23.0

Results: The mean operation time in group A was 46.10 +/- 7.25 minutes while in group B, the mean operation time was 77.82 +/- 9.97 minutes [p<0.001]. The frequency of wound infection was 5.13 percent vs 0 percent [p=0.49] and hematoma formation was 5.13 percent vs 7.69 percent [p=0.999] between the two groups respectively which were statistically insignificant. However, seroma formation between the two groups was 23.08 percent vs 5.13 percent, which was statistically significant [p=0.023]

Conclusion: Sublay mesh repair for ventral hernias is better than onlay mesh repair for ventral abdominal wall hernias in terms of frequency of complications. However, it requires a longer operative time

Pulmonary nodular amyloidosis mimicking metastatic lung lesion in a patient with colon cancer

Amyloidosis is defined as abnormal aggregation of amyloid proteins. Amyloidosis can be localised or systemic affecting the lung, heart, spleen, liver and kidneys. The most common form of pulmonary amyloidosis is the nodular type. The disease is idiopathic and linked to many systemic diseases. The clinical manifestations and prognosis of respiratory tract amyloidosis depends on its etiology and anatomical location. Radiologically, the nodular pulmonary amyloidosis may appear as single or multiple nodules in any lobe, and, therefore, may mimic as primary pulmonary or metastatic neoplasms. Here, we report a case of 70-year female who was diagnosed with colon cancer, which was treated by surgery. During metastatic follow-up, her CT chest showed right lung nodule highly suspicious for metastatic lesion from the colon. Thoracoscopic wedge resection of the lung nodule done after micro-coil localisation technique under CT guidance. The histopathology report showed pulmonary nodular amyloidosis. This case indicates that histological examination is necessary to differentiate a benign pulmonary nodule from a metastatic lung nodule, especially in a patient with underlying malignancy

Daily consumption of commercial chicken feed and meat lead to alterations in serum cholesterol and steroidal sex hormones in female rats

Poultry consumption is increased worldwide owing to better taste, easy availability and low cost. The present study was designed to investigate the effects of the chicken feed, conventional chicken meat and organic chicken meat on the % growth rate, serum cholesterol, progesterone, testosterone and estrogen levels in female rats. Hundred female Albino Wistar rats were randomly assigned to four groups [n=25]. Group I was control rats fed on standard chow, group II treated with commercial chicken feed, group III rats fed with conventional chicken meat and group IV with organic chicken meat for a period of 6 weeks. % Growth rate, serum cholesterol, progesterone, testosterone and estrogen levels were estimated after the treatment. The present study showed significant increase in growth rate, serum cholesterol levels and imbalance in serum steroidal hormone levels. It is therefore, suggested from the present study that the intake of commercial chicken feed and commercial chicken meat may be the potential cause of development of polycystic ovary syndrome in females due to steroid hormonal imbalance

Laparoscopic cholecystectomy for empyema gall bladder

Objective: To describe the experience of treating empyema gall bladder with laparoscopic cholecystectomy. Study Design: Descriptive observational study

Place and Duration of Study: The study was carried out at Combined Military Hospital [CMH] Peshawar, from Feb 2012 till May 2014 for a period of twenty eight months

Material and Methods: Twenty eight patients were enrolled in the study who fulfilled the criteria for empyema and were willing for laparoscopic cholecystectomy, chances of conversion to open cholecystectomy and risk of complications involved. We defined the operative difficulty levels according to the intra-operative findings. Level 1-adherent ornentum, level 2-oedematous gall bladder wall, level 3-necrotic gall bladder wall, level 4-adherent gut and level 5 - adherent Hartmann's pouch and oedematous Calot's triangle having no defined planes. The results were noted in terms of time taken for the operation and complications of the operative procedure. Results: Twenty eight patients of empyema gall bladder underwent laparoscopic cholecystectomy. Mean age was 46.2 +/- 7.1 years. Average duration of symptoms was 4.1 +/-2.3 days. Two patients had level-I operative difficulty, 6 patients had level-II difficulty, 9 patients had level-3 difficulty, 2 patients had level-IV difficulty and 9 patients had level-V difficulty. In 21[75%] patients total cholecystectomy was performed, anterior partial cholecystectomy was done in 2 patients [7.1%] and 5 patients [17.9%] were converted to open cholecystectomy. One patient [3.5%] had Stresburgh Bismuth type D injury and was managed by open exploration and T-tube placement. No mortality was encountered in the study group

Conclusion: The technique of laparoscopic cholecystectomy can be used effectively for treating empyema gall bladder specifically in American Society of Anaesthesiologists [ASA] I and II patients. Further randomized controlled trials can elaborate its efficacy. This will not only prove to be cost effective but it will also add to the comfort of the patient

Creases/lines on skin: dilemma and counter

In youthful skin, the collagen support is intact and the skin remains moisturized and stretchy. It is flexible to numerous facial expressions that have been espoused, as well as on a daily basis atmospheric/environmental exposure. However, as the time passes the support and organization declines and the skin becomes unable to restore its elasticity. The skin commences to lose its attitude as the collagen support deteriorates. Whenever someone grin, frowns, or squint, it put strain on the collagen in the skin. The consequence of these facial expressions is collective and facial lines initiate to become visible. This review covers the advancements of injectable fillers for filling in wrinkles or creases in the face. To achieve the finest results in treating facial wrinkles or depressions, the suitable filler must be injected with a skill that suits best the individual indication. Fillers are classified as resorbable and non-resorbable stable fillers. With resorbable fillers only a provisional result can be obtained, that means the patient has to experience cyclical management. Whereas with non-resorbable fillers long-term fall out can be attained that may last for years and even decades. All fillers may have side effects like swelling, erythema, nodules subsequent to treatment and in very rare cases years after the injection odd body granulomas may produce that may be defiant to treat

Double outlet left ventricle: management

Double outlet left ventricle [DOLV] is a rare but substantial congenital cardiac anomaly, presenting with varied anatomical findings. This requires a relevant surgical approach, pertinent to the type of presentation. The condition can be quite difficult to diagnose. This implies the need for scrutiny and sensitive diagnostic procedures during the pre-op period. The case presented here was in a critical state on admission and was stabilised with Sildenafil during the pre-op preparation. A surgical plan for Arterial Switch was made, keeping in mind the diagnosis suggestive of TGA, VSD with an AP Window at first. DOLV was confirmed on the operating table and Rastelli type of correction was performed with a relatively uneventful stay in the post-op ICU

Framingham risk score in impaired glucose tolerant population: a sub analysis of diabetes prevention and awareness program of Pakistan

Objective: To assess the 10-year risk of coronary artery disease [CAD] in subjects with impaired glucose tolerance [IGT] using Framingham risk score

Methods:Data for this study was collected from Diabetes Prevention and Awareness Program. Primary prevention team visited different primary health care centers, factories, service organizations and offices within Karachi, Pakistan. IGT was diagnosed according to World Health Organization criteria after taking informed consent. Information regarding social-demography, dietary habits and physical activities were obtained by a designed questionnaire on one-to-one based interview. Framingham risk score [FRS] was used to assess risk of developing CAD

Results:A total of 315 subjects with IGT were recruited for the study. Mean age of subjects was 44.1 +/- 9.8 years and mean BMI was 27.3 +/- 5.0 kg/m[2]. Overall, 31.4% of the participants were at risk of having CAD. Males were 6.4 times and hypertensive subjects were 2.44 times more likely to have CAD in next 10 years

Conclusion:According to the findings of the study, male and hypertensive IGT subjects were more likely to develop CAD in next 10 years. Community based awareness programs are needed to educate people regarding healthy lifestyle in order to reduce the risk of IGT and CAD

Phytochemical analysis of Hibiscus caesius using high performance liquid chromatography coupled with mass spectrometry

Various species in genus Hibiscus are traditionally known for their therapeutic attributes. The present study focused on the phytochemical analysis of a rather unexplored species Hibiscus caesius [H. caesius], using high-pressure liquid chromatography coupled with mass spectrometry [HPLC-MS]. The analysis revealed five major compounds in the aqueous extract, viz. vanillic acid, protocatechoic acid, quercetin, quercetin glucoside and apigenin, being reported for the first time in H. caesius. Literature suggests that these compounds have important pharmacological traits such as anti-cancer, anti-inflammatory, anti-bacterial and hepatoprotective etc. however, this requires further pharmacological investigations at in vitro and in vivo scale. The above study concluded the medicinal potential of H. caesius

Association of SNP rs9939609 in FTO gene with metabolic syndrome in type 2 diabetic subjects, rectruited from a tertiary care unit of Karachi, Pakistan

To determine the association of SNP in FTO gene, rs9939609, with Metabolic Syndrome [MS] in type 2 diabetic subjects at a tertiary care unit of Karachi, Pakistan. We genotyped FTO rs9939609 SNP in 296 patients with type 2 diabetes from the Out Patient Department [OPD] of Baqai Institute of Diabetology and Endocrinology [BIDE]. MS was defined on the basis of International Diabetes Federation [IDF] and National Cholesterol Education program [NCEP]criterion. Association between the rs9939609 SNP and MS was tested through chi-square and Z-tests by using odds ratio [OR] with 95% confidence intervals. The frequency of MS as defined by IDF criterion was significantly higher in female subjects as compared to male subjects [p= 0.006]. Carriers of ? 1 copy of the rs9939609 A allele were significantly more likely to had MS [69.6%] than non-carriers [30.4%], corresponding to a carrier odds ratio [OR] of 0.52 [95% confidence interval [CI] [0.29-0.93], with a similar trend for the ATP III-defined MS."A" allele carriers under dominant model, carry all the criterion of MS more significantly as compared to non-carriers. The FTO rs9939609 SNP was associated with an increased risk for Metabolic Syndrome in type 2 diabetic populations at a tertiary care unit of Karachi, Pakistan

Differences in various biochemical and clinical parameters with respect to family history of non communicable diseases in fourth year MBBS students of Karachi, Pakistan

To observe the differences of various biochemical and clinical parameters with respect to Family History [FH] of Non-communicable Diseases [NCDs] in fourth year Bachelor of Medicine, Bachelor of Surgery [MBBS] students. This observational study was conducted at Baqai Institute of Diabetology and Endocrinology from December 2013 to January 2014. Total 50 medical students from Dow University of Health Sciences [DUHS] participated in the study. Statistical Package for Social Sciences [SPSS] version 13 was used to analyze the data. For cross tabulation and mean comparison z-test and t test were applied. Out of 50 subjects, there were 26 [52%] females. Mean age of the study population was 21.56 +/- 0.90 years. Mean serum cholesterol levels with positive FH of NCDs was significantly higher than negative FH of NCDs [p=0.005]. Mean value of low density lipoprotein [LDL] of positive family history of NCDs was found higher than those with negative FH [p=0.006] being statistically significant. The insulin levels in subjects with positive FH of NCDs were higher than subjects with negative FH of NCDs [p=0.685]. However, serum leptin and plasma renin showed no significant difference with the negative FH of NCDs being higher compared to positive FH of NCDs [p=0.068] and [p=0.884] respectively. However, Waist circumference, Body mass index and central obesity in subjects with positive FH of NCDs shows increasing trend but no statistically significant difference [p > 0.05] was observed. In our study of various biochemical and clinical parameters with respect to FH of NCDs, Serum Cholesterol and LDL levels were observed higher and statistically significant

Evaluation of outcome of totally extra peritoneal laparoscopic inguinal hernia repair with Lichtenstein open repair

The objective of this study was to evaluate outcome of total extraperitoneal laparoscopic inguinal hernia repair with Lichtenstein open repair in terms of postoperative pain. Quasi experimental study. Surgical unit 1 Rawalpindi and Allied hospitals from January to June 2012. Sixty patients, with unilateral, primary, inguinal hernia were alternately allocated to undergo either total extraperitoneal [TEP] laparoscopic repair of inguinal hernia or Lichtenstein tension free, mesh repair of inguinal hernia. Pain scores at 12, 24, and 48 hours and at 7 days of follow up were noted using a visual analogue scale. Total number of intravenous injections of Diclofenac Sodium requested by the patient for pain relief was also noted. At 12 hours after surgery, the mean pain scores in the TEP group were 3.1 +/- 1.8 and in the Lichtenstein group they were 4.2 +/- 2.1 [p 0.031]. At 24 hours after surgery, the scores were 2.3 +/- 1.5 and 3.1 +/- 1.9 for the TEP and Lichtenstein groups, respectively [p = 0.026]. At 48 hours after surgery, the mean pain scores in the TEP group were 1.5 +/- 1.1 while in the Lichtenstein group they were 2.0 +/- 1.6 [p = 0.041]. At 7 days after surgery, the scores were 0.3 +/- 0.5 in the TEP group and 0.4 +/- 0.8 in the Lichtenstein group [0.137]. The mean number of injection of Diclofenac Sodium required by the TEP and Lichtenstein groups was 3.1 +/- 1.6 and 5.8 +/- 2.2, respectively [p = 0.011]. Less postoperative pain and requirement for analgesics were reported by patients who underwent total extraperitoneal laparoscopic repair of inguinal hernia as compared to those who underwent inguinal hernia repair by Lichtenstein tension free mesh hernioplasty

Intraocular pressure; incidence of steroid induced rise in local population of normal, V.K.C and C.S.G patients

To assess the incidence of steroid induced rise in intra-ocular pressure in different group of patients. The study was conducted in the department of ophthalmology Akhtar Saeed Trust Teaching Hospital of Akhtar Saeed Medical and Dental College Lahore and Continental Medical College Lahore from Jan 2009 to Oct 2010. Three groups were formulated in which group A comprised of normal population with no ocular disease, group B included patients with vernal keratoconjunctivitis while group C comprised of chronic simple glaucoma patients with controlled intraocular pressure. Dexamethasone 0.1% eye drops were used four times daily for four weeks and patients were evaluated weekly in terms of IOP monitoring after which they were labeled as either low or non-responders, moderate responders or high responders. In group A 40% of the patients showed rise in IOP, group B showed 95% rise in IOP and the response in group C cases was 100%. Topical steroids result in significant rise in IOP therefore careful monitoring should be done in all patients on corticosteroids

Gender Wise HIV Disease Awareness among Primary School Teachers in Islamabad

To assess the level of awareness and methods of primary prevention about HIV/AIDS among primary school teachers. A descriptive cross-sectional study of 60 male and female teachers, between 25-40 years of age, teaching for at least three years in public and private schools situated in suburb of Islamabad, was conducted using a structured questionnaire. A stratified random sampling design was used to collect data. Analysis was done on SPSS version 17. The study was conducted at Golra Station suburb in Islamabad from October 2012 to December 2012. 77 percent respondents have heard about the AIDs, 40 percent believe that they should not quit good relations with the AIDs Patient, 88 percent believe it is our moral obligation to help the aids victims, 50 percent believe AIDS is a major issue, and same strength responded that it is not their problem. Most of the respondents believe that AIDS is a preventable disease. Majority of the respondents are of the opinion that Government is not solely responsible to control AIDS, all the stake holders must participate in the control of AIDS. It is inspirational to know that majority has knowledge relating to HIV/AIDS. The study emphasizes the need to educate the teaching community about the prevention methods and to endow them with the crucial information and skills to facilitate them to inculcate knowledge to the younger generation at a younger age group as this can challenge the moral and ethical issue relating with the sexual spread of AIDS. However, taboos of public discussions of sexual illness remain a key limitation towards preventive activities

Comparison of different doses of tranexamic acid on post-operative bleeding in patients of CABG surgery

To compare three different dosing schedules of tranexamic acid to achieve good hemostasis intraoperatively and in post-operative period. Randomized controlled trials. Anaesthesia department, Armed Forces Institute of Cardiology/ National Institute of Heart Diseases [June 2011 to Jan 2013] A total of 128 patients, due for coronary artery bypass grafting were included in this study after informed consent. The patients were randomly divided into four groups. Group A, being the control group, did not receive tranexamic acid during the operation, whereas the remaining three groups received tranexamic acid just after the reversal of heparin with protamine sulphate. Group B received low dose, group C received medium dose and group D received high dose of tranexamic acid both as bolus and followed by infusion. Six patients, 4 from group B and 2 from group D were dropped out due to incomplete data or some complication. The blood loss at 6 hours and 24 hours after surgery were noted along with amount and type of transfusions needed and clinical outcomes. The total cardio-pulmonary bypass time, aortic cross-clamp time and chest closure time were also noted. Haemoglobin levels, coagulation profile and activated clotting time were noted and compared pre and post operatively. All the 4 groups were comparable with respect to age, weight, gender and personal history. Average 1eeding in group A was similar to group B after six hours [p = 0.755] and 24 hours [p = 0.343] but significantly higher as compared to group C [p < 0.001] and group D [p <0.001]. Group B also had more blood in chest drain as compared to group C [p <0.001] and group D [p <0.001]. Group C and group D had almost similar amount of blood loss after 6 hours [p = 0.916] as well as after 24 hours [p = 0.834]. This study showed that tranexamic acid, when given at a loading dose of 20 mg/kg or greater and followed by a maintenance infusion of 15 mg/kg/hr or greater, significantly reduced the amount of blood loss, both intra-operatively and post- operatively, in patients undergoing on-pump coronary artery bypass grafting

Off-pump Bidirectional Glenn shunt using clamp and sew technique

To evaluate the efficacy of performing Bidirectional Glenns [BDG] using "clamp and sew technique". Quasi-experimental study. Armed Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi from 1[st] January 2011 to 31[st] December 2013. All patients subjected to BDG using clamp and sew technique during study period were included. The salient operative steps included. 1] Dissection of superior vena cava, azygous vein and pulmonary arteries 2] Clamping and division of superior vena cava at cardiac end 3] Clamping of ipsilateral branch pulmonary artery and its anastomosis to the divided superior vena cava. Observed variables included oxygen saturations and internal jugular venous pressure before, during and after the procedure, postoperative ventilation requirements, ICU stay, neuro-cognitive assessment, pleural drainage and mortality. A total of 27 patients were included. 85.2% patients had unilateral BDG while 14.8% patients had bilateral BDG. Mean internal jugular venous pressure on clamping superior vena cava was 29.21 +/- 6.13 mmHg [range 19-23 mmHg] and mean clamp time was 14.32 +/- 3.39 minutes with a range of 11-21 minutes. Mean Glenn pressure was 14.29 +/- 2.53 [range 12-18 mmHg]. Mean postoperative Oxygen saturation was 86.07 +/- 2.71% which was significantly increased as compared to preoperative oxygen saturation of 71 +/- 5.16% [p < 0.001]. Mean ICU stay was 70.45 +/- 8.94 hours [38-210 hours]. No neuro-cognitive impairment was observed and there was no 30 day in hospital mortality. Off-pump BDG with clamp and sew technique is a safe procedure in selective patients. It avoids the need for cardiopulmonary bypass and high cost associated with it

Inguinal hernia repair; a comparative study, Bassini's versus hernioplasty

To compare the results of Inguinal Hernia repair using commonly employed methods of Bassini's and Mesh repair. This study included 90 cases of hernia repair ranging over a period of 18 months from October 2008 to Mar 2010 at Social Security Hospital Lahore. All the cases were done by the consultants and senior surgeons. The methods of repair included Bassini's and Hernioplasty with Prosthetic mesh. Out of 90 patients, 88 were males [97.78%] and 02 were females [2.22%]. Male - female ratio 45: 1. The peak incidence was found in 3rd and 4th decades of life. 56[62.22%] had Rt.sided Inguinal hernia, 29 [32.22%] had Lt. sided and 5[5.56%] had bilateral Inguinal hernia. 72 patients [80%] had Indirect Inguinal hernia, 17 [18.89%] had direct inguinal hernia while 1[1.11%] had both types. All the cases were done under Spinal anaesthesia. The Bassini's repair was performed in 50% cases, using non-absorble no. 1 Prolene interrupted suturing [Group- A]. In the Group - B, 50% cases underwent Hernioplasty with prosthetic prolene mesh 6x11 cms. Post-operative follow up was done for a period of 01 year. In the group- A, 3 [6.67%] patients had recurrence and 3 [6.67%] had infection of the wound. In group - B, 01 patient [2.22%] got infected and none of the cases did not get recurrence over a period of 01 year. Hernioplasty with prosthetic mesh is a better treatment modality for inguinal hernia repair to get a low recurrence rate