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Introduction: Ileal perforation is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these regions. Methods: The study was conducted in department of surgery LLR hospital, Kanpur. One hundred ten patients, fulfilling the including criteria, admitted to Surgical Emergency department were taken up for emergency surgery. The surgical management was done as primary repair (group A) and loop ileostomy (group B). The patients were assigned into two groups by even and odd method. Results: An increased rate of postoperative complications was seen in group B when compared with group A. In group A, 4 (9.09%) patients landed up in peritonitis secondary to leakage from primary repair requiring reoperation. In group B, 22 (39.29%) patients developed wound infection, 12 (21.43%) burst abdomen and 2 (3.57%) retraction of ileostomy. Mortality in primary repair was 3 (6.81%) and in loop ileostomy was 5 (8.9%). Conclusion: Patients presenting within 48 hours of ileal perforation, primary repair is better than loop ileostomy.

His bundle electrograms were obtained in 26 patients before and after intravenous administration of glucagon (50 μg/kg). The group consisted of 4 patients with normal conduction and 22 patients with conduction disease. The P-A interval, measured in all patients, was 35 ± 1.4 msec (mean ± standard error of the mean) before and 30 ± 1.5 msec after infusion of glucagon ( P P P In summary, glucagon increased sinus nodal automaticity, as manifested by an increase in sinus rate and decrease of sinus nodal recovery time, and improved intraatrial conduction as manifested by a reduction of the P-A interval and atrial functional and effective refractory periods. Glucagon had no effect on A-V nodal or intraventricular conduction.

A patient is reported who had left bundle branch block at age 21 and complete heart block at age 31. Electrophysiological studies revealed complete block distal to the His bundle with normal A-H interval, suggesting bilateral bundle branch disease. Hemodynamic studies revealed elevated left ventricular (LV) end-diastolic pressures which normalized with ventricular pacing, and slight increase of LV volumes. Coronary arteriography was normal. These findings suggest a diagnosis of Lenegre's disease. We believe this to be the youngest reported patient with this diagnosis. This case suggests that “benign” left bundle branch block in young adults may be a forerunner of progressive conduction disease. Electrophysiological studies in the catheterization laboratory may allow correct diagnosis prior to the development of heart block.