Histomorphological features of placentae in pregnancies complicated with intrauterine growth restriction

Fetal growth retardation is most commonly caused by placental letdown to meet the increasing demand for oxygen and nutrients of the developing fetus. Intrauterine growth restriction [IUGR] is common happening in Pakistani setup especially in rural areas. Current literature suggests that placental causes are more common than the maternal causes in intrauterine growth restriction. Macroscopic and microscopic examination of placenta can help us to identify the patho-physiology of placental involvement. This is reasonable especially in those cases of intrauterine growth retardation which are not perplexed by maternal causes. To identify macroscopic and microscopic features of placenta in pregnancy complicated with IUGR. Descriptive study. This study was conducted at Sheikh Zayed Medical College/Hospital, Rahim Yar Khan in collaboration with Department of Pathology Quaid-e-Azam Medical College, Bahawalpur and Anatomy Department, Nishtar Medical College, Multan. Study duration was two years from July, 2010 to June, 2012. One hundred and fifty placentae, 85 from cases of intrauterine growth retardation and 65 from normal [control] were enrolled for the study. Fetal and placental weights and placental diameter and thickness were measured. Tissue for histological examination was obtained from: i] Umbilical cord ii] membranes and iii] three placental zones. The tissues were processed and stained with Haematoxlyin, Eosin and Mallory's Trichrome. The prepared tissues were studied microscopically for villous and intervillous lesions utilizing various criteria. Macroscopically there was significant decrease in placental weight, fetal weight, and placental diameter and thickness. Microscopic findings were increased fibrinoid necrosis [46.7%], increased perivillous fibrinoid deposition [16.7%], increased syncytial knots [60%] and increased placental infarction [1.8%]. These findings document comparatively higher frequency of fibrinoid necrosis and perivillous fibrinoid deposition. This draws ours attention to the predominant role of placental causes in cases of idiopathic intrauterine growth retardation

Anatomy resource centre

It has been seen that just delivering the lectures of anatomy followed by dissection may fail to produce a long lasting understanding of the subject. The students are also unable to appreciate the importance of clinical anatomy integrated within various medical disciplines. A medical college or university may look at restructuring the medical curriculum with an anatomy resource centre which can have a pivotal influence on self-directed learning. [1] To prepare an innovative resource centre for teachers. [2]. To rain student to achieve sufficient knowledge, skill and attitude when given a problem-solving exercise. The resource centre is equipped with routine cadaveric dissection. Such gross structural relationships are made more meaningful by the use of living anatomy such as conventional radiographs, CT, MRI, ultrasound, laparoscopic, videos and surface anatomy. Simultaneous presence of microscopic anatomy [histology] can help to understand cell biology and molecular medicine in great detail. It is also necessary to use plastic models to overcome the complexity of the structures such as perineum and joints. Web-based computer sites can supplement the effort and to achieve what is called 'self-directed assessment skill'. Once the students are aware of the normal structures, they can be challenged with abnormal structures or tissues. An anatomy resource centre thus, can be integrated with various disciplines. However, it is felt that an efficient clinical anatomy curriculum can only lead to the success in developing an innovative anatomy resource centre for teachers and students

Childhood primary angiitis of the central nervous system

To analyze the clinical course and magnetic resonance angiographic [MRA] abnormalities in children with primary angiitis of the central nervous system [cPACNS]. Cohort study. Neurosciences and Neuroradiology Department of the Children's Hospital, Lahore, from January 2009 to December 2010. The cohort comprised consecutive patients diagnosed as having cPACNS based on clinical findings and identification of arterial stenosis on magnetic resonance angiography [MRA] in the absence of an underlying condition that could cause these findings. The treatment protocol for ischaemic infarcts consisted of induction therapy with intravenous steroids pulses and intravenous immunoglobulin followed by maintenance therapy with azathioprine and low dose aspirin. When indicated, they were treated with anticoagulants at least for 4 weeks along with induction therapy. Patients were followed at a single centre and systemically assessed for clinical presentation, classification of disease as progressive or non-progressive, adverse effects of anticoagulants, aspirin, azathioprine and their hospital course. Sixty-eight children with medium-large vessel cPACNS [62% boys, 38% girls] with mean age of 8.5 +/- 3.5 years were enrolled in this study. Motor deficit [70%]; headache [64%] and fever [20%] were the commonest symptoms; whereas hemiparesis [60%]; seizures 55% [focal 35%, generalized 20%] and decreased conscious level [30%], were the commonest neurological findings. Neuroradiological findings were ischaemic strokes in 50 [73.5%], haemorrhagic strokes in 10 [14.7%] and ischaemic haemorrhagic lesions in 8 cases [11.8%]. Angiographically 51 [51/68, 75%] of the cohort had non-progressive [obliterative] and 17 [17/68, 25%] had evidence of progressive arteriopathy at the time of admission. No secondary haemorrhagic lesions were documented among infarcts strokes, which were treated with heparin and oral anticoagulants. Outcome was survival in 56 cases [81.5%] and death in 12 cases [18.5%]. All survivors were discharged on long-term oral aspirin; 15 of them were also commenced on azathioprine. Neurological findings among the 56 survivors were; normal 20%, minor disabilities in 25%, moderate disabilities in 20% and severe disabilities in 35%. The spectrum of cPACNS includes both progressive and non-progressive forms with significant morbidity and mortality. This treatment protocol of immunosuppressive therapy may improve long-term neurological outcome in children with medium-large vessel childhood primary angiitis of the CNS

Clinical spectrum of infantile spasm at presentation

To determine the clinical and EEG findings in children with infantile spasms at their initial presentation to the Neurophysiology Department, Children's Hospital, Lahore, Pakistan. Observational study. The Neurophysiology Department, Children's Hospital, Lahore, Pakistan, from January 2008 to December 2010. Children aged

Risk factors of carcinoma breast in younger age group females

A prospective study on carcinoma breast was carried out at Bahawal Victoria Hospital, Bahawalpur from July 1997 to June 2000 and a total of 75 cases were detected. Of these thirty patients [40 percent] work between age of 25-30 years, an uncommon age group. The common risk factors were absent; all belonged to poor socioeconomic group. Eighty percent of them were from rural area related to cultivation of cotton crop, where use of organophosphorus compounds as pesticides are common. Twenty [67 percent] presented with lump breast, 17 percent with ulceration and 13 percent had nipple discharge. Upper outer quadrant was involved in 23 percent, IOQ in 17 percent, IOQ in 13 percent and two quadrants in 27 percent. Duration of symptoms was less than six months in 60 percent of young patients. Most patients [90 percent] were in stage II and III at presentation. The tumor in these patients behaved aggressively. Intraductal carcinoma was found in 80 percent of patients