Comparison of vaginal and abdominal hysterectomy: peri- and post-operative outcome

Abdominal and vaginal hysterectomies are the two predominant operative modalities for various uterine conditions; however the indications for selecting a particular procedure in any setting may not be optimally defined. This study was undertaken to evaluate the appropriate route of hysterectomy [abdominal or vaginal] in a hospital population for women with benign disease by comparing peri-operative and post-operative complications. This quasi-experimental study was undertaken at the Department of Obstetrics and Gynaecology, Fauji Foundation Hospital/Foundation University Medical College, Rawalpindi from January to December 2007. Eighty subjects were equally divided into vaginal and abdominal hysterectomy groups by convenience [non-probability] sampling. The primary outcome measures were operative time, primary haemorrhage, wound infection, post-operative analgesia, febrile morbidity, hospital stay and secondary haemorrhage; secondary outcome measure were estimated cost, re-admission and reopening. There were no differences in the patients' mean age, parity, body mass index, and preoperative haemoglobin levels between groups. Vaginal hysterectomy was associated with less febrile morbidity, wound infection operative time, economic cost, bleeding requiring transfusion and re-admission than abdominal hysterectomy. Main indication for women having abdominal operation was leiomyomas, whereas more women having uterovaginal prolapse had vaginal hysterectomy. Patients requiring a hysterectomy for benign lesions having a moderate-sized uterus can be offered vaginal route for surgery

Inverted Meckel's diverticulum causing intussusception in an adult

Adult intussusception is rare, making-up only about 1% of the causes of bowel obstruction intussusception, secondary to an inverted Meckel's diverticulum, is also a rare occurrence. Chronic abdominal pain, lower gastrointestinal bleeding, and recurrent obstructive symptoms may lead to an unnecessary delay in diagnosis. This case report describes a rare cause of adult intestinal intussusception due to inverted Meckel's diverticulum. Intussusception was diagnosed on emergency ultrasound of the patient, who was successfully managed with surgery

Peripheral puddling of contrast-classical enhancement pattern of giant cavernous hepatic hemangioma revealed on computed tomography in an adult male

A forty two years old male was admitted with three months history of vague right upper quadrant abdominal pain, together with nausea and early satiety. On abdominal examination, there was a palpable mass in the right upper quadrant. The sonographic examination of the liver revealed a large echogenic mass. Computed tomographic scan [CT scan] of the abdomen revealed a very large solitary isodense mass in the right and left lobes of the liver. The mass was superficially placed in the liver abutting the antero-lateral wall of the abdomen. The mass measured 10x8 x 8 cm. It revealed a curvilinear hyperdense area in the centre with hypodense portion as well. Arterial phase of contrast enhanced CT scan demonstrated the location and margins of the mass clearly. It was occupying left supero-medial and inferomedial quadrants of the left lobe of the liver [segments 4a and 4b] as well as right superoanterior and infero-anterior quadrants [segments 8 and 5 respectively]. The mass was compressing the porta hepatis, gall bladder, inferior vena cava and the head of the pancreas. Peripheral enhancement of the mass was seen caused by the puddling of contrast in dilated, ectatic vascular spaces within the tumor that was iso-attenuating with the aorta. Based on above mentioned findings a diagnosis of giant cavernous hepatic hemangioma was made

Mayer Rokitansky Kuster Hauser syndrome with urogenital sinus anomaly

Mayer Rokitansky Kuster Hauser [MRKH] syndrome is a rare disorder, characterized by the congenital absence of uterus and associated renal tract anomalies. The case presented with primary amenorrhea and primary infertility, despite development of normal female secondary sexual characteristics. CT scan revealed absent uterus, a solitary left sided pelvic kidney and a vesicovaginal communication that, on cystoscopy, revealed urogenital sinus anomaly manifesting as a common channel formed due to absent anterior wall of vagina and posterior wall of urethra. The urogenital sinus anomaly in MRKH syndrome has not been reported earlier

Deficiency of vitamin C in south Asia

Vitamin C [L-ascorbic acid] is a water soluble vitamin which is an antioxidant and has a wide variety of biological functions for growth and development of the human body. It is essential for maintaining good health. The objective of this review is to share with the scientific community, the status of vitamin C in the South Asian populations compared to other populations in the world. The focus in this review is on populations from Pakistan, India, Thailand, Malaysia, Nepal and Singapore. Mean plasma levels of vitamin C of Indians/South Asians living abroad did not vary much compared to other ethnic groups, however, there was a significant decrease in these levels among those living in Pakistan and India. In general, males, smokers, persons using drugs of abuse, individuals infected with H. pylori or parasitic infections and those with low-HDL cholesterol have lower plasma levels of vitamin C when compared to females, non-smokers and normal healthy subjects free from drugs of abuse and infections [parasitic as well as H. pylori] and having normal levels of HDL cholesterol. In winter, plasma levels of vitamin C are, generally, higher compared to summer. Availability of non-sweet fruits, namely oranges, grape fruit, guava, lime and strawberries in winter could be the reason for that. There is a positive relationship between serum haptoglobin [Hp] levels and serum vitamin C concentrations. Individuals carrying a Hp2-2 phenotype [less stable Hp] have lower levels of vitamin C. The prevalence of vitamin C deficiency [plasma levels < 2 mg/ml] is highest among Indians and people of South Asian origin compared to other races except the Mexican population. Lower intake of fresh fruits and vegetables and over-cooking of food by South Asians might contribute to the high prevalence of vitamin C deficiency in these populations. The high proportion of individuals with low levels of vitamin C in Pakistani, Indian, Malay and Chinese populations compared to most Western populations might explain higher rates of cardiovascular disease and cancer among South Asians