Omphalocele with Double Prolapse of Ileum through Patent Vitellointestinal Duct: A Rare Presentation / 소아외과

Although Meckel's diverticulum is the most common vitellointestinal duct (VID) anomaly, patent vitellointestinal duct (PVID) is the most common symptomatic embryological defect. Patient may present with the anomaly itself or due to complications like intestinal obstruction secondary to volvulus, intussusception or adhesions. Prolapse occurs if the diverticulum is wide-mouthed enough to allow bowel to come out or due to increased intra-abdominal pressure like cry or cough. Bowel prolapse through PVID is rare and double prolapse of proximal as well as distal loop in a newborn is extremely rare. Omphalocele with prolapsing bowel through PVID as found in our index case is even rarer in literature. The pediatric surgeon should be familiar with these varied manifestations in the newborn because the prolapsed bowel can progress to gangrene and complications if not identified and operated upon early.

Outcome of the surgical treatment of bullous lung disease: a prospective study

This study aimed at evaluating the outcome of surgery for bullous lung disease by comparing the preoperative and postoperative subjective dyspnea score, pulmonary function and clinical features. This prospective study was conducted from May 2009 to October 2011, on 54 patients operated for bullous lung disease. Follow-up at 3-6 months consisted of taking a comprehensive history, physical examination, radiological work-up, and evaluation of changes in subjective dyspnea score, arterial blood gas analysis [ABG], and pulmonary function test [PFT]. After comparison with preoperative values, the student's paired t-test was used to calculate the statistical significance. With approximately 21.6 cases per year, the most common underlying lung pathology was primary bullous lung disease, followed by COPD. The most common presenting complaint was spontaneous pneumothorax in tall young adults in their fourth decade of life with a history of smoking. Bullectomy, with or without decortication, was done for all cases. Improvement in mean PaO2 [arterial partial pressure of oxygen], SaO2 [arterial oxygen saturation] and PaCO2 [arterial partial pressure of carbon dioxide] was seen in most cases but was statistically insignificant. Improvement in mean FEV1 [forced expiratory volume in 1st second], FVC [forced vital capacity] and FEV1 / FVC was statistically significant, with FEV1 being the most reliable indicator of postoperative progress. Improvement in subjective dyspnea score was statistically significant and showed an inverse correlation with FEV1. Those with diffuse pulmonary parenchymal involvement had poorer baseline values and less significant postoperative improvement. Complications occurred more commonly in those with diffuse disease. Mortality was seen exclusively in those with diffuse disease. We conclude that surgery is required for bullous lung disease more frequently in our community since we have a high number of young patients with primary bullous lung disease and localized parenchymal involvement and these patients have a good surgical outcome. Potentially fatal complications like pneumothorax and recurrent infections can therefore be prevented in them. Those with underlying diffuse disease and severely decreased FEV1 [especially below 1 L] also benefit from surgery but require careful patient selection

Seroprevalence of HBsAg and anti-HCV in general healthy population of Swat district with frequency of different HCV genotypes

The main purpose of this study was to find out the seroprevalence of HBsAg and anti HCV in apparently healthy population of district Swat. The other objective was to find out the different types of genotype prevalent in this part of the country. This is a descriptive, observational study which is community based and was conducted by the Hepatology section of Medical Department, Saidu Teaching Hospital, Saidu Sharif from May 2007 to August 2008. Screening camps were held in all the four sectors to which the district was arbitrarily divided. Sera were checked by 3rd generation Elisa technique for HBsAg and anti HCV antibody. Positive cases for anti HCV were recalled in batches and the blood samples taken for HCV RNA testing by PCR and Genotyping. Data was available on a total of 4680 healthy men and women. There were 2870 male and 1810 female participants. We found 3871 [82.7%] subjects Negative. One hundred sixty four [3.5%] were positive for HBsAg and 645[13.8%] were positive for anti-HCV antibodies. Only 15 volunteers [0.3%] were infected with both HBV and HCV. Two hundred twenty cases, who were positive for HCV RNA BY PCR testing were checked for genotyping. One hundred nine [49.5%] cases had genotype 3a, 74[33.7%] cases were having genotype 3b, 19 cases [8.7%] had mixed, 10 cases [4.5%] had Ib and eight cases[3.6%] were untypeble. In district Swat of NWFP, prevalence of hepatitis B surface antigenmia is 3.5% and anti Hepatitis C antibody is 13.8% with a combined prevalence of 17.3%. Genotype three is the commonest genotype [83%] prevalent in this area and six months combination antiviral therapy can be undertaken without checking for genotype in routine