Ultrasonographic appearance and measurement of epiphyseal ossification centres of fetal peripheral long bones for assessment of gestation age

To determine the ultrasonographic appearance and size of epiphyseal ossification centers of fetal peripheral long bones for assessment of third trimester gestational age. Descriptive, Observational study. This study was carried out at Department of Radiology, Dow University of Health Sciences/Civil Hospital Karachi, from February 2009 from July 2009. 200 pregnant females were examined having gestational age of 28 or more weeks. Obstetrical ultrasound was done using 3.5 MHz convex transducer on Toshiba ultrasound scanner model Nemio-17. Measurement of Biparietal Diameter, [BPD], femur Length [FL] and abdominal Circumference [AC], placental localization and assessment of liquor was done as per standard protocol. The distal femoral, proximal tibial and proximal humeral ossification centers were identified and measured. Gestational age correlated well with appearance and size of distal femoral, proximal tibial and the proximal humeral epiphyseal ossification centers but even better with the sum of the three ossification centers. Ultrasonographic visualization of the epiphyses ossification centers may be a useful marker of fetal gestational age

Vesico-vaginal fistula abdominal repair versus repair via vaginal route

To evaluate the outcome of Vesico-vaginal Fistulae [VVF] repair by abdominal and vaginal route. Interventional / clinical trial. Department of Urology, Chandka Medical College Teaching Hospital and Almas Medical Centre Larkana. Feb; 2005 to Nov; 2010. After routine clinical examination and investigation, patients having Vesico-vaginal Fistulae [VVF] were selected for repair. All patients had under gone examination those anesthesia [EUA] and cystoscopy. The patients having complex fistulae or associated with urethral, ureteric and colonic involvement or with preexisting malignant pelvic pathology were excluded from the study. Patients were divided in to 02 groups on the basis of the site of the fistula and the method of repair. Group-I comprised of those patients who had low type or uncomplicated fistulae and were operated by vaginal approach. Group-II consisted of those patients who had high type or large fistulae and were operated by abdominal approach. Postoperative follow up was carried out on weekly basis for 03 to 06 months. Our study included 32 cases. Group-I and II comprised of 18 and 14 patients respectively. The mean age was 34 years [ranged from 22 to 45 years]. The main cause of vesico-vaginal fistulae was obstetrical in 28[87.5%] and iatrogenic gynecological [hysterectomy] in 04 [12.5%] patients. No major difficulty was experienced except in 01[0.83%] case in group-1 who had a previous failure history of repair. The mean operative time was 95 minutes [range 80 to 125 minutes] and 145 minutes [range 110 to 175 minutes] in group-1 and group-2 respectively. Peroperative blood transfusion was required in 06 [33.33%] and 13 [93%] patients of group-1 and group-II respectively. Statistically significant difference was found between these two groups [P< 0.05]. Postoperative complications like wound infection occurred in 01[7.15%] of group- 1 and haematuria was present for few days in o4 [22.22%] and 05[35.5%] in group-1 and group-2 respectively. The mean hospital stay was 07 [range 5-10] days. Foleys catheter was removed at 02 week time in all cases. The success rate was achieved 15[83.33%] and in all 14 [100%] cases for group-1 and group-2 respectively and statistically no significant difference was found between two groups [P=NS]. All the patients were followed up regularly except 03 [16.5%] and 05 [35.5%] patients of group-1 and group-II respectively. Long term complications like urinary stress incontinence was observed in 2 [11.1%] patients of group-I, where as small capacity bladder and stone formation was observed in 02[14.3%] of group-11 cases. Birth trauma is still a major cause of vesico vaginal fistula in our region. Although, there is no significant difference in outcome of different technique but interposition of tissue between suture lines have a vital role to achieve a high success rate. Further more, best chance of success achieved with first attempt of repair. Strategic approach and proper training of medical and paramedical staff is recommended

Experience of upper urinary tract stones with dornier mpl 9000 lithotripter

To report our experience with Dornier MPL9000X Lithotripter in terms of safety, efficacy and complications in the management of upper urinary tract stones. Retrospective study. From 19[th] April 1998 to 15 August 2007 in the department of Nephrology, Chandka Medical College, Larkana. All patients who had renal calculi up to 2.5cm in size were selected for extra corporeal shock wave lithotripsy with Dornier MPL 9000 on the basis of clinical examination, laboratory investigations, X-Ray, intravenous urography and ultrasonography. Simple analgesics /sedation were used before the procedure, except in children where general anesthesia was used. A total of 1965 patients were treated with 3930 sessions [Average 4.1 sessions per patients]. Male to female ratio was 1.8:1. Average age of the patients was 35.3 years. The average stone burden was 1.8cm in diameter. Stone did not break in 3.3% cases, where as in 53 [2.69%] cases partial fragmentation had occurred. Over all success rate was 84%. About 10.2% cases were lost to follow up. Complications like colic pain, transient haematuria and stein Strasse was observed in 33%, 17% and 2.5% respectively. Extra corporeal shock wave lithotripsy for renal calculi was simple, safe and effective in selected group of patients

Oesophageal foreign bodies experience at Nawabshah

One Hundred and fifty cases of Foreign Bodies in the food passage, treated over a period of 4 years [January 1992 to December 1995] at the Peoples Medical College Hospital Nawabshah. 101 patients [6.73%] were males and 49 [32.7%] were females with a male to female ratio of 2:1. Most of the cases [44%] were between the age group of 1-10 years. The most common type of foreign body recovered were coins, found in 88 cases [58.7%] followed by bone in 32 cases [21.3%], denture in 06 cases [4.0%] and impacted meat bolus in 05 cases [3.3%], while office pin in 02 cases [1.3%], ring marble and seed were recovered in 01 case [0.66%] each. Dysphagia of varying degree was the commonest complaint followed by regurgitation and dyspnoea. Upper oesophagus was the commonest site of lodgement. Majority of the patients [138 cases] were during the first 24 hours of ingestion

Clinico-radiological co-relation in cases of osteoarthritis of the knee joint

Over a period of 6 months a prospective study was jointly conducted by the Department of Radiology and Orthopedics, Peoples Medical College, Nawabshah on patients of Osteoarthritis Knee Joint to find out the association between clinical and radiological findings. Of the 124 patients evaluated there were 94 [75.81%] males and 30 [24.19%] females giving a M:F ratio of about 3:1. The age incidence revealed maximum cases in the fifties i.e. 53 [42.74%]. The results of the study demonstrate that there is good correlation between clinical rating and radiological grading amongst cases of osteoarthritis of knee joint, except in the clinical group which failed to give any radiological evidence of the disease. Hence, it can be safely recommended that surgeons can plan their treatment on radiological grading of osteoarthritis of the knee joint

Prevalence of helicobacter pylori in 156 consecutive patients with dyspepsia in the interior of Sindh, Pakistan

To observe the prevalence of Helicobacter Pylori in patients with dyspepsia. Design: Prospective and Retrospective study of 156 patients suffering from dyspepsia. Setting: Surgical out patients department and Surgical Wards of Peoples Medical College Hospital, Nawabshah. Subjects: 156 cases of dyspepsia with different age groups from 16 to 60 years. Main outcome measures: Barium Meal examination, upper gastrointestinal endoscopy, three endoscopy biopsies from gastric antrum for rapid urease test and Histopathological examination for detection of Helicobacter pylori. In 102 [65.38%] of these patients, the histology specimens showed Helicobacter pylori in 88% of patients with duodenal ulcer, 85% of patients with gastric ulcer, 80% of patients with gastric erosion and duodenitis, and 63% patients with gastritis. The urease test was positive at six hours in 82 [52.56%] of these 156 patients. The Urease test was positive in 70% of each group of patients with endoscopic findings of gastric erosions, gastric ulcer and duodenal ulcer and duodenal erosions. The Helicobacter pylori does play a role in peptic ulcer disease in people of interior of Sindh and identification of Helicobacter pylori by histological technique is better than using urease test