ABSTRACT
Amniotic band syndrome also known as ADAM complex, amniotic band sequence, congenital constrictions, bands and Pseudo Ainhum is a congenital disorder caused by entrapment of fetal parts [usually a limb or digits] in fibrous amniotic bands while in utero. Syndrome which is featured by one or more characteristic fibrous bands that encircle, deepen, strangulate and amputate parts of the human body. It start in a fetus and continues throughout life if not checked and treated. It is not an uncommon condition in our country but unfortunately data remains scarce. A prospective study. Pediatric and General Surgical Department of CMH Multan. June 2010 to June 2012. Characteristic progressive constriction band was undertaken. The patients were examined clinically and findings recorded. An X-ray to rule out underlying bone anomaly was done. Treatment required multiple staged procedures. Correction of the constriction ring was done by excision and Z-plasty to prevent or alleviate lymphoedema, separation of distally fused digits and skin grafting of defect. Fifteen patients comprising of ten male and five females were seen. Age of presentation ranged from second week of life to 12 years with mean age of 14 months. A total of twenty one limbs and one penile shaft were effected. These included two right upper limbs, three left upper limbs, ten right lower limbs and six left lower limbs. Penile shaft of one of the patients just short of glans was involved. Four main types of lesions were found which comprised of constriction rings, intra uterine amputations, acrosyndactyl and simple syndactyl. Pseudo Ainhum is a disease of unknown etiolgy and could cause morbidity in new born. The syndrome and its complications are amenable to corrective surgery with good results. Early surgery is required for successful outcome
ABSTRACT
Premature infants with necrotizing enterocolitis [NEC] or intestinal perforation [IP] are treated either surgically with laprotomy or peritoneal drain placement. [1] To develop a hypothesis about the relative effect of these 2 therapies on risk adjusted outcomes through 18 months in premature infants. [2] To obtain data that would be useful in designing and conducting a successful trial of this hypothesis. A prospective, observational study. In pediatric surgical departments of Military Hospital Rawalpindi and Combined Military Hospital Rawalpindi. From Nov 2005 to April 2007. To assist in risk adjustment, the attending pediatric surgeon recorded the preoperative diagnosis and intraoperative diagnosis and identified infants who were considered to be too ill for laprotomy. Severe NEC or IP in 156 of 2987 premature infants; 80 were treated with initial drainage and 76 were treated with initial laprotomy. By 16 months, 76 [50%] had died; outcome remained worse in subgroup with NEC. Laprotomy was not performed in 76% [28 of 36] of drain treated survivors. Drainage was commonly used, and outcome was poor. Our findings, particularly the risk adjusted odds ratio favoring laparotomy, indicate the need for a large, multicenter clinical trial to assess the effect of initial surgery therapy on out come at > 16 months