Frequency of contralateral patent processus vaginalis in children presenting with unilateral hernias

To determine the frequency of contralateral patent processus vaginalis [PPV] in children who presented with unilateral inguinal hernias. A Descriptive Study. Department of Paediatric Surgery, Military Hospital Rawalpindi, from November 2006 to November 2007. All children under the age of 6 years and presenting with unilateral inguinal hernia were included. Those children who had a hernia on the contralateral side, or a history of swelling in the past, previous operations on the contralateral side, associated conditions like connective tissue disorders, ascites or VP shunts were also excluded. A standard Rehbein procedure was carried out for hernia repair on both sides. The results were analyzed and presented as mean [range] or mean +/- SD. There were 76 patients who underwent bilateral inguinal explorations. Males were 66 [86.8%] and 10 [10.8%] were female. Almost two thirds [n=52, 68.4%] were children younger than two years of age [mean age 1 year and 9 months]. There was a preponderance of left sided hernias [45 vs. 31, 59.2% vs. 40.8%]. The asymptomatic contralateral side exploration showed the presence of a definite PPV in 5 [6.6%] patients. The mean operating time was 35 + 10.4 minutes. The risk of contralateral hernia, in children presenting with one sided inguinal hernia is quite low. This does not justify routine exploration of the contralateral groin to prevent only a few clinical hernia developments later on

study of diabetic foot syndrome

This study was carried out to determine the number and predisposing factor of foot infection in the adult onset diabetes mellitus. An observational study. The study was carried out at PAF Hospital Islamabad, from June 2003 to June 2005. A total of 130 patients with adult onset diabetes mellitus were included in this study. The population was mixed. Clinical profile and investigations were recorded. Patients were managed as indoor cases. Plain insulin was used to control the diabetes. Broad-spectrum antibiotics and serial debridments, where required, were carried out. A total of 18.5% of the hospitalized diabetic population was due to foot infection. Males were affected 1.5 times more than the females. The disease was bilateral in 4% cases. Poor control of diabetes, bad foot hygiene, peripheral neuropathy, trauma, ingrowing toenails, callosities and corns were implicated as predisposing factors in majority of cases. Foot infection in diabetics is a common occurrence and both sexes are involved though males more commonly than females. Majority of the patients were elderly and have poor knowledge and insight of their disease

Anesthesia crisis resource management

The critical scenario in which rapid response is needed, for example. Malignant Hyperthermia, occurs rarely. Hence conducting training about such clinical events leaves no alternative but to use simulation. The aims of anesthesia crisis resources management [ACRM] training are to learn principles of complex problem solving, decision making, resource management and team work behavior to improve medical and technical skills. In medical training, simulator can substitute for actual patients and recreate actual clinical environment for anesthesiologists, surgeons, radiologists, cardiologists, gynecologists, etc. for their training. Simulators range from simple mannequin to high fidelity simulators. Mannequin represents the patient, and the participants act as surgeons, anesthetists and operating room assistants in a replica of operation theatre. The high fidelity simulators are programmed to create a special situation which the trainees are required to diagnose and manage the situation and resources accordingly. A panel consisting of consultants and instructors trained in this field are observing and recording all the details on the video tape which is used later on for the debriefing sessions. Simulators have high face validity because they ease trainees' transition to actual patient. Simulators can effectively identify errors and appropriateness of decision making. There is a risk that clinician might acquire inappropriate behavior or develop a false sense of security in their skills that could theoretically lead to harm the patient. The trainees develop an underst and ing that how stresses contribute to the occurrence of error. The ACRM training is an effort to improve our underst and ing about the crisis management aiming at reducing error and ultimately improve patient safety