ABSTRACT
Leeches are found in fresh water as well as moist marshy tropical areas. Orifical Hirudiniasis is the presence of leech in natural human orifices. Leech have been reported in nose, oropharynx, vagina, rectum and bladder but leech per urethra is very rare. We report a case of leech in urethra causing hematuria and bleeding disorder in the form of epistaxis and impaired clotting profile after use of stream water for ablution. The case was diagnosed after a prolonged diagnostic dilemma. A single alive leech was recovered from the urethra after ten days with the help of forceps. The hematuria and epistaxis gradually improved over next 48 hours and the patient became asymptomatic. Natives of leech infested areas should be advised to avoid swimming in fresh water and desist from drinking and using stream water without inspection for leeches
Subject(s)
Humans , Male , Middle Aged , Leeches , Urethra , EpistaxisABSTRACT
To determine the frequency of wound infection with skin closure by removable subcuticular sutures in non complicated open appendectomy wound. Descriptive case series. Department of Surgery Railway Hospital Rawalpindi, Seven months and ten days, from 1[st] Nov, 2009 to 10[th] June, 2010. The study was carried out after taking approval from the hospital ethics committee. Seventy three adult patients of either sex admitted in department of surgery with diagnosis of acute appendicitis were included in the study by non probability consecutive sampling. All the patients were explained about the procedure and an informed written consent was obtained. Right grid iron abdominal incision centred over the Me Burney's point was used to open the abdomen. Appendicectomy was done. In all patients subcuticular stitches by using polypropylene 2/0 were applied to close the skin. All the patients were followed on 3[rd], 7th and 30[th] post operative day for examination of wound. Data was entered in the predesigned Proforma [annexed] for analysis. Out of 73 patients 6 [8.2%] suffered from wound infection. Successful open management of the infected wounds was done. Rest of the patients had uneventful recovery. Frequency of wound infection is negligible with removable subcuticular skin suture in non complicated open appendicectomy wound
ABSTRACT
Raynaud's syndrome is a known complication of cold injuries. Stress, smoking and metabolic diseases may further aggravate the disease course. The purpose of this study was to determine the efficacy of Cervico-thoracic sympathectomy as compared to conservative management in severe Raynaud's syndrome after frostbite. This non-randomized controlled trial was conducted at Railway Hospital, Rawalpindi and Islamic International Medical Complex, Islamabad between January 1999 and June 2006. All patients sustained severe cold trauma in the mountain ridges of Himalayas in Kashmir. In all cases, an informed consent was obtained from patients and families. All operations performed were free of charges. Out of the total 48 patients who developed incapacitating Raynaud's syndrome of the upper limbs after frost bite, 17 patients underwent thoracic sympathectomy through anterior supraclavicular route. Remaining 31 patients were treated conservatively and were placed in the control group. Data was collected on pre-designed proforma and assessed using SPSS [version 11]. Chi-square test was applied to assess the effectiveness of the two treatment modalities. All operated cases initially showed improvement in symptoms and incapacitation. Among sympathectomised patients, 11 patients became symptom free and 3 patients showed mild but improved symptoms. Two patients after initial transient improvement developed incapacitating symptoms requiring further treatment, one patient developed gangrene of distal phalanx nine month after sympathectomy requiring amputation of the finger. Frequency of attacks and duration between the attacks reduced in all operated patients of cervical sympathectomy [p<0.05] as compared to conservative management. Cervical sympathectomy is a very effective modality of treatment in patients having severe Raynaud's disease of upper limbs secondary to frost bite