Role of low-lying pubic tubercle in the development of inguinal hernia

Background: Hernia is defined as abnormal protrusion of whole or a part of a viscus through the wall that contains it. Among all external abdominal hernias, inguinal hernia is one most commonly encountered. Many factors are responsible for the formation of the inguinal hernia but, what makes a few people more susceptible to this situation is still clearly not proved. The lowness of pubic tubercle is associated with narrow origin of internal oblique muscle from lateral inguinal ligament which fails to protect the deep inguinal ring consequently lead to inguinal hernia.Methods: The study was conducted in Sardar Patel Medical College and attached hospital, Bikaner for duration of 12 months from March 2018 to February 2019. It is a case-control study with 50 cases and 50 control meeting inclusion criteria. In all patients, following parameters SS line, ST line, height, weight was recorded and evaluated.Results: The mean value of ST line in our study group is 7.37±0.182 cm which is significantly greater (p=0.0001) than the controls the mean value being 7.01±0.262 cm. In our study, 98% of cases were having ST line >7.01 cm whereas 66% of controls were ST line under 7.01 cm.Conclusions: Group of people with low lying pubic tubercle are at high risk of developing inguinal hernia.

A prospective study of fetomaternal outcome in cases of placenta previa

Background: The incidence of placenta previa ranges from 0.5-1% amongst hospital deliveries. Placenta previa is major cause of antepartum haemorrhage and is potentially devastating complication. Obstetric haemorrhage is most common cause for maternal and perinatal morbidity and mortality in India. This study aimed to determine frequency, type of placenta previa, risk factors and adverse fetomaternal outcomes of placenta previa.Methods: This was a prospective study carried out in Department of Obstetrics and Gynaecology, Government Medical College and Sir-T hospital, Bhavnagar from July 2007 to July 2009 to analyze fetomaternal outcome in cases of placenta previa. All patients of placenta previa with gestational age > 28 weeks up to full term were included in the study. All cases were confirmed by Ultrasound examination. All cases were carefully analyzed to find out the incidence, type of placenta previa, its clinical presentation and its outcome in relation to mode of delivery, birth weight, maternal and perinatal morbidity.Results: There was total 50 cases of placenta previa out of 5636 deliveries. The prevalence of placenta previa was 0.88% and was more commonly present among multiparous women (82%). Most common type was type IV placenta previa in 23 (46%) cases followed by type III in 11 (22%) cases. Out of 50 cases, 06 (12%) cases had atonic PPH and 02 (04%) cases underwent peripartum hysterectomy. Most common predisposing factors were age >35 years (04%), multiparity (50%), previous cesarean section (16%) and previous history of abortion (12%). All cases of perinatal mortality were between 28 to 30 weeks weighing between 1-1.5 kg. There was no maternal mortality in this study.Conclusions: Managing a case of placenta previa during pregnancy poses a great challenge to every obstetrician in present day obstetrics due to its increased risk of maternal and perinatal complications.

Intersphincteric Resection for Patients With Low-Lying Rectal Cancer: Oncological and Functional Outcomes

The aim of this review is to evaluate the outcomes after an intersphincteric resection (ISR) for patients with low-lying rectal cancer. Reports published in the literature regarding surgical, oncological, and functional outcomes of an ISR were reviewed. The morbidity after an ISR was 7.7%–32%, and anastomotic leakage was the most common adverse event. Local recurrence rates ranged from 0% to 12%, 5-year overall survival rates ranged from 62% to 92%, and rates of major incontinence ranged from 0% to 25.8% after an ISR. An ISR is a safe procedure for sphincter-saving rectal surgery in patients with very low rectal cancer; it does not compromise the oncological outcomes of the resection and is a valuable alternative to an abdominoperineal resection. While the functional outcomes after an ISR were found to be acceptable, the long-term functional outcome and quality of life still require careful investigation. ISRs have been performed with surgical and oncologic safety on patients with low-lying rectal cancer. However, patients must be selected very carefully for an ISR, considering the associated functional derangement and the limited extent of the resection.

Clinical Study of Risk Factors of Postpartum Hemorrhage in 345 Cases of Low-lying Placenta / 实用妇产科杂志

Objective:To analyse the risk factors of postpartum hemorrhage in vaginal delivery patients with low-lying placenta.Methods:We retrospectively evaluated the data from January 2014 to December 2015 of 345 cases of vaginal delivery pregnant women with low-lying placenta.According to postpartum hemorrhage,the data were divided into two groups:single factor analysis and multivariate logister regression analysis were used to assess the risk factors.Results:Postpartum hemorrhage in 47 cases,the total rate is 13.6％.Univariate analysis showed that assisted reproductive conception,history of prenatal hemorrhage,placenta from the cervix within the distance ≤ 10 mm,placental adhesions were more prone to postpartum hemorrhage(P ＜ 0.05).Logistic multivariate regression analysis showed that assisted reproductive conception (OR =8.181,95％ CI 3.072-21.791) and placental adhesions(OR=6.543,95％ CI 3.107-13.775) were independent risk factors for postpartum hemorrhage.Conclusions:Systematic prenatal care,carefully transvaginal ultrasound examination before labor and evaluation of these risk factors,may be able to provide a better choice of mode of delivery to low-lying placenta patients and predict postpartum hemorrhage risk,thereby reducing its postpartum hemorrhage rate.

Terminal myelocystocele: a case report

Terminal myelocystocele is a rare form of occult spinal dysraphism in which the hydromyelic caudal spinal cord and the subarachnoid space are hemiated through a posterior spina bifida. A 1.5 month old boy presented with a large lumbosacral mass and urinary incontinence. The magnetic resonance imaging, operative findings and pathological findings revealed a low lying conus with a dilated central canal dorsally attached to the subcutaneous tissue. Ventral subarachnoid space was enlarged and herniated through the laminar defect of the sacrum. The lesion was typical of a terminal myelocystocele. The clinical features are different from those of myelomeningocele in many aspects. Though the incidence is low, terminal myelocystocele should be included in the differential diagnosis of congenital lesions presenting as a lumbosacral mass.

Subtemporal Transpetrosal Approach for Aneurysms of the Low-Lying Basilar Bifurcation

Surgical approaches for aneurysms of the basilar artery trunk are variable and utilized depending on the location of the aneurysms and direction of the fundus of the aneurysms. We operated one patient with low lying basilar bifurcation aneurysms facing toward the brain stem by subtemporal transpetrosal approach with successful clipping of aneurysms. The advantage of this approach to low-lying basilar bifurcation or basilar trunk aneurysms over the pterional, subtemporal(transtentorial), combined supratentorial and infratentorial, transoral, and suboccipital approach are discussed.

Diagnosis of Placenta Previa and Low-lying Placenta By Means of B Scan / 昆明医科大学学报

From January 1987 to April 1991, we used the ultrasonography in the diagnosis of placenta previa of 197 cases. The diagosis of placenta previa is made to assess the relationship of the lower margins of the placenta and the internal os. There were total 74 eases of placenta previa (37.6%), 37 cases of (18.8%) partial placenta previa, 46 cases of low-lying placenta (23.4%), and 40 cases of "relative low-lying placenta" (20.2%). The high ratio diagnosis of the total placenta previa was made at 28-36 weeks.(P