Risk factors predisposing to abruption placentae. Maternal and Fetal outcome

Abruptio placentae is one of the leading causes of perinatal deaths. Abruptio placentae increase the neonatal morbidity and mortality. It is one of the recognized causes of low birth weight. The purpose of this study was to examine the risk factors for abruptio placentae together with the maternal and fetal outcome in a large population based data set. All cases of abruptio placentae presented to the Department of Obstetrics, Wad Medani Teaching Hospital, Sudan during the period January 1997 through to December 2002 were collected. All infants born to those cases were also collected and analyzed as live birth or stillbirth. The live born infants were followed for one month to detect the neonatal deaths. The study also aimed to determine the predisposing factors for abruptio placentae. The study was designed as a case control study from live, singleton births and singleton fetal death. The total number of abruptio placentae collected during this period was 1028, while the total number of births during the same period was 15620 giving and incidence of 1028/15620 [6.5%] for abruptio placentae. The combined stillbirths and first month deaths were 20.2%. Abruptio placentae was associated with pre-eclampsia, diabetes, polyhydramnios and hypertension. Parity and maternal age were not associated with an increased incidence of abruption placentae. This study had the advantage of complete ascertainment of all reported cases of abruptio placentae during a period of 6-years. We found an increased risk for abruptio placentae associated with maternal diabetes, hypertension, pre-eclampsia and polyhydramnios. We found that infants born after abruptio placentae were small for gestational age and had lower Apgar scores than the control infants. The possibility of abruptio placentae should be considered by the clinician when managing pregnant women with any of those characteristics. Abruptio placentae should be managed in centers were there is advanced maternal and neonatal facilities

comparative study of twin and triplet pregnancy

Multiple pregnancy now warrants special attention from the obstetrician. The incidence of multiple pregnancy had increased during the last 15 years. Multiple pregnancy is a high-risk pregnancy since it is associated with increased perinatal morbidity and mortality. In addition, almost every maternal and obstetrical problem occurs more frequently in multiple than in singleton pregnancies. In view of the above we designed our study. This was a comparative and descriptive retrospective study conducted during the period January 1985 to December 1999 at Wad Medani Teaching Hospital, Wad Medani, Sudan. The study included the follow up of 597 twin pregnancies and 30 triplet pregnancies. The variables used were the age, the parity, the incidence, the sex of neonates and their weights. The study also concentrated on the mode of delivery, and it highly considered the maternal and perinatal complications. During the period of the study the total number of pregnancies received was 44605. Twin pregnancies accounted for 597/44605 [1.3%], while triplet gestation showed an incidence of 30/44605 [0.1%]. In twin pregnancy ovulation occurred spontaneously in 43/597 [7.2%] and it was induced in 167/597 [28%]. On the other hand, ovulation occurred spontaneously in triplets 19/30 [63.3%] and it was induced in 11/30 [36.7%]. The common maternal complication was pre-term labor, which affected 35.5% in twins and 76.7% in triplets. The rate of cesarean section was 53.1% in twins while in triplet it was 83.3%. The mean birth weight in twin pregnancy was 1890 gm for males and 1780 gm for females. In triplet gestation, the mean birth weight was 1760 gm for males and 1720 gm for females. The maternal mortality rate was 35.8/100.000 live births in twin pregnancies while it was 99/100000 in triplet gestation. The perinatal mortality rate was 115/1000 for twin and 223/1000 for triplet pregnancy. Multiple pregnancy is a high-risk pregnancy, and to decrease its maternal and fetal complications it must be diagnosed early. It should also receive almost antenatal care and care at delivery. Early hospitalization plays an important role of reducing these complications. It must be treated by one obstetrician

Obstructed labor in a teaching hospital in Sudan

This study was aimed to deal with a serious obstetrical problem in Wad Medani Teaching Hospital, Medani, Sudan. The study reviewed the incidence of obstructed labor, its clinical presentation and methods of diagnosis. The study also includes the methods of treatment and its complications. A prospective and descriptive study was carried out in Wad Medani Teaching Hospital, Medani, Sudan. Case notes were studied for all cases with obstructed labor received during the period 1 January 1997 to 31 December 1999. The data was analyzed. The literature was reviewed for similar studies. During the period 207 cases of obstructed labor were diagnosed. The total number of deliveries during the same period was 16221, giving an incidence of 1.27%. The most striking symptoms are tachycardia and low blood pressure, while the common sign is the non-engagement of the presenting part. The most common complication is septicemia, Obstructed labor remains a major obstetrical problem. Adequate antenatal care and proper care at delivery could prevent it. The obstructed labor should always be anticipated and the attendant should not wait for the advanced classical signs to make the diagnosis. Early intervention is associated with an excellent outcome

Maternal mortality in a teaching hospital in Sudan

Although there is a great advances in obstetrics in recent years, a hard core of maternal mortality still lingers and is considered to be an irreducible minimum. Nevertheless there has been worldwide decline in maternal mortality over the past decades. Yet maternal mortality is still the major public health problem throughout the world. A retrospective study carried out at the Medani Teaching Hospital, Medani City, Sudan. Case notes were reviewed for all the 877 women died during the period 1985-1999. All parturients were followed for at least 6 weeks after delivery so that deaths due to sequel of delivery and puerperium were also included. The data was analyzed and the literature was reviewed to compare the results of similar studies. Out of the total number of deliveries in that period [N = 44,605], 877 women died with a rate of 1,966 per 100,000. This rate showed a decline each year, being 2,661 per 100,000 during the period 1985-1989. The mortality rate during 1990-1994 was 2,021 per 100,000 and 1,363 per 100,000 during the last period of 1995-1999. Sepsis was the cause of death in almost one third of cases, while malaria accounted for 37.2%. The number of preventable deaths had decreased steadily. The study highlighted the existence of a serious and preventable obstetrical problem. Sepsis, malaria hemorrhage and hypertensive disorders are the main contributory factors. Poor antenatal care, poor intranatal care, and poor provision of health services add more to the problem. Research into the problem of malaria, sterilization, anesthesia, vascular accidents, and indication for cesarean section together with social and medical improvements will definitely reduce the maternal morbidity and mortality

Treatment of chronic anal fissure with isosorbide dinitrate and its cost versus open lateral sphincterotomy

Internal anal sphincterotomy for treating chronic anal fissure can irreversibly damage anal continence. Reversible chemical sphincterotomy may be achieved by topical application of nitric oxide donors [isosorbide dinitrate]. This study was undertaken to compare local application of isosorbide dinitrate with lateral internal sphincterotomy. A sample of 153 patients with chronic anal fissure was allocated to treatment with sphincterotomy [69 patients] or local isosorbide dinitrate tablets [84 patients]. Patients were followed-up for one year. Common age group was 30-40 years. The healing rate was 97% in surgical group and 47.8% in medical group. The recurrence after healing in last group was 44.4%. The cost of treatment by sphincterotomy under local anesthesia is nearly equal to treatment by topical application of isosorbide dinitrate tablet. Lateral internal sphincterotomy under local anesthesia is considered the operation of choice in surgically fit patients in treatment of chronic anal fissure. Topical application of isosorbide dinitrate can be used for those who are surgically unfit or refuse operation

Tumores neurogénicos del tórax / Neurogenic tumors of the thorax

En el período comprendido entre Enero de 1975 y Diciembre de 1994, se trataron un total de 36 pacientes con tumores neurogénicos del mediastino.La edad osciló entre los 15 y 62 años, y la distribución por sexo fue de 22 mujeres y 14 varones.Todos los casos fueron abordados quirurgicamente y dos de ellos fueron operados conjuntamente con el Servicio de Neurocirugía.De los 36 pacientes, 13 fueron sintomáticos (dolor torácico,tos seca y disnea de esfuerzoy los 23 cursaron en forma asintomática.el par radiológico y la tomografía computada lineal hasta 1980 y luego la Tomografía Axial Computada son los requisitos diagnósticos indispensables.Se hallaron 20 neurilemomas (55,5 por ciento) 7 neuroblastomas (19,4 por ciento), 4 neurofibromas (11,1 por ciento),3 Schwanomas malignos (8,3 por ciento) y 2 Tumores de Askin (5,5 por ciento).Creemos que la cirugía y terapéutica absoluta en los tumores neurogénicos del tórax

Divertículo de Zenker nuestra experiencia / Zenker's diverticula authors'experience

Se presentan 29 pacientes con diagnóstico de divertículo de Zenker operados entre Junio de 1981 y Junio de 1995, a todos ellos se les realizó como tratamiento miotomía cricofaringea,asociado a diverticulectomía en 25 casos y a diverticulopexia en los 4 restantes.El porcentaje de complicaciones fue del17,2 por ciento y no hubo mortalidad en la serie

Study of T lymphocyte subsets in patients with cryptogenic postsplenectomy fever

Total T cells and both T helper [Th] and T suppressor [Ts] subsets were studied twice [pre and postoperative] in 40 patients undergoing splenectomy in the Main Alexandria University Hospital. Twenty patients had an uneventful postoperative course [group I], while the other 20 suffered from postsplenectomy fever. In only 8 of these a demonstrable cause for the fever, was detected, and those were excluded from the postoperative sample. In the remaining 12, fever was found to be cryptogenic [group II]. Results of patients with schistosomiasis preoperatively, and both postoperative groups I and II showed no significant differences. However, there was a trend for an increase in total T cells with a decrease in Th and constancy in Ts cells after splenectomy. These trends were more evident in patients with postsplenectomy cryptogenic fever [group II]. On the other h and, the differences between control and preoperative values in schistosomal patients were significant only as regards the Ts [less in control group] and the Th/Ts ratio [higher in the control group]

Nova apresentação das derivações do plano frontal no eletrocardiograma / New presentation of frontal plane derivations in electrocardiogram

Foram realizados 77 eletrocardiogramas de individuos normais e com diversas cardiopatias. Utilizou-se um eletrocardiografo que permite a inversao da polaridade das derivacoes do plano frontal e selecionaram-se seis delas que foram ordenadas conforme a medida angular: DIII (+ 120 graus) aVF (+ 90 graus), DII (+ 60 graus), -aVR (+ 30 graus), DI (0 graus) e aVL (- 30 graus), o que permite a visibilizacao da morfologia das deflexoes, de maneira ordenada e progressiva, como a das derivacoes precordiais. Analisou-se aVR com polaridade invertida e valorizou-se sua morfologia predominantemente positiva e sua integracao na sequencia das derivacoes. Ficou assim, facilitada a determinacao do eixo eletrico, do diagnostico de bloqueio de ramo direito e esquerdo, do infarto inferior, do hemibloqueio anterior e das hipertrofias ventriculares. Com esta nova apresentacao o ensino da eletrocardiografia torna-se mais logico e simples, dispensando a memorizacao das morfologias das derivacoes, como no modelo classico

Complicaciones y secuelas alejadas de los traumatismos toracicos. / Complications and delayed sequelae of thoracic injuries

Se presentan 33 casos de complicaciones y secuelas alejadas sobre un total de 408 pacientes tratados por traumatismos toracicos. Se describen las mismas, las conductas adoptadas y el indice de morbimortalidad que las mismas condicionan, asi como su frecuencia aproximada

Miastenia grave - Timectomia. A proposito de 12 observaciones. / Myasthenia gravis - Thymectomy. Apropos of 12 observations

Se presentan 12 enfermos con miastenia grave intervenidos quirurgicamente entre marzo de 1979 y mayo de 1982. Se realizo timectomia total por esternotomia transversa, en pacientes seleccionados para la cirugia, como medida terapeutica coadyuvante de su enfermedad. Todos ellos fueron adultos jovenes y se obtuvieron buenos resultados postoperatorios