Evaluating a murine model of endometritis using uterine isolates of Escherichia coli from postpartum buffalo

Ascending infection of the uterus with Gram-negative bacteria is responsible for postpartum endometritis in cattle and buffalo and can adversely affect fertility. Development of a laboratory animal model for bovine endometritis would facilitate the understanding of the pathogenesis as it is difficult to conduct controlled experimentation in the native host. In the present study, 30 virgin Swiss Albino mice [5-8 weeks old] were used to evaluate the pathogenic potential of Escherichia coli, isolated from the normally calved postpartum buffalo to induce endometritis. Mice in the diestrus phase of the estrous cycle were randomly allotted to one of the following four intravaginal inoculation [100 microL] treatments: EG [experimental group]-1: sterile normal saline; EG-2, -3 and -4: E. coli@ 1.5 × 104, 105 and 106 CFU/ml, respectively. The animals were then scarified 36 h post-inoculation to study gross and microscopical lesions. Gross changes were confined to EG-4. Acute endometritis was recorded in 50% of the EG-3 and 66.7% of the EG-4. The rate of acute endometritis development was significantly higher in EG-4 [P<0.05] as compared to the other groups. The present study demonstrated that the animal model for bubaline endometritis can be developed in mice by intravaginal inoculation of E. coli@ 1.5 × 106 CFU/ml at diestrus. Ease of intravaginal inoculation, apparent absence of systemic involvement and high infective rate are the advantages of the model over other studies

Congenital familial erythrocytosis: a case report with literature review

Familial erythrocytosis is a heterogeneous group of hereditary conditions with an increased total red blood cell volume. The disease occurs in a familial pattern and follows a relatively benign course. The absence of leukocytosis and thrombocytosis differentiates it from polycythemia vera. The best characterized primary erythrocytosis is the autosomal dominant primary familial and congenital polycythemia. In most families, erythrocytosis is due to abnormal hemoglobin with increased oxygen affi nity. In other families, erythrocytosis is caused by an autonomous production of erythropoietin [EPO]. EPO receptor gene mutations are also responsible for erythrocytosis when no secondary causes are apparent. Presented herein is a family with familial erythrocytosis possibly due to high autonomous production of EPO, which as per the literature is the fi rst of its kind in the Indian context

Insulin lipohypertrophy: a non-fatal dermatological complication of diabetes mellitus reflecting poor glycemic control

Lipohypertrophy has been a recognized complication of insulin therapy. Despite improvements in insulin purity and the introduction of recombinant human insulin, its prevalence has remained high particularly in those with a poor glycemic control. Injection of insulin into a site of lipohypertrophy, although painless, may lead to erratic absorption of insulin, with the potential for poor glycemic control and unpredictable hypoglycemia. Rotation of injection sites can reduce the frequency of the problem but does not abolish it. The importance of this complication is not only cosmetic but also in its impact on insulin absorption, and hence glycemic control. Lipohypertrophy is characterized by a benign "tumor-like" swelling of fatty tissue secondary to subcutaneous insulin injections. A strong association of lipoatrophy and lipohypertrophy with insulin antibodies might suggest that autoimmune phenomena with insulin play a role in the development of both. Presented here is a young type 1 diabetic on human insulin with poor glycemic control who developed lipohypertrophy at the injection sites around the umbilicus

Acardiac Parabiotic Triplet.

Acardiac parabiotic twin commonly known as parasite occurs rarely and may lead to high output cardiac failure, hydrops or premature delivery in the pump fetus. Doppler USG of acardiac fetal umbilical vessels and fetal echocardiography aids in the diagnosis. Treatment can be done prenatally by stopping the blood flow to the acardiac twin without affecting the pump twin, achieved by endoscopic (fetoscopic) ligation or laser coagulation of the umbilical cord or Bipolar cauterization or intra-fetal radio frequency ablation or USG guided thrombosis of umbilical cord.

Surgical anatomy of the hepatic arteries: a prelude to living donor liver transplantation

In the setting of Liver Transplantation as a new and emerging specialty in Pakistan the need has arisen for exact descriptions of the hepatic vascularization to avoid iatrogenic vascular damage. Exact knowledge of the arterial anatomy is required to plan the best resection as well as to minimize the risks of donor morbidity. We studied variations of extrahepatic arterial anatomy in forty six patients who underwent major hepatobiliary or pancreatic resections with complete exposure and/or skeletonization of the extrahepatic arterial anatomy. The extrahepatic arterial anatomy in twelve cadaveric dissections was also studied. The commonest arterial variant seen in our series was Type 1 i.e. 91.37% . The prevalence of anatomical variants was 8.63% . Knowledge of the variation in the hepatic arterial anatomy will help us in planning and performing the safe procurement of grafts from living donors with less risk of serious ischemic complications

Identification and preservation of the external laryngeal nerve during thyroid surgery: surgical and anatomic considerations

Iatrogenic injuries of external branch of superior laryngeal nerve [EBSLN] during thyroid surgery are not uncommon due to the possibility of anatomic variations in the relationship of this nerve with superior thyroid vessels and the result may be devastating to those patients who rely on their voices professionally. The study included 2 groups. Group A was a prospective nonrandomized analytical series of all consecutive patients undergoing thyroidectomies for various conditions in Surgical Unit II, Shaikh Zayed Postgraduate Medical Complex, Lahore, Pakistan during a three years period [November 2004 - November 2007]. This group consisted of 133 patients. Male to female ratio was 1:3. Mean age was 35.22 years [range: 17-71 years]. Ninety one [68.42%] patients had bilateral dissection [total, sub-total or neartotal thyroidectomies] and 42 [31.57%] had unilateral dissection [hemithyroidectomy I lobectomy and isthumusectomy]. Thus, a total of 224 superior polar dissections were carried out. Three [3 .296 %] patients out of the 91 patients in the bilateral dissection group had asymmetrical nerves. Eighty one [60.9%] patients had benign disease, 32 [24.06%] had malignancy and 20 [15.03%] had toxic goiter. Nerve could not be identified in 42 [18.75%] polar dissections [positive identification in 182 [81.25%] polar dissections]. Three [2.25 %] patients in this study had clearly documented EBSLN injury as determined by voice changes, patient interview and IDL. In Group B, the anterior neck triangles of 19 embalmed human cadavers [i.e. 38 neck half preparations] of both sexes and variable ages with neither enlarged thyroid glands nor any other signs of abnormality in this region were dissected in the dissection halls of two medical colleges in Lahore. The course and topographical relations [especially in relation to the superior thyroid vessels, superior pole of the thyroid and the cricothyroid muscle] of the EBSLN as well as bilateral asymmetry were noted as for Group A. Nerves were classified according to classification of Cernea et al. Good knowledge of the anatomy and relations of the EBSLN with meticulous dissection and ske letonisation and individual ligation of the superior polar vessels is the key to success

Efficacy of ultrasound diagnostic criteria using scoring system for infantile hypertrophic pyloric stenosis [IHPS]

An analytic cross sectional study in the Department of Paediatric Surgery, Mayo Hospital, Lahore conducted. Twenty patients of non-bilious projectile vomiting with a control group of 20 patients were evaluated from June 2001 to May 2002. An attempt was made to prepare a diagnostic criteria with a scoring system using ultrasonography as a primary tool. Pyloric diameter was 9.1

Mathieu repair in distal penile hypospadias with or without stent

To compare the outcome of two techniques for repair of distal penile hypospadias: Mathieus repair with and without stent. Prospective observational descriptive study. Department of Paediatric Surgery, Mayo Hospital, Lahore from September 2000 to September 2002. Sixty boys were randomly assigned the two groups of thirty boys each. Detailed scrutiny of procedure done and analyses of the clinical outcome made prospectively. A total of sixty patients were treated in two separate groups. All the boys had Mathieus repair done for distal hypospadias. In group A stent/ indwelling catheter was used for 7-8 days while in group B no stent was used. Stratification was done using Chi square test. Median age was 4 years and most of them belonged to low socioeconomic class [61.6%]. A high percentage [48.3% were born to mothers of age ranging from 30-40 years. Sixteen [26.66%] patients had a family history of hypospadias. Only twelve mothers [2 0%] gave a positive history of drug intake in first trimester. Sixteen [26.66%] patients had associated anomalies of undescended testis / inguinal hernia. Twenty four [40%] patients were brought because of the abnormal appearance of the childs penis while their stream [21.66%] and dysuria [25%] were presenting complaints of two other major groups. Mathieus repair was done in all cases with group A. Thirty boys [50%] having a stent post operatively and the group B thirty boys [50%] were without stent. Total complications rate is 46.66% with group a showing eight cases [26.66%] and group B having twenty [66.66%] cases with compliec. Major complication in group B was urinary retention in eleven cases [36.66%] while no patient had retention in group A. overall twenty six [86.66%] in group A and twenty one [70%] in group B showed satisfactory results. Mathieus repair without stent has been advantage of shorter hospital stay but a fair proportion of patients [36.66%] having urinary retention calls for further studies on a larger scale

Efficacy of bupivacaine infiltration in post operative pain relief in children

A series of 156 cases in being presented in which Bupivacaine was used either as a nerve block or for infiltration of operative field. This article presents an overview of the post-operative pain in children with a special emphasis on regional blockade by Bupivacaine