Neurological outcome following delayed fixation of unstable thoracolumbar spinal injuries with short segment posterior fixation

To evaluate the improvement in neurological deficit following late decompression and stabilization of the fractured thoracolumbar spine. Between January 2001 and August 2004 neurological recovery in 120 thoracolumbar fractures was studied after posterior stabilization at the Hospital for Bone and Joint Surgery, Srinagar, India. There were 88 male and 32 female patients. Fall from a height, usually a tree, was the most common [90%] cause of injury. Seventy-six patients [63%] had neurologic deficit at the time of presentation. The unstable spine was fixed, between 4-18 days after trauma, by posterior short segment instrumentation [Steffee]. Neurological recovery for the patients was recorded in the follow-up period. Frankel grade was used to assess the neurological status. The average follow-up period was 25 months [range 8-44 months], and average age was 34 years [18-54]. There were 40 patients [30%] with an incomplete neurological deficit, namely, patients with Frankel grade B, C, and D. Two grades of improvement were found in 8 patients, and one grade improvement in 32 patients with incomplete lesion. Only one third of the patients with complete neuro deficit improved at the final follow-up. The overall result of the surgery for partial lesions was an improvement of at least one Frankel grade in all cases, but no improvement in most of the cases with complete lesion. This study demonstrates a clear relationship between the level of injury and Frankel grades, translational injuries are associated with a more severe neurologic grade, and surgical intervention appears to improve the neurological outcome, even when the intervention is inadvertently delayed [average 7.9 days]

Eradication of H. Pylori by quadruple or triple therapy.a comparative study

Quadruple therapy appears to be more effective than standard therapy in management of patients with helicobacter pylori infection. No data is available on the relative efficacy of triple and quadruple drug regimens from Pakistan. Consecutive patients with peptic ulcer and H. pylori infection were randomized to receive omeprazole 20 mg twice daily along with either amoxycilline [500 mg four times daily] and clarithromycin [500 mg twice daily] [Group A] or tri-protassium dicitrate hismuthate [120 mg four times daily], metronidazole [400 mg thrice daily] and tetracycline [500 mg 4 times daily] [Group B] for 10 days. Presence H. Pylori infection was looked for using an fecal antigen test before treatment and 30 days after completion of treatment. 17 of 21 patients in Group A and 16 of 23 in Group B had eradication of infection [80.9 and 69.56% respectively by protocol analysis]. Side effects occurred in 2 [1%] and 4[2%] patients in Group A and B, respectively. Discontinuation of drug was not required in any patient. Quadruple therapy for initial therapy of H. Pylori infection does not offer any advantage over standard triple therapy

Siriraj score as a tool for clinical diagnosis of stroke

Siriraj stroke score is a diagnostic tool to differentiated ischemic from haemorrhagic shock. This study was carried out to access SSS accuracy as compared to CT scan. This study was carried out in the Department of Medicine and Neurology of Mayo Hospital, Lahore. Thirty two patients were included in the study who had stroke SSS was applied as well as CT scan was done. Out of them 6% were misdiagnosed. Overall predictive accuracy was 87.5%. Siriraj stroke score is not 100% accurate. CT scan should be advised before starting definitive stroke therapy

Clomiphene citrate for ovulation inducation in patients with polycystic ovarian sndrome

To provide fertility assistance and to determine the response of clomiphene citrate in polycystic ovarian syndrome. Observational study. Department of Obstetrics and Gynecology Lady Willingdon Hospital Lahore. Eighty-four patients of polycystic ovarian syndrome who required fertility assistance were subjected to clomiphene citrate therapy for duration of 12 months from February 2005 to January 2006. Clomiphene citrate [50-150mg] was administered from second to sixth day of menstrual cycle and TVS performed on 12th and 16th day of cycle for follicular growth, ovulation, endometerial thickness and echogenic pattern. Ovulation, conception rate, miscarriage rate and ovarian hyperstimulation rate were assessed. In addition the thickness and echogenic pattern of the endometrium was observed in conceived group. Forty-six patients [54.76%] ovulated in six cycles while twenty-seven [32.14%] remained anovulatory. Sixteen women [34.79%] conceived during the study period. Out of which ten women [62.5%] miscarried. Endometerial thickness did not differ [P>.50] between the conceived and non-conceived group but echogenic grade A pattern [75%] was observed during the conceived cycles [P<. 001]. Clomiphene citrate [CC] is a successful drug for ovulation induction in patients with polycystic ovarian syndrome. But the discrepancy in ovulation and pregnancy rate s upport that clomiphene citrate therapy has antiestrogenic effect at the endometrium, which interferes with implantation of pregnancy. The high miscarriage rate in these patients demand some other forms of therapies. These include weight reduction, use of insulin sensitizing drugs, gonadotrophin therapy and ovarian drilling to reduce high LH levels, thus correcting disturbed hormonal milieu, ovulation resumption and pregnancy outcome

Primary post partum haemorrhage: outcome of different treatment measures

This study was carried out to compare the efficacy and safety of different therapeutic measures used for controlling primary postpartum haemorrhage [PPH]. The venue of this work was the Department of Obstetrics and Gynaecology Lady Willingdon Hospital Lahore over a period of six months from July 1, 2005 - December 31, 2005. Fifty patients of primary PPH were recruited in this study. After identifying the risk factors for primary PPH thorough history, examination and investigations, these patients were treated medically and surgically to control haemorrhage. Control of bleeding by different measures was secured for the survival of patients. Medical intervention included use of oxytocins, and prostaglandins. Different surgical procedures like manual removal of placenta, suturing of genital tract tears, bimanual uterine compression and packing, stepwise devascularization and caesarean hysterectomy were done. Results of different procedures were analysed by using research proforma. The results show that out o f fifty, fifteen [30%] were booked patients. The major predisposing factor was grand multiparity in twenty-five [50%] patients. The predominant cause was uterine atony in thirty [60%] cases. Twenty [66%] patients were completely cured by different oxytocins. Eight [16%] had manual removal of placenta and two [4%] required evacuation of retained products of conception. Nine [18%] were treated by suturing the tears and lacerations. The commonest morbidity [66%] was anaemia. Mortality rate was 6%. In conclusion there is a need to reduce the alarmingly high maternal mortality and morbidity caused by primary PPH. Its main predisposing factors should be controlled. High parity, illiteracy and ignorance coupled with inadequate maternity services contribute towards this tragedy. If patients reach hospital well in time, effective management of obstetric haemorrhage should be prompt restoration of circulatory volume, accurate diagnosis of the cause of bleeding and early appropriate therapy to arrest the bleeding

Amnion graft in vaginoplasty: an Experience at 3 teaching hospitals of Lahore

This study was carried out to determine the outcome of vaginoplasty using amnion graft. It was conducted in 3 different hospitals of Lahore including Lady Willingdon hospital. Sir Ganga Ram hospital, and General hospital from March 2001 to March 2005. Ten patients with Mayer-Rokitansky -Kauster-Hauser syndrome [MRKH] included in the study, underwent vaginoplasty using amnion graft. All patients were followed upto 6 months and beyond to determine the outcome of vaginoplasty and coital function. The patients' age ranged between 18-30 years. Eight patients [80%] were married and two were unmarried. The procedure was uncomplicated in nine while one had rectal injury, which was repaired successfully before application of graft. Follow up ranged upto 6months and beyond. Eight patients had excellent vaginal depth upto 8cm after 6months. One patient had cicatrisation. One patient lost follow-up. Five had satisfactory coital function. Ammon graft vaginoplasty is an ideal, simpler method and provides good results n ot only in terms of improvement in vaginal length but also couple's satisfaction at coitus

Stroke in elderly patients admitted at Mayo Hospital, Lahore

Early constitute a major proportion of our population. Our study at West Medical Unit of Mayo Hospital, Lahore was based on elderly patients presenting with various types of stroke. Out of 206 elderly patients, 28 had stroke. 12 were female and 16 male. 3 had transient ischemic attack [TIA], 16 suffered from thrombotic stroke and 9 from haemorrhagic event. 6 patients from study group died and 2 left against medical advice. We concluded that stroke is a disease of the elderly imposing major impact on their mortality rates, age being a major risk factor. Hence stress should be laid on the disease as well on the elderly which constitute a major portion of our population

Circulating platelet aggregates in essential hypertension

A study was carried out in 24 normotensive and 49 hypertensive subjects to measure the in-vivo platelet aggregation. Platelet aggregation ratio [PAR], which determines the circulating platelet aggregates quantitatively, was measured using the method of Wu and Hoak. The mean +/- SEM of PAR in the normotensive group was 0.90 +/- 0.01, whereas in the hypertensive group it decreased to 0.57 +/- 0.01 showing a significant decline [p < 0.0001]. The PAR was inversely correlated with the level of blood pressure. These results suggest increased level of circulating platelet aggregates in hypertension. This increased stickiness of platelets and hyperaggregability may lead to impeded blood flow and subsequent development of atherosclerotic complications. The results also suggest that the increased in-vivo platelet aggregation may be associated with the raised haemodynamic stress in the arterial vasculature