Selective management of typhoid perforation of bowel

To evaluate the selective management of enteric typhoid perforation, according to the time of presentation, in terms of morbidity and mortality. Descriptive case series. Surgical unit of DHQ teaching hospital, Rawalpindi, from April 2004 to April 2011. A total of 84 patients were included, and divided into two groups. Forty patients, who presented early [within 48 hours] constituted group A, were managed by primary closure. of perforation while patients who presented late were put in group B and stoma was made. The age range was 10 to 40 years. Seventy five patients were males and 9 females. Forty four patients presented with features of systemic toxicity. All group A patients were managed by primary closure of perforation. In group B, ileostomy was performed in 20 patients after bowel resection, and the perforation was exteriorized in 22 patients with single perforation. Two patients had primary anastomosis. Overall mortality was 11.9%. Primary closure should be reserved for selective patients who present early, without gross peritoneal contamination. Patients who present late, or are severely ill, should be managed by ileostomy

Obstetrical prognosis after placental abruption

Placental abruption is the premature separation of normally situated placenta after 24 completed weeks of pregnancy and before delivery of a baby. It is self extending process with accumulation of blood clots leading to more separation of placenta. The study was conducted to assess the perinatal mortality, morbidity in relationship to the severity ofplacental abruption and to estimate the magnitude of abruption. It is a descriptive and observational study. The study was conducted in the department of obstetrics and gynaecology, Sir Ganga Ram Hospital, Lahore over a period of one year from May, 2009 to May 2010. A total of 80 patients with the diagnosis ofplacental abruption after 24 completed weeks of gestation were included in this study. Neonates were evaluated at the time of birth and followed upto 46 hours after birth. Among the 80 patients, only 14 were [17.5%] booked, while 66 [82.5%] remained unbooked. A total of 27 [33.75%] patients had pregnancy induced hypertension, 65 [81%] were anaemic. Polyhydramnios and multiple pregnancy were seen in 3 and 4 patients respectively. Majority of patients i.e. 47[58.75%] delivered by abdominal route. Regarding the fetal outcome alive born babies with placental abruption were 41 [51.25%] in which 23 [28.75%] were preterm and 18 [22.5%] were full term. Thirty six [45%] intrauterine dead fetus and in whome 25 [31%] were preterm and 11 [13.75%] were full term, only 3 were still births. Twenty four [30%] neonates required resuscitation, while 20 [25%] neonate were shifted to neonatal intensive care unit. latrogenic prematurity was the underlying cause of most complications. Perinatal morbidity and mortality is significantly high in patients of abruption placentae. Hypertension is a major predisposing factor for placental abruption

Uterine torsion in twin pregnancy

A young married women in her 3rd ongoing pregnancy, having no alive issue presented at 37+ weeks with labor pains. Cesarean section was planned because of twin pregnancy and past bad obstetrical history. During operation, the uterus was found to have rotated to 180 degree to the right. A transverse incision was made on posterior wall of uterus to deliver babies. After suturing the incision site, the uterus was repositioned in right place. This paper presents a case of torsion of gravid uterus in which the delivery and repositioning of the uterus was successful

Transcatheter embolization of acute non-variceal gastrointestinal hemorrhage

To determine the efficacy and safety of transcatheter embolization of nonvariceal gastrointestinal hemorrhage. Descriptive analytical study. Radiology Department. The Aga Khan University Hospital, Karachi, Pakistan, from October 1999 to August 2004. The study included 27 patients who underwent angiography for suspected gastrointestinal hemorrhage. The presumptive diagnosis was based on the findings of endoscopy in 08 patients, scintigraphy in 05 patients and on clinical findings only in 14 patients. Nine patients had gastroduodenal hemorrhage, 04 patients had hemobilia and 14 patients had lower gastrointestinal bleeding. Five patients had comorbidities. One patient had uremia, 2 had hepatitis C, 1 had cirrhosis and 1 had coagulopathy. Technical success, clinical success, complications and patient survival were assessed. Nine patients had upper gastrointestinal hemorrhage, 4 patients had hemobilia and 14 patients had lower gastrointestinal bleeding. Etiology of bleeding was known in 15 patients and unknown in 12 patients. Clinical success was achieved in 23 [85.18%] of 27 patients. Two patients had early rebleeding. One of these was managed surgically and recovered. The other had severe coagulopathy and was unfit for surgery. Two patients had bowel infarction, one of these was managed surgically and recovered and the other died of complication of procedure. One patient had small splenic infarcts and was managed conservatively. Overall 85.18% success was achieved for the embolization procedure. Two of 27 patients died. One patient died because of recurrence of bleeding and other died because of infarction of right hemi-colon which occurred as complication of embolization. Transcatheter embolization is effective and safe in patients with nonvariceal gastrointestinal hemorrhage

Perinatal outcome after cervical cerclage

Over a period of one year from January, 1997 to December, 1997, 50 patients with cervical incompetence were managed with McDonald's cervical cerclage in the department of Obstetrics and Gynaecology, Nishtar Hospital Multan. The incidence of cervical incompetence requiring surgical approach in our hospital-based study was 1.6%. Our results confirmed a success rate in the form of a successful pregnancy outcome i.e., a live birth or prolonging the duration of pregnancy thus improving fetal survival rate of 90% as compared to 52% in previous pregnancies. This represents 39 [76%] full-term pregnancies, 6 [12%] premature deliveries and 5 [10%] abortions. Cerclage was applied at various gestations in the 2nd trimester but only after 14 weeks of pregnancy. Optimum time for application of cerclage was observed to be 18 weeks or below. The possibility of having a mature baby in the group of low number previous abortions was higher as compared to the group with a higher number of habitual abortions. Better pregnancy outcome was seen in low parity group [less than 2 previous deliveries] as compared to higher parity groups. This study, like many others in the past, confirms that cervical cerclage is a successful way of treating cervical incompetence