Urethral Duplication With Dorsal Chordee: A Case Report and Literature Review.

Urethral duplication is a diverse spectrum of disease having multiple anatomic variants. The clinical presentation varies from being asymptomatic to recurrent urinary tract infections. A high level of clinical suspicion and awareness among primary caregivers is needed to make a proper diagnosis. All patients presenting with any sort of penile deformity or abnormality of the urinary stream should be evaluated to rule out this condition. In this case report the patient had presented with the urinary stream being directed towards his abdomen due to abnormal dorsal curvature of the penis which was due to tethering of the accessory urethra.

Male Genital Mutilation in the Name of Ritual Circumcision: A Case Report and Literature Review.

Unlike female genital mutilation, the alteration of male genitals has not received much attention. Circumcision is the most common and oldest surgical procedure being performed. When performed by surgeons or well-trained personal the procedure is safe, but most of the times it is being performed by untrained people with no or little medical background. This has led to many complications. Total skin loss is an uncommon but serious complication. There is an ongoing debate regarding the management of this complication. Here, we present a case of total penile skin loss which had resulted from penile mutilation in the name of ritual circumcision.

Penile Hair Tourniquet Syndrome (PHTS): A Case Report of a Two-Year-Old Boy.

Penile hair tourniquet syndrome (PHTS) is an unusual phenomenon. A physician should have a high index of suspicion when a circumcised child presents with glans swelling and inflammation. It must be considered a surgical emergency, as early diagnosis and treatment can prevent complications (e.g., urethra-cutaneous fistula, complete urethral transection, penile gangrene, and penile amputation). We report a case of two-year-old boy to highlight the importance of early diagnosis and prompt treatment.

Penetrating scrotal injury due to a bamboo stick in a child: A case report and literature review.

The penetrating scrotal trauma is rare in children. Due to low incidence of penetrating scrotal injuries in children, the evaluation and management of this type of injuries has not been well described. To prevent the long term sequalae and complications all such injuries require a prompt surgical exploration and management. We are reporting a five-year-old boy with a penetrating injury in his scrotum due to a bamboo stick. After the stabilization and lab and radiological workup patient was subjected to surgical exploration. Inspite of the severity of the trauma the testis and the spermatic cord were spared of any injury.

Predictors of mortality and morbidity in peritonitis in a developing country.

OBJECTIVE: Generalized peritonitis is still a common emergency managed by most general surgeons throughout the world. If the outcome in these patients can be correctly predicted, then better management can be instituted to those patients in need. This study aims to identify factors in patients with peritonitis which have a significant bearing on morbidity and mortality. These factors could be later used to predict the outcome in patients with generalized peritonitis. MATERIAL AND METHODS: A total of one hundred patients with peritonitis were studied. Factors including age, pulse and respiratory rate, temperature, hemoglobin, total leukocyte count, hematocrit, urea, creatinine, sodium, potassium, pH, PaO2 levels at the time of surgery along with peritoneal contamination and duration of surgery were noted. Using the Students t test, factors were identified which had a statistically significant influence on the outcome. RESULTS: Thirty-six patients in the study developed complications and 17 died. Statistics showed that 8 factors influenced morbidity and 11 influenced mortality. CONCLUSION: Identifying variables which influence the outcome of patients with peritonitis is an important initial step. Once these factors have been identified, the outcome of patients can be correctly predicted and better management can be instituted to those patients in need.

Mannheim Peritonitis Index and APACHE II--prediction of outcome in patients with peritonitis.

BACKGROUND: Early prognostic evaluation of patients with peritonitis is desirable to select high-risk patients for intensive management and also to provide a reliable objective classification of severity and operative risk. This study attempts to evaluate the use of scoring systems such as Acute Physiological and Chronic Health Evaluation score (APACHE II) and Mannheim Peritonitis Index (MPI) in patients with peritonitis. METHODS: A prospective study was conducted using 101 consecutive patients (69 male, 32 female) having generalized peritonitis over a two-year period. Both scoring systems were applied to patients before laparotomy. Based upon the scores, patients were arranged into three groups. The outcome of patients was noted and the accuracy of the two systems was evaluated. RESULTS: In the MPI system, mortality was 0 in the group of patients with a score of less than 15, while it was 4% in the patients scoring 16-25 and 82.3% in those with scores of more than 25. Similarly, in the APACHE II system, no mortality was noted in patients with scores less than 10. Mortality was 35.29% and 91.7% in the groups scoring 10-20 and more than 20, respectively. CONCLUSION: Both scoring systems are accurate in predicting mortality; however, the APACHE II has definitive advantages and is therefore more useful.