Conventional and conservative management of placenta accreta is two ends of a single continuum: A report of three cases and literature review.

Placenta accreta (PA) is a critical condition that represents a significant source of morbidity and mortality observed in women with multiple prior cesarean sections. Precise prenatal identification of affected pregnancies permits optimal obstetric management. Antenatal diagnosis leads to less blood loss and a requirement for blood transfusion than women diagnose during cesarean section.

Perceptions of doctors on being treated by a doctor just completing the house job.

OBJECTIVE: To determine the percentage of medical teachers and fresh doctors who feel that graduating doctors are competent or incompetent to handle common ailments and to evaluate the reasons for their perceptions. STUDY DESIGN: Sequential mixed method. PLACE AND DURATION OF STUDY: First phase extending from December 2010 to December 2011 and second phase was conducted in March 2014. METHODOLOGY: First phase comprised electronic distribution of questionnaire to 100 medical teachers and fresh doctors working in hospitals attached with 5 private and 5 public sector medical colleges of Lahore and Karachi to rate an average house officer on a frequency scale of 1 - 6 and do self-assessment, in case of a fresh doctor. The second phase included interviews of 20 medical teachers to explore justification for their rating in the survey questionnaire and for triangulation of data. Quantitative data was analyzed through SPSS version 15 to calculate frequencies and percentages and interviews were analyzed through quasi-statistical approach. RESULTS: In survey, 38.36% out of 73 medical teachers and 30% out of 20 medical teachers in interviews confirmed their confidence on consulting fresh doctors for common ailments as opposed to 61.64% and 70% respectively, expressing their dissatisfaction. Self-assessment of fresh doctors indicated that 40% are confident in handling common medical conditions as opposed to 33.3% out of 75 respondents, who are not confident about their clinical skills. CONCLUSION: Faculty and self-assessment of fresh doctors has a fair overlap, indicating room for further improvement in the house job training program.

Pattern of visceral injuries following blunt abdominal trauma in motor vehicular accidents.

OBJECTIVE: To determine the frequency of various visceral injuries following, high-speed motor vehicle crashes with special reference to frequency of liver injuries, severity and complications. DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Surgical Unit III, Jinnah Hospital, Lahore, from August 1999 to February 2002. PATIENTS AND METHODS: The study included 100 consecutive patients of blunt abdominal trauma. Patients of either gender and age above 12 and below 70 were included in this study. Purposive non-probability sampling was done. Injuries were identified, graded and managed accordingly. The data was then entered into SPSS and descriptive statistical tests were applied. RESULTS: Liver was the most common organ injured (35%), followed by spleen (32 %) and small gut (30 %). In 23 patients, liver was the only organ injured. Most of the liver injuries fell under grade I (42.8%) followed by grade II (28.35%) and grade III (22.85%) and were treated by suture hepatorrhaphy alone in 71.42% cases. The operated cases were mostly complicated by wound infection (33.76%). Overall mortality remained high (12%) and was related to a combination of delays in arriving at a diagnosis due to non-availability of CT scan and routine use of peritoneal lavage. CONCLUSION: Liver is the most commonly affected organ in high speed motor vehicle crashes that is reliably treated by suture hepatorrhaphy. The rate of postoperative infection and morbidity is high.