scholarly journals DISORDERS OF SEXUAL DEVELOPMENT

2015 ◽  
Vol 22 (04) ◽  
pp. 401-407
Author(s):  
Naima Rasool
Keyword(s):  
Surgical Management ◽  
Reconstructive Surgery ◽  
Sexual Development ◽  
Case Series ◽  
Military Hospital ◽  
Team Approach ◽  
Complex Spectrum ◽  
Disorders Of Sexual Development ◽  
Clinical Presentations ◽  
Study Results

Objectives: To evaluate the etiology, clinical presentations, investigationsand surgical management of patients presenting with atypical genitalia in Pediatric surgerydepartment. Disorders of Sexual development are one of the most complex congenitaldisorders encountered by the treating physicians. In recent years, the diagnostic ability andsurgical techniques of gender reconstructions have improved remarkably. The spectrumincludes chromosomal, genotype and phenotype abnormalities. The birth of a baby withatypical genitalia poses diagnostic and treatment challenges. This article focuses on etiology,clinical presentations, investigations and surgical management of patients presentingwith ambiguous genitalia. Study Design: A descriptive, prospective case series. Setting:Department of Pediatric Surgery, Military Hospital, Rawalpindi, Pakistan. Period: October 2010to June 2014. Methods: All patients with atypical genitalia, who underwent any kind of genitalreconstruction surgery were included in the study. Results: A total of 28 patients were operatedupon during the study period. Age ranged from 11months to 12 years. Patients were dividedinto two groups on the basis of their karyotyping. Seventeen patients had 46 XY and 11 had 46XX. No mosaic pattern was seen. Male genital reconstructive surgery was done in 16 patientswhile 12 underwent female genital reconstructive surgery. Conclusions: Disorders of sexualdevelopment present as a complex spectrum of psychosocial, sexual, endocrine and surgicalimplications, thus management demands a multidisciplinary team approach. Appropriatelytimed surgical intervention after thorough work up and detailed counseling, produce excellentcosmetic and functional results.

scholarly journals Histopathological spectrum of disorders of sexual development: a case series of seven cases

2020 ◽  
Vol 8 (6) ◽  
pp. 2303
Author(s):  
Saroj Ashok Bolde ◽  
Arva Ali Pirosha ◽  
Sushma N. Ramraje ◽  
Shubhangi V. Agale
Keyword(s):  
Sexual Development ◽  
Genital Tract ◽  
Gonadal Dysgenesis ◽  
Case Series ◽  
Androgen Insensitivity Syndrome ◽  
Disorders Of Sexual Development ◽  
Mrkh Syndrome ◽  
Primary Amenorrhoea ◽  
Derivatives Of ◽  
Rule Out

Disorders of sexual development (DSD) refer to cases in which there is a discordance among at least two of the following; genetic sex, gonadal sex, genital tract sex and phenotypic sex. DSDs are quite rare with reported incidence varying from 1 in 4,500 to 1 in 5,500. Ovotesticular disorder is amongst the rarest variety of DSD comprising only to 3-10% of all cases of DSD with only 500 cases reported till now worldwide. Frequency of MRKH syndrome is 1 in 4,500 cases and is the cause of amenorrhoea in 15% of cases of primary amenorrhoea. Authors present a case series of seven cases of DSDs with three cases diagnosed as androgen insensitivity syndrome, two cases of true ovotesticular DSD (true hermaphrodite), one case each of mixed gonadal dysgenesis and Mayer-Rokitansky-Kuster Hauser (MRKH) syndrome. Authors received the histopathology specimen of these cases in this department which was extensively sampled to study the gonads and the other derivatives of Mullerian and Wolffian duct and to rule out presence of any malignancy.

scholarly journals HEPATITIS–B VIRUS INFECTION;

2018 ◽  
Vol 21 (05) ◽  
pp. 950-955
Author(s):  
Arif Zulqarnain ◽  
Imran Iqbal ◽  
Naveed Anjum
Keyword(s):  
Hepatic Encephalopathy ◽  
Hepatitis B Virus ◽  
Virus Infection ◽  
Hepatitis B ◽  
Demographic Data ◽  
Case Series ◽  
Female Ratio ◽  
Clinical Presentations ◽  
Study Results ◽  
B Virus

Objective: To describe the clinical presentations of hepatitis B virus infectionin children. Methodology: Children presenting with symptoms of liver diseases and otherdiseases who were found to be HBsAg positive by screening or ELISA method were enrolled.Children suffering from thalassemia, hemophilia and hemolytic anemia, which need multipletransfusions, were excluded. On the basis of history, examination and investigations the clinicalpresentation of the patient was categorized. Basic demographic data, relevant clinical history,physical examination, lab investigations and clinical presentations category were entered in thepredesigned proforma. As this is the descriptive study, no hypothesis were required. Design:Descriptive case series. Setting: Paediatric unit-2 NishtarHospital Multan. Period: 16th May2012 to 15th November 2012. Results: Study results consist of relative frequencies of differentclinical presentations of HBsAg positive patients. Fifty children who were HBsAg positive wereenrolled in a six month period. Out of 50 patients, 21 (42%) were of hepatic encephalopathy,14 (28%) were with acute hepatitis, 12 (24%) were cirrhosis, 2 (4%) were asymptomatic carrierand 1 (2%) was presented with chronic hepatitis B. There were 40 (80%) males and 10 (20%)females. The overall male to female ratio was 4:1. Conclusions: Most common presentationwas hepatic encephalopathy which has a very bad prognosis, next comes the acute hepatitisand then cirrhosis. There is another inference that males are more and severely affected byhepatitis-B virus infection.

scholarly journals Frequency of Satisfactory Outcome after Surgical Management in Isolated Orbitozygomatic Fractures

2021 ◽  
pp. 48-55
Author(s):  
Tarique Hussain Shaikh ◽  
Kashif Ali Channar ◽  
Aftab Ahmed Kumbhar ◽  
Wajid Ali Rajper ◽  
Farzana Lakho ◽  
...  
Keyword(s):  
Surgical Management ◽  
Maxillofacial Surgery ◽  
Case Series ◽  
Health Science ◽  
P Value ◽  
Chi Square ◽  
Satisfactory Outcome ◽  
Study Results ◽  
Chi Square Test ◽  
Surgery Department

Objective: To determine the frequency of satisfactory outcome after Surgical Management in Isolated Orbitozygomatic fractures. Study Design: Case series Descriptive study. Place and Duration: Oral Maxillofacial Surgery Department of Dentistry, Liaquat University of Medical Health Science, Jamshoro ,from 11thAugust 2020 to10thMarch 2021. Methodology: Total 87 patients of Isolated Orbitozygomatic fractures with Enophthalmos and or Diplopia were included. All patients were operated, open reduction and internal fixation of zygoma at 3 points. Postoperatively Diplopia was ruled out by a range of eye movements and Enophthalmos was measured by Hertel Exophthalmometer. Final assessment was done after six weeks postoperatively. Descriptive statistics were calculated. Stratification was done and poststratification chi square test or t-test was applied. P-value ≤0.05 was considered as significant. Results: There was 85.1% male and 14.9% female. Mean age was 33.45±7.93 years. 73.6% were classified as ASA-I and 26.4% were classified as ASA-II. At first, third and sixth week, 4.6% patients were found with positive upward gaze, 2.3% with positive down gaze, 0% with positive horizontal gaze and 2.3% with positive secondary peripheral gaze while 85.1% with < 3 mm Enophthalmoson Hertel Exopthelmommeter and 13(14.9%) with >3 mm Enophthalmoson Hertel Exopthelmommeter. The satisfactory outcome was 88.5%. Conclusion: Our study results showed 88.5% satisfactory outcome. The long-term prognosis after repair of zygomaticomaxillary complex fractures is very good.

scholarly journals REPRODUCTIVE OUTCOMES AFTER ABDOMINAL MYOMECTOMY

2021 ◽  
Vol 71 (4) ◽  
pp. 1311-13
Author(s):  
Yasmin Fatima ◽  
Mumtaz Amir
Keyword(s):  
Uterine Fibroids ◽  
Case Series ◽  
Military Hospital ◽  
Reproductive Outcomes ◽  
Assisted Reproductive Technique ◽  
Infertile Women ◽  
Abdominal Myomectomy ◽  
Spontaneous Conception ◽  
Study Results ◽  
Reproductive Technique

Objective: To determine the frequency of reproductive outcomes after abdominal myomectomy in infertile women. Study Design: Case series. Place and Duration of Study: at Combined Military Hospital, Multan Pakistan, from Sep 2015 to Feb 2017. Methodology: This study included 60 women who underwent myomectomy to retain their capabilities of reproduction. Inclusion criteria were infertile women with uterine fibroids. Routine investigation was done to all patients like ultrasound and hysterosalpingogram before and after the procedure. The procedure of abdominal myomectomy was done under general anesthesia. All fibroids were enucleated and large blood vessels were tied. Vicryl no.1 was used to close the uterine defect. All patients were followed up for 3, 6 and 12 months interval and data was collected for conception, spontaneous conception, and conception with assisted reproductive technique, live birth and miscarriage. Results: In this study mean age was 27.33 ± 4.03 years, mean number of fibroid was 1.366 ± 0.48 and mean size of fibroid was 7.06 ± 1.64 cm. Twenty eight (46.7%) women had conceived after myomectomy, in which 92.9% had spontaneous conception and 7.1% by assisted reproductive technique. Conclusion: Abdominal myomectomy should be the standard treatment of infertile women with uterine fibroids if no other underline cause of infertility. Moreover, this study results also showed that younger patients might be benefited more in term of reproductive outcomes after abdominal myomectomy.

Percutaneous Pulmonary Valve Implantation in a Bangladeshi Center: A Case Series

2020 ◽  
Vol 28 (1) ◽  
pp. 1-6
Author(s):  
Fatema Nurun Nahar ◽  
Jufan Mansur Al ◽  
Shubert Stephan ◽  
Hossain Mir Mahmud
Keyword(s):  
Heart Disease ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Pulmonary Valve ◽  
Case Series ◽  
Military Hospital ◽  
Percutaneous Pulmonary Valve Implantation ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve ◽  
Pulmonary Valve Implantation

INTRODUCTION Incidence of congenital heart disease is 25 per thousand live birth in Bangladesh which is much higher than other countries. Tetralogy of Fallot, the commonest cyanotic heart disease (5%) and some other complex diseases with right ventricular outflow tract abnormality demand surgical correction and revision in many occasions including percutaneous intervention. As a resource constraint country, it was a difficult task to introduce percutaneous pulmonary valve implantation (PPVI) with MelodyTM. However, it was started on 12th December 2012 in Combined Military Hospital Dhaka, Bangladesh and cases performed till October 2019 were included in this series. METHODS Retrospective analysis of six cases who had PPVI with MelodyTM in Combined Military Hospital, Bangladesh. Patient with dysfunctional conduit between right ventricle (RV) and pulmonary artery causing (a) Symptoms of exceptional dyspnoea of various grade (NYHA II,III, IV) (b) RVEVD >150 ml/m2 ±regurgitant fraction >40% (c) RVOT peak instantaneous gradient > 30 mm Hg. (d) RV dysfunction (RVEF<40%) were accepted for the procedure and outcome were analyzed. RESULTS Mean age was 9.56 ± 2.96 years, weight was 28.75 ± 8.61 kg, height was 137.5 ± 17.52 cm. Mean age at surgery was 4.25 ± 2.72 years. Female were 66.66%. Aortic homograft was used in 66.66% cases. Eighteen mm Ensemble was used in four (66.66%) cases and 20 mm and 22 mm in one each. Immediate result was excellent with no residual PS in two cases and negligible residual flow acceleration across pulmonary valve in four cases. No PR seen in all except one. One patient developed Bacterial endocarditis after 3 years and was treated. CONCLUSION Aim of PPVI is to prolong the life expectancy of conduits which were placed surgically from right ventricle to pulmonary artery. In our case series, we found that Melody valve is functioning well without any complications like infective endocarditis or stent fracture. KEYWORDS PPVI, MelodyTM, RVOT, Outcome

scholarly journals Symptom Cluster-Matching Antidepressant Treatment: A Case Series Pilot Study

2021 ◽  
Vol 14 (6) ◽  
pp. 526
Author(s):  
Sławomir Murawiec ◽  
Marek Krzystanek
Keyword(s):  
Depressive Symptoms ◽  
Pilot Study ◽  
Antidepressant Treatment ◽  
Case Series ◽  
Symptom Cluster ◽  
Study Results ◽  
Cluster Matching ◽  
The Individual ◽  
Meta Analyses ◽  
Effectiveness Studies

Despite treating depression with antidepressants, their effectiveness is often insufficient. Comparative effectiveness studies and meta-analyses show the effectiveness of antidepressants; however, they do not provide clear indications as to the choice of a specific antidepressant. The rational choice of antidepressants may be based on matching their mechanisms of action to the symptomatic profiles of depression, reflecting the heterogeneity of symptoms in different patients. The authors presented a series of cases of patients diagnosed with depression in whom at least one previous antidepressant treatment was shown to be ineffective before drug targeted symptom cluster-matching treatment (SCMT). The presented pilot study shows for the first time the effectiveness of SCMT in the different clusters of depressive symptoms. All the described patients obtained recovery from depressive symptoms after introducing drug-targeted SCMT. Once validated in clinical trials, SCMT might become an effective and rational method of selecting an antidepressant according to the individual profile of depressive symptoms, the mechanism of their formation, and the mechanism of drug action. Although the study results are preliminary, SCMT can be a way to personalize treatment, increasing the likelihood of improvement even in patients who meet criteria for treatment-resistant depression.

scholarly journals Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199455
Author(s):  
Nicola Maffulli ◽  
Francesco Oliva ◽  
Gayle D. Maffulli ◽  
Filippo Migliorini
Keyword(s):  
Surgical Management ◽  
Revision Surgery ◽  
Case Series ◽  
Sports Participation ◽  
Patellar Tendinopathy ◽  
Symptom Duration ◽  
Level Of Evidence ◽  
Training Time ◽  
The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

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