We are presenting a case of a 13-year-old girl with a chief complaint of lower abdominal pain. A computed tomographic scan showed a 10-cm right ovarian mass. The serologic testing showed high alpha-fetoprotein level. The patient underwent a right adnexectomy and an omentectomy. The final diagnosis was a yolk sac tumor with a major (95%) fibrosarcoma component, based on morphology and further confirmed by an extensive panel of immunohistochemistry. Postoperatively, the alpha-fetoprotein level dropped to normal. The patient completed 7 cycles of multiagent chemotherapy with cisplatin without major complications. At her 7-month follow-up, the patient still remains disease free. To our knowledge, our case is the first of its kind in the literature to document yolk sac tumor associated with fibrosarcoma in a teenage female. Owing to the rarity of this entity, the prognosis of this patient is widely unknown and it is yet still to be seen.
This study aimed to assess the association between the waist-hip ratio and the extent of coronary artery disease by coronary angiography. A cross-sectional study was conducted in the Department of Cardiology, CPE Institute of Cardiology, Multan, from 09-Oct-2020 to 08-Apr-2021. One hundred fifty patients with CAD planned for coronary angiography (CAG) were included. Data regarding the patient's age, gender, and detailed clinical histories, such as co-morbid conditions such as hypertension, family history of CAD, diabetes mellitus, smoking, and waist-hip ratio, were collected for each patient. All patients underwent coronary angiography. In each patient, a Gensini score was calculated, and the mean value of the Gensini score was noted. The mean age of patients included in this study was 52.48±7.48 years. The mean waist-hip ratio was 0.83±0.10. The mean Gensini score was 36.68±6.84. There were 100 (66.6%) male and 50 (33.3%) female patients. Diabetes was found in 55 (36.6%), andhypertension in 81 (54.00%). Out of 150, 65 (43.3%) patients were smokers. A family history of CAD was found in 36 (24%). There was a significant correlation between the waist-hip ratio and the Gensini score, with a correlation coefficient of 0.679 and p-value <0.0001. Based on the results, it can be concluded that the waist-hip ratio is associated with the risk of coronary artery diseases, especially coronary artery disease.
Background: Head injury is the most serious problem all around the world. Over the last 200 years both surgical and conservativemanagement have been evolved. Chronological surgical management yields better outcome by decreasing mortality andmorbidity. Wound debridement, repair of dural defect and closure of wound are standard principles in management.Objective: To study the outcomes of surgical management of depressed skull fracture.Material and methods: This study was conducted in Shifa Medical center from 1st June 2016 to 30thJune 2019. Clinical featurescause, and computerized tomography (CT) pictures were compiled in proforma. Whenever depressed fracture size exceeded than5mm, cosmetically disfiguring and fracture over the sinus were operated. All the patients were followed for six months.Results: Total of 60 patients were included 42 patients (70%) were male and 18(30%) were female. Pediatric population was majorcontributor 36 out of 60 patients (ratio60%). 56 patients (93.33%)operated, 4 patients (6.67%) were treated conservatively. These 4patients(6.67%) had severe head injury and were put on ventilator 32 patients (53.3%)fully recovered, 12 patients (20%) hadmoderate disability, 8 patients (13%) had severe disability and 3 patients(4.8%)pass away in this study.Conclusion: It was found that, depressed skull fracture was mostly common in children. Usage of antibiotic and anticonvulsantshad effective results in term of preventing infection and epilepsy during perioperative period. Initial stage surgical treatment isexceptionally required where size of fracture exceed 5mm. Outcome depended upon the sternness of injury and existence ofassociated intra cerebral lesion.Key words: surgical management, depressed skull fracture (DSF) and CSF leakage.
Objectives: To compare the effect of ketamine nebulization and ketamine gargleon post operative sore throat. Study Design: Randomized control trial. Setting: Department ofAnaesthesia Ibn e Sina Hospital. Multan and National, Lahore. Period: May 2016 to May 2017.Methodology: After provision form ethical committee and informed consent to be included instudy. Patients of age 20-60 years, ASA status I and II, elective surgeries under GA and both sexwere included in the study through consecutive sampling technique. SPSS software was used toanalyze all variables included in the study continuous variables were measured and presentedas mean and standard deviation, categorical measurement were measured in numbers andpercents. Chi square test was applied to check the difference among both groups. P value ≤0.05 was considered as significant. Results: Overall, 100% (n=160) patients were included, inthis study; divided into two equal groups, 50% (n=80) in each, gargled ketamine group (GKgroup) and nebulization group (NK group) respectively. The incidence of postoperative sorethroat at 0, 2, 4, and 24 hours, in GK group, was (n=8) 40%, (n=4) 20%, (n=3) 15% and (n=3)15%respectively. While, at corresponding time point in group NK it was (n=1) 5%, (n=7) 35%,(n=4) 20% and (n=2) 10%respectively. Conclusion: The observations of our study revealedthat ketamine nebulization and ketamine gargles having no significant difference in reductionof POST incidence.
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