Objective
To evaluate the efficacy of primary in situ extracorporeal shockwave lithotripsy (ESWL) for the treatment of ureteric calculi in children.
Patients and methods
The Wolf 2500 Piezolith was used to treat 63 children (aged 4 months to 12 years) with 76 ureteric calculi, including 10 children with impacted calculi. The calculi were located in 14 upper, 13 mid and 44 lower ureters, and the stone burden varied from 4 to 17.8 mm (mean 12.6). All children aged ≤10 years were treated under general anaesthesia; lithotripsy was attempted under intravenous sedation in the older children.
Results
At the 3‐month follow‐up, there was an overall successful outcome in 55 children (87%), which included 12 of 13, eight of nine (89%) and 35 of 41 (85%) of the children with upper, mid and lower ureteric calculi, respectively, and nine of the 10 with impacted calculi. Re‐treatment was required in 20 (36%) patients, while auxiliary procedures after ESWL were required in three (6%). The major complications encountered were ureteric obstruction with sepsis in two children, bacteraemia in another and urinary retention due to a urethral stone fragment in a fourth child.
Conclusions
In situ ESWL was an effective treatment modality for ureteric calculi at all levels in children, even when impacted. In the short term, complications were minimal, but the long‐term effects need further assessment.
A rural institutional study was carried out with the object of recording the number and type of gynaecological malignancies in relation to socio-economic status, age, parity, contraceptive use and mode of presentation in current gynaecological practice. Between 1985 and 1999 gynaecological malignancies comprised 42.52% of all malignancies in women. Cancer of the cervix (33.3%) and breast (27.3%), constituted 60.6% of all cancers in women. Cervical cancer (80%) and ovarian cancer (15%) were the main gynaecological tumours. Endometrial cancer was found only in 2.0% of all female genital malignancies; 76.5% women were from villages. Seventy-two per cent of women with gynaecological malignancies were from a lower socio-economic class. Nearly half (44.6%) of the overall cases occurred between ages of 35 and 49 years. Most women, irrespective of the site of cancer, were multiparous. Sterilisation had been the main birth control method used. Other methods of contraception had hardly been used and hence had no relevance to the incidence of cancers. Over the years the number of gynaecological cancers is increasing, irrespective of social class, with more cases at younger age.
Background: Induction of labour is a common intervention, required in situations where continuation of pregnancy may be lifethreatening for the mother and/or fetus. In industrialized countries, the induction rate ranges from 10-25%.
Methods: Randomized controlled trial was conducted at Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur.
Results: APGAR score at 1 min and 5 minutes was 6.64 and 6.84 in oral misoprostol and vaginal misoprostol group respectively, while at 5 minutes it is 6.7 oral group and 7 of vaginal misoprostol group. 34% of cases need NICU admission in Group-A (Oral misoprostol) and 14% in Group-B (Vaginal misoprostol) group. Meconium aspiration syndrome which is present 10% of patients in Group-A (Oral Misoprostol) while it is present in 6% of patients in Group-B (Vaginal misoprostol).
Conclusion: The lesser incidence of meconium-stained liquor and NICU admissions and fewer caesareans with better neonatal outcome in women induced with oral misoprostol outweigh its advantages over the vaginal misoprostol
Keywords: Misoprostol, Labor, Induction, Fetomaternal outcome.
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