Intravenous leiomyomatosis complicated by Budd��Chiari syndrome

A 76-year-old woman with intravenous leiomyomatosis complicated by Budd-Chiari syndrome is described.     

A BEFORE AND AFTER TRIAL OF THE EFFECTIVENESS OF NETWORK ANALYSIS IN HEALTH OPERATIONS MANAGEMENT

An intervention trial using “before-and-after” approach was undertaken to address the question whether network analysis as a health managerial tool of control can favourably affect the delays that occur in planning and executing the antimalaria operations of a Station Health Organization in a large military station. Exposure variable of interest was intervention with a network diagram, by which the potential causes of delay along the various activities were assessed and remedial measures were introduced during the second year. Sample size was calculated using conventional alpha and beta error levels. The study indicated that there was a definite beneficial outcome in that the operations could be started as well as completed in time during the intervention year. There was reduction in time requirement in 5 out of the 9 activities, the exact ‘p’ value being 0.08, by both parametric and non-parametric tests. The use of network analysis in health care management has been recommended.KEY WORDS: Health services research, Health care, Health plan implementation, Malaria, Network analysis, Operations research     

SPECTRUM OF ACUTE RENAL FAILURE IN A SERVICE HOSPITAL

A prospective study of 82 patients with acute renal failure was carried out over the last 2 years. Mean age of the patients was 35.6 years (8-82 years). Male to female ratio was 3.5:1. The etiological factors were septicaemia in 18 patients (21.95%), aminoglycoside toxicity in 16 patients (19.51%), open heart surgery in 8 patients (9.76%), volume depletion and blood loss in 12 patients (14.63%), glomerulonephritis in 4 patients (4.88%), renal allograft dysfunction in 4 patients (4.88%), and miscellaneous causes in 20 patients (24.39%). Non-oliguric renal failure was observed in 39.02 per cent cases. Dialysis support was required in 65.8 per cent of the cases; with average 5.6 (4 to 11) dialysis sessions. Four patients of acute renal failure following open heart surgery were given continuous arterio-venous haemofiltration. Overall mortality was 32.5 per cent, septicaemia accounting for 60 per cent of the deaths.KEYWORDS: Antibiotics, Aminoglycoside, Renal failure acute, Septicemia     

Parental perception of acute scrotal pain in children

IntroductionAcute scrotal pain (ASP) remains one of the more common urological emergencies in the paediatric age group. Acute testicular torsion is the only true urological emergency, where delay in presentation or management can lead to loss of the affected testicle. Since prompt presentation, diagnosis and treatment are critical for testicular salvage, multiple patient and hospital specific factors may influence orchidectomy rates. Parental awareness of the sequelae of ASP may be a significant factor in delayed presentation of children to hospital. We examine the awareness among parents of the implications of ASP in this snapshot study.MethodsA prospective study was planned, and all boys between the ages of 2 and 16 years presenting to the unit with ASP and undergoing emergency scrotal exploration were considered for inclusion in the study. The accompanying parents/guardians of all these boys were asked to complete a questionnaire assessing their awareness of ASP and its potential consequences.ResultsOver a period of 26 months (July 2010 to September 2012), 76 boys were eligible for the study. The response rate was 81.6%. Only a third (30%) presented to hospital within six hours of onset of pain and just under a quarter (22%) of the cohort attended the emergency department directly. Parents overwhelmingly (96%) felt that there ought to be increased public awareness of the condition. The majority of parents questioned (n=41, 66%) did not fully appreciate the implications of ASP.ConclusionsThis is a first snapshot study demonstrating the apparent lack of awareness among parents about the implications of ASP, which could influence the rate of testicular salvage.     

Selection of platelets for refractory patients by HLA matching and prospective crossmatching

A multi-site clinical study compared platelets chosen for refractory patients by prospective platelet crossmatching using stored donor platelets and HLA-based selection. Seventy-three patients who were refractory to random-donor platelets received two plateletpheresis components, one chosen by HLA-based criteria and the other by crossmatching. Patients were carefully evaluated to exclude nonimmune factors that could adversely affect transfusion results. Each of the five study sites used a crossmatch procedure with which it had experience. Results from this study indicate the following: 1) The overall rate of successful transfusion was similar when an HLA-based method of donor selection that includes all grades of matching and mismatching was compared to a crossmatch-based method of donor selection. 2) HLA-based selection that restricts recipients to grade A and BU matches was superior to a selection method based upon crossmatching alone. Donor selection based on HLA matching (grades A or BU) was also superior to selection based on any degree of HLA mismatching (grades BX, C, or D). 3) Selection of donors based on HLA-cross-reactive groups (defined by in vitro serologic crossreactivity) was no more successful than that based on grade C and D mismatches and was no more successful than selection by crossmatching alone. 4) Lymphocytotoxic and platelet antibodies were not detected in many of the enrolled patients, even though patients demonstrating nonimmune factors were eliminated from the study. It can be concluded that HLA-compatible (grades A and BU) platelets provide optimal support for refractory patients, but that crossmatch-selected platelets are acceptable as an alternative component.