Modified anchored B-Lynch uterine compression suture for post partum bleeding with uterine atony

A prospective observational study was performed to evaluate the performance of a modified uterine compression suturing technique for the management of refractory post partum hemorrhage (PPH) at two leading tertiary referral centers in Colombo, Sri Lanka. An modified anchored B-Lynch suture was done in 17 women with PPH due to uterine atony. In 13 of the women (76%), bleeding was arrested and the uterus conserved. Four women (24%) did not respond to the anchored compression sutures, necessitating emergency post partum hysterectomy. Mean age was 31.2 years. Nine of the women (53%) were primiparous and eight (47%) parous. Mean estimated blood loss was 1994 ml (range 1200-3300 ml). This newly modified anchor B-Lynch compression suture appeared effective in controlling about 75% of PPH due to uterine atony, which allowed uterine conservation. This simple modification can provide a first line surgical step to control PPH.     

Chronic inflammatory demyelinating polyneuropathy associated with intestinal tuberculosis.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an increasingly common but under-recognized neurological disorder. It is immune mediated, and usually has a relapsing and remitting course. However, the initial presentation may be rapid. It can be associated with significant morbidity and mortality, particularly if there is a delay in diagnosis and treatment. It has been associated with both infective and non-infective etiologies. We present a case of CIDP associated with ileocecal tuberculosis (TB), presenting with progressive motor weakness and significant weight loss. The patient's symptoms improved to some extent with intravenous immunoglobulin and steroid, but improved significantly after being started on anti-TB therapy. However, his symptoms relapsed when he stopped his anti-TB treatment prematurely whilst continuing the immunosuppressive therapy. Upon resuming the anti-TB therapy, he made a good recovery. CIDP associated with TB has only been reported once. Our case highlights the need to consider TB in patients with neurological disorders.     

Lipoblastoma: Clinical Features, Treatment, and Outcome

Background  

Lipoblastoma is a rare, benign, encapsulated tumor arising from embryonic white fat. On histology they typically contain variably differentiated adipocytes, primitive mesenchymal cells, myxoid matrix, and fibrous trabeculae. The tumor occurs primarily in infancy and early childhood. It often occurs in the extremities and trunk, and rarely develops in the head and neck and other sites.     

The crystallization behavior and the mechanical properties of segmented poly(ether ester) thermoplastic elastomers

The isothermal melt crystallization of three segmented copoly(ether ester)s based on PBT as the hard and PTMO as the soft segments differing in their hard segment content was investigated. The kinetics of crystallization was studied using polarizing microscopy and DSC. Two regimes of crystallization were observed. Spherulitic structures of low crystallinity are formed via predominantly athermal nucleation in regime I at supercoolings ΔT_u < 30°C. Ill-defined aggregations of lamellae grow at ΔT_u > 30°C. The crystallization follows an apparent Avrami-equation; the Avrami-constants cannot be explained in terms of a simple model. The structure of the samples was investigated by SAXS and compared to the structure of samples crystallized by rapid quenching and subsequent annealing. Much higher long spacings are obtained on isothermal crystallization. The long spacing increases with decreasing ΔT_u. It increases at constant ΔT_u with decreasing average hard segment length contrary to the samples crystallized by subsequent annealing of the quenched melt. In this case polymers differing in composition do not differ with regard to the long spacing obtained at constant ΔT_u. The modulus in the Hookean-range as derived from stress-strain curves at T > T_g does not reflect the details of the morphology or chain architecture but it is found to depend logarithmically on the volume fraction of crystallinity in the sample. Data of pure PBT are described by the same relationship.     

Team climate for innovation: what difference does it make in general practice?

OBJECTIVE: Teamwork in primary healthcare is associated with patient care processes and staff outcomes. The ability of teams to be innovative is a hypothesized mechanism. We examined the characteristics of general practices with good team climate for innovation, and assessed the impact of climate on chronically ill patients' assessment of their care and on the job satisfaction of the staff. DESIGN: Large cross-sectional study. SETTING: Australian general practices. PARTICIPANTS: A total of 654 general practitioners and staff and 7505 chronically ill patients from 93 general practices in 6 Australian states and territories. MEASURES: The Team Climate Inventory and the Overall Job Satisfaction Scale, customized for use with general practices, were administered to general practitioners and practice staff, and the General Practice Assessment Survey was administered to patients. Practice characteristics were collected by survey from the principal doctor or practice manager. RESULTS: Mean scores of team climate in Australian general practices were similar to those reported in the UK, except that in our study there was no association between the number of doctors in a practice and their team climate. Better team climate was found in practices with fewer non-clinical staff. Team climate predicted the job satisfaction of the general practitioners and staff, irrespective of the number of practice staff. Better team climate was associated with greater satisfaction by patients with their care. CONCLUSIONS: Team climate is important for patient and staff satisfaction. In large general practices, separate sub-cultures may exist between administrative and clinical staff, which has implications for designing effective team interventions.     

Autoimmune hepatitis in children: a report of two cases

In regions where chronic hepatitis B infections are still endemic, autoimmune hepatitis (AIH) is considered rare, and it is even rarer in the paediatric population. AIH in the paediatric population is categorised into type 1 and 2, which are differentiated by their autoantibody profiles. We present two cases of paediatric type 1 AIH. Two girls aged 11 and 15 years were referred to our hospital with chronic liver disease, one of whom had decompensated disease. Both patients were started on prednisolone. The patient with advanced liver disease died from complications due to infections that included the pandemic novel influenza A H1N1, while the other patient responded to treatment. These two cases serve to highlight the importance of considering AIH in any paediatric patient presenting with features of chronic liver disease, as the response to treatment is good.