Due to continued improvement in molecular and immunodiagnostic methods, more leukemia subtypes are being defined and diagnosed by their genetic and immunophenotypic profiles rather than by morphologic features alone. These advances, while relegating morphologic review and bone marrow (BM) blast counts to a lesser relevance, have elevated expectations of a full diagnostic work up using any specimen containing blasts, regardless of BM blast status. In some clinical situations, the pathologist is often asked to render a complete diagnostic and prognostic work up of leukemia on a peripheral blood (PB) sample, due to poor specimen quality or blast yield in a BM sample, with the intuitive assumption that PB and BM blasts, in the same patient and at a given point of time, are identical. In an attempt to evaluate the immunophenotypic aspects of this assumption, we searched our records for cases of acute leukemia that had immunophenotyping of both PB and BM at the time of diagnosis, and found five cases: two acute myeloid leukemia (AML) and three acute lymphoblastic leukemia (ALL) cases. Utilizing similar pre-analytical conditions and similar FC gating strategy, positivity of the blasts in PB vs BM for some commonly used markers was compared. Significant differences were seen in several myeloid, lymphoid, and platelet markers in all patients. This discordance may carry significant clinical implications.

The precise incidence of incisional hernia after midline cesarean section is unknown. The aim of this study was to analyze the incidence and risk factors for hernia after elective lower midline caesarean section (CS). A prospective cohort study of 284 women for incisional hernia development after elective midline CS) was conducted at Prince Hashem Ben Al-Hussein hospital from April 2006 to December 2008. All patients included had a history of at least two previous CSs. Patients were divided in two groups: one study group consisted of women who had an incisional hernia and the control group consisted of women who had not developed an incisional hernia within two years post CS. Within the two groups, potential risk factors (age, body mass index, parity, number of previous cesareans, type of previous incision, chronic cough, diabetes mellitus, heart disease, low albumin, anesthesia type, postoperative fever and wound complications) were statistically analyzed with the development of incisional hernia. The two year hernia frequency was 5.6% .Independent risk factors of incisional hernia development included: increase in number of previous CSs, obesity, and wound complications. We concluded that this incidence was higher than previously estimated. Counseling on the family size for this group of women will reduce the chance for further CS with its associated risk. In addition, measures to reduce wound infections may reduce the incidence of incisional hernia following elective midline cesarean section.

The present study was undertaken to establish the efficacy of low dose ketamine infusion in combination with propofol in maintaining hemodynamic stability when used for sedation during spinal anaesthesia compared to propofol alone. Sixty adult with ASA physical status I and II patients undergoing urological procedures were studied after giving informed consent. Patients receiving spinal anaesthesia with 0.5% bupivacaine were randomly assigned to sedation with propofol - ketamine [Group I (n=30)] or propofol only [Group II (n=30)]. Group I patients received a loading dose of propofol (0.4 mg/kg) and ketamine (0.1 mg/kg) followed by a continuous infusion of low dose propofol (1.2 mg/kg/hr) and ketamine (9.3 mg/kg/hr) whereas group II patients received a bolus dose of propofol (0.5 mg/kg?) only followed by a continuous infusion of propofol (1.5 mg/kg/hr). Monitored parameters included: heart rate, systolic blood pressure, diastolic blood pressure and sedation scores rated on a five point scale. Parameters were recorded at baseline and at predetermined intervals of 5, 10, 15, 20, 25, 30, 45, 60, 75 and 90 minutes after spinal anaesthesia. Heart rate, systolic and diastolic blood pressure were all significantly higher in group I patients at various intervals as compared to group II patients. Sedation scores revealed no significant difference at the predetermined time intervals between the two groups. In conclusion, the propofolketamine combination confers hemodynamic stability during spinal anaesthesia as compared to Propofol alone.

Explosion inside the bladder occurring during transurethral resection is rarely recognized as a complication of endoscopic resection of bladder tumors. We report a case of intravesical explosion during an endoscopic resection of a bladder tumor. Damages to the bladder were minor. We discuss the possible causes of this complication as well as the different preventive measures. A focused review of the English literature is given.

We report the case of a 60-year-old female Libyan patient who presented with a three day history of vomiting, colicky abdominal pain, and constipation. She was dehydrated, tachycardiac, with a distended, tender abdomen and exaggerated bowel sounds. She had leucocytosis and an increased blood urea nitrogen level. Plain abdominal x-ray films showed dilated small bowel loops and pneumobilia. Ultrasound and computed tomography (CT) examinations confirmed the diagnosis of gallstone ileus. The obstruction was spontaneously relieved by passing the stone into the cecum.