A 32 year old primipara, at 39 þ 2 weeks, presented to labour ward, with left sided chest pain and shortness of breath. She was mildly hypotensive, tachycardic, dyspnoeic and extremely tender over the left side of her abdomen. There was no evidence of vaginal bleeding or uterine activity but fetal bradycardia was detected. It was presumed to be a major placental abruption. The patient was resuscitated with colloids and taken to theatre for immediate caesarean section.A live female, weighing 3.12 kg, was delivered with Apgar scores of 3 at 1 minute and 6 at 5 minutes. Cord bloods indicated a significant fetal acidosis (venous pH 6.77, BE À21.3, arterial pH 6.73, BE À24.0). The placenta had a succenturiate lobe but there was no retroplacental clot or evidence of haemorrhage. Her oxygen saturations remained stable throughout the anaesthetic state and there were no difficulties with ventilation. Post-operatively, she appeared fully recovered, with normal observations, although she still complained of a mild ache in her left loin. Post-operative electrocardiogram and chest X-ray were normal.One hour following delivery, she became hypotensive and her haemoglobin had fallen to 3.8 g/dL. She was acutely tender in the left loin with abdominal distension and increasing oedema. Abdominal ultrasound demonstrated a large haematoma in the area of the spleen suggesting spontaneous splenic rupture with retroperitoneal haemorrhage.The patient was returned to theatre with a combined surgical and obstetric team. Laparotomy was performed and massive retroperitoneal bleeding demonstrated. The liver, spleen and pelvic organs were confirmed to be normal. One thousand, two hundred and eighty grams of blood clot was removed, but despite extensive examination, no specific bleeding point was identified and the retroperitoneal space was packed with 18 abdominal packs. The bleeding appeared to be controlled and for the first time in several hours, her vital signs stabilised.Two hours following transfer to intensive therapy unit, she became hypotensive, tachycardic, hyperkalaemic and developed a coagulopathy suggesting continued intraabdominal bleeding. Her abdominal distension recurred resulting in abdominal compartment syndrome. She was taken back to theatre but once again no specific bleeding point was visualised. Therefore, the abdomen was repacked and the interventional radiology team was called.Using a right femoral artery approach, a flush aortogram was performed that identified the source of bleeding in the left upper quadrant. Selective angiograms of the splenic and left renal arteries were normal. Super-selective catheterisation of the left middle adrenal artery confirmed this to be the site of haemorrhage. There was no evidence of an aneurysm (Fig. 1a). The vessel was embolised with a 2 by 20 mm fibred platinum coil (Boston Scientific) using a coaxial catheter and haemostasis confirmed. Part of the coil was noted to be lying free in the aortic lumen but overall, the coil was thought to be secure (Fig. 1b). The radiologists felt it...

Financial decisions (capital budgeting, capital structure and dividend policy) are the most important components of corporate finance and now a days have received the attention of researchers and practitioners. Financial decisions influence the financial performance of a firm. Uncertainty, corporate social responsibility, and stakeholders interest are the most important determinants of the financial decisions. The purpose of this study is twofold: firstly, this study provides a systematic review of literature summarizing the theoretical and empirical literature of the financial decisions, their determinants and financial performance. Secondly, it provides the empirical evidence based on survey and data was collected from Chief Financial Officers of Telecommunication, Banking, and Insurance companies listed in Karachi Stock Exchange (KSE) of Pakistan. This study used SPSS and AMOS for data analysis. This study finds that the financial decisions and their determinants are critical factors for the financial performance of firms.

This experimental research has been designed to explore the impact of visual cues (visual clips) of school stress on student’s mood and academic performance. It was aimed at investigating the relation between positive guided imagery and negative mood. Participants in the study included 90 boys and 95 girls (N = 185) with the age range of 10-14 years. The sample was randomly selected from different public and private schools of Multan and Bahawalpur. They were randomly assigned to two groups: Group 1 had negative Mood Induction Procedure (MIP) only; group 2 was treated with negative mood induction procedure which was followed by a Positive Guided Imagery (PGI). Students completed demographic sheet and School Situation Survey (Helms & Gablem, 1989) prior to experimentation. The results revealed that academic performance decreases after negative mood induction but not after positive guided imagery. Both groups showed insignificant difference at pre and post-induction 1 level, while a significant difference was found between both groups at post induction phase 2.

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