Medical Specialties Commons^™

Experience With Larangeal Mask Airway In Pakistani Patients, F A. Khan, M A. Afzal, R S. Kamal

Department of Anaesthesia

One hundred and thirty seven adult patients undergoing peripheral surgery were studied regarding ease of larangeal mask airway (LMA) insertion, airway maintenance during surgery and complication encountered during insertion, maintenance and in the postoperative period. In a majority (84%) of patients, the airway was positioned correctly at the first attempt, 3% patients had mild laryngospasm at insertion and in 85% a good airway was obtained. No airway related problems were encountered intraoperatively. Two percent patients had laryngospasm on removal of LMA. Postoperatively, the complaint of sore throat and uvular trauma was seen in 4% cases.

Parotid Gland Lipoma: A Rare Entity, S Muzaffar, N Kayani, S H. Hasan

Department of Pathology and Laboratory Medicine

No abstract provided.

Efficacy Of Octreotide In Diarrhoea Due To Vibrio Cholerae: A Randomized, Controlled Trial, Z Abbas, I Moid, A H. Khan, S M. Jafri, S H. Shah, S Abid, S Hamid

Section of Gastroenterology

Although octreotide, a long-acting analogue of somatostatin, is currently used in the treatment of chronic secretory diarrhoea due to various causes, its role in the management of acute secretory diarrhoea is not well established. In the present study, therefore, the therapeutic value of octreotide in the management of cholera, a classical example of acute secretory diarrhoea, was investigated. During an outbreak of cholera, patients admitted with acute secretory diarrhoea of < or = 24 h duration and a purging rate > 100 ml/h were enrolled on the study and randomly assigned to octreotide (N = 17) and control (N = 16) groups. All 33 patients received intravenous fluid replacement and antibiotic …

Hereditary Ovarian Cancer Syndromes In Three Pakistani Families, A B. Aziz, M Sabih, I A. Malik

Department of Obstetrics & Gynaecology

No abstract provided.

Complications Of Endotracheal Intubation In Mechanically Ventilated Patients In A General Intensive Care Unit, Fazal Hameed Khan, Fauzia A. Khan, Robyna Irshad Khan, Rehana S Kamal

Department of Anaesthesia

During a period of one year, 126 patients were prospectively audited to analyse complications of endotra­cheal intubation in a general intensive care unit setting. A total of 62 complications were observed in 48 patients. The most frequent complications during intubation were hypotension and bradycardia. The blockage of endotracheal tubes significantly increased with the duration of intubation. Sore throat was the commonest (22%) complication following extubation. Other complications like stridor and ulceration of mouth and lips which followed extubation were not related to the duration of intubation.

Pregnancy Induced Hypertension--Anaesthetic Considerations, N A. Zubair

Department of Anaesthesia

No abstract provided.

Pneumococcal Sepsis In The Newborn--An Emerging Problem?, Z A. Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Resistance Of Blastocystis Hominis Cysts To Chlorine, M Zaki, V Zaman, N A. Sheikh

Department of Pathology and Laboratory Medicine

No abstract provided.

Fulminant Hepatic Failure In Pregnant Women: Acute Fatty Liver Or Acute Viral Hepatitis?, S S. Hamid, S M. Jafri, H Khan, H Shah, Z Abbas, H Fields

Section of Gastroenterology

Background: Hepatitis E virus, which is endemic in our region, can cause severe liver dysfunction in pregnant women and this can be clinically confused with acute fatty liver of pregnancy.

Methods: We studied the clinical and laboratory data as well as the maternal and fetal outcomes of 12 pregnant women presenting with fulminant hepatic failure in order to determine the etiology of the disease. The clinical diagnoses were subsequently correlated with serologic assays for acute HEV infection. All patients were severely ill with deep jaundice, grade 3-4 encephalopathy and abnormal prothrombin times.

Results: A clinical diagnosis of acute viral …

Subcutaneous Phaeohyphomycosis: Infection With Pigmented Fungi, I N. Soomro, A Kennedy

Department of Pathology and Laboratory Medicine

No abstract provided.

Needle Localization Of Non-Palpable Breast Lesions, S Khan, N Mitha, F Kazi, M Siddiqui

Department of Surgery Docs

Screening mammography identifies suspicious, non palpable mammary lesions. Mammographic needle localization (MNL) is currently being used to facilitate excision biopsy of these lesions. Thirty-two patients underwent biopsies of the breast after MNL for non-palpable lesions. Mammographic indications for biopsy consisted of microcalcifications (48%), mass or abnormal density (21%) or mass+abnormal density (24%). The carcinoma was identified in four cases (12%). Two of these were in situ, one was microinvasive and one was frankly invasive. Three were treated with a modified radical mastectomy. One of these non palpable lesion demonstrated nodal metastasis but none showed distant metastasis. All radiologically detected abnormalities …

Risk Of Uterine Rupture After The Partographic 'Alert' Line Is Crossed--An Additional Dimension In The Quest Towards Safe Motherhood In Labour Following Caesarean Section, K S. Khan, A Rizvi, J H. Rizvi

Department of Obstetrics & Gynaecology

To determine if prolonged active phase of labour is associated with increased risk of uterine scar rupture in labour following previous lower segment caesarean section, a retrospective cohort study (1988-91) was done to analyse active phase partographs of 236 patients undergoing trial of labour following caesarean section, 7 (3%) of whom had scar rupture. After onset of active phase (3 cm cervical dilatation), a 1 cm/h line was used to indicate "alert". A zonal partogram was developed by dividing the active phase partographs into 5 time zones: A (area to the left of "alert" line), B (0-1 h after "alert" …

Penile Fracture, M A. Khan, M N. Sulaiman

Department of Surgery Docs

No abstract provided.

Churg-Strauss Syndrome With Intestinal Perforation, Javaid A. Khan, Imran Hassan, Shahid Pervez, Wasim Jafri, Shaista Khan

Department of Pathology and Laboratory Medicine

No abstract provided.

Endobronchial Tuberculosis--Manifesting By Coughing Up Of Bronchial Cartilage, A M. Memon, A Shafi, H Thawerani

Section of Pulmonary & Critical Care

No abstract provided.

The Extranasal Glioma - A Cause Of Neonatal Respiratory Distress, Muneer Amanullah, F Attar Z

Department of Surgery Docs

Normal brain tissue in an abnonnal configuration, occurring at a site away from the cranial cavity, is temied an Extranasal Glioma. Since its first description in 1852 by Reid², only 140 patients with this entity have been reported. Heterotopic brain tissue when present in a confined area may cause obstmction, pressure and pain. Its occurrence in the nasopharyngeal region is relatively rare and only 19 cases have been reported so far², the majority presenting with respiratory distress in the early neonatal period. The objective of this report is to create an awareness amongst the physicians of …

Chemotherapy-Induced Non-Hodgkin's Lymphoma In A Patient With Hodgkin's Disease--A Case Report, I A. Burney, I A. Malik

Section of Internal Medicine

Modern chemotherapy and radiation treatment of Hodgkin’s disease has resulted in overall cure rates in excess of 60%1 . However, the greatly improved survival rates have also led to increasing incidence of long-term side-effects of these treatment modalities2 . The most serious consequence is the occurrence of second cancer3 . We report a case of non-Hodgkin’s lymphoma occurring in a patient who was previously treated for Hodgkin’s disease.

Moyamoya Disease Of Childhood As A Cause Of Recurrent Cerebral Ischemic Attacks--A Case Report, S Ibrahim, S S. Hyder

Department of Paediatrics and Child Health

No abstract provided.

Community Acquired And Post-Transfusion Hepatitis C "Is There A Difference?", A R. Qureshi, S Hamid, W Jafri, F Ejaz, H Shah, Z Abbas, S Abid, H Khan

Section of Gastroenterology

We analyzed 77 consecutive hepatitis C antibody positive patients to compare the history, laboratory data and histological features of community acquired (CA) and post-transfusion (PT) hepatitis C. Forty-six patients had "CA" and 31 "PT" hepatitis C. Mean age in both groups was same (45.67 vs 46 years). Male to female ratio was 2:1 in the CA group and 1:2.4 in the PT group. Mean duration between jaundice and first presentation was 8.9 years in the CA group and the mean duration between transfusion and first presentation was 9.8 years in PT group. No significant difference was found between two groups …

Localized Tuberculosis And Myelofibrosis With Myeloid Metaplasia : An Extremely Unusual Presentation, Suhail Muzaffar

Department of Pathology and Laboratory Medicine

Myelofibrosis with myeloid metaplasia (MMM) is usually considered primary agnogenic, however, it may be secondary to various diseases, The association of tuberculosis with MMIM is exceedingly rare, however, the pathogenetic relationship between the two is difficult to define. We present a case report showing simultaneous presentation of localized active tuberculosis and MMM The literature on the subject is also reviewed with special emphasis on pathogenic relation­ship between the two.

Phase Ia/Ib Trial Of Anti-Gd2 Chimeric Monoclonal Antibody 14.18 (Ch L4.18) And Recombinant Human Granulocyte-Macrophage Colony-Stimulating Factor (Rhgm-Csf) In Metastatic Melanoma, James Murray, Eugenie Kleinerman, Shu-Fang Jia, Michael Rosenblum, Omar Eton, Antonio Buzaid, Sewa Legha, Merrick Ross, Lora Thompson, Mansoor Saleh

Haematology and Oncology, East Africa

We performed a phase Ia/Ib trial of chimeric anti-GD2 monoclonal antibody 14.18 (ch14.18) in combination with recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) to determine the maximum tolerated dose as well as immunologic and biologic responses to the regimen. Sixteen patients with metastatic malignant melanoma received escalating doses of ch14.18 (15-60 mg/m2) administered intravenously for 4 h on day 1. Twenty-four hours later, subcutaneous injections of rhGM-CSF were administered daily for a total of 14 days. Significant side effects were related to ch14.18 infusion and consisted of moderate to severe abdominal and/or extremity pain, blood pressure changes, headache, nausea, diarrhea, peripheral …

Treatment Practices For Degedege, A Locally Recognized Febrile Illness, And Implications For Strategies To Decrease Mortality From Severe Malaria In Bagamoyo District, Tanzania, A.M. Makemba, P.J. Winch, V.M. Makame, G.L. Mehl, Zul Premji, J.N. Minjas, C.J. Shiff

Pathology, East Africa

Malaria remains one of the chief causes of mortality among young children in sub-Saharan Africa. Verbal autopsies for cases of childhood mortality in Bagamoyo District, Tanzania demonstrated that degedege, a locally defined illness of children characterized by fever and convulsions, is frequently treated by traditional healers. To investigate this further, an ethnographic study was carried out in one village that included in-depth interviews with 14 traditional healers and 3 focus groups with parents. Parents and traditional healers were unanimous in their conviction that degedege requires traditional treatments, at least initially, and that these treatments are effective. While traditional healers do …

Allergic Bronchopulmonary Aspergillosis: An Unusual Complication Of Bronchial Asthma, S F. Hussain, J A. Khan, M A. Khan

Section of Pulmonary & Critical Care

Asthma is a common medical problem in Pakistan. Allergic Bronchopulmonary Aspergillosis (ABPA), an immune mediated disease, is an unusual complication of bronchial asthma which can result in bronchiectasis, pulmonary fibrosis, respiratory failure and death. Early diagnosis is important so that with proper therapy permanent lung damage can be prevented. First described in 19521 , ABPA was thought to be a rare disorder, but with increased awareness amongst the physicians and better diagnostic techniques, äases are being recognized more frequently. The clinical features of ABPA (cough, fever, hemoptysis and lung infiltrates) are usually mistaken for pulmonary tuberculosis (TB). We present three …

An Audit On Hospital Management Of Bronchial Asthma, J A. Khan, S Saghir, G Tabassum, S F. Husain

Section of Pulmonary & Critical Care

Medical audit is a new concept in developing countries like Pakistan. We carried out this retrospective study on bronchial asthma. The purpose was to see if care given to patient with asthma meets the accepted international standard or not. During this audit several deficiencies were found. Documentation in notes about signs indicating severity of asthma was very poor. Peak flow recording in the notes was also very deficient. There was no documentation in notes whether inhalers technique of the patients has been checked or not. This audit shows that care given to asthma patients is far from satisfactory and we …

Coexistent Tuberculosis And Carcinoma Of The Colon, M Y. Sheikh, A H. Yousuf, T R. Khalid, M U. Islam, M N. Ahmed

Department of Radiology

No abstract provided.

Selective Increases In Antibody Isotypes And Immunoglobulin G Subclass Responses To Secreted Antigens In Tuberculosis Patients And Healthy Household Contacts Of The Patients, R Hussain, G Dawood, N Abrar, Z Toossi, A Minai, M Dojki, J J. Ellner

Department of Pathology and Laboratory Medicine

Mycobacterium tuberculosis-specific antibodies (immunoglobulin M [IgM], IgE, IgG, and IgG subclasses) were determined in 164 tuberculosis patients (pulmonary involvement, n = 135; lymph node involvement, n = 29), 59 healthy household contacts (HC), and 51 healthy endemic donors (EC) by a quantitative enzyme-linked immunosorbent assay for reactivity with culture filtrate. Among the isotypes, significant differences between tuberculosis patient groups with either pulmonary or lymph node involvement and healthy control groups (HC and EC) were detected only for IgG (P < 0.001) and IgG1 (P < 0.001) antibodies. Pulmonary patients also showed a significant difference with IgM (P < 0.01) and IgE (P < 0.05) antibodies. HC showed elevation of only IgM antibodies compared with EC, indicating that IgM antibodies may be an indicator of recent infection with M. tuberculosis. These results suggest that the switching of IgM antibody response to IgG1 is a critical event in disease progression. Polyclonal IgG1, IgG3, and IgE antibodies also showed significant elevation (P < 0.05) in patients compared with EC. A strong correlation (rho = 0.254; P < 0.003) was observed between M. tuberculosis-specific IgG1 and polyclonal IgG1 in patients, suggesting that activations of antigen-specific and polyclonal antibodies are related events. No correlation was found between IgG1 antibodies and purified protein derivative skin test results. Since IgG1 antibody responses to culture filtrate are present only after disease establishment, IgG1 responses could provide a useful diagnostic marker of disease.

A Young Boy With Abdominal Pain, A Jabbar, A Afaq, W Jafri, M Siddiqi, M Ahmed, S Hasan

Section of Gastroenterology

At times, acute diffuse abdominal pain can be a diagnostic dilemma, especially when the symptoms appear to be out of proportion to the findings on physical examination. The case of a young boy with abdominal pain is presented.

Primary Amyloidosis Of Gut Presenting With Dysphagia, Zaigham Abbas, Shahab Abid, Naim -Ur- Rehman, Shahid Pervez

Department of Pathology and Laboratory Medicine

No abstract provided.

Evaluation Of Oral Midazolam As Pre-Medication In Day Care Surgery In Adult Pakistani Patients, N Ahmed, F A. Khan

Department of Anaesthesia

A placebo controlled randomized double blind study was designed to assess the suitability of oral Midazolam as a premedication in day care surgery in adult Pakistani patients. Fifty ASA I and II patients aged between 20-60 years received either Midazolam 7.5 mg or a placebo approximately one hour prior to surgery. Midazolam 7.5 mg produced significant anxiolysis and sedation (p < 0.001) in comparison to placebo after one hour of premedication. There was a significant difference (p < 0.001) in the mean heart rate and blood pressure in both groups after 1 hour of premedication with a lesser rise in blood pressure and heart rate in the Midazolam group. Psychomotor performance assessed by 'n' deletion test was impaired by Midazolam (p < 0.001) and recall of pictures revealed differences (p < 0.05) in the groups at one hour after premedication. However, at four hours after surgery there were no differences in both groups. These findings indicate that rapidly acting oral Midazolam in doses of 7.5 mg provided safe and effective premedication in terms of anxiolysis, sedation, amnesia and psychomotor performance and is suitable for day surgery.

A 55 Year Old Diabetic Presenting With A Rash And Polyneuropathy, S Hyder, H Rasool, H Naqvi, Naila Kayani

Department of Pathology and Laboratory Medicine

No abstract provided.