Internet Scientific Publications

Loss of guide wire, a rare completely avoidable complication of central venous catheterization

Sun, 08 Nov 2009 20:14:14 -0600

Although percutaneous catheterization of central veins is a routine technique, it is a procedure requiring advanced operating skills, expert supervision, and attention to detail in order to prevent adverse effects. Here we describe a case of lost guide wire during central venous catheterization (CVC).

Pemphigus Vulgaris of the Anal Canal: Report of a Rare Case and Review of the Literature

Sun, 08 Nov 2009 20:14:13 -0600

Pemphigus vulgaris (PV) is a rare mucocutaneous autoimmune disease which uncommonly affects the lower gastrointestinal tract. We present the case of a 28-year-old woman with oral PV who presented with signs and symptoms suggestive of mucosal involvement of the anus. The patient’s oral disease was controlled with steroids; however, she developed defecatory pain and was referred for proctologic evaluation. Examination under anesthesia revealed an area of denuded anoderm near the dentate line. Histopathologic analysis of biopsies revealed suprabasilar acantholysis, intercellular IgG deposition, and other changes confirming the diagnosis of anal PV. Of note this is one of the first case reports of biopsy-proven PV involving the anal canal.

A Case of an Atypical Mycobacterial Ulcer Following an Intramuscular Injection

Sun, 08 Nov 2009 20:14:12 -0600

Buruli ulcer is a chronic, indolent, necrotizing disease of the skin and soft tissue. Buruli ulcer is the third most common mycobacterial disease of immunocompetent hosts, after tuberculosis and leprosy, and is caused by toxin-producing mycobacteria named Mycobacterium ulcerans. Over the last 2 decades, a re-emergence of cases has occurred, leading to the 1998 World Health Organization (WHO)Buruli Ulcer Initiative and the Fifty-Seventh World Health Assembly Resolution on Buruli Ulcer, which have stimulated ongoing research into diagnosis, pathogenesis, and effective treatment.We would like to report such a case of atypical mycobacterial ulcer following local trauma due to intramuscular injection.

Postoperative Complications Of Typhoid Ileal Perforation In Children In Azare, Nigeria

Sun, 08 Nov 2009 20:14:11 -0600

Tyhoid ileal perforation (TIP) is one of the most serious complications of typhoid fever causing high morbidity and mortality in many parts of the West African subregion. Surgery is the current prefered method of treatment, with survivors having high rates of infective postoperative complications that are life-threatening. This is a retrospective review of 46 children out of 670 treated for typhoid fever, who underwent laparotomy for typhoid ileal perforation. The most common postoperative complications were wound infection, wound dehiscence and enterocutaneous fistulae. The mortality rate was 28.3% with 65% of deaths ocurring in the first 3 postoperative days; due to septicaemia and later enterocutaneous fistula. This study highlights the challenges involved in the management of these complications in a resource-limited area.

Perineal trauma, the diaphragm was not far!

Sun, 08 Nov 2009 20:14:09 -0600

Perineal injuries may occur in association with penetrating and blunt pelvic injuries. Life-threatening injuries should be addressed first, including laparotomy for hemorrhagic solid organ injuries, major arterial injuries and hollow viscus injuries. We report the case of a young male patient who suffered from a penetrating perineal trauma with rectal, gastric and diaphragmatic injuries.

Tuberculosis of the penis: rare clinical entity

Sun, 08 Nov 2009 20:14:09 -0600

Prevesical Space Hematoma in a Patient on Anticoagulation Therapy

Sun, 08 Nov 2009 20:14:07 -0600

In this article, we describe an anticoagulated patient who developed a large prevesical space hematoma while recovering from an acute respiratory illness. This diagnosis should be considered in the anticoagulated patient who develops abdominal pain, a lower abdominal wall mass and an anemic syndrome. Diagnosis is usually confirmed by CT scan or ultrasound. Non-operative management is recommended.

Mirror Hand Deformity - A Rare Congenital Anomaly Of The Upper Limb

Sun, 08 Nov 2009 20:14:04 -0600

Mirror hand deformity is a very rare congenital disorder. We report a case of a two-year-old child suffering from this disorder, which is being managed in the Department of Plastic & Reconstructive Surgery of King Fahad Medical City, Riyadh, Saudi Arabia.

Giant Mature Sacrococcygeal Teratoma in an Adult - a Case Report

Sun, 08 Nov 2009 20:14:03 -0600

Teratoma is a congenital germ cell tumor, composed of a wide diversity of tissue, containing all three germ cell layers. The sacrococcygeal area is the commonest site of extragonadal teratomas in infants, but presents as a rare diagnostic dilemma in adults. We present a rare case of giant mature sacrococcygeal teratoma in an adult female patient.

Maggots: World’s smallest surgeons.

Sun, 08 Nov 2009 20:14:03 -0600

Here we report 3 cases of ulcers with maggots. All wounds are clean after removal of the maggots. Neglected ulcers and poor hygiene are implicated as important causes of infestation. We used turpentine for all cases for removal of maggots with good result. Maggots can be used for the treatment of non-healing ulcer and MRSA infection. Collagenase is responsible for debridement of the wound in presence of maggots.

Recurrent Large Cervico-Axillary Lipoma in a 2-Year-Old Boy: Case Report

Sun, 08 Nov 2009 20:14:02 -0600

Lipomas are the most common subcutaneous soft-tissue tumors of mesenchymal origin and have an overall recurrence rate of 5%. The axillary region is an unusually reported localization for lipomas. We report a huge recurrent cervico-axillary lipoma in a 2-years-old boy, which, to our knowledge and according to a review of English literature, has not been reported before in children. This benign lesion needs careful and meticulous complete surgical excision to avoid recurrence.

Incidental Finding of a Type IV Hiatal Hernia Following Trauma Work-up

Sun, 08 Nov 2009 20:13:59 -0600

Hiatal hernias are the result of defects in the diaphragmatic hiatus wherein gradual enlargement of the hiatal orifice allows abdominal contents to herniate into the mediastinum. This is usually a naturally acquired condition but similar clinical presentations may occur after trauma or after previous surgery on the gastroesophageal junction (i.e., fundoplication). The stomach by itself is most typically involved; however, other associated organs may be included within the hernia sac including the spleen, colon, pancreas, or liver. We present a trauma activation patient of our level one institution who was to have an asymptomatic hiatal hernia.

Gall Stone Ileus: A Rare Complication of Gallstone Disease. Case Report and Literature Review.

Sun, 08 Nov 2009 20:13:59 -0600

Gallstone ileus is a rare complication of gall stones associated with high morbidity and mortality. Misdiagnosis is common. The condition should be suspected in all patients presenting with features of small-bowel obstruction in absence of a surgical scar and external hernia, especially in elderly females. The diagnosis can always be confirmed by pain X-ray, ultrasound and CT scan demonstrating Rigler’s triad. Surgical treatment involves removal of the impacted stone with immediate or delayed dealing with the fistula.

Recurring abdominal wall wounds and cutaneous sinus tract formations secondary to spilled gallstones

Sun, 08 Nov 2009 20:13:56 -0600

Introduction: Perforation of an inflamed, gangrenous gallbladder during laparoscopic cholecystectomy inevitably leads to intraoperative spillage of bilious contents and possibly gallstones. In rare cases, spilled gallstones that escape detection during laparoscopic surgical field washout can predispose to multiple types of complications, which are documented in the surgical literature, in the months to years following surgery.Results and Discussion: Spilled gallstones can embed within the abdominal wall musculature in the months following laparoscopic cholecystectomy and serve as a nidus for inflammation and infection. This case demonstrates an instance of simultaneous development of chronically draining wounds and complex cutaneous sinus tracts in both the right flank and periumbilical area secondary to spilled gallstones. These complications began one year after laparoscopic cholecystectomy.Conclusion: Surgical removal of spilled gallstones is necessary to avoid the rare instances where they produce complications of infection, inflammation, and cutaneous sinus tract formations.

A rare post-ERCP complication: a case report of pneumoperitoneum, pneumo-retroperitoneum, and surgical emphysema following unsuccessful ERCP.

Sun, 08 Nov 2009 20:13:54 -0600

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure performed to diagnose and treat pancreatic and biliary diseases. In about 5%-10% of patients it causes adverse events. Pancreatitis is the most common complication; duodenal perforation, hemorrhage and cholangitis are less frequent. Duodenal perforation is an infrequent complication of ERCP, usually associated with sphincterotomy; it may be asymptomatic, passing un-noticed, or causing abdominal symptoms. The management of symptomatic perforation should be initially conservative including bowel rest, nasogastric suction, hydration and antibiotics. These patients must be carefully observed, because 20%-40% may require surgical treatment. Surgery is recommended in patients with persistent biliary obstruction, cholangitis, a septic status and those whose symptoms do not improve after a brief period of non-operative management. Here we present a case of post-ERCP pneumoperitoneum, pneumo-retroperitoneum, and surgical emphysema treated successfully with operative intervention but with non-visualized perforation.

Epidemiology, perception and treatment of females presenting with lower urinary tract symptoms at a government hospital in central India

Sun, 08 Nov 2009 20:13:53 -0600

Aim: To study the epidemiological and sociological features, and patient’s perception of various lower urinary tract symptoms (LUTS) in females, coming to our institution in central India; thus creating awareness among treating physicians as well as patients.Material and method: This study is a prospective epidemiological study of 51 adult female patients with LUTS, who attended the surgery and gynecology OPD in our institution. The study is based on history and clinical examination of patients in OPD. Complete history of complaints, associated symptoms and obstetric history was taken. General and local examination, including per vaginal and per speculum examination, was done and data were analyzed.Results: More than half of the females with LUTS were middle aged (31-55yrs). The most common symptom was frequency. Education level was very low in three fourth of them. The first consultation was taken after months or even years after appearance of symptoms in about two third of cases. Half of the patients with stress incontinence were elderly (aged 55 years or more), all were multi-para (parity 3 or more), more than half had associated pelvic organ prolapse and 40% had history of hysterectomy.Conclusion:An Indian female with LUTS, usually treated as a case of UTI, needs to be better evaluated by the treating physician. The high prevalence of risk factors for LUTS, such as multi-parity, negligent attitude towards the symptoms and late presentation to seek medical care in most of the Indian females, is due to unawareness, lack of education and motivation.

Strıctureplasty In Dıffuse Intestınal Crohn’s Dısease: Report Of A Case

Sun, 08 Nov 2009 20:13:52 -0600

In Crohn’s disease, both medical and surgical treatments are palliative; however, operative therapy can provide effective symptomatic relief for those patients with complications from Crohn’s disease, such as intestinal obstruction due to strictures. Segmental intestinal resection followed by primary anastomosis is the usual surgical technique. As an alternative to segmental resection, stricturoplasties have been the procedures of choice to deal with short bowel syndrome in patients with extensive involvement by the disease such as diffuse jejunoileitis and for those who are at risk for developing short bowel syndrome due to previous resections. Depending on the length of the stricture, the reconstruction can be fashioned in the form of Heineke-Mikulicz and/or Finney strictureplasty. Side-to-side isoperistaltic strictureplasty has emerged as a bowel-sparing surgical alternative for the management of longer segments of disease with multiple strictures. We, hereby, aimed to present the treatment of a 21-year-old patient with diffuse intestinal strictures due to Crohn’s disease.

Abdominal Cocoon – A Potential Disaster In Patients With Previous Surgical Scar Undergoing Laparoscopy

Sun, 08 Nov 2009 20:13:51 -0600

Abdominal cocoon is of obscure etiology resulting in the formation of matted bowel loops, encased in a dense fibrous sheath, sometimes stuck to the parietes. This interesting condition could result in bowel injury during minimal access surgery, at introduction of a laparoscopic trocar.

A Rare Case Of An Ulcerated Pilomatrixoma Of The Right Axilla

Sun, 08 Nov 2009 20:13:50 -0600

Pilomatrixomas are benign tumors of hair matrix cells characterized by basaloid and eosinophilic ghost cells. Other names for pilomatrixoma include pilomatricoma and calcifying epithelioma of Malherbe. Most cases of pilomatrixoma occur in children under the age of 10, and the condition is twice as common in females as males.Pilomatrixomas are most common in the head and neck region and may occur at eyebrow, lids and medial canthus. Occurrence of pilomatrixomas at the axilla is rare. We would like to report such a rare case of an ulcerated pilomatrixoma in the right axillary region.

CANNON BALL SECONDARIES? - Not always!!!

Sun, 08 Nov 2009 20:13:50 -0600

Perforated Appendicitis - An Experience From A Tertiary Care Center In Kashmir

Sun, 08 Nov 2009 20:13:46 -0600

Appendicitis is a very common surgical emergency and in spite of advances in medical care, this condition still gets complicated and leads to morbidities and mortalities. Aim: This study was conducted to study the profile of patients treated with perforated appendicitis at the Surgical Department of a tertiary care center in Indian Kashmir. Methods and Materials: The study was conducted retrospectively and cases treated for perforated appendicitis from Jan. 1999 to Dec. 2007 were studied. Results: Over a period of 8 years, 834 patients were treated for appendicitis and out of these, 67 cases had perforated appendicitis. Delay in reporting to expert healthcare was a major factor leading to perforation. Seventy-three per cent of perforated appendicitis cases had a postoperative complication as compared to only 4% in the non-perforated appendicitis group. Conclusion: Perforated appendicitis is associated with significant morbidity and mortality and steps need to be taken to prevent the delayed reporting of patients at expert healthcare facilities.

Acute Perforated Duodenal Ulcer In Maiduguri

Sun, 08 Nov 2009 20:13:41 -0600

Background: Effective medical management of peptic ulcer disease (PUD) has reduced the incidence of gastric outlet obstruction (GOO) as a complication, but the frequency of perforation, especially in the elderly, remains unchanged and is in fact on the increase. There is a changing trend in emergency surgery for perforated duodenal ulcer (PDU) from definitive anti-ulcer surgery to simple closure followed by Helicobacter pylori eradication.Aims/Objective: To present our experience in managing PUD with simple closure followed by Helicobacter pylori eradication.Patients and Methods: This is a retrospective study where hospital records of 55 patients managed for PUD over a 9 year period (Jan. 1999-Dec. 2007) were obtained from ward admission register, theatre operation registers and patient’s case files from the medical records department. The patient’s biodata, clinical and operative findings and treatment outcome were extracted and analysed.Results: There were 55 patients; 44 males and 11 females (M:F=4:1). Their ages ranged between 18 and 65 years with a mean +/-SD of 39.9 +/-13.5 years. Most of the patients (34; 61.8%) were below 40 years of age and the majority (39; 71.0%) had a history suggestive of chronic peptic ulcer disease. Twenty-six (47.3%) of the patients presented within 24 hours of perforation, while 9 (16.4%) presented more than 72 hours afterwards. The latter group accounted for most (5; 55.6%) of the mortality. All the perforations were anterior pyloroduodenal and all except one had simple closure with omental patch followed by a course of a proton pump inhibitor and Helicobacter pylori eradication therapy.Conclusion: Simple closure with omental patch followed by Helicobacter pylorieradication was effective with low morbidity and mortality despite patients’ late presentation in our center.

Prolonged use of antibiotics in complicated appendicitis: Does it prevent post-appendicectomy complications?

Sun, 08 Nov 2009 20:13:39 -0600

Introduction: The main objective of the study was to determine if the duration of antibiotic use had an effect on the incidence of postoperative complications in acute appendicitis.Methods: The use of antibiotics with its duration along with its relation to the operation, and the incidence and types of post-operative complications were recorded in 3 patient groups (normal appendix, simple appendicitis and severe appendicitis).Results: This study included 135 patients for a year’s time with severe appendicitis (69 patients, 51.1%); 95% of patients received antibiotics including 41.4% for >48hours. The overall complication rate was 9.6%, with the highest rate in the severe group (7.4%) and the most common complication being wound infection (7/13 - 53.9%). All patients developing wound infection received at least 48 hours of antibiotics.Conclusion: The incidence of complications is higher in patients with severe appendicitis, and our observational study has shown that prolongation of antibiotics beyond 48 hours does not necessarily reduce the risk of complications. This gives a basis for conducting a future prospective randomized trial.

Umbilical pilonidal sinus mimicking umbilical adenoma

Sun, 08 Nov 2009 20:13:34 -0600

Pilonidal sinus is a common problem in the sacrococcygeal region, and is rarely observed in other regions like the periumbilical area. We discuss here a case of pilonidal sinus presenting as an umbilical nodule along with the predisposing and differential diagnoses.

Thrombophilia in Malignancy: A Review of the literature

Sat, 07 Nov 2009 19:36:31 -0600

Hypercoagulable state is a well recognized complication of malignancy. Venous thrombosis manifests mainly as deep venous thrombosis or pulmonary embolism. Autopsy studies have reported increased rates of pulmonary embolism among cancer patients as compared to patients without malignancy.1 The risk of recurrence is also high among the cancer patients.2 Patients who present with an unprovoked venous thromboembolism (VTE) are more likely to have an underlying cancer than those patients with an identifiable risk factor.3, 4 Concurrent VTE and cancer also increases the risk of death. The increased risk for deep venous thrombosis in cancer patients is often not considered while planning treatment.

Vascular reactivity in the simvastatin treated experimental diabetes with endothelial disfunction

Sat, 07 Nov 2009 19:36:31 -0600

Background: Vascular diseases are the principal causes of death and disability in people with diabetes. The bioavailability of nitric oxide (NO) represents a key marker in vascular health. Statins have anti-oxidant, anti-thrombotic and angiogenetic effects. They also increase NO by up-regulating nitric oxide synthase. It is aimed to asses the effect of simvastatin treatment on the general characteristics of diabetes and vascular reactivity in 14 week-old streptozotosin-diabetic rats. Methods: Twenty-four Sprague-Dawley male rats are divided into four groups as control, control-statin, diabetes and diabetes-statin. Four rings were taken from every rat’s thoracic aorta. After taking a submaximal contraction with phenilephrine at the ring with endothelium, an acetylcholine relaxation was taken. While Na-nitroprusside relaxation reaction was gaining at one of the rings without endothelium, a cumulative contraction with phenilephrine and a cumulative contraction with KCL were obtained. Results: We observed that hyperglycemia and weight-loss seen in diabetic rats are treated with simvastatin partially, but still different from the control group. Simvastatin treatment has lowered the plasma triglyceride and cholesterol levels. In isolated aortic rings of diabetic rats, after pre-contraction is performed with single dose Phenilephrine, it is observed that decreasing response in endothelial releasing responses with acetylcholine is treated partially with simvastatin treatment. After thapsigargin, endothel-related acetylcholine releasing responses are decreased; the releasing response in diabetes-statin group differs from the diabetic group. Conclusion: Simvastatin treatment in diabetic rats, in addition to treatment of diabetic dislipidemia, has also treated endothel-related releasing response in diabetes partially. We observed that thapsigargin reduces the response of the aortic rings to the current substance.

Bilateral Proptosis: Unusual presentation of Cortical Sinus Thrombosis.

Sat, 07 Nov 2009 19:36:30 -0600

We report a rare presentation of Cortical Sinus venous thrombosis. This case presented with bilateral proptosis in an adult female. CT scan of brain showed left cavernous sinus and bilateral superior ophthalmic vein thrombosis with Right subdural hematoma (9cm x1.5cm).

Rectus sheath hematoma in elderly, medical or surgical treatment?

Sat, 07 Nov 2009 19:36:29 -0600

Anticoagulation induced bleeding complications to occur more frequently in the elderly. Two patients with Rectus sheath hematoma as a result of bleeding complication of warfarine therapy are reported.

Diagnosis Of Multiple Endocrine Neoplasia Type 1 In A Patient With Back Pain; Case Report And Review Of Literature

Sat, 07 Nov 2009 19:36:29 -0600

Multiple endocrine neoplasia syndrome 1 (MEN1) is a paracrine genetic autosomal dominant disease consisting of tumors in parathyroid, pancreas and pituitary glands. We report a case of a 44 year old male with MEN1 presenting insulinomas, parathyroid adenomas and a pituitary prolactin producing microadenoma.A 44 year old male presented to the emergency department with complaints of back pain. Initial imaging of the abdomen to rule out nephrolithiasis showed an 11cm mass at the head of the pancreas. On further questioning, the patient reported to have frequent symptoms suggestive of hypoglycemia for more than 20 years.Laboratory data on admission showed low glucose (46 mg/dl) and high calcium (12 mg/dl). A 72 hour fasting test confirmed the diagnosis of insulinoma. Hypercalcemia work-up revealed an elevated PTH (Calcium 12.6 mg/dl and PTH 200 pg/ml); a parathyroid scan showed multiple adenomas. A pituitary MRI did not reveal any tumors. However, labs were remarkable for decreased total testosterone (144 ng/dl), and elevated prolactin (104 ug/L). CT-guided biopsy of the mass at the head of the pancreas was consistent with a neuroendocrine tumor. The patient subsequently underwent resection of the pancreatic mass and parathyroidectomy. His hypercalcemia resolved after surgery and his hyperprolactinemia improved with dopamine agonist therapy. Unfortunately, his hypoglycemia did not resolve.We report the case of a 44 year old male patient with a new presentation of tumors of the parathyroid, pancreas and pituitary glands. Excellent history taking, further testing, and clinical suspicion lead to the diagnosis of MEN1 syndrome.

Ventriculo-peritoneal shunt failure in the adult patient

Sat, 07 Nov 2009 19:36:29 -0600

A Ventriculo-Peritoneal (VP) shunt is a diversion of the Cerebrospinal fluid (CSF), by means of an implanted shunt, to a receptacle in the peritoneal cavity. Shunts are not curative, but serve only as a diversion of the excess fluid and do not correct the underlying disease. Shunt failure is pretty common in the pediatric population and its not uncommon to have multiple shunt revisions in a lifetime 1. On the other hand, the experience and literature on VP shunts in the adult seems pretty limited. Also, the diagnosis of shunt failure can be confounded by a variety of factors in an adult patient.

Factitious Gastrointestinal Bleeding: A Case Of Münchhausen Syndrome.

Sat, 07 Nov 2009 19:36:28 -0600

Münchhausen syndrome is a psychiatric disorder characterized by patients presenting with dramatic symptoms but with inconsistent histories. Presentations of Münchhausen are varied and very few cases of patients presenting as factitious gastrointestinal bleeding with blood in stools and abdominal pain have been reported. We report a case of a young female presenting with severe abdominal pain and bloody diarrhea. The unrelenting symptoms led to an extensive workup which was negative and prompted reconsideration in approach to the patient’s management. A thorough search of her room was performed which revealed four syringes partially filled with blood.

Symptomatic Hypermagnesemia in the Absence of Renal Failure

Sat, 07 Nov 2009 19:36:27 -0600

Hypermagnesemia is an uncommon clinical finding, and symptomatic hypermagnesemia is even rarer. Symptomatic hypermagnesemia has a low incidence of occurrence, because the kidney is able to eliminate excess magnesium by rapidly reducing its tubular reabsorption to almost negligible amounts. Renal failure is the most common cause of hypermagnesemia. [1] Other causes of hypermagnesemia such as lithium therapy, Milk alkali syndrome, exogenous intake, Addison disease, tumor lysis syndrome and hypothyroidism are much rarer. [1] We report a case of symptomatic hypermagnesemia, in a sixty-one year old woman that has been taking milk of magnesia for chronic constipation.

Incidence and management of ISH in a tertiary care hospital of Chandigarh (India).

Sat, 07 Nov 2009 19:36:27 -0600

Isolated systolic hypertension (ISH) is defined as a raised systolic pressure with normal diastolic pressure. It is a major risk factor for cardiovascular disease in patients more than 50yrs of age. Early detection and treatment of ISH reduces the incidences of stroke, heart attack and heart failure. Despite this, ISH remains under-recognised and undertreated. Hence the present study was undertaken to assess the incidence and management of ISH in a tertiary care hospital. The study was carried out by the Department of Pharmacology in collaboration with the Department of Medicine, Government Medical College & Hospital, Chandigarh (India). A questionnaire-based proforma was made to be filled by patients with ISH. A total of 90 patients were included in the study. The most commonly prescribed anti-hypertensive in our study was Amlodipine (24.78%) followed by Atenolol (15.4%). The pattern of prescription is not typical for ISH since the patients were suffering from co-morbid conditions like heart failure, ischaemic heart disease, diabetes etc.

Effect of antihypertensive therapy on some cognitive functions of patients of hypertension.

Sat, 07 Nov 2009 19:36:26 -0600

Aim- Hypertension associated with the decline in cognitive functions. There are certain studies which revealed that antihypertensive therapy improves the cognitive functions in patients of hypertension. Some other studies do not support this conclusion. So this study was done to see the effect of antihypertensive therapy on cognitive functions in patients of hypertension in our setting.Material and methods: Cases of hypertensions were recruited from the OPD of private physician. Baseline cognitive function tests were administered before starting the antihypertensive therapy and after three months of treatment. To see the effect of hypertension on cognitive functions baseline cognitive functions of cases were compared with healthy volunteers.Results: During comparison of cases and controls, it was found that there is decline in cognitive functions as indicated by Immediate recall test, Mental balance test, Forward digit span test, Word list memory test, Recognition test and Six letter cancellation test. Out of these tests, Immediate recall test, Word list memory test, Recognition and Six letter cancellation test showed improvement after three months of antihypertensive therapy. Some tests like Remote memory test, Recent memory test, Backward digit span test, Paired associate test, Ray’s figure test, Line test, Delayed recall test showed no decline. Out of these, only Delayed recall test showed improvement after three months of antihypertensive therapy.Conclusion: hypertension associated with the decline in cognitive functions and antihypertensive therapy improves the cognitive functions in these patients.

Progressive Presentation of Type 2 Heparin-Induced Thrombocytopenia (HIT-2) in ESRD: An Illustrative Case Report

Sat, 07 Nov 2009 19:36:25 -0600

Heparin-induced thrombocytopenia (HIT) is a well known side effect of heparin therapy. Type-1 HIT is a non-immune response that is relatively common in patients exposed to heparin. It is often transient, rarely deadly, and resolves quickly after heparin is withdrawn. Type-2 HIT is a more severe form of the syndrome that is immune-mediated and associated with systemic arterial and/or venous thrombosis. HIT commonly develops within fourteen days of initial heparin exposure, but delayed-onset cases are becoming increasingly reported. HIT can also develop in patients who have previously been exposed to heparin without subsequent development of the syndrome. We present a case of HIT-2 in a patient with ESRD who had been receiving unfractionated heparin therapy for a large proportion of the previous 7 months without development of thrombocytopenia. This case underscores the importance of continuous monitoring for HIT even after the patient has been receiving heparin treatment either periodically or continuously for extended periods of time.

Hiatal Hernia: An Uncommon Presentation of Chest Pain

Sat, 07 Nov 2009 19:36:24 -0600

Chest pain presents a diagnostic challenge with a long list of differential diagnosis. Chest pain due to gastrointestinal causes includes esophagitis, GERD, gastritis, esophageal spasms and rarely pancreatitis, cholecystitis and peptic ulcer disease. Here we present an uncommon cause of chest pain: hiatal hernia (HH). HH can be life threatening if not diagnosed and treated early. This case report reviews the different types of HH with symptoms and signs, diagnosis and therapeutic options.

Touraine Solente Gole Syndrome – The disease and associated Tongue fissuring

Sat, 07 Nov 2009 19:36:22 -0600

Touraine Solente Gole syndrome, a relatively rare inherited disorder is epitomized by finger clubbing, skeletal changes and pachyderma. We report a case of pachydermopersotosis with thick fissured tongue, a yet unrecognized association .

Role of Molecular Targeted Therapy in Adult Gastrointestinal Stromal Tumors

Sat, 07 Nov 2009 19:36:21 -0600

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of gastrointestinal tract. GISTs can occur anywhere along the GI tract but are most common in the stomach (50%) and small bowel (25%). Colon (10%), omentum / mesentery (7%), and esophagus (5%) are less common primary sites. Liver metastases and/or dissemination within the abdominal cavity are the usual clinical manifestations of malignancy. Lymph node metastases are extremely uncommon; its spread to the lungs or other extra-abdominal locations is also extremely rare. Survival has greatly improved since 2002, when imatinib mesylate was approved by the Food and Drug Administration (FDA) for unresectable, recurrent or metastatic gastrointestinal stromal tumors (GISTs). In January 2006, the FDA approved second-line use of sunitinib in patients with advanced GIST resistant or intolerant to imatinib. This review article discusses the optimal approach for care of patients with GIST and role of molecular targeted therapy in management of GIST.

Primary Aortoduodenal Fistula

Sat, 07 Nov 2009 19:36:21 -0600

Primary aortoduodenal fistula is a rare cause of gastrointestinal bleeding that is difficult to diagnose. A “herald” bleed often precedes fatal hemorrhage. Endoscopy, ultrasound, angiography and CT scan have all been utilized in an attempt to confirm this diagnosis with limited success. We report a 51-year-old male who presented with occasional melanotic stools, and then developed massive upper gastrointestinal bleeding. A primary aortoduodenal fistula was identified between an atherosclerotic abdominal aortic aneurysm, and the third portion of the duodenum in surgery. The aneurysm was resected and grafted and the duodenum repaired. The patient developed a severe coagulopathy and expired post-operatively. This case illustrates a rare presentation of both abdominal aortic aneurysm and gastrointestinal bleeding. We will discuss the challenges in diagnosis and management of this unusual problem.

Primary Peritoneal Echinoccocosis: An Uncommon Cause Of Acute Abdomen

Sat, 07 Nov 2009 19:36:18 -0600

Echinococcosis is characterized by worldwide distribution but primary peritoneal echinoccosis especially as a cause of acute abdomen is rare, even in areas where hydatid disease is endemic. The aim of this work is to report a case of primary multiple infected intraperitoneal hydatid cyst as a cause of acute abdomen.

Pathophysiological basis of radiological findings in cerebrospinal fluid hypovolemia- a case report and review of the literature

Sat, 07 Nov 2009 19:36:16 -0600

Post-dural puncture cerebrospinal fluid (CSF) leak tugs on the intracranial pain-sensitive structures leading to headache. This is characteristically postural in nature. MRI of the brain and cervical spine demonstrate dural enhancement, with low lying cerebellar tonsils, and venous distention.

Cytomegalovirus Infection and Thrombosis: Coincidence or Connection?

Sat, 07 Nov 2009 19:36:15 -0600

Introduction:Sporadic cases of concomitant acute cytomegalovirus (CMV) infection and thrombosis have been reported several times in the past. However,the incidence of thrombosis among patients with acute CMV infection has never been studied. Moreover, since acute CMV infection is common, it might be diagnosed in patients suffering from thrombosis without actually triggering it.Aim: To study the incidence of thrombosis among patients with acute CMV infection hospitalized in a tertiary medical center. Among these patients, we compare the incidence of CMV-induced thrombosis with that of CMV-accompanied thrombosis.Methods: Medical charts and imaging study reports of all patients diagnosed with acute CMV infection during the years 2005-2006 were reviewed for the presence of thrombosis and for its acquired as well as inherited predisposition.Results: Overall 160 patients were diagnosed with acute CMV infection during the years 2005-2006. Six (3.8%) of these patients were diagnosed concomitantly with thrombosis. Of these patients, four were immunocompromised. Either the acute CMV infection or the thrombosis was diagnosed incidentally in all of these patients. Acquired predispositions for thrombosis, other than acute CMV infection, were present in four of them. Hence, the incidence of CMV-induced thrombosis and CMV-accompanied thrombosis was 1.3% and 2.5%, respectively. Conclusions: Though thrombosis among patients with acute CMV infection is not rare, it is unclear whether CMV actually triggered thrombosis in most of these cases. A case controlled study is needed to confirm the association between acute CMV infection and thrombosis.

Cerebral Amyloid Angiopathy ---“A rare cause of Primary Intracranial Hemorrhage in Indian Elderly patients”.

Sat, 07 Nov 2009 19:36:14 -0600

Cerebral amyloid angiopathy (CAA) is one of the important causes of primary intracerebral haemorrhage (PICH) in older people. Lobar, recurrent or multiple simultaneous hemorrhages in older patients should raise suspicion of its diagnosis. A definitive diagnosis of CAA requires pathological examination of the affected tissue. However, with modern imaging techniques, it is possible to make a diagnosis of ‘probable CAA’ in patients presenting with PICH.

Biomarkers And Screening Tests For Abdominal Aortic Aneurysm: A Brief Review

Sat, 07 Nov 2009 19:36:14 -0600

BACKGROUND: Abdominal aortic aneurysm (AAA) is a deadly disease and hence various modalities to be used to diagnose at an earlier stage.OBJECTIVE: To find out the usefulness and limitations of various biomarkers in diagnosing AAA and drug to prevent/treat it.MATERIAL AND METHODS: Published data were collected from web using keywords biomarkers, clinical methods, screening tests and abdominal aortic aneurysm. RESULTS: Biomarkers identified for AAA are osteopontin (OPN), osetoprotegrin (OPG), Matrix metalloproteinase-9 (MMP-9), circulating levels of tumor necrosis factor-α, interleukin-1β, interleukin -6, interferon-γ, amino terminal propeptide of type 3 collagen, C-reactive protein (CRP), fibrinogen, total WBC count, albumin and ultrasonogram of abdomen.Co-existing illnesses influence inflammatory biomarkers. Promising biomarker is osteopontin which is useful to assess status and progression of AAA. The drug, Irbesartan (angiotensin II blocker) has been shown to reduce the size of aneurysm by dwindled the secretion of osteoprotegrin.CONCLUSIONS: Primary focus should be on early detection and management. To achieve this goal, orientation of primary care professionals towards symptoms and signs of AAA, surgeons to look for during abdominal surgeries and radiologists to observe during USG/ CT scan of abdomen.

ARDS following talc pleurodesis

Sat, 07 Nov 2009 19:36:13 -0600

Recurrent and symptomatic pleural effusion is not uncommon for patients with lung malignancy. In these cases, chemical pleurodesis is used to prevent reaccumulation of the effusion as a palliative measure. . Pleurodesis can be done with talc and various other chemotherapeutic agents. Talc remained the most commonly used one as it is cheaper and easily available. Pleurodesis using mixed talc (containing small talc particles) produces more lungs and systemic inflammation and more hypoxemia than graded talc which can lead to a variety of clinical manifestation from hypoxia to adult respiratory distress syndrome. These complications can be predicted based upon the clinical predictors and can be easily prevented.

Myocardial infarction following parenteral beta agonists for asthma in two patients with normal coronary arteries- a call for caution

Sat, 07 Nov 2009 19:36:13 -0600

Background. Severe asthma is often treated with parenteral beta agonists. There is however, no solid evidence supporting this treatment and it is no longer recommended in current guidelines.Methods and Results. We have recently treated two patients who developed a myocardial infarction with elevated serum troponin and angiographically-normal coronary arteries following administration of parenteral beta-agonists.Conclusion. Parenteral beta agonist administration in severe asthma may result in myocardial infarction. In addition there is a possibility of Takatsubo or stress-induced cardiomyopathy. We suggest that parenteral beta-agonists should be used, if at all, with extreme caution.

The Frequency and Significance of Iron-Deficiency Anemia in Patients with Selected Concurrent Illness

Sat, 07 Nov 2009 19:36:09 -0600

Approximately 30% of the world’s population is anemic, of which 50% is iron deficiency anemia (IDA). The extent to which IDA affects patients with concomitant illness has not been described.A systematic review was conducted on the prevalence of IDA and its relationship to clinical outcomes in selected concurrent illness. After pooling the results of eligible studies, we found considerable disparities in the prevalence for IDA, which varied by the diagnostic tools employed. When bone marrow aspirates were used, the prevalence of IDA was: 52% for rheumatoid arthritis, 53% for inflammatory bowel disease, 54% for HIV, and 73% for heart failure. However, when serum ferritin was used, the estimates were: 39%, 22%, 38%, and 32%, respectively. Decreased survival and peak VO2 were also reported in heart failure patients with IDA.IDA is prevalent in concomitant illness and can be underestimated. It may also be an important indicator of adverse prognosis.

Primary Amyloidosis presenting as Cardiogenic Shock and Pseudoinfarction. A case presentation.

Sat, 07 Nov 2009 19:36:08 -0600

Primary Systemic Amyloidosis is a rare disease characterized by the deposition of fibrils, amyloid, in multiple organs, leading to multisystemic dysfunction and death. The heart is frequently involved causing infiltration of the cardiomyocytes and specialized cells of the conducting system provoking heart failure, arrhythmias and blocks of various types, and electrocardiographic changes that resemble a myocardial infarction. We present a case with a previous history of hypertension that presented in cardiogenic shock with an electrocardiogram supportive of anterior myocardial infarction; a postmortem examination revealed Primary Systemic Amyloidosis.

Alzheimer’s disease presenting with Sudden Onset Multiple Intracranial Bleeds

Sat, 07 Nov 2009 19:36:07 -0600

An 89 year old woman with a past history of dementia and hypertension, presented with sudden onset dysphasia. An initial computed tomography (CT) head showed two synchronous acute intracerebral hematomas, one in the left parieto-occipital region and the other in right frontal region. Subsequent magnetic resonance imaging (MRI) done a week later, showed multiple intracranial bleeds that had increased in number since the CT. There was no evidence of malignancy. She was managed conservatively

Treatment Of The Hospitalized Alcohol-Dependent Patient With Alcohol Withdrawal Syndrome

Sat, 07 Nov 2009 19:36:03 -0600

Alcohol-related disorders remain a significant cause of patient morbidity and mortality. These disorders include alcohol intoxication, withdrawal, abuse, and dependence. While primary care physicians certainly play an important role in managing these conditions, the hospital physician should be equally aware of the acute management of alcohol withdrawal and be prepared to help treat the patient for alcohol abuse and dependence. The objective of this manuscript was to review the contemporary literature regarding treatment of these conditions and distill the knowledge into useful clinical information for a practicing physician. We first addresses alcohol withdrawal syndrome with a discussion of underlying pathophysiology, diagnostic criteria, clinical evaluation, treatment goals, and specific treatment options including pharmacotherapy. To address long-term continuity of care, we include a discussion of alcohol abuse and dependence, specifically addressing clinical assessment and various long-term therapy modalities. With a review of this information, we hope to simplify the management and treatment goals for the internal medicine physician for patients with alcohol-related disorders.

Fatal Lactıc Acıdosıs Due To Metformıne

Sat, 07 Nov 2009 19:36:01 -0600

A 55 year-old male patient was admitted to emergency department. He ingested 50-60 tablets of 850 mg metformin for suicidal attempt. Blood glucose 352 mg/dL, ALT 52 IU/L, AST 39 IU/L, LDH 441 IU/L, lactate over 181 mg/dL, pH 7.29, pO2 44 mmHg, pCO2 39 mmHg, HCO3 18 mEq/L, oxygen saturation was 74%. Bicarbonate was given by intravenous push at a dose of 1 mEq/kg body weight and the patient was transferred to the intensive care unit. Haemofiltration was performed for lactic acidosis. As a result, haemofiltration should be initiated immediately in patients with acidosis associated with metformin. Thus mortality rates can be lessened.

Serum Immunoglobulins (IgG, IgA, IgM) levels in Preeclampsia and Eclampsia Pregnancies

Fri, 06 Nov 2009 17:58:18 -0600

Bacground: Preeclampsia is the most common pregnancy-specific complication. It is thought to be associated with modulation of immune response. Objective: The aim of this study was to investigate the serum levels of immunoglobulins-IgG, IgA and IgM in pre-eclampsia and eclampsia, and to examine the influence of the immunoglobulins with pre-eclampsia and its complication eclampsia, if any. Methods: The study was conducted among fortythree subjects consisting of seventeen pre-eclampsia patients, eleven eclampsia patients and fifteen healthy normotensisve pregnants of singleton gestations in their third trimester. Serum immunoglobulin levels were analyzed by solid phase indirect ELISA method. Results: It was shown that serum IgG concentrations were 7.95±0.69g/L, 7.66±0.46g/L and 7.10±0.61g/L; IgA concentrations were 4.07±0.32g/L, 4.10±0.32g/L and 3.65±0.32g/L; and IgM concentrations were 2.01±0.21g/L, 2.92±0.29g/L and 2.16±0.16g/L in pre-eclampsia, eclampsia and normotensive pregnant respectively. There were no significant change in IgG and IgA between pre-eclampsia and eclampsia, but IgM level was found to be significantly higher in eclampsia than that in pre-eclampsia (t=7.87, p=0.0001). Except systolic blood pressure with IgG (r=0.689, p=0.04) and to some extent with IgA (r=-0.637, p=0.065), gestational age (r= -0.890, p=0.0001) and proteinuria (r=0.747, p= 0.008) with IgM; none of the maternal characteristics is associated with the serum immunoglobulin concentration in pre-eclampsia or eclampsia. Conclusion: It is revealed that serum immunoglobulins levels are elevated with pre-eclampsia and its complication eclampsia.

Opportunities for Generic Drugs in India

Fri, 06 Nov 2009 17:58:17 -0600

Branded drugs play an important role in medications, but generics are their cost effective alternatives. Generics are similar to branded drugs in terms of purity, efficacy and are perceived to be safer as compared to new drug molecules, as they tend to be older and time tested. Indian pharmaceutical market of generic drugs is increasing day by day. The present communication describes various aspects and prospects of generic drugs in Indian Pharmaceutical Sector.

Augmenting hospital funding with user fee charge: The revolving fund scheme.

Fri, 06 Nov 2009 17:58:16 -0600

Background: Health care delivery has remained crippled in most third world countries. In Nigeria, various attempts by subsequent governments to improve on it has at best been on paper.Method: Analysis of hospital data for the period spanning 7 years before the onset of the revolving fund and eleven years after its onset was done. Method of application was also documented.Result: Service delivery was improved. Morbidity was reduced. Workers moral were better. However, improved services brought in more patients, resulting in increase mortality. Conclusion: An improved revolving fund scheme practiced by many establishments may improve the general status of our institutions.

Diclofenac As Microspheres

Fri, 06 Nov 2009 17:58:15 -0600

Diclofenac is currently the eighth largest-selling drug and the most frequently used NSAID (Non-steroidal anti-inflammatory drug) in the world, since its introduction in Japan in 1974. Diclofenac is among the better tolerated NSAIDs. Only major adverse effect of Diclofenac is that it causes direct and indirect irritation of the gastrointestinal tract (GIT). To reduce the side effects on gastrointestinal tract (GIT) and to improve therapeutic efficacy of Diclofenac, it can be formulated in polymeric microspheres. A brief review on why Diclofenac is incorporated into microspheres, the polymers that can be used, various methods of preparation are given in this review article.

Cytopathological Review of Breast Lesions In Ile-Ife Nigeria

Fri, 06 Nov 2009 17:58:13 -0600

INTRODUCTION: Aspiration Cytology of breast lump is an established method of rapid diagnosis of breast lump..MATERIALS AND METHODS: The FNAC database in our hospital was assessed for relevant information. The diagnostic categories include: Normal, Inflammatory, Benign, Suspiciously Malignant and Malignant.RESULTS: 757 cases were analyzed. The age-range was13-90 years.( mean age 39.1+/- 15.6ears, ) . The peak age group was 20 - 29years (24.3 %). Benign lesions were predominant (50.2%). Malignant lesions (31.4%), suspiciously malignant 9.5% and inflammatory lesions 7.4%.The malignant and suspiciously malignant occur more in the elderly. 5(0.7%) patients were males, three of which were malignant.CONCLUSION: This study further confirms the predominance of benign breast lesions in the young. Malignant lesions predominate in the 4-5th decade of life. However, both diagnoses cut across all age groups. FNAC is a veritable tool for early diagnosis of breast cancer in a low-resource setting such as ours

Hemangioblastomas at the University Hospital of the West Indies: a retrospective survey and review of the literature

Fri, 06 Nov 2009 17:58:13 -0600

We present our experience with hemangioblastomas at the University Hospital of the West Indies, Jamaica, over a 23 year period, between January 1985 to December 2007.There were a total of five tumors from five patients with an age range of 19 to 49 years and an average age of 32.8 years. The male to female ratio was 1:4. All the tumors were within the posterior cranial fossa and no patient had more than one lesion. None of the patients were diagnosed with polycythemia vera. All patients were found to have hydrocephalus at the time of presentation. All had definitive surgery and the mortality rate was zero. To date, there have been no recurrences. None of the patients were screened for von Hippel Lindau disease.

A Comparative Study of Extra-Amniotic Infusion of Corticosteroids versus Normal Saline for Induction of Labour.

Fri, 06 Nov 2009 17:58:12 -0600

Objective: To compare the efficacy of extra-amniotic corticosteroids with normal saline in inducing labor .Material and methods: This was a prospective randomized controlled study. 50 women with a gestational age of 36 to 42 weeks, an unfavourable cervix, and medical indications for delivery were assigned to receive either 20 mg of dexamethasone in saline solution (study group n = 25) or saline solution only (control group n=25) administered extra amniotically through an intracervical inflated Foley balloon catheter.Result: The mean time intervals between induction of labor to the active phase and between induction of labor to delivery were significantly shorter in the study group compared with those of the control group (5.0 ± 1.8 hours vs 6.69 ± 1.52 hours, p < 0.001, 10.27 ± 4.70 hours vs 14.00 ± 5.57 hours, p < 0.05, respectively).Conclusion: Induction of labor with use of an intracervical Foley balloon catheter and extraamniotic corticosteroids reduces the time interval from induction of labor to delivery. Cervical ripening with extra-amniotic corticosteroids possesses the advantages of simplicity, low cost, and lack of systemic or serious side effects.

The incidence and pattern of stroke in bayelsa state, nigeria

Fri, 06 Nov 2009 17:58:11 -0600

Stroke is a major cause of death in adults’ world wild and it contributes to disability and reduced quality of life. In this study stroke patients constituted 2.3% of the total hospital admissions and 9.3% of medical admissions. In order to understand the pattern of stroke in Bayelsa state, a total number of 28 stroke patients out of 300 patients that were admitted over a period of seven months, between November 2007 and June 2008 at the Niger Delta University Teaching Hospital, Okolobiri were studied. Questionnaires which assessed their biodata, clinical and laboratory data’s were used. Risk factors assessed were hypertension (89%), alcohol (57%), tobacco smoking (53.5%), Male factor (m: f =1.15:1). The mean age of the study group was 62.2±9. 64% of the stroke patients were in the active social segment of the society. Stroke affected more of the poor society who lived in the rural areas. The prevalence of ischaemic stroke was higher than haemorrhagic stroke. In conclusion, hypertensive heart disease was a major co-morbidity of stroke.

Pott’s Spine With Bilateral Psoas Abscess In A Hiv Positive Patient

Fri, 06 Nov 2009 17:58:10 -0600

We describe a case of psoas abscess

Private providers of Healthcare in India: A policy analysis.

Fri, 06 Nov 2009 17:58:09 -0600

This paper aims to critically analyze the role of private providers of healthcare in India, especially the unqualified medical practitioners. Due to the critical shortage of human resource for health, unqualified practitioners play an important role in the delivery of healthcare to a large section of society. But their role is often ignored in policy decisions. This paper also makes some practical recommendations on the inclusion of this semi skilled health manpower in the areas which are underserved by the conventional health care infrastructure. We tried to address the issues of cost and quality of care by private providers. We also examined the increasing role of corporate multispecialty hospitals in large metropolitan urban areas.

Recent Techniques For Oral Time Controlled Pulsatile Technology

Fri, 06 Nov 2009 17:58:09 -0600

Pulsatile drug delivery system is defined as the rapid and transient release of certain amount of drug molecules within a short time period immediately after a predetermined off-release period, i.e., lag time. [1] Pulsatile drug delivery aims to release drug on programmed pattern i.e. at appropriate time and at appropriate site of action. Pulsatile systems are gaining a lot of interest as the drug is released completely after defined lag time. Pulsatile drug delivery system is time- and site-specific drug delivery system, thus providing special and temporal delivery and increasing patient compliance.

The role of Mondia whitei in reproduction: a review of current evidence

Fri, 06 Nov 2009 17:58:08 -0600

Mondia whitei has been used as a traditional cure for male infertility problems for a very long time. Unlike other medicinal plants used for treatment of male infertility, Mondia whitei effects on the male reproductive system have been thoroughly researched. This review sums-up the scientific evidence supporting Mondia whitei as an aphrodisiac.

Affordability of essential medicines used for treating chronic diseases in Malaysia: An academic perspective

Fri, 06 Nov 2009 17:58:06 -0600

The aim of this study is to measure the affordability of drugs used in treating common chronic diseases. The study was conducted in the Universiti Sains Malaysia (USM) and in 5 private retail pharmacies. The study measured prescriptions contents of Universiti Sains Malaysia panel of clinics claim forms of patients for the year 2006. Affordability of medicines used was calculated using private retail pharmacies prices. Affordability was expressed as the number of days’ salary required by lowest wage earners to pay for one month treatment. The number of day’s salary would have to pay by the worker ranged from 0.11-6.56 days’, 0.13-2.88 days’, 0.13-4.70 days’ and 1.04-2.93 days’ wage for the treatment of hypertension, diabetes, asthma and for multiple conditions, respectively. Low affordability was noted for most of the branded products, most combined treatments and all multiple chronic cases treatments. Government must intervene to ensure affordability of medicines among the public.

Maternal Deaths During Caesarean Delivery In A Developing Country-Perspective From Nigeria

Fri, 06 Nov 2009 17:58:06 -0600

OBJECTIVE: To examine the changing trend in maternal deaths during caesarean delivery in a tertiary care hospital in Nigeria over an 8 year periodMATERIALS/ METHODS:An observational retrospective study was carried out at the University of Nigeria Teaching Hospital (UNTH), Nigeria to determine the causes and risk factors for maternal deaths during caesarean delivery from July 1998 to June 2006. RESULTS: A total of 6798 women delivered during the study period. There were 1579 caesarean sections (23% caesarean section rate).There were nine documented deaths during the course of anaesthesia and surgery to given an incidence of 5.6/1000 anesthetics.Six deaths were directly attributable to anaesthesia, three were indirectly attributable. CONCLUSION: The number of maternal deaths in this study was initially high. Since the increased use of spinal anaesthesia and employment of more doctors, the rates have dropped drastically.

Impacts of deforestation on malaria in south-eastern Nigeria: the epidemiological, socio-economic and ecological implications

Fri, 06 Nov 2009 17:58:05 -0600

Forest resources in Nigeria are undergoing severe exploitation pressure due to demographic growth and socio-economic development. Through the process of forest clearing, deforestation alters the ecology of local malaria vectors. The overall goal of this study was to seek to clarify the mechanisms linking deforestation, economic development and malaria epidemiology and the ecological implications. The research methodology stresses a mix scale approach involving social research in areas of active and non-active deforestation in Ebonyi state Nigeria and the descriptive assessment and analysis of the forest resource exploitation issues, as well as the implication for sustainable forest resource management. Findings indicate that the income status of individuals residing in the areas of active deforestation was lower than those of areas of non-active deforestation. Higher yearly episodes of malaria and the tendency to spend less amount of money for malaria treatment characterized the areas of active deforestation and the inhabitants had higher preference for use of woodfuel and use of forest medicinal herbs for malaria treatment. In the areas of active deforestation, the mosquito night biting/landing rates were considerably higher than those of areas of non-active deforestation. Conservation policies aimed at slowing deforestation will impact malaria and would reduce the increasing incidence of deforestation-dependent malaria epidemics.

Knowledge, Attitude And Practice Of Ante-Natal Attendees Toward Prevention Of Mother To Child Transmission (PMTCT) Of Hiv Infection In A Tertiary Health Facility, Northeast-Nigeria

Fri, 06 Nov 2009 17:58:02 -0600

Objective: Knowledge, attitude and practice of pregnant women toward PMTCT have not been evaluated in any tertiary health facility in the Northeast Nigeria. Methods: A structured questionnaire was used to obtain data from 172 women that consecutively attended the antenatal clinic of University of Maiduguri Teaching Hospital to determine their level of knowledge, practice and attitude toward PMTCT. sResults: Knowledge on modes of transmission, risky behaviours and prevention of HIV and other STIs was high among the women. The use of breast milk substitute by HIV positive nursing mothers and condom during sexual intercourse did not receive very encouraging responses from 42 (24.4%) and 58 (33.7%) of the women respectively. Those that discourage BMS indicated spouse dislike as a major reason and the fact that the community places higher premium on breastfeeding. Majority of those that discouraged condom use said the practice was against their religious beliefs while a few believes withdrawal before ejaculation and use of antibiotics after sex can equally prevent HIV infection. Conclusion: The pregnant women accepted PMTCT as a veritable means of preventing infants from HIV infection and a means to determine HIV status. Majority implored greater involvement of male partners and other family members during PMTCT counselling sessions. Staff training, awareness creation and community mobilization were identified as key to success of PMTCT programmes and fight against stigma and discrimination.

Gastroenterologist versus Surgeon Performed Endoscopic Gastrostomy: A Multi-Centre Comparative Study.

Fri, 06 Nov 2009 17:58:01 -0600

PEG tube placement has been widely embraced by endoscopists as a means of accessing the gastrointestinal tract for feeding. In this study we compared the outcomes of PEG tube placement by gastroenterologists and surgeon endoscopists.Materials and MethodsData on PEG outcomes were retrospectively collected over 31 months from the Georgetown Hospital in the Cayman Islands where PEGs were performed exclusively by surgeons. This was compared with data collected over the same period from the University Hospital of the West Indies in Jamaica where PEGs were performed exclusively by gastroenterologists.ResultsThere were 74 PEG tubes placed by gastroenterologists and 35 placed by surgeons. The gastroenterologists had a higher collective case volume than surgeons (37 vs 18 cases per year). There were no significant differences between gastroenterologist and surgeon performed PEG in terms of procedural success (98.6% vs 100%; P=0.84), overall morbidity (6.8% vs 8.8%; P=0.71), early mortality (4.3% vs 0; P=0.549) or late mortality (11.8% Vs 0; P=0.049).ConclusionsAppropriately trained surgeon endoscopists and gastroenterologists can site PEG tubes with similar success and complication rates.

Tubercular pericardial effusion: a case report

Fri, 06 Nov 2009 17:58:00 -0600

A case of tubercular pericardial effusion is reported in a 38 year old male. There were no stigmata of tuberculosis anywhere in the body or the any evidence of immuno-compromised state .Computed tomography scan with polymerase chain reaction was diagnostic in this case. Patient was treated with anti tubercular therapy and responded well.

Sexually Transmitted Diseases- Ten Years Experience In Benue State

Fri, 06 Nov 2009 17:57:58 -0600

Prevalence of urinary schistosomiasis among aids patients in otukpo benue state.

Fri, 06 Nov 2009 17:57:54 -0600

Background: Although there has been no proven association between urinary schistosomiasis and the human immunodeficiency Virus (HIV) infection, the resulting raw surfaces and wounded mucosa that characterize infestation with genito- urinary schistosomiasis may increase the susceptibility of patients infested with this trematode to HIV infection. Hence, prevention of urinary schistosomiasis may also prevent and reduce susceptibility to HIV infection. The aim of this paper is to determine the prevalence of urinary schistosomiasis among people living with HIV/AIDS (PLWAS) and Non HIV persons in Otukpo , an urban area of Benue state where HIV / AIDS is highly endemic.Methods: sediments of the centrifuge urine of the patient were examined microscopically. Schistosoma haematobium was identified by its terminal spine.Result” four hundred (20% out of two thousand confirmed HIV patients tested positive for schistosomiasis. Two hundred and ninety (14.5%) of the non-HIV infected patients were positive for the trematode.Conclusion: the prevalence of urinary schistosomiasis is high in Otukpo area, both among the PLWAS and on- HIV persons. Preventive interventions for both schistosomiasis and HIV should be intensified in the area.

Autolobectomy in Swyer-James (Mcleod’s) Syndrome: Value of Preoperative V/Q Scan

Fri, 06 Nov 2009 11:32:59 -0600

Swyer James (Mcleod’s) syndrome (SJMS) is an uncommon disease and asymptomatic patients may not be diagnosed until later in life. A 34-year-old man with SJMS is presented in this case report. V/Q scan showed markedly diminished perfusion and ventilation in the left upper lobe which was like a surgically resected lobe (autolobectomy). This case report underlines the V/Q scan findings potentially may lead the surgeons for choosing the best surgical treatment plan.

Bone Scan Appearance of Bilateral Femoral Head Osteonecrosis Secondary to Polyostotic Fibrous Dysplasia.

Fri, 06 Nov 2009 11:32:58 -0600

We present the whole body bone scan images of a 44-year old male who complained of dizziness and vertigo. MRI showed a fibro-osseous lesion at the base of the skull involving the clivus and the greater wing of sphenoid, consistent with fibrous dysplasia. Whole body bone scan showed osteoblastic lesions involving base of the skull, right first rib, and bilateral humeri, suggestive of polyostotic fibrous dysplasia, and intense uptake in both hips. X-ray of the hips showed bilateral coxa magna with extensive hypertrophic changes. Patients with polyostotic fibrous dysplasia are prone to repeated femoral neck fractures which can cause femoral head osteonecrosis. This, we concluded, was the likely cause of intense MDP in both hips.

Acute scrotum in children: Role of nuclear testicular scanning in diagnosis

Fri, 06 Nov 2009 11:32:58 -0600

Nuclear scanning with Tech 99m pertechnitate has evolved as a major diagnostic tool for evaluating the paediatric patients with acute scrotum. It is simple, quick and accurate for differentiating the patients with testicular torsion from other causes of acute scrotum.Between march 2001 and march 2007,we prospectively studied 148 patients with acute scrotum;out of whom 91 patients were subjected to nuclear scanning.10 patients(9.9%)were diagnosed as having testicular torsion which was confirmed on surgical exploration(accuracy 100%).one patient had epididymo orchitis and one patient had missed torsion..79 patients had normal scan;All the patients with normal scan were managed conservatively with no adverse sequelae on follow up.

False-Positive Whole-Body I-131 Scan In Thyroid Carcinoma Caused By Gastrooesophageal Reflux Disease

Fri, 06 Nov 2009 11:32:57 -0600

Many false-positive findings on I-131 scans have been reported. Recognition of them may avoid unnecessary repeated therapeutic doses of radioactive iodine. The authors describe a false positive cervical and mediastinal radioiodine uptake due to gastro oesophageal reflux disease in a 63 yr-old man with papillary thyroid cancer. Trough this case report, causes of such scintigraphic features are reviewed.

Nasopharyngeal Carcinoma (NPC) : The value of 18-Florine Fluorodeoxyglucose (FDG) Positron Emission Tomography Computed Tomography (PET / CT) in comparison to conventional imaging modalities Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)

Fri, 06 Nov 2009 11:32:49 -0600

PURPOSE: To evaluate the clinical usefulness of 18F FDG PET/CT in the management of NPC in comparison to conventional imaging modalities. METHODS: This retrospective study was done at Ospedale Niguarda, Milan, Italy. Data acquired from 24 NPC patients between May 2003 and December 2006. They had FDG PET/CT and CT or MRI during initial diagnosis and at follow up. Each findings was tabulated and compared with tissue biopsy at diagnosis and clinical status during follow up after therapy. Statistical calculation was done to derive the value of each modalities.RESULTS; The sensitivity and accuracy of PET / CT and CT / MRI are equally high at diagnosis. At follow up, a negative PET / CT finding suggests complete remission with sensitivity and negative predictive value of 100%. CONCLUSIONS: 18F FDG PET/CT is a potential modality to be utilized in following up NPC patients for evaluating response to therapy.

Chronic Lead Exposure in Nuclear Medicine.

Fri, 06 Nov 2009 11:32:48 -0600

Mood, Weight, and Physical Activity Among Obese Individuals Enrolled In a Long-term Weight-loss Program: Trajectories and Associations with Gender

Thu, 05 Nov 2009 14:59:25 -0600

Objective: To examine the trajectories of mood, weight and physical activity, and associations between mood, weight, and gender, among 213 obese individuals.Methods: Prospective, longitudinal design. Assessments at baseline and 6, 12, and 18 months of Profile of Mood States, Paffenbarger Physical Activity Questionnaire, and weight.Results: Total mood disturbance decreased from baseline to 6 months, with no change thereafter. Weight decreased from baseline to 6 to 12 months, and increased from 12 to 18 months. Physical activity increased from baseline to 6 months, and 12 to 18 months. Increased physical activity predicted greater vigor and less fatigue over time. Females high in distress at 6 months lost less weight than females low in distress and at 18 months gained more weight than those low in distress. There were no such associations among males.Conclusion: The trajectories of mood, weight and physical activity were synchronous only in the short-term. Distress monitoring, targeted to females who relapse, may be warranted.

The War at Home: Consequences of Loving a Veteran of the Iraq and Afghanistan Wars

Thu, 05 Nov 2009 14:59:22 -0600

Objective. The experiences of parents, partners, and siblings of Iraq and Afghanistan War veterans were explored, to understand the consequences of repeated deployments on participants’ mental health. Method. Purposive sampling was used. Respondents completed preliminary electronic surveys and participated in one of three focus groups. Results. High levels of relationship and psychological distress exist. Reactions and coping with deployment were split along gender lines, with females reporting anxiety and males reporting avoidance or anger. Veterans returned with significant emotional demands. The need for social and emotional support was identified. Conclusion. Similar to the experiences of spouses of veterans, extended family members are negatively impacted during deployment and reintegration. They are struggling to cope and lack the necessary skills to do so. Attempts at help seeking are unsuccessful. Recommendations include training for clinicians, school counselors and physicians to address the needs of this population, and also development of support groups for families of veterans and the veterans themselves.

Book Review of “Advances in the Use of Hypnosis for Medicine, Dentistry, and Pain Prevention/Management”

Thu, 05 Nov 2009 14:59:21 -0600

Change in Serum Trace Elements Concentration before and after Removal of Gallbladder with Gallstone

Thu, 05 Nov 2009 13:14:06 -0600

Epidemiological evidence among the human population has shown a significantly increased incidence of gallstone disease worldwide. The levels of nutrients are represented by different physiological and pathological processes. The aim of this work is to analyze the change in trace element (Al, Cd, Cr, Co, Cu, Fe, Pb, Mg, Mn, Ni, Se, and Zn) concentrations of human serum 48h before and after the removal of gallbladder with gallstone in 15 patients by using Inductively Coupled Plasma – Atomic Emission Spectroscopy (ICP-AES). The results showed increased post operative serum Fe, Ni and Se levels and decreased level of other elements significantly. The results were statistically compared (p < 0.05). This study indicates the complexity of interpreting changes in trace elements in serum after surgery.

Peptic ulcer disease and helicobacter pylori infection at kano, nigeria.

Thu, 05 Nov 2009 13:14:06 -0600

Background. Helicobacter pylori infection has been identified as an important risk factor for the development of peptic ulcer disease and is probably the most important cause of relapse in those previously treated for peptic ulcer disease. The aim of this study was to determine the prevalence of Helicobacter pylori infection in patients with peptic ulcer disease at the Aminu Kano Teaching Hospital (AKTH), Kano, North-Western Nigeria.Methods. The study was cross sectional and conducted between December 2004 and May 2006. Consecutive patients with endoscopic diagnosis of peptic ulcer disease at the Endoscopy Unit of Aminu Kano Teaching Hospital, Kano were recruited. Other patients who had endoscopy within the study period for dyspepsia but with normal endoscopic findings were recruited as controls. Three gastric antral and two body biopsies were taken from each patient, and histological evaluation for presence of Helicobacter pylori was done using haematoxilin/eosin and modified Giemsa stains.Results. The Prevalence of Helicobacter pylori infectionin all the study subjects was found to be 81%. Helicobacter pylori were found present in 93.3% of patients with peptic ulcer disease. Presence of H. pylori infection in patients with duodenal ulcer and gastric ulcer were 95.8% and 90.9% respectively. However 80% of those with normal endoscopic findings also had Helicobacter pylori infection.Conclusion. Helicobacter pylori infection is very common among patients with peptic ulcer disease in Kano Nigeria. Patients with non-ulcer dyspepsia also have, to a lesser extent a high prevalence of Helicobacter pylori infection.

A Case of Merkel Cell Carcinoma Metastasis to the Head and the Body of the Pancreas

Thu, 05 Nov 2009 13:14:05 -0600

Merkel cell carcinoma (MCC) is a rare, cutaneous, malignant tumor of neuroendocrine cells. It has a high propensity for local recurrence and regional lymph node metastasis. Thus far, only two cases of MCC with metastasis to the pancreas have been reported in the scientific literature. Here we present the case of a 65-year-old male who presented with abdominal pain of gradually increasing severity over the past two weeks accompanied by jaundice, lower back pain and non-bloody vomiting. He had been diagnosed with MCC of the right gluteal mass 10 months prior with subsequent excision, radiation and chemotherapy. On current admission, computed tomography revealed two masses on the pancreas. After dual sphinctetomies of the bile duct and pancreatic duct, and covered wall stent placement, presenting symptoms resolved and continued radiation and chemotherapy prescribed. This case illustrates the possibility of metastisis of MCC to the pancreas even with excision, ration therapy, and chemotherapy of the primary site.

Complications Of PEG – Prevention And Management

Thu, 05 Nov 2009 13:14:05 -0600

Per cutaneous gastrostomy (PEG) is one of the most common procedure performed by the gastroenterologist for various indications. It has its own complications and morbidity. Complications are divided in the forms of minor and major, though majority of them are minor still they are higher in incidence with high morbidity. This review article illustrates the complications associated with PEG and various methods to prevent and manage the complications.

Long, parallel cystic duct in a patient presenting with obstructive jaundice

Thu, 05 Nov 2009 13:14:03 -0600

Cystic duct anomalies are commonly seen on ERCP and MRCP and can pose difficulty during laparoscopic surgery. We report a rare case of a 30-year-old female patient who presented with right upper quadrant pain, tenderness, jaundice, elevated liver function tests, and ultrasound evidence of gall bladder calculi with dilated CBD. Endoscopicretrograde cholangiopancreatography (ERCP) revealed a long, cystic duct running parallel to CBD. Laparoscopic cholecystectomy confirmed long cystic duct.

Acute massive lower gastrointestinal bleeding from a rectal Dieulafoy-like lesion in a patient with chronic liver disease

Thu, 05 Nov 2009 13:14:01 -0600

Recurrent and life threatening gastrointestinal hemorrhage occur rarely from Dieulafoy’s lesions. Initially described in the gastric lesser curvature, these lesions have been described in other parts of the gastrointestinal tract. We report a case of acute massive lower gastrointestinal bleeding from a rectal Dieulafoy-like lesion in a patient with a history of chronic liver disease. An overview of the possible etiology and management of this rare presentation is presented.

Caecal Lipoma, Unusual Cause of Recurrent Appendicitis, Case Report and Literature Review

Thu, 05 Nov 2009 13:13:59 -0600

Lipoma is called the universal tumour. It can occur anywhere in the body. Caecal lipomas are considered rare probably because they are often asymptomatic or only mildly symptomatic, however they can cause significant pain, melena or diarrhoea or more serious conditions like intussusception and intestinal obstruction.We report a case of caecal lipoma presented as recurrent appendicitis reviewing the literature and evaluating the clinical features, diagnosis and treatment of this disease.

Case Report: Drug Toxicity Leading to Vanishing Bile Duct Syndrome and Cholestatic Jaundice

Thu, 05 Nov 2009 13:13:59 -0600

A 37 year old black woman is described with difficult-to-control diabetes (DM), morbid obesity, hypertension, and chronic skin abscesses. During admission for control of skin abscesses, she received trimethoprim-sulfamethoxazole (TMP-SMZ), which was continued for 30 days after discharge. She then required admission for UTI and was treated with antibiotics. Metformin and glimepiride were added at the time of discharge, as parenteral insulin was poorly controlling the DM. Shortly thereafter she developed a cholestatic drug reaction, which progressed to end-stage liver disease (ESLD) with the histologic features of vanishing bile duct syndrome (VBDS). Clinical characteristics of medication-induced cholestatic liver disease and VBDS are discussed.

Hereditary protein C deficiency presenting as venous mesenteric ischemia in three successive generations

Thu, 05 Nov 2009 13:13:58 -0600

Mesenteric ischemia is an important cause of short bowel syndrome and death. This is a case report of a 48-year-old man who underwent surgery for suspected acute mesenteric ischemia. The intraoperative findings included acute mesenteric venous thrombosis with gangrene of a short segment of the small bowel. Family history revealed that his father and grandfather died of a similar disease. Laboratory findings showed protein C deficiency. In this situation acute thrombosis can be prevented effectively. Thus, Screening of the first-degree relatives of patients with definitive diagnosis of inherited thrombophilia is highly recommended.

Pathogenesis of inflammatory bowel disease (IBD)

Thu, 05 Nov 2009 13:13:58 -0600

The inflammatory bowel disease (IBD) is chronic inflammatory disease of gastrointestinal tract that include Crohn’s disease and ulcerative colitis, characterized by chronic recurrent ulceration of the bowel and of unknown etiology. They have become important health problems. In present review, the pathophysiology of IBD is reviewed, with emphasis on the genetic predisposition and inflammatory cascades underlying the production of symptoms and the course of the disease.

Post-traumatic Hepatic Cyst: An unusual sequel of liver injury

Thu, 05 Nov 2009 13:13:57 -0600

Traumatic cysts of liver are amongst the less frequently known sequelae of liver trauma. The incidence of this entity is very low. We report a case of large post-traumatic liver cyst in a young adult male, who sustained blunt abdominal trauma three months back. The cyst was diagnosed by CT scan and was treated by percutaneous drainage of the cyst with supra-cath under ultrasonic guidance. The aim of presentation of this report is to highlight the fact that this rare lesion can be safely treated by this alternative minimally invasive modality in an ambulatory setting.

Umbilical Hernia Rupture Associated with Hepatic Cirrhosis

Thu, 05 Nov 2009 13:13:57 -0600

We report an umbilical hernia rupture in a patient with hepatic cirrhosis and ascites. These patients should be identified early and the hernia electively repaired.

Acute mesenteric vein thrombosis after glue injection for Gastric varices – a case report

Thu, 05 Nov 2009 13:13:55 -0600

Mesenteric vein thrombosis (MVT) is a relatively rare condition. Here we report a case of MVT following glue injection for fundal varix. MVT is usually characterized by the presence of abdominal pain, which is out of proportion with the physical findings. The etiology of this condition is not known. Embolism can occur through a large porto- venous shunt following glue injection. Mesenteric venous thrombosis (MVT) accounts for 5-10% of patients presenting with acute mesenteric ischemia (AMI)1. The etiology of this entity is not clearly defined. Several hypercoagulable states such as antithrombin III, protein C and protein S deficiencies may play a role in pathogenesis of this entity. Here we report a case of acute mesenteric venous thrombosis following the glue injection therapy for gastric varices.

ERCP in a district general hospital in England: a review of 1550 procedures over nine years

Thu, 05 Nov 2009 13:13:51 -0600

Objectives: To describe the practice of ERCP in a district general hospital.Design: Descriptive study with prospective data collection from all patients undergoing ERCP between 1997 and 2006.Endpoints: The main outcomes were technical success (cannulation rates and therapeutic success rates) and safety (complication rate).Results: Technical success rates were high: cannulation of common bile duct was achieved in 95% of all 1550 ERCPs, increasing to 98% during 2001-2006; high success rates were also achieved for sphincterotomy, pre-cut incision, stent insertion and stone removal. The complication rate was low: acute pancreatitis occurred in 3%, perforation in 0.3% and haemorrhage in 0.4%, with a decrease in complications over time; procedure-related mortality was 0.2%. During the study period, the success rates for cannulation and therapeutic procedures increased, while complications decreased.Conclusions: ERCP in a district general hospital was associated with a high degree of technical success and a low risk of complications.

Effect Of Ovariectomy And Of Estrogen Administration Upon Duodenal Ulceration Induced By Cysteamine

Thu, 05 Nov 2009 13:13:48 -0600

Duodenal ulcers were induced in ovariectomized, intact and old mice using cyteamine hydrochloride. Under these experimental conditions ovariectomy and old age strikingly increased sensitivity to ulcer induction while estrogen administration showed a decrease in sensitivity to ulcer induction. Nevertheless, the administration of estrogen in old showed no effects in either intact or overiectomized mice. This change in ulcer sensitivity reflected from histological, histochemistry and biochemical studies. The histological study was performed by using haematoxylin-eosin staining technique. The histochemistry of the duodenal region was studied by using periodic acid Schiff reaction (PAS) for glycoproteins. The biochemical study was performed to study various constituents of glycoproteins like hexose, fucose, sialic acid and the protein. The result showed that ulcer severity was more in overiectomized cyteamine treated mice and old mice treated with cyteamine. The histological studies showed the ovariectomy decreased or not shown any change in the ulcer sensitivity considering cryptus Lieburkuhn and bruner’ glands. The same result reflected in histochemistry study by differential intensity in the staining property of the bruners gland. The biochemical study showed that the glycoprotein contents were reduced many folds in overiectomized cyteamine treated mice and their reversal in estrogen administered ovariectomized cysteamine injected mice. These findings prove that estrogen protect the duodenal ulcer form cysteamine administration.

Etiology of thrombosed external hemorrhoids: results from a prospective cohort study

Thu, 05 Nov 2009 13:13:44 -0600

Objectivive To find out causes of thrombosed external hemorrhoids (TEH). Subjects and Methods Prospective cohort study of individuals with and without TEH with comparison of answers to a questionnaire. Results One hundred forty-eight individuals were enrolled, 72 patients with TEH and 76 individuals without TEH but with alternative diagnoses, such as a screening colonoscopy or colonic polyps. Six independent variables were found to predict TEH correctly in 79.1% of cases: age of 46 years or younger, use of excessive physical effort, and use of dry toilet paper combined with wet cleaning methods after defecation were associated with a significantly higher risk of developing TEH; use of bathtub, use of the shower, and genital cleaning before sleep at least once a week were associated with a significantly lower risk of developing TEH. Conclusions Six hypotheses on the causes of TEH should be considered in future studies on etiology and prophylaxis of TEH.

Endoscopic Treatment Of Recurrent Gastro-Gastric Stricture Following Revision Of A Divided Roux-En-Y Gastric Bypass

Thu, 05 Nov 2009 13:13:40 -0600

Balloon dilation as a treatment for post-surgical anastomotic strictures is minimally invasive and relatively safe. The benefit of “through-the-scope” endoscopic balloon dilation has a reported long-term improvement for patient symptoms. This is a case report of a patient who developed severe dysphagia following revision of a divided Roux-en-Y gastric bypass with formation of a gastro-gastric anastomosis. The patient developed a gastro-gastric anastomotic stricture that rapidly recurred following multiple endoscopic dilations with balloon dilators. Following repeat endoscopic dilations, the anastomotic stricture was treated by submucosal injections of triamcinolone into the stricture, using a protocol described for esophageal strictures. Because this treatment prevented recurrent symptoms, she did not require repeat dilation for 3 months, prior to small intestinal transplantation. Repeat upper endoscopy prior to transplantation surgery revealed a patent gastro-gastric anastomosis. This case report demonstrates that injection of corticosteroid directly into a surgical anastomotic stricture improves the long-term efficacy of dilation.

Radical External Beam Radiotherapy With Intraluminal High Rate Dose Brachytherapy In Patients With Carcinoma Esophagus

Thu, 05 Nov 2009 13:13:37 -0600

Aims: - Oesophageal carcinoma is an uncommon malignancy, accounting for approximately 1% of all malignancy and 6% of all gastrointestinal malignancies, patients with carcinoma oesophagus usually present with advanced disease. A combination of external and intraluminal radiation therapy is useful to palliate these patients. We report the findings of a retrospective study done on patients with carcinoma oesophagus who were treated withExternal radiationtherapy Followed by Intraluminal brachytherapy.Methods- 21 patients who received ILBT followed by EBRT in year 2006-7, of unresectable carcinoma oesophagus without any history of previous anticancer treatment were given external radiotherapy, 40 Gy in 20 fractions over 4 weeks. After gap of two to three week all patients were given Intraluminal high dose rate brachytherapy (5 cGy /3fr/one week apart) were enrolled for this retrospective study. After completion of treatment patients were evaluated every moths for clinical response, toxicity and survival. Results- Majority of patients were ranged 48-66, with median age of presentation was 57 years. 20 (95%) were male and 1(5%) was female patient. Dysphagia free survival was seen in 20 (95%) of patients. Recurrence was seen in one (5%) patient after completion of four months of follow up. Complete response seen in 19 patients (90.4%) at the completion of treatment. Two patients (9.52%) showed persistent disease. Conclusions- The use of HDR-ILBRT, as a treatment for unresectable oesophageal cancer, was significantly effective and HDR-ILBRT contributed to improve outcomes, as well as symptoms free survival in patients with advanced oesophageal cancer. Oesophageal stricture is a common late toxicity in IBT for oesophageal carcinoma. Late complications, including oesophageal ulcer and fistula, were not seen in the present study.

Bile composition in patients with noncirrhotic portal hypertension

Thu, 05 Nov 2009 13:13:31 -0600

Background and Aims: Stasis is an important predisposing factor for gall bladder sludge and hence gall stones. The present study was done to find out whether bile composition is altered in patients with noncirrhotic portal hypertension with portal biliopathy. Methods: 35 patients with noncirrhotic portal hypertension with portal biliopathy documented on ultrasound, ERCP / MRCP were prospectively evaluated for gallbladder emptying response to fatty meal by ultrasonography using Ellipsoid method. In 10 patients with extra hepatic portal vein obstruction, bile was collected from common bile duct during ERCP for analysis. Ten healthy age and sex matched controls were taken for comparison.Results: The mean age of the patients in our study was 29.93 +11.7 years. Gallstones were seen in 16.1% and sludge was present in 9.6% of patients of extra hepatic portal vein obstruction . Gallbladder varices were seen in 29.03% patients on USG/ Doppler ultrasonography. Gallbladder ejection fraction was significantly less in extra hepatic portal vein obstruction patients than controls (40.6±16.73% vs 57.71±13.25%, p=0.007). Patients with extra hepatic portal vein obstruction had significantly higher cholesterol levels (10.32+2.96) than in controls (6.86+3.36) (p<.02) and the bile acid levels were also higher in patients than controls although statistically not significant (p=0.07)). The cholesterol saturation index was comparable in patients with extra hepatic portal vein obstruction and controls. Conclusions: Ejection fraction was significantly lower in extra hepatic portal vein obstruction compared to controls. Extra hepatic portal vein obstruction patients had significantly higher cholesterol levels than in controls and the bile acid levels were also higher in patients than controls although statistically not significant .

Verrucous Cyst In An Immunocompromised Patient

Wed, 04 Nov 2009 22:37:49 -0600

Verrucous cysts are distinctive cutaneous cysts with a verrucous lining. Like many other squamous cutaneous lesions, verrucous cysts too, are linked to Human Papilloma Virus. Clinically they have been mistaken for epidermoid cysts, dermatofibroma, basal cell carcinoma, and in this case, Kaposi sarcoma. Histologically the lesion is characterized by an intradermal infundibular cyst, lined by papillated epithelium that is marked by prominent hypergranulosis and irregular keratohyaline granules. Often squamous eddies are seen in the epithelium. While the link of verruous cysts with HPV is well documented, we describe a case of a verrucous cyst that occurred in an HIV positive patient.