unusual presentation, pilomatrixoma in the buttock area - a case report

Pilomatrixoma is benign tumor of skin appendages it is rare tumor mainly involving head, neck face and upper extremities. 1 A 16-year-old male developed a lesion, over a period of 2 year, at the middle of right buttock. The presumed diagnosis was a sebaceous cyst / pyogenic granuloma. An excision biopsy was performed and the histopathologic diagnosis was a pilomatrixoma

Diffuse lung uptake on [99m]Tc-MDP bone scintigraphy-case report

A [99m]Tc-methylene diphosphate [MDP] bone scan of a 35 years old female patient performed for possible skeletal metastasis from carcinoma breast. Diffuse [99m]Tc-MDP uptake was seen in both the lung fields on [99m]Tc-MDP bone scintigraphy. Biochemical and radiological evaluation excluded all the known causes of the diffuse [99m]Tc-MDP lung uptake. Raised serum ferritin levels of 1226ng/ml [normal range for adult female = 13 - 15 ng/ml] was the only abnormal biochemical finding and attributed as the possible cause of lung uptake

Spectrum of dermatological conditions in a ruralcommunity

Objective: To determine the prevalence ofdermatological conditions in a rural community

Study Design: Cross-sectional descriptive study

Place and Duration of study: Study was conductedin Tehsil Headquater Hospital Bhawhana in May,2011

Materials and Methods: 300 patientsbelonging to Tehsil Bhawana and surroundingvillages reported in the camp. Forty three patientsboth male and female had dermatological conditionsand were included in the study. They wereevaluated, diagnosed and given treatment forvarious dermatological conditions

Results: Meanage of patients was 24.48 +/- 14.48. Out of thesePatients 17 patients [39.53%] had Scabies,6[13.95%] had Acne Vulgaris, 5[11.6%] hadurticaria, 4 patients [9.3%] had contact dermatitis, 2[4.6%] had pemphigus vulgaris [PV], 2 [4.6%]hadburn injuries, 2 [4.6%] had seborrhic dermatitis and1 patient [2.3%] each of vitiligo and Helmenthicinfections, 3 patients [6.9%] had lichen planus [LP]

Conclusion: Scabies is the most prevalentdermatological condition in rural communities andthe scenario can be improved by improvement in thehygienic conditions and the general publicawareness

Spectrum of complications of snake bites - a tertiary care hospital experience

To highlight the spectrum of haematological, central nervous system complications and treatment outcome in cases of ophitoxaemia. This descriptive analytical study was carried out at Combined Military Hospital, Kharian. All cases of ophitoxaemia admitted in Combined Military Hospital [CMH] Kharian cantonment from June 2007 to November 2008. During the study period a total of fifty cases of snake bites were admitted in CMH Kharian. These cases reported between June 2007 to Nov 2007 and then between June 2008 to Nov 2008. No case of snake bite reported from December 2007 till May 2008. There were 33 [66%] male and 17 [34%] females. The mean age was 34.8 years. The mean hospital stay was 5.06 days [maximum 13 days]. There were 34 events of haematological complications and nine patients developed central nervous system [CNS] complications including respiratory failure in seven patients warranting mechanical ventilator support. Antivenom [AV] was administered to 32 patients only. Dose of AV ranged from 40-200 ml with a mean value of 37.29 ml. The administration of AV was associated with allergic febrile reactions in twenty five patients [78.1%]. In this study four patients died with mortality rate of 8%. The bite to needle time in the patients with fatal outcome was > 24 hours. Snake bites are still associated with fatal outcome, mainly because of late administration of AV. Successful management of haematological and central nervous complications requires the availability of facilities for mechanical ventilator support and blood components

Analysis of different causes of mechanical intestinal obstruction

To find out the frequency of different causes of Mechanical Intestinal Obstruction, presenting at CMH Rawalpindi. None random convenient sampling. The study was done in CMH Rawalpindi from July 2003 to Dec. 2003. Hundred patients fulfilling the inclusion criteria were included in the study. Most of the patients were soldiers and their families. Data was collected on the patient proforma. A total of 100 patients were treated for mechanical bowel obstruction during the study period [83 male and 17 female]. Seventy- nine [79%] patients had obstruction of the small intestine and twenty-one [21%] had obstruction of the large intestine. Adhesions and External hernia accounted for almost more than half the causes of mechanical intestinal obstruction in our patients. The adhesions represent leading cause of intestinal obstruction. There were 38 cases of intestinal obstruction due to adhesions in all these cases the plain abdominal x-rays revealed the typical features of small bowel obstruction with air fluid levels and dilated loops of bowel. In 35 of these patients there was a history of previous abdominal surgery including 9 females and 26 males. The initial treatment was conservative by keeping the patients nil orally, nasogastric decompression and intravenous fluids. Intestinal obstruction is one of the common clinical conditions in Pakistan. Mechanical intestinal obstruction due limited to adhesions, is the most common cause, followed by strangulated/ obstructed external hernia, malignancy and tuberculosis

Diabetic foot infections; role of granulocyte colony stimulating factor [G- CSF]

[1] To evaluate the effects of G-CSF in eliminating infection in diabetic foot wound [2] To compare the effects with conventional diabetic foot management. Prospective, open, randomized comparative study. Medical and Surgical Department of Allied, DHQ Hospital and Nawaz Medicare Faisalabad. From Jan 2000 to Nov 2000. Fifty diabetic patients with foot infections were included in this study. The mean age was 52 years ranging from 27 to 60 years. They were divided into two equal groups [Group A and Group B], The male patients were 41 [82%] and female 9 [18%]. Forty six percent of patients were on oral hypoglycaemic drugs, and 54% on insulin. The trauma preceding infection was 20%, Peripheral neuropathy 94% and peripheral vascular disease 34%. Thirty two percent of patients were smoker. Group A were subjected to G-CSF [Neupogen] therapy [n=25] subcutanously daily for 5days in addition to conventional measures. Whereas patients in Group B received only conventional therapy. Both groups received similar antibiotic and insulin treatment. G-CSF therapy was associated with earlier eradication of pathogens from the infected ulcer [median 5 [range 2-11] vs11 [6-31] days in the group B; [p=<0.0001], quicker resolution of cellulitis [6 vs 14 days; p<0.0001], shorter hospital stay [8 vs16 days; p<0.0001], and a shorter duration of intravenous antibiotic treatment [7 vs 14 days ;p<0.0001]. No G-CSF treated patient needed surgery, whereas three patients in group B underwent toe amputation and six had extensive debridement under anaesthesia [p<0.0001]. G-CSF therapy was generally well tolerated. Granulocyte colony stimulating factor [G-CSF] may be used as a good adjuvant therapy along with conventional measures for the management of diabetic foot infection, as it promotes the healing of diabetic foot ulcer/cellulitis and consequently prevents many hazardous complications like amputation of limbs, long hospital stays, extensive and prolonged antibiotic use and last but not the least the total misery of the patients

Typhoid Fever; clinical experience with levofloxacin, its efficacy and safety

To find out the efficacy and safety of Levofloxacin in patients suffering from typhoid fever. Non-comparative and prospective study. Medical Units of Allied and DHQ Hospital [PMC] Faisalabad. From May 2002 to July 2004. All suspected febrile patients were examined and provisionally diagnosed to have typhoid fever were admitted for the purpose of study till they were satisfactorily discharged. This clinical study was conducted on 70 patients of Enteric Fever. Fifty-two patients were male and 18 were female. The mean age for male patients in the study sample was 37.58 +/- 8.13 while the mean age of females was 21.92 +/- 4.73 years. Fever as a symptom was present in all 70 [100%] of the patients. Anorexia was there in 61 [85.5%] patients and abdominal pain in 49 [70%] patients. Twenty-seven [38.5%] patients had constipation along with other features. Diarrhea was present in 6 [8.5%] patients. Relative bradycardia was present in 20 [28.5%] patients. Hepa tomegaly was there in 31[44.3%] and Splenomegaly in 24 [34.3%]. Elevated liver enzymes were found in 29 [41.4%] of the patients and blood cultures positive for Salmonella typhi was seen in 19 [27.1%] patients. Widal test was positive at dilution of 1:160 in almost all of the cases and at 1:320 dilution in 18% of cases in current study. The success rate of Levofloxacin in our study was 100% in the form of settlement of fever and other symptoms and signs. The side effects were seen in 17 [24.2%] patients. In conclusion levofloxacin is effective in treatment of typhoid fever and its use in this indication is safe

99mTc MAG3 and 99mTc DTPA; comparison to evaluate renal functions in renal transplant patients

Renal scintigraphy evaluates the renal function non-invasively. The present study was conducted to compare 99mTc MAG3 and 99mTc DTPA in renal transplant patients for the evaluation of renal functions. Materials and 99mTc MAG3 and 99mTc DTPA studies were performed on 33 renal transplant patients and 10 normal subjects, with 1 day interval in between the two studies. Renal transplant patients were categorized as normal, acute tubular necrosis, rejection, urine outflow obstruction and urinary tract infection groups on the basis of routine clinical investigations and preliminary results of scintigraphic studies. Both radiopharmaceuticals, 99mTc MAG3 and 99mTc DTPA were having equal diagnostic efficacy, however image quality with 99mTc MAG3 was superior to that of 99mTc DTPA. Renograms clearly differentiated various renal groups. Correlation between glomerular filtration rate [GFR] and effective renal plasma flow [ERPF] was good [r=0.89 at P<0.00001]. In terms of perfusion index [PI] our results with both agents were similar [r=0.96 at p<0.00001], clearly differentiating all cases of rejection from acute tubular necrosis. PI was raised in rejection cases, while normal in all other groups. In cases of acute tubular necrosis and rejection, 99mTc MAG3 based parenchymal retention index [R-20/3] was markedly raised, compared to that of 99mTc DTPA [p<0.00001]. 99mTc- MAG3 and 99mTc DTPA have equal diagnostic efficacy in renal transplant patients. However visual delineations of the kidneys is better with 99mTc MAG3, especially in cases with compromised renal functions