Wilson's disease; neurological manifestations in patients presenting to tertiary care facility

Objectives: to determine the frequency of various neurological manifestations of Wilson's disease in patients presenting to tertiary care facility

Study design: cross sectional study

Setting: neurology ward, JPMC, Karachi

Period: 14-03-2012 to 13-09-2012

Patients and Methods: a total of 150 diagnosed patients of Wilson's disease between the age 15 and 55 years were recruited. Structured questionnaire was used to collect the data regarding neurological manifestations of Wilson's disease along with slit lamp examination for kayser- Fleischer rings. Data were entered and analyzed in SPSS version 17. Chi-Square test was used as test of significance

Results: mean age + S.D of patients was 38.7 + 8.23 years. Most of the patients [42%] belongs to age between 41 to 50 years. Male to female ratio was 2:1. Tremor was the most common neurological manifestation [88.7%] followed by dysarthria in 77.3%, dystonia was present in 59.3%, chorea in 36%, and Parkinsonism in 28.7%. All patients had the Kayser-Fleischer ring positive. Upon stratification of gender, tremor and dysarthria were more common in males as compared to females. Only dysarthria was significantly noted to increase with increasing age up to 5th decade of life and decreased after age of 51 years. [P value < 0.001]

Conclusion: neurologic manifestations are very common in patients of Wilson's disease, tremor being the most common with male predominance

Delayed radionecrosis of the larynx: case series and literature review

Radionecrosis of larynx is a rare complication of radiotherapy in this era of mega voltage radiotherapy. We report two cases of post radiotherapy delayed radionecrosis of larynx. The data was collected from medical record, surgical record, imaging and histopathological results of two patients discussed. The radionecrosis developed between 9 to 18 months after completion of radiotherapy. Both patients ultimately required total laryngectomy

Comparison of efficacies of 10% ichthammol glycerine and 3% ciprofloxacin - 1% dexamethasone by means of sustained release of drug by wick method in treatment of otitis externa

Objective: to compare the efficacies of 10% Icthammol glycerine and 3% Ciprofloxacin - 1% Dexamethasone by means of sustained release of drug by wick method in treatment of otitis externa

Study design: quasi experimental study

Place and duration of study: department of ENT CMH, Rawalpindi from Jan 2007 to Jan 2008

Methodology: 100 patients who met the inclusion criteria were included in study divided into two equal groups of 50 each by random sampling technique. The patients in group A were given 3% Ciprofloxacin - 1% Dexamethasone and patients in group B were given 10% Icthammol glycerine wick. Both groups of patients were analyzed on third day for reduction in pain by Visual Analogue Scale [VAS] and visible reduction of edema by degree of opening of External Auditory Canal [EAC]

Results: out of 50 patients in group A 76 %[ 38] were males and 24 %[ 12] females.66 %[ 33] patients in group B were males and 34 %[ 17] females. On third day in group A, 76 %[ 38] patients had marked reduction of pain whereas14 %[ 7] had moderate and 10 %[ 5] had mild reduction. In group B, on third day 38% [19] patients had marked pain reduction, 30% [15] had moderate and 32% [16] had mild pain reduction. 86%[ 43] patients in group A had visible reduction of external canal edema as compared to 60%[30]patients in group B

Conclusion: 3% Ciprofloxacin - 1% Dexamethasone wick is more effective in treating patients of otitis externa as compared to 10% Icthammol glycerine wick

Unusual oropharyngeal foreign body

We present an unusual case of foreign body [sewing needle] in a young man, who swallowed it with bolus of food. It penetrated through soft palate into parapharyngeal space, detected with image intensifier and removed successfully. Postoperative course remained uneventful

Stapled Hemorrhoidectomy: hope or hype!

This study was carried out to assess the feasibility of Stapled haemorrhoidectomy. This included 45 patients of which twenty nine were males and sixteen females. Age ranged from 23 to 84 years. The severity of the disease ranged from 3rd to 4th degree haemorrhoids. Place of study was Sir Ganga Ram, Masood and Wishaw Hospital Scotland. Period of study was two years from October 2002 to October 2004