Malignant hyperthermia: survival without dantrolene - a case report

We encountered a case of malignant hyperthermia in a 52 year old male undergoing open reduction/internal fixation of humerus fracture under general anesthesia. Isoflurane has been reported as a potent triggering agent of malignant hyperthermia. Dantrolene remains the gold standard for treating this life threatening syndrome but it is not available in many countries including Pakistan. However, we successfully managed our patient by timely recognition of this syndrome and administering prompt and effective symptomatic treatment

Gestational hypertension; maternal and fetal outcome in women with role of hyperurecemia

Aim of the study was to ascertain prospectively the prognostic value of serum uric acid for fetal and maternal outcomes in women with gestational hypertension. This prospective study was conducted at department of Gynae and Obs, Maternal and Child Health Center, PIMS Islamabad, from January to December 2003. A total of 200 women with a gestational age >20 weeks, and blood pressure >130/90 mmHg were inducted in the study. At presentation serum uric acid, creatinine, hemoglobin, and platelets were measured along with blood pressure. All patients were divided into group A [uric acid <4.5 mg/dl] and group B [>4.5 mg/dl] and were followed for one month after the delivery to record pregnancy and neonatal outcome. A significant difference [p<0.05] in the levels of uric acid, hemoglobin, platelet count, creatinine and blood pressure was noted between patients of group A and B. A significant decrease [p<0.05] in preterm delivery, baby birth weight and increase in fetal mortality was noted in patients of group B as compared to those of group A. Regarding maternal outcome preeclampsia [p=0.005, CI: 0.143-0.689], deranged liver functions [p=0.000, CI: 0.062-0.397], and disseminated intravascular coagulation [p=0.005; CI: 0.049-0.626] was noted in patients of group B as compared to group A. The patients of Group B showed a significant low birth weight, increased fetal mortality rate [p=0.005, CI: 0.030-0.622] and more chances of shifting neonates to NICU [p=0.002, CI: 0.164-0.667] as compared to those of group A. Hyperuricaemia in setting of gestational hypertension was associated with adverse fetal and maternal outcome

Anesthetic management of the parturient with combined protein C and S deficiency

Protein S is a vitamin K dependent co-factor of protein C. Deficiency of Protein C and S results in a hypercoagulable state, which is treated with anticoagulation. This is the first report of a patient with combined protein C and S deficiency, who underwent a Cesarean section under spinal anesthesia in KRL Hospital Islamabad [Pakistan]

Demographic pattern of male breast cancer: an institutional based study

Male breast cancer incidence rises with age with peak in the 6[th] and 7[th] decade. It is one of the rare diseases and accounts for less than 1% of all malignancies worldwide. It is usually diagnosed in the late stage with poor prognosis. The purpose of this study was to know the demographic pattern and tumour characteristic of breast cancer in men reported at Institute of Radiotherapy and Nuclear Medicine [IRNUM], Peshawar. Retrospective data was collected from the [IRNUM], Peshawar for a period of three years [2006-2008]. The evaluation was done from the histopathological reports of mastectomy and biopsy specimens. All male patients in the age group 26-86 year with breast cancer were included in the study. The age of the patients and tumour characteristics recorded were size, grade, type, skin involvement and stage. Total number of male patients with breast cancer were 31 [2.1%] out of the total patients with breast malignancy during the study period with the mean age of 58.3 years. Tumour size ranged from 2 to 12 Cm. with average of 3.6 Cm. Invasive ductal carcinoma was found in 87%, papillary carcinoma in 6.5%, each of malignant fibrous histocytoma and sarcoma in 3.2% cases. Maximum number of patients was of grade II [41%].Patients in whom stage of the disease was known were 22 cases with 45.5% had stage III disease and 32% had stage IV disease. Skin involvement was found positive in 8 [25.8%]. Due to poor health care system breast cancer is diagnosed in a late stage of the disease and prognosis is poor

Emergency surgical management of a massive anterior mediastinal teratoma in a neonate

Generally an anterior mediastinal teratoma is diagnosed because of space occupying effect which produces respiratory distress and pneumonic episodes. However there have been few reports where there was the need to address the problem soon after birth [Fig. 1] because of severe respiratory compromise 2, 3. This was also the case in our patient. A full term baby who had to be transferred from 1000 Km. distance because of none availability of neonatal surgical facility there. He was transported with respiratory support after having been diagnosed on a plain x-ray and on MRI. [Fig. 2, 3, 4]. Emergency resuscitation and management resulted in successful outcome. Details of treatment are presented in this care report