Russell Body Lesions of the Colon: Case Report and Literature Review / 대한소화기학회지

Russell bodies (RB) are rare manifestations within the lower gastrointestinal tract. To date, there are only three other reported cases of RB lesions of the colon; two were polyps, and the third was a case of a multifocal RB lesion of the gastrointestinal tract. This paper reports a case of a tubulovillous adenoma with RB of the sigmoid colon in a patient diagnosed incidentally as part of the UK National Health Service Bowel Cancer Screening Programme. A thorough hematological investigation is required to exclude hematological malignancies because of its association with plasma cell neoplasm. These lesions should undergo clonality analysis to exclude the monoclonal proliferation of plasma cells. Ideally, a bone marrow aspirate and investigations for amyloidosis should be performed to exclude underlying hematological malignancies.

Russell Body Lesions of the Colon: Case Report and Literature Review / 대한소화기학회지

Russell bodies (RB) are rare manifestations within the lower gastrointestinal tract. To date, there are only three other reported cases of RB lesions of the colon; two were polyps, and the third was a case of a multifocal RB lesion of the gastrointestinal tract. This paper reports a case of a tubulovillous adenoma with RB of the sigmoid colon in a patient diagnosed incidentally as part of the UK National Health Service Bowel Cancer Screening Programme. A thorough hematological investigation is required to exclude hematological malignancies because of its association with plasma cell neoplasm. These lesions should undergo clonality analysis to exclude the monoclonal proliferation of plasma cells. Ideally, a bone marrow aspirate and investigations for amyloidosis should be performed to exclude underlying hematological malignancies.

Quality of drug stores: Storage practices and regulatory compliance in Karachi, Pakistan

Objective: To assess and evaluate the drug storage quality and regulatory compliance among privately operated drug stores of Karachi Pakistan

Methods:A cross-sectional survey of drug stores located in Karachi was conducted from May to December 2013. A total of 1003 drug stores that were involved in the sales, purchase and dispensing of pharmaceutical products were approached by non-probability purposive sampling technique, and the information was collected using a close ended, structured questionnaire

Results:Out of 1003 drug stores inspected only 4.1%[n=41] were found compliant to regulatory requirements. Most of the stores 74.9%[n=752] were selling general items along with the drugs. Only 12%[n=124] stores were having qualified person working on the store, out of which 33% were pharmacist. 47.4%[n=400] of the stores had drug sales license displayed in the premises and 33.4%[n=282] of the stores had expired drug sales license. 11.4%[n=94] stores were found selling vaccines without proper refrigerator and only 11.7% stores had the power backup for the refrigerator. Only 40.2%[n=403] of stores were protected from direct sunlight and 5.4%[n=54] having air conditioning in the premises

Conclusion:The regulatory compliance of majority of the drug stores operated privately in different areas of Karachi is below standard. Only a few drugs stores have adequate facilities to protect the drugs from extreme temperature, sunlight and provision of refrigeration. Very few of the drug stores carry out drug sales under the supervision of qualified pharmacist. There is a dire need to improve the storage practices in the drug stores by complying with the regulatory standards/laws as specified by the Drug Regulatory Authority of Pakistan

Influence of size of tympanic membrane perforation on outcome of myringoplasty

The objective of this study was to determine the influence of size of central tympanic membrane perforation on outcome ofmyringoplasty. Descriptive-Interventional Study. ENT Department PNS SHIFA Karachi. The study was completed in seventeen months from 22nd August 2009 to 22nd Jan 2010. The study consists of 60 cases. Non-Probability Convenience Sampling. After obtaining informed consent sixty patients undergoing myringoplasty at PNS SHIFA Karachi during the study period fitting the inclusion criteria were selected. Patients were examined and the size of tympanic membrane perforation was recorded. Perforation up to two quadrents was labeled as small perforation, three quadrents as large perforation and four quadrents labeled as subtotal perforation. The patients were managed by myringoplasty using Endaural incision with underlay technique to place the graft harvested from Temporalis fascia under General Anesthesia. All surgeries were performed by second author [senior consultant surgeon]. After undergoing myringoplasty patients were followed in ENT OPD on 2nd week to check the status of ear after removal of BIPP and eight weekly interval to check complete healing of graft for final result.:After 8wks 100% [n=20] patients with small perforation, 85% [n=17] with large perforation and 60% [n=12] with subtotal perforation had perfect healing and graft was intact. Smaller perforations have a greater chance of healing after surgery

Cranioplasty our experience in last 5 years

The incidence of craniofacial deformities in our country is not less than other countries. However the surgical treatment of these deformities is considered either difficult or out of the reach for most people. We present our experience at PNS Shifa in the last 5 yrs. Five cases of craniofacial anomalies were operated at PNS Shifa, Karachi, from 2005 to 2010. Two had hypertelorism; one associated with frontonasal encephalocoele; one with plagiocephaly, one had Scaphocephaly and one with microcephaly. All the cases recovered well from surgery. Average age at surgery was 5 months. One case [20%] developed CSF leakage from nose and had to be re-explored. Cosmetic results were from good to very good. With better facilities of anesthesia and better imaging techniques the surgery for craniofacial deformities is becoming safe and available in our country.

Tympanic membrane disintegration by otomycosis

To report ear drum disintegration in cases of otomycosis. Case series study. E.N.T and Head and Neck Surgery Department PNS Shifa Hospital Karachi and E N T Department of Combined Military Hospital, Quetta Cantt from August 2009 to October 2010. 242 patients with clinical diagnosis of otomycosis were registered over a period of 15 months. On registration ear was meticulously cleaned under microscope removing fungal debris to establish the integrity of eardrum. In the same sitting cream with combination of triamcinolone acetonide, neomycin sulphate, gramicidin, nystatin was applied all around within external auditory meatus [EAM] on effected walls and same drops were advised locally thrice daily for 3 to 5 days. Every patient was advised to report back immediately on occurrence of irritation, earache, ear discharge, blockage of ear and pain. Out of 242patients [140 males and 102 females] 110 [45.45%] were cured after single visit as outpatient adopting a regimen of single application of antifungal cream and thrice daily antifungal ear drops for 5 days after proper cleaning of fungal debris from EAM. 73 [30.16%] cases were cured of otomycosis after two sittings of same regimen. 59 [24%] patients neglected the otomycosis for days to weeks till the time pain became unbearable. In 18 [7.43%] patients ear drum was perforated by otomycosis and all these patients had neglected the disease. Neglected Qtomyeosis has all the potentials to create a defect in ear drum causing chronic disability .Meticulous cleaning and local antifungal therapy still remains the gold standards for curing otomycQsis

Acute parapharyngeal abscess secondary to streptococcal mastoiditis

A rare case of parapharyngeal abscess caused by Streptococcus pneumoniae presenting as neck abscess is reported. The patient had 20 days history of cough, fever and swelling behind right ear. He had not responded to multiple antibiotic treatments given earlier. On the basis of clinical examination and CT scan finding, he was diagnosed as having parapharyngeal abscess pointing in the neck. The abscess was drained and the patient was treated with injectable Ceftriaxone, due to identification of penicillin - resistant Streptococcus pneumoniae

neglected foreign body in the nasopharynx

Foreign bodies of upper aerodigestive tract in young children are frequently encountered by ENT specialists due to their peculiar habit of putting objects in their mouth. We report a case of foreign body nasopharynx that remained undiagnosed for a long time despite multiple visits to general and ENT OPD's with complaints of complete nasal obstruction and history of foreign body ingestion by a child. A radio-opaque foreign body of the nasopharynx was revealed on X-ray and removed per orally under general anaesthesia resulting in complete resolution of symptoms. The physician must have a high index of suspicion, particularly for persistent symptoms and necessitates further investigation before making diagnosis of a case of rhinosinusitis or empirically prescribing antibiotics

Compartive study of laser and conventional surgery in laryngeal diseases

CO2 Laser in laryngeal disease has been discussed only insufficiently in literature and even those reported were individual case reports with small caseloads. This comparative study was carried out during June 1995 to June 1997 at CMH Rawalpindi involving a total number of 100 patients. Purpose of this study was to compare conventional surgical techniques currently in practice with that of laser. Some advantages and disadvantages of both the techniques are discussed. The financial effects of both the techniques are also compared. The addition of the carbon dioxide laser to the instrumentation available to the laryngeal surgeon has improved the precision of traditional endolaryngeal surgical procedures and has made the endolaryngeal approach possible for operations formerly performed only by external approaches