Atrial myxoma: 14 years experience

Introduction: Cardiac tumors constitute only 0.2% of all tumors. Primary cardiac tumors occur infrequently with an incidence of 0.0017% to 0.19%, estimated on autopsies performed in non-selected populations. Left atrial myxomas are the most prevalent [75% to 80%] and right atrial are less common [10% to 18%]. Surgical excision yields an excellent prognosis and recurrence rate of only 3% with a very low morbidity and mortality

Objective: We aimed to review our experiences with this rare entity and highlight the various aspects of myxoma presentation, diagnosis and outcomes

Methodology: A retrospective chart review done on patients underwent excision of myxoma with histopathological confirmation since January 1991 till December 2015. Standard surgical approach adopted was single atrial, augmented with Biatrial approach where needed

Results: A total 42 cases were identified and 28 cases with complete data were included in the analysis. Mean age was 54.4 [ +/- 17.7] years, with female predominance [58% vs. 42%]. Preoperative comorbidities included hypertension [39.2%], diabetes [28.5%], IHD, dyslipidemia, and COPD [10.7%] that were comparable among gender. The mean dimension of myxoma measured on echocardiography was 4.9x3.5x2.7 cm. Sixty four percent had left sided and 35.7% had right sided myxoma. Most common symptom was dyspnea [71%], constitutional symptoms [39.3%] and stroke in [18%]. Echo being the diagnostic modality of choice. Post-operative complications occurred in 6 patients and mortality occurred in 2 [7.2%]. Mean post-operative follow up was 8.3 months and 10 years telephonic follow up completed in [32%] cases, with 2 late non-cardiac mortalities

Conclusion: Our results showed that the prevalence of cardiac myxoma is comparable with global estimates. Female gender was predominant and age and right atrial myxoma was slightly higher in our sample compare to other published literature. Myxoma can be excised successfully with a low rate of morbidity, mortality and recurrence

Successful treatment of giant left subclavian artery pseudoaneurysm abutting the arch of the aorta and descending aorta

A 28-year-old woman presented with 3-month history of fever of unknown origin and progressively increasing cough. She was diagnosed with pulmonary tuberculosis on bronchial lavage cultures. A chest X-ray performed on follow-up showed a new opacity in the left apical area of the chest. Computed tomography scan of chest showed a large 10 cm pseudoaneurysm of the left subclavian artery 1 cm from its take off from the arch of the aorta. The pseudoaneurysm was approached through a left posterolateral thoracotomy and opened following a proximal and distal control. A 3 cm longitudinal defect was identified in the subclavian artery within its intrathoracic portion. This was debrided and repaired with an autologous pericardial patch. The patient had an uneventful recovery and remained well on follow-up

profile of 60 patients of cutaneous leishmaniasis visiting dermatology departments of Hayatabad medical complex and lady reading hospital, Peshawar

To document the profile of patients of cutaneous leishmaniasis [CL] visiting Dermatology departments of Hayatabad Medical Complex and Lady Reading Hospital, Peshawar. Irrespective of age and sex, a total of 60 patients with a clinical diagnosis of CL were enrolled for the study. A total of 38 male and 22 female patients were enrolled for this study. Age range of the patients was 15 months to 50 years. A sizeable number of patients presented with nodular presentation. CL is usually seen in males on exposed areas as noduloulcerative lesions.

Herpes zoster in children

To study the epidemiology and clinical features of childhood herpes zoster. The study was carried out from March 2008 till February 2012. Forty two cases of herpes zoster in children less than 12 years of age were enrolled from the outpatient departments of Lahore General Hospital and Jinnah Hospital Lahore. Patients were subjected to detailed history, physical examination and relevant investigations. Out of 42 patients with herpes zoster, 57.1% were males and 42.9% were females. The mean age was 8 years with an age range of 18 days to 12 years. In most patients a single dermatome was involved [69%] and thoracic dermatome was involved in the majority [40.4%]. The most common symptom was pruritus in 52%, followed by pain in 12%. A positive history of previous exposure to varicella was present in 31% patients only, and out of these 61% were exposed before the age of two years. Six patients gave history of chickenpox in mother during pregnancy. Majority of patients i.e. 83.3% showed no evidence of immunosuppression on history, examination and investigations. Three patients were anti-HCV positive [7.1%], two [4.6%] had tuberculosis, one [2.3%] patient was taking steroids and one [2.3%] was diagnosed as leukemia. Most of the children with herpes zoster had no obvious evidence of immunosuppression. History of previous exposure to varicella was found in only 31% with majority being exposed below two years of age. Herpes zoster is a relatively mild disease in children with pruritus being the main symptom in 52% and pain occurred in only 12% of cases.

Clinicopathological study of cutaneous chromoblastomycosis in Pakistan

To recognize commonest clinical presentations of chromoblastomycosis and isolate fungi responsible for causing chromoblastomycosis in our part of the world. The study included all patients with clinical diagnosis of chromoblastomycosis and skin histopathology and fungal culture confirming clinical diagnosis. The disease started in all our patients during their childhood. All presented with psoriasiform plaques and showed infection with Phialophora dermatitidis Psoriasiform plaques can be the clinical presentation of chromoblastomycosis. P. dermatitidis is the fungus commonly seen in our enrolled patients

Frequency of cutaneous leishmaniasis among clinically suspected cases, visiting tertiary care hospitals of Peshawar

Background: Cutaneous leishmaniasis is a parasitic disease that is endemic in many countries in the world including Pakistan

Objectives: To determine the frequency and distribution of cutaneous leishmaniasis among suspected cases visiting various tertiary care hospitals in Peshawar

Subjects and Methods: This was a descriptive study in which a total of 320 clinically suspected people of cutaneous leishmaniasis visiting Lady Reading Hospital Peshawar and Kuwait Teaching Hospital were enrolled. This study was conducted from Sep. 2008 to Feb. 2009

Results: Out of 320 enrolled patients, 223 were found positive for cutaneous leishmaniasis during the study period. Prevalence of cutaneous leishmaniasis was higher in local population [73.06%] than in Afghan refugees [58.66%] visiting tertiary care hospitals. There was an increased burden ofinfection among children of 0-9 years while lowest prevalence was recorded in adults above 50 years of age. Prevalence was significantly higher amongst males [76.47%] as compared to females [57.75%]

Conclusion: There is high prevalence of cutaneous leishmaniasis among suspected cases in Khyber Pakhtunkhwa, Pakistan and younger population is mainly affected. Prompt measures are recommended to control this disease

Frequency of mucocutaneous manifestations in HIV positive Pakistani patients

Mucocutaneous manifestations are commonly observed in HIV patients. These range from various opportunistic infections, inflammatory dermatoses to neoplasms and drug reactions. To observe the nature and frequency of mucocutaneous manifestations in patients of HIV, with or without antiretroviral therapy and their correlation with CD4 cell counts. The duration of study was one year, starting from July 2009 to July 2010. The patients were enrolled from the HIV clinic and inpatient departments of Jinnah Hospital Lahore. Patients meeting the inclusion and exclusion criteria were subjected to a detailed history and clinical examination. Investigations were carried out where required. Treatment profile was also noted. The data was recorded on a pro forma and was analyzed later. A total of sixty two patients were enrolled in the study. There were 49 [79%] males and 13 [21%] females. The age range was 4 to 58 years. Cutaneous manifestations were seen in 51 [82%] patients. The most common cutaneous findings were fungal infections seen in 33.87% patients, followed by viral infections [29.03%], xerosis [22.58%] and bacterial infections [12.9%]. Less common manifestations were photosensitivity, scabies and hyperpigmentation. CD4 cell count was found to be more than 455xl0[9]/ in 22 patients while it was less than 455xl0[9]/in 40 patients. Skin manifestations were found in 19 [86.36%] patients with a high count and in 33 [82.5%] patients with a low count. Cutaneous manifestations are commonly seen in patients of HIV infection

Frequency of sensitivity to Parthenium hysterophorus in patients with chronic extensive eczematous eruption

Eczema is a pruritic skin disorder of exogenous or endogenous nature. Allergic contact dermatitis is of exogenous nature and can be caused by many allergens including plants. In this quasi-experimental study, 50 patients presenting with extensive eczematous eruption were enrolled. They were patch tested with fresh crushed extract of flowers of Parthenium hysterophorus. Three patch test readings were taken at 48 hours, 72 hours and 120 hours. Patch test readings were read according to ICDRG criteria. Forty four [88%] out of 50 enrolled patients were male while 6 [12%] were female with male to female ratio of 7.3:1. Average age of the patients was 56.8 years with S.D +/- 12.6 years. Fifty four percent of enrolled patients showed positive patch test reactions to fresh crushed extract of flowers of P. hysterophorus with a male to female ratio of 5.7:1. P. hysterophorus is a leading cause of extensive eczematous eruption of exogenous type in a specific group of patients

Efficacy of terbinafine vs. griseofulvin in tinea capitis in the Northern areas of Pakistan

Since longtime griseofulvin has been in use to treat tinea capitis. However due to its decreasing efficacy, higher doses and side effects a search is going on to find out a better treatment. alternative. Terbinafine is one such therapeutic option. To compare the efficacy and safety of terbinafine and griseofulvin in tinea capitis in Northern Areas of Pakistan. Children 3 to 12 year-old who were clinically diagnosed for tinea capitis and confirmed by potassium hydroxide microscopy were included in the study. One group was treated with terbinafine at a dose of 62.5mg for children weighing less than 20kg and 125mg for those weighing 20-40kg and other group with griseofulvin at a dose of 15mg/kg body weight. Both groups were treated for a period of 4 weeks. Visits were scheduled at baseline and week 2, 4 and 6 for evaluation of efficacy and safety monitoring. Efficacy was evaluated on the basis of clinical improvement and mycological cure. Terbinafine showed comparatively higher clinical cure in our patients as compared to griseofulvin at week 2 [35% vs. 22%], week 4 [50% vs. 38%] and week 6 [70% vs. 55%] [p<0.05]. Similarly, mycologic cure with terbinafine was better than griseofulvin at week 2 [30% vs. 20%], week 4 [45% vs. 35%] and week 6 [60% vs. 50%] [p<0.05]. Trichophyton tonsurans was the most common organism isolated. There were no major side effects except nausea and abdominal pain in either group. Terbinafine is more effective than griseofulvin in treating tinea capitis in our part of the world

Role of systemic steroids in the outcome of Stevens-Johnson syndrome and toxic epidermal necrolysis

Stevens-Johnson syndrome [SJS] and toxic epidermal necrolysis [TEN] are cutaneous adverse reactions which usually develop as a result of drug therapy. The role of systemic steroids in the treatment of SJS and TEN is debatable. To see the clinical outcome of patients suffering from SJS or TEN, treated with or without steroids. Forty patients of SJS and TEN were enrolled from the inpatient department of Jinnah Hospital Lahore. Clinical data were recorded on a pro forma. Clinical outcome of patients treated with or without steroids was recorded and analyzed. A total of forty patients were enrolled in the study. Twenty nine patients were suffering from SJS and 11 were suffering from TEN. Twenty three patients of SJS [79.31%] were treated without steroids. Two patients died [8.7%] and twenty one [91.30%] recovered. Six patients were given steroids [20.68%], out of these 2 [33.3%] died and 4 [66.76%] recovered. There were eleven patients of TEN, four [36.37%] were managed without steroids, one expired [25%] and rest of the three [75%] patients recovered. Seven [63.63%] patients were given steroids, three [43.86%] patients expired while four [57.14%] recovered

Scleromyxedema in an HCV-positive male

Scleromyxedema is rare chronic cutaneous mucinosis usually associated with a monoclonal gammopathy and underlying systemic disease. We report a 42-year-old male who developed scleromyxedema and was also HCV positive