Pheochromocytoma: a rare cause of childhood hypertensive encephalopathy

Pheochromocytomas are rare neuroendocrine tumours of chromaffin tissues. They are catecholamine secreting tumours which cause severe hypertension and other systemic disturbances. Of all the causes of childhood hypertension, pheochromocytoma constitutes less than 1%. We report the case of a 12 years old child who presented with hypertensive encephalopathy, confirmed histologically to be secondary to pheochromocytoma, and cured with meticulous critical care and surgical resection

Brain Abscess in children

To find out the clinical presentation, radiological characteristics, various underlying predisposing conditions and causative organisms of brain abscess in children in our setup. Descriptive study. The Children's Hospital and the Institute of Child Health, Lahore, over two years from September 2001 to August 2003. All children [<16 years] presenting with brain abscess were included to study demographic, clinical and radiological features. In addition, attempts were made to find out underlying predisposing conditions and causative organisms. Twenty-five children with brain abscess were managed over 2 years. The mean age was 7.8 years [range 9 months to 16 years]. Male to female ratio was 2.1:1. Most patients [43%] presented with 4 weeks history of illness, with mean duration of illness at presentation of 29.3 days. Main presenting complaints were fever [72%], vomiting [48%], headache [44%] and convulsions [32%]. Five patients [20%] had papilledema at presentation, another 4 [16%] had paresis/paralysis and 3 [12%] had cranial nerve palsies. Majority [64%] had solitary abscess, located in parietal, temporal, frontal and occipital lobes in order of frequency. No underlying predisposing condition was identified in 8 [32%] cases; while 8 [32%] had cyanotic congenital heart disease, 5 [20%] patients had otic infection [mastoiditis], 2 [8%] were postoperative cases and one each developed brain abscess secondary to ventriculo-peritoneal [VP] shunt infection and pulmonary tuberculosis. Causative organisms were isolated in 40% cases, which included Staphylococcus aureus, Staphylococcus epidermidis, Streptococcal species, Klebsiella, E.coli and Proteus. Awareness of predisposing factors, early recognition of clinical features and understanding of the prevalent microbial profile is imperative for better management of children with brain abscess

Glimepiride - A short term trial of the clinical efficacy

Diabetes is a common disorder and is reaching epidemic proportions especially in the third world. In the last few years new drugs have emerged targeting at better pharmacokinetic and low side effect profile. Among them have been various insulin sensitizers and newer sulfonylurias. Glimepiride with an impressive tract record offered more benefits and improved quality of life. The clinical efficacy in relation to the commonly used or traditional sulfonylurias was thus evaluated in this short term open trial involving 48 patients. The objective was to determine the clinical efficacy, tolerability, side effect profile and the equivalent dose of glimepiride compared to conventional sulphonylurias. The advantages of this new second generation sulfonyluria are discussed

Computer based learning of Cardiac sound and Murmurs

It is most important that students learning cardiology are trained cardiac auscultation on the bedside on actual patients, but this is not always possible. Recording various sounds and murmurs and their reproduction on the computer in a graphic presentation serves as a good alternate. Our study demonstrates that this is an effective, ingenious and acceptable alternative. Computer based medical education is an effective method of teaching and serves to stimulate the student into interacting with the simulated patient in a game like fashion. This is especially true in cardiology, which is difficult to learn at the undergraduate level. The students hear the sounds and at the same time see the phonocardiographic representation in the real time. This makes complex sounds easy to understand where the abnormality can be instantly identified through simultaneous auditory and visual aid. Once the student understands the basic foundations the process becomes easy. Computer technology has helped the process of understanding cardiac sounds and murmurs. This technology should be freely used in conjugation with traditional bedside teaching. Ths students should become familiar with this technology to gain the maximum benefit. The future of education lies in part in the proper use of this technology especially where patients are not readily available or where the ratio of the number of student to patient is unacceptably high