Evaluation of anesthetic efficacy of 4% articaine as buccal infiltration vs 2% lidocaine as IANB in the mandibular 1st molar with irreversible pulpitis

The purpose of this prospective, randomized, study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:200,000 epinephrine for buccal infiltration and inferior alveolar nerve block respectively in patients experiencing irreversible pulpitis in permanent mandibular first molars. Sixty emergency patients diagnosed with irreversible pulpitis of a mandibular first molar ran-domly divided into two groups. Thirty patients received buccal infiltration of 1.7 ml of 4% articaine with 1:100,000 epinephrine and thirty patients received standard inferior alveolar nerve block with 1.8 ml of 2% lidocaine with 1:200,000 epinephrine. Endodontic access was begun 10 minutes after solution deposition, success [anesthetic efficacy] was defined as none or mild pain [Visual Analogue Scale recordings] on endodontic access preparation or pulp extirpation. Twenty-two patients out of 30 did not experience pain with 4% articaine [success = 52.4%] and 20 out of 30 patients did not experience pain in 2% lignocaine group [success = 47.6%]. There was no statistically significant difference between the articaine formulation as buccal infiltration and lidocaine formulation as IANB with regard to anesthetic success [p value =0.220]. Even though buccal infiltration of 4% articaine and IANB of 2% lidocaine were equally effective, buccal infiltration can be considered a viable substitute in IANB for anesthetizing mandibular first molar with irreversible pulpitis

Etiology and incidence of maxillofacial skeletal injuries at tertiary care hospital, Larkana, Pakistan

The objective of this study was to determine the causes, incidence and distribution of maxillofacial injuries. This was a descriptive study performed at the tertiary care hospital of Larkana [Accident and Emergency Department of Chandka Medical College, Hospital and Outpatient's Department of Bibi Aseefa Dental College Hospital, Larkana] from 1st February 2011 to 30th August 2013. Two hundred and eighty eight patients of maxillofacial injuries were included in this study patients less than 11 years of age, suffering from neurological disorders and patients with isolated cases of dental and nasal injuries or only with facial lacerations were excluded. Information and data were collected from history, clinical examination and surgical preoperative records of each patient. Results showed that the most common etiology was road traffic accident [170] 59%, interpersonal violence [31] 10.76%, gunshot injuries [28] 9.7%, falls [19] 6.5% and others [40] 13.88%. The mandible was the most frequent bone fractured, which accounted for [148] 50.38% followed by zygomatic complex [52] 18% and [24] 8.3% maxillary bone. Fracture in combination form involved [64] 22%. It was concluded that road traffic accident was the most common etiological factor of maxillofacial skeletal trauma, while second most common cause was the interpersonal violence. Mandible was the most commonly fractured bone

Prevalence of dental caries in Bibi Aseefa Dental College, Larkana areas

The study was conducted for the first time in Bibi Aseefa Dental College [BADC], Larkana from April 2012 to March 2013 to evaluate the prevalence of dental caries in Larkana city and its adjoining areas, and to know the effect of age, gender, socioeconomic status, oral hygiene status and attitude towards dental awareness to caries prevalence. It was a Cross-sectional study. Six hundred patients between 13-20 and 21-30 years of age were selected from dental OPD, BADC, Larkana. The dentition was examined using WHO 1997 guidelines. The results were tabulated and statistically analyzed. Chi-square test was used to evaluate results. The overall caries prevalence in 13-20 years and 21-30 years old groups in Larkana city and adjoining areas determined was 100%.The mean DMFT value was higher i.e. 3.42 in age group 13-20 years. Besides age, the gender, socioeconomic status, oral hygiene status and attitude towards dental awareness were significantly related to dental caries prevalence. It was concluded that prevalence of dental caries in Larkana city and its adjoining areas was found considerably higher, and it was significantly related to bad oral hygiene and socioeconomically deprived patients which indicates lack of awareness and motivation. Prevalence of dental caries decreased with increasing age

Frequency of fourth canal in permanent mandibular first molars

This study was carried out to investigate the frequency of fourth [distolingual] canal in the permanent mandibular first molars and to determine the effect of modified access cavity preparation for endodontic treatment. It was an observational study. The study was conducted at the Department of Operative Dentistry, Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad from September 2009 to February 2010. Two hundred permanent mandibular first molars were selected from male and female patients presenting for endodontic treatment. The method used for exploring the fourth canal was the modified access cavity preparation which involved changing the triangular access cavity shape to a quadrangular shape. The study involved careful selection criteria, pre-operative radiological examination and then triangular access cavity preparation. The number of canals found by triangular access cavity preparation was noted on the proforma before extending the shape to a quadrangular shape and then a thorough exploration of the floor of the pulp chamber was done. Finally, if fourth canal was present, the presence of the fourth canal was confirmed by taking two periapical radiographs at two different angles with 15 # K files in the root canals. The data collected were analyzed using the chi square test. The results showed that fourth canal was found in 36% of permanent mandibular first molars. The effect of modified access cavity preparation was significantly higher [P= 0.0001] in cases with a fourth canal than in teeth with three canals [P= 0.05]. Statistically there was insignificant difference [P= 0.7] between the genders for the occurrence of fourth canal. This study demonstrates that there is a greater frequency of fourth canal in the permanent mandibular first molar teeth than previously thought. Also changing the shape of access cavity from a triangular outline to a quadrangular outline facilitates in locating the fourth canal

Validity of different methods for MB-2 canal location in permanent maxillary molars

The purpose of this study was to evaluate the effectiveness of naked eye examination and Dental-operating microscope [DOM] examination for the location of second mesiobuccal canal [MB-2] in extracted maxillary first and second molars, considering the sectioning of the tooth as gold standard for the location of MB-2. This was a cross-sectional comparative study. One hundred extracted permanent maxillary first and second molars [50 of each] were stored in 10% neutral formalin. Using high speed headpiece standard endodontic access cavities were prepared. Initially, the mesiobuccal, distobuccal and palatal canals were located. Subsequently, the location of MB-2 canal was attempted by examining the pulp chamber floor with naked eye using only an endodontic explorer and canal confirmed with 10# K-file. MB-2 canal orifice was either located or not located with this method. Teeth in which MB-2 canal was not located were further explored under DOM. Yet again MB-2 canal orifice was either located or not located. Finally the mesiobuccal roots of each tooth were sectioned. The sections were explored with endodontic explorer and 10# K file with the adjunctive use of DOM at a magnification of 12x to decide the real presence of MB-2 canal. 42% and 60% of MB-2 canals in maxillary first molar, 20% and 38% of MB-2 canals in maxillary second molar were detected with naked eye and with DOM examination respectively. While 66% and 42% of MB-2 canals were actually present in maxillary first and second molar respectively as confirmed by gold standard [sectioning of teeth]. It is concluded that DOM examination may be more effective for location of the MB-2 canal than naked eye examination

Microvascular decompression in patients with intractable idiopathic trigeminal neuralgia

To evaluate etiology and implications of microvascular decompression [MVD] in patients with intractable idiopathic trigeminal neuralgia. Descriptive case series. Neurosurgery department of Hayatabad Medical Complex, Peshawar from January 2007 to December 2009. Patients with idiopathic trigeminal neuralgia [ITN] irrespective of age and sex, were included in the study. Patients responding to medical treatment were excluded. MRI brain was done for all patients to exclude secondary causes. Microvascular decompression was performed in all patients under general anesthesia. Patients were examined on seventh postoperative day and the clinical findings were documented. Outcome of surgery was declared as successful when there was a commensurate relief of neuralgia paroxysms and deep background pain along with total withdrawal of medications. Fifty two patients were operated for trigeminal neuralgia. There were 23 [44%] males and 29 [56%] females [M:F 1:1.26]. Age ranged between 20-70 years [Mean 56 years]. Right sided neuralgia was present in 34 [65%] cases. In 50 cases [96%] a neurovascular conflict was found. The superior cerebellar artery [SCA] was the cause of compression in 45 [86.53%] patients, anterior inferior cerebellar artery [AICA] in two patients, and one patient each, the vessel involved was posterior inferior cerebellar artery [PICA], basilar artery, and petrosal vein. In 2 patients trigeminal nerve was found encased by tight arachnid adhesions. Trigeminal nerve entry zone was the point of conflict in 38 cases [73.07%]. The mandibular division [V3] was involved in 30 cases [57.7%] followed by maxillary division [V2] in 18 cases [34.61%] and ophthalmic division [V1] in 4 cases [94.23%]. Cerebrospinal fluid [CSF] leakage occurred in 3 cases [5.76%]. One patient developed wound infection. One patient [1.92%] expired in the postoperative period due to mid brain stroke. The main etiological factor of trigeminal neuralgia was vascular compression, especially by SCA, of the 5[th] nerve roots at brain stem. Microvascular decompression is safe and effective therapy for all ages

Management of supratentorial brain abscess

To analyze the management out come of symptomatic supratentorial brain abscess by burr hole aspiration. This descriptive study with 40 cases of symptomatic unilocular supratentorial pyogenic brain abscess was conducted at Department of Neurosurgery, Hayatabad Medical Complex, Peshawar from February 2006 to January 2008. Patients having history of headache for more than 14 days and diagnosed with contrast enhanced CT scan were included in the study. All patients were continued on antibiotic and were followed weekly for 1[st] month then monthly till the CT brain showed abscess resolution or no response to treatment was found. The data was recorded and analyzed using SPSS version13.0. The longest diameter on preoperative CT scan was measured in all patients, which ranged from 2.3cm to 4.1cm, with a mean of 3.39cm +/- 0.5. Male to female ratio was 2:1 and mean age was 12.6 +/- 9.7. Out of 40 patients, 13[32.5%] patients required aspiration only once, 18 [45%] required twice and 9 [22.5%] patients for three times. All patients were followed for period of 3 to 7 months; the mean follow up period was 4.4 months +/- 1.033. The treatment was successful in 95% patients as only two patients [5%] did not show any response to treatment and required further excision. Burr hole aspiration is a reasonably good method to treat symptomatic unilocular supratentorial brain abscess that is larger than 2 cm

Role of ultrasound in rotator cuff tears

The objective of the study was to determine the role of ultrasound in rotator cuff tears and to calculate the sensitivity, specificity, positive and negative predictive values of ultrasonographic findings in Supraspinatus tears with magnetic resonance imaging [MRI]. Validation study. The study was conducted in the Radiology Department CMH Lahore, from April 2004 to October 2004. This study included 40 patients above 35 years of age who presented with shoulder pain and were referred for Ultrasound shoulder in Radiology Department. They were followed for their Magnetic Resonance Imaging [MRI] performed in Children Hospital. Defence National Hospital Lahore and Military Hospital Rawalpindi. Out of 40 patients 17 patients were diagnosed as having rotator cuff tears on ultrasound while 23 patients were normal. When MRI was conducted in these patients, it showed 19 rotator cuff tears while 21 patients were normal. Out of 17 patients with cuff tears on Ultrasound, 10 showed full thickness tears while 7 had partial thickness tears. Out of 19 patients with cuff tears on MRI, 11 had full thickness tears and 8 had partial thickness tears. Ultrasound should be the primary diagnostic method for shoulder pain and detection of rotator cuff tears because it is economical, noninvasive, quick and easy to perform. The MRI technique should be used secondarily because it provides more information about extent of tendons and has lower risk of artifacts

Diagnostic upper gastrointestinal endoscopy

To evaluate Oesophagogastroduedenscopy [OGD] in term of its indications and endoscopic findings. Retrospective audit. Medical "C" unit Department of Medicine Government Lady Reading Hospital Post Graduate Medical Institute Khyber Medical University Peshawar from July 2002 to June 2007. Adult patients who underwent upper gastrointestinal [GI] endoscopies during the last 5 years period were included in the study. The procedure was performed as per the standard protocol with diagnosis based on established criteria. A total of 2282 were scoped 53.3% [n=1216] were female and 467% [n=1066] male. The mean age of the study population was 43.75 Standard Deviation [SD] +/- 1800 Dyspepsia [54.5%], upper GI bleed [12.3%], recurrent vomiting [11.1%] and dysphagia [7.8%] accounted for the common indications of the procedure. Endoscopy was normal in 164% [n=374] of patients Amongst the others [n=1908] single endoscopic diagnosis was made in 91% of the patients and in the remaining 9% of patients combination of lesions were seen. The endoscopic findings included gastritis and duodenitis alone or in combination [29.4%] oesophagitis [13.9%] duodenal ulcer [6.6%] gastric ulcer [7.4%] oesophageal varices [3.7%] and growth oesophagus [2.9%]. Gastric ulcer was more common than duodenal ulcer. Upper GI endoscopy is safe and an excellent diagnostic modality with high diagnostic yield. Dyspepsia upper GI bleed recurrent vomiting and dysphagia are the commonest indication for OGD. Gastro-duodenitis oesophagitis peptic ulcer disease oesophageal varices and growth oesophagus are the common endoscopic diagnosis

Percutaneous needle peritoneal biopsy in the diagnosis of exudative ascites

Percutaneous needle peritoneal biopsy in diagnosis of exudative ascites has gained wide acceptance and many workers have utilized it with a high diagnostic yield and no significant complications. Present study has been carried out to determine the efficacy of percutaneous needle peritoneal biopsy in the diagnosis of exudative ascites of unknown aetiology. It is a descriptive case study conducted in Medical 'C' Unit, Lady Reading Hospital, Postgraduate Medical Institute, Khyber Medical University Peshawar over a period of 2 years, i.e., from Nov, 2003 to December 2005. A total of 45 patients having unexplained exudative ascites underwent blind needle peritoneal biopsy. The biopsy specimen was subjected to histopathology. Ascitic fluid was also obtained for analysis. Post biopsy patients were observed for 24 hours for any untoward complications. A total of 45 patients [17 male and 28 female] with age range from 20 to 65 years and having exudative ascites were studied. The commonest presentation of our patients was abdominal distension [93.3%], pain abdomen [46.67%], fever [44.4%] and weight loss [33.3%]. Histopathology of the peritoneal biopsies was reported as follows. Eighteen cases [40%] showed non specific chronic inflammation, 10 [22.2%] cases showed caseating granulomatous inflammation suggestive of tuberculosis and 6 [13.3%] cases showed metastatic adenocarcinoma. In one patient peritoneal mesothelioma was reported. In the remaining10 patients [22.2%] biopsies were either non representative or inconclusive. The ascitic fluid showed predominantly lymphocytes in 86.6% of cases. Only three patients were reported to be having atypical cells on fluid cytology. The procedure was found safe. No patient was lost due to complications related to the procedure. Only one patient had evidence of intra peritoneal bleed. The commonest problem post biopsy was pain [91.1%] and mild swelling [53.3%] at biopsy site. Peritoneal biopsy is fairly safe and inexpensive procedure with good diagnostic efficacy in patients with undiagnosed exudative ascites

Dengue fever outbreak: a clinical management experience

To determine the frequency of dengue as a cause of fever and compare the clinical and haematological characteristics of Dengue-probable and Dengue-proven cases. An observational study. The Combined Military Hospital, Malir Cantt., Karachi, from August 2005 to December 2006. All patients with age above 14 years, who were either hospitalized or treated in medical outdoor clinic due to acute febrile illness, were evaluated for clinical features of Dengue Fever [DF], Dengue haemorrhagic fever [DHF] and Dengue Shock Syndrome [DSS]. Patients showing typical clinical features and haematological findings suggestive of Dengue fever [As per WHO criteria] were evaluated in detail for comparison of probable and confirmed cases of Dengue fever. All other cases of acute febrile illness, not showing clinical features or haematological abnormalities of Dengue fever, were excluded. The clinical and laboratory features were recorded on SPSS 11.0 programme and graded where required, for descriptive and statistical analysis. Out of 5200 patients with febrile illness, 107[2%] presented with typical features of DF, 40/107[37%] were Dengue-proven while 67/107[63%] were Dengue-probable. Out of Dengue-proven cases, 38 were of DF and 2 were of DHF. Day 1 temperature ranged from 99-1050C [mean 1010C]. Chills and rigors were noticed in 86 [80%], myalgia in 67%, headache in 54%, pharyngitis in 35%, rash in 28%, and bleeding manifestations in 2% cases. Hepatomegaly in 1[0.5%], lymphadenopathy in 1[0.5%] and splenomegaly in 12 [11.2%] cases. Leucopoenia [count < 4x109 /L] was noted in 73%, platelet count <150 x109 /L in 84% and ALT > 40 U/L in 57% cases. Frequency of clinically suspected dengue virus infection was 107 [2%], while confirmed dengue fever cases were 40 [0.8%] out of 5200 fever cases. Fever with chills and rigors, body aches, headache, myalgia, rash, haemorrhagic manifestations, platelet count, total leukocyte count, and ALT, are parameters to screen the cases of suspected dengue virus infection; the diagnosis cannot be confirmed unless supported by molecular studies or dengue specific IgM

Study of raised alanine aminotransferase in patients of type 2 diabetes mellitus

The aim of the study was to determine frequency of fatty liver, hepatitis C and hepatitis B in type 2 diabetes with raised ALT in our population. This was a descriptive study. Study has been carried out at medical out patient clinic in CMH Malir, over a span of one year [2005-2006]. We studied patients of type 2 diabetes who had persistently raised serum ALT [alanine aminotransferases] for more than eight weeks. In medical out-patient clinic, 101 patients of type 2 diabetes with raised serum ALT were studied.Age, sex, BMI [body mass index] and duration of diabetes were recorded and blood was tested for plasma fasting glucose, triglycerides, cholesterol, anti HCV antibodies and HBsAg. Ultrasonography of upper abdomen was done in all patients to look for liver size, fatty liver or any evidence of chronic liver disease. Results showed positive association of raised ALT in type 2 diabetic patients with high body mass index, recent onset diabetes, fatty liver, raised triglycerides and poorly controlled diabetes. About 22% of the studied patients were positive for hepatitis C. Mild to moderate elevation in serum ALT is commonly encountered in patients of type 2 diabetes mellitus. Most of these individuals are overweight and/or have fatty liver on ultrasonography

Upper gastrointestinal endoscopic findings in patients with dyspepsia

The aim of the study was to evaluate oesophagogastroduedensocopy [OGD] findings in patients presenting with dyspepsia. This retrospective, observational study was conducted in Medical "C" unit. Department of Medicine Post Graduate Medical Institute Government Lady Reading Hospital Peshawar from August 2002 to September 2005. Adult patients who underwent upper gastrointestinal [GI] endoscopies for dyspepsia during the period were included in the study. The endoscopies were performed as per the standard protocol with diagnosis based on accepted criteria. A total of 765 patients with dyspepsia had endoscopy. Amongst them 49.8% [n=381] were female and 50.2% [n=384] male. The mean age of the study population was 39.43 years [SD+ 17.46]. A single endoscopic diagnosis was made in 57.2% [n=438] of the studied patients. In 12.8% [n=98] combinations of lesions were seen. Gastritis [13.85%, n=106], oesophagitis [11.1%, n=85], duodenal ulcer [8.1%, n=62], hiatus hernia [7.32%, n=56], duodenitis [7%, n=54%] and gastric ulcer [3.4%, n=26] were the common finding on endoscopy. Duodenal ulcer was more common as compared to gastric ulcer [8.1% vs. 3.4%]. Endoscopy was normal in 30% [n=229] of patients. These patients apparently had functional dyspepsia. Gastro-duodenitis, oesophagitis, peptic ulcer disease and hiatus hernia are the commonest endoscopic diagnosis in patients with dyspepsia. Upper GI endoscopy is a useful diagnostic modality in elucidation of the causes of dyspepsia

Acute extradural haematoma: factors affecting the outcome

The objective of the present study was to determine the factors that affect the outcome in the management of acute extradural haematoma. Material and The study was carried out at the Department of Neurosurgery, PGMI Hayatabad Medical Complex Peshawar, from 1st January 2000 to 31st December 2001. The clinical record of patients who were operated for acute extradural haematoma in the Neurosurgical Unit was reviewed. Their clinical condition, Glasgow coma score [GCS], duration and mode of trauma at the time of presentation were noted. The CT Scan findings, and the surgical procedure done, were analyzed. The postoperative outcome was assessed on the basis of Glasgow coma score. In this study 108 patients operated for acute extradural haematoma were selected. The ages ranged from 8 months to 65 years with male to female ratio of 5:1. Out of these patients, 26 [24%] were less than 15 years, 38 [35.1%] were between 16 and 30 years, 32 [29.6%] between 31 and 45 years. A satisfactory out come was achieved in 74 [69%] cases that presented within 12 hours as compared to those who presented late. Patient's age less than 45 years had better outcome as compared to those with more than 45 years of age. Mortality rate was 8% [n=7]. Timely surgery in patients who are in younger age group has better out come. The size of the haematoma and mode of trauma are also important factors that affect the outcome

Frequency and clinical course of hepatitis E in tertiary care hospitals

To find out the frequency of hepatitis E virus as a cause of acute hepatitis and its clinical course in hospitalized patients. Design: Cross-sectional hospital-based study. Place and Duration of Study: The study was conducted in two tertiary care teaching hospitals i.e., Khyber Teaching Hospital and PGMI Lady Reading Hospital, Peshawar [Pakistan] from January to December 2002. Patients and Amongst the total number of 1922 admitted patients, 148 had history of nausea, vomiting and jaundice and raised serum bilirubin with raised hepatic transaminases [ALT], were screened for HBV [hepatitis B virus], HCV [hepatitis C virus] and subsequently for HEV [hepatitis E virus]. Acute hepatitis A, autoimmune hepatitis and Wilson's disease were excluded by doing appropriate test as and when required. The patients with hepatitis E were then monitored by checking their serial transaminases on day 1,4,8 and day 18 or until their transaminases dropped to normal. They were also clinically assessed and followed-up. Amongst the total admission of 1922 patients during one year period, 148 had acute hepatitis and out of these, 21 patients [14.189%] suffered from hepatitis E. Seventeen patients were below the age of 40. There were increased number of cases during the late summer and early winter seasons. Majority of the hepatitis E patients recovered during the short follow-up period of two weeks. Two patients had fulminant hepatitis. A four months pregnant young female died of her illness despite intensive treatment. Hepatitis E virus is fairly common cause of acute hepatitis in hospitalized patients. Most of the patients are having a benign self-limiting illness

Surgical management of trigeminal neuralgia by microvascular decompression

To find out the of Microvascular Decompression for trigeminal Neuralgia, not responding to conservative treatment. Material and Between January 1998 and December 2001. Fifty patients underwent Microvascular decompression for trigeminal neuralgia in the Department of Neurosurgery, Hayatabad Medical Complex, Peshawar. There were 36[72%] male and 14[28%] female patients. Among them 48[96%] were unilateral cases of trigeminal neuralgia. Right side was involved in 18[36%] and left side in 32[64%]. All patients underwent Microvascular Decompression. During surgery, Superior Cerebellar Artery was found to be the offending vessel in 27[54%], Anterior Inferior Cerebellar Artery in 10[20%], Posterior Inferior Cerebellar Artery in 01[02%], Unnamed vessel in 04[08%], Vein in 03[06%]. In 03[06%] no vascular compression could be detected during the surgery. During the follow-up period 40[80%] patients had excellent Results:. Good were achieved in 06[12%] and no response in 04[08%] of patients. After surgery 04[08%] patients developed transient vomiting and vertigo, 01[02%] patient developed wound infection and 01[02%] had Cerebrospinal Fluid Leak from wound. Cerebrospinal Fluid Rinorrhoea occurred in 02[04%] patients. One patient [02%] developed permanent ipsilateral Facial nerve weakness. There was 01[02%] postoperative death. Trigeminal neuralgia is disease of different etiologies. Vascular compression of the trigeminal nerve roots at its entry into pons is one of the most accepted aetiology. Microvascular decompression has become one of the primary treatment of trigeminal neuralgia. We believe that in patients where medical treatment fail to respond, Microvascular decompression is the treatment of choice in trigeminal neuralgia

Preliminary experience of infliximab treatment in Crohn's disease

This is a preliminary study of resistant Crohn's disease treated with Infliximab [Remicade], a monoclonal antibody to Tumor necrosis factor alpha [TNF]. The aim of the study was to determine the efficacy of Infliximab in patients with moderate to severe active Crohn's disease. Material and The Prospective open label observational study was conducted in the department of Medicine and Gastroenterology Al Hammadi Hospital Riyadh Saudi Arabia from December 2000 to December 2001. Ten Patients with confirmed Crohn's disease of the bowel who had less than satisfactory response to conventional treatment were given Infliximab. Amongst the 10 patients 6 had luminal crohn's disease [60%] and 4 had fistulizing crohn's disease [40%]. Three patient had an associated extra intestinal manifestation of the disease, two having arthritis and an another had erythema nodosum. Out of 10 patients, 8 cases showed improvement in their disease [80%]. All the 4 cases with fistulising disease showed improvement in their disease with disappearance of the fistula in 3 cases. Patients with luminal crohn's disease 4 out of 6 improved clinically and in 2 cases there was no change in symptomatology. The arthritis and skin lesion resolved with improvement in bowel disease. Infliximab treatment is associated with remarkable clinical improvement in patients of crohn's disease with minimal adverse effects but further assessment of its long-term efficacy and safety needs to be determined

Diagnosis of liver abscess by ultrasound

Amoebic liver abscess is common in Pakistan whereas pyogenic abscess is more prevalent in the west. Timely diagnosis of the liver abscess significantly lowers the morbidity and mortality. Present study involves ultrasound examination of 200 consecutive patients in a five year period [September 1990 - August 1995] at civil teaching hospital, Abbottabad and private clinics. One hundred and ninety six patients [98%] had amoebic liver abscess. In a similar number of cases the abscess was solitary. Abscess was located in right hepatic lobe in 184 [92%] Majority of patients [76%] were males while 24% were females. Age of our patients was between 10-60 years and size of the lesion varied between 3-16 cm. Ultrasound has proved to be excellent imaging modality in the diagnosis liver abscess. In selected cases abscess can be aspirated or drained under ultrasound guidance

Radiological manifestations of primary gout

Gout is an ancient disease not uncommonly seen in radiological practice. Twenty-two patients of suspected gout were examined over a period of 11 years [1984-1995]. There were 20 males and 2 females with ages between 35-70 years. First metatarsophalangeal joint was involved in 18 patients. Tophaceous deposits in hands were seen in one, whereas another patient had urate deposit in the lateral condyle of the humerus. One patient had opaque renal stones bilaterally and lucent stones in the right kidney, confirmed by ultrasound, were observed in one case. All of the patients had hyperuricemia. A definite family history was recorded in only three cases. Two patients in the present series were diabetic