Adenoid cystic carcinoma presenting as an ulcer on the floor of the mouth: a rare case report

Adenoid cystic carcinoma is a rare epithelial tumour, and comprises about 1% of all malignant tumours of the oral and maxillofacial region. It is a malignant tumour which may develop in the trachea, bronchus, lungs or mammary glands, in addition to the head and neck region. Occurrences in the head and neck are mostly detected in the major salivary gland, oral cavity, pharynx and paranasal sinus where it presents as a slow growing firm nodular swelling. The aim of the article is to highlight the unique presentation of adenoid cystic carcinoma as a solitary ulcer on the floor of the mouth.

A swelling of the maxilla: a case report and differential diagnosis

Ossifying fibromas are benign fibro-osseous tumors of mesenchymal origin. Although ossifying fibromas have principally been found in the jaw, they have also been reported in the frontal, ethmoid, sphenoid, and temporal bones, as well as the orbit and anterior cranial fossa. Ossifying fibromas affecting the jaw exhibit variable behaviors ranging from slow growth to occasionally aggressive local destruction. In the present article, we discuss a differential diagnosis considered for maxillary swellings and report a rare case of ossifying fibroma occurring in the maxilla.

Hysterectomy as a management option for morbidly adherent placenta

To determine the outcome of interval [delayed] hysterectomy as compared to cesarean [immediate] hysterectomy in cases of placental invasion in previous cesarean sections. Comparative study. Department of Obstetrics and Gynecology, Unit II, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from January 2008 to June 2011. The study subjects included 28 women with history of previous cesarean section who had low lying as well as morbidly adherent placenta [MAP] of variable degree. Patients were classified into two groups [group A and B] according to whether cesarean or interval hysterectomy was needed at time of delivery. Demographic data, obstetrical risk factors such as parity and number of previous cesarean sections were compared as well as radiological and histopathological findings, and details of the management. Chi-square, Fisher's exact and t-tests were used to compare proportions and mean values. The frequency of MAP in previous cesarean sections turned out to be 1.83/1000 [28/15,340] deliveries. Mean maternal age [26.54 vs. 29.13 years, p=0.05], mean gestational age [33.8 vs. 36 weeks, p=0.05], estimated blood loss [2615.38 vs. 1506.6 ml, p=0.001], volume of blood transfused [9.76 vs. 2.9 pints, p=0.001] and the duration of hospital stay [10.69 vs. 32.86 days, p=0.001] differed significantly between group A and group B. One maternal death occurred in each group. Eight patients had other complications in group A compared to 3 patients in group B. Three neonatal deaths occurred in group A compared to nil in group B. The frequency of morbidly adherent placenta was 1.83/1000 deliveries. The management and outcome differed markedly according to emergency and scheduled antenatal diagnosis. Counselling and antenatal radiological screening can reduce the high morbidity and mortality associated with it

Frequency and treatment of methicillin resistant staphylococcus aureus in obstetric and gynaecological sepsis

To perform culture and sensitivity for pathogens causing puerperal and postoperative wound sepsis and determine the frequency of Methicillin Resistant Staphylococcus aureus [MRSA] in such infections. Observational study. Obstetrics and Gynaecology Ward, Jinnah Postgraduate Medical Centre, Karachi, from December 2008 to May 2010. All patients presenting with puerperal sepsis or postoperative wound infection were enrolled. Pus was collected for culture and sensitivity using standard technique. Two samples were taken from each patient; one before starting the treatment and one at the end of treatment. Ames transport medium was used. Empirical treatment with triple regimen [Ampicillin, Metronidazole and Gentamicin] was started immediately to cover Gram positive as well as negative bacteria in addition to anaerobic infection. After receiving the sensitivity report, antimicrobial agent were changed accordingly. Samples from ward and theater staff and environment were also taken to look for possible mode of transmission. Data was recorded on a proforma. Discrete variables are expressed as percentages. Staphylococcus aureus was the most frequent organism isolated in 34% cases. Methicillin sensitive Staphylococcus aureus was seen in 20% cases and methicillin resistant Staphylococcus aureus was seen in 14.6%. Out of these 14.6% MRSA, [17] 77% was associated with puerperal sepsis and rest [5] 23% was associated with post-operative wound infection. It showed best sensitivity to vancomycin. Staphylococcus aureus and E.coli were common agent of postoperative infections and puerperal sepsis

Loading dose of magnesium sulphate versus standard regime for prophylaxis of pre-eclampsia

To determine the efficacy of single dose of magnesium sulphate versus the standard Pritchard regime in the management of pre-eclampsia. Quasi-experimental study. Jinnah postgraduate Medical Centre, Karachi from January 2004 to January 2006. All women with severe pre-eclampsia and impending eclampsia were included in the study. Patients with pregnancy induced hypertension and mild to moderate pre-eclampsia were excluded. From the 100 women included in the study, after matching for age, parity and gestational age, 50 were given only bolus dose of magnesium sulphate and 50 were given the standard regime. They were observed for one week for the number of convulsions. Fisher's exact test and Chi-square test were used to analyze results. There was no significant difference in the two groups in term of occurrence of seizures, one patient developed fit with Pritchard regimen. The rate of caesarean section was lower in group A, 12% versus 30% in group B [p=0.05]. There was no significant difference in prenatal outcome in either group [82% live births in group A versus 72% amongst group B [p=0.2]. Few side effects like vomiting, dizziness and irritation at the site of injection were observed when standard treatment was used. Single dose treatment was also found to be cost-effective costing Pak Rs. 45 [US $ 0.56] as compare to Pak Rs. 195 [US $ 2.4] in control group. No maternal death was observed in either group. Having the equal effectiveness, ease of monitoring and cost effectiveness, single loading dose of magnesium sulphate is preferable over the standard regime in the management of pre-eclampsia as a prophylactic measure for prevention of seizure

Stressful life events, social support and coping strategies among female patients with acute myocardial infarction and their matched controls

The present research investigated differences in stressful life events, perceived social support and coping strategies among female patients diagnosed with acute myocardial infarction [AMI] and their matched controls. It was hypothesized that there is significant difference in stressful life events, perceived social support and coping strategies among female patients with acute myocardial infarction [AMI] and their matched controls. It was further hypothesized that there is relationship between stressful life events and coping, and between social support and coping. A self constructed stressful life events questionnaire, Berlin Perceived Social Support Scale [Schwarzer and Schulz, 2000], and Proactive Coping Scale [Greenglass, 1999] were used for measuring study variables. The sample of the present research comprised of 50 females [25 diagnosed with AMI and 25 age matched controls]; recruited from three major hospitals of Lahore city. Age of the study sample ranged from 45-65 years. Statistical Package for Social Sciences was used for analysis of the data. Independent sample t- test and Pearson Product Moment Correlation were used. The findings suggested that there is significant difference in stressful life events, perceived social support and coping strategies among female patients with AMI and their matched controls. A positive correlation was found between stressful life events and coping strategies, and between social support and coping strategies employed. Implications of the study along with limitations and suggestions were discussed for future researches