Always look beyond the stones: hyperoxaluria overlooked

We report a case of hyperoxaluria type I in a nine-yearold boy with nephrolithiasis. His initial management included multiple percutaneous nephrolithomies and lithotripsy. Metabolic screening was not undertaken initially. Hyperoxaluria was finally diagnosed by elevated urine oxalate [1.363 mmol/24h]. A diagnosis of hyperoxaluria type I was confirmed by liver biopsy. His kidney function was nearly normal and he was started on pyridoxine and crystallization inhibitors. He will require a liver transplant to cure his primary hyperoxaluria. Clinical clues of primary hyperoxaluria type I are positive family history or presentation with several renal stones. Irrespective of the above, all patients with first presentation of renal calculi should undergo metabolic screening including urinary oxalate level determination

Warfarin induced alopecia: a case report and review of literature

Warfarin induced alopecia is a very rare complication. Very few cases have reported in the literature. We describe a 35 year old male who developed multiple patches of alopecia in the face and head secondary to Warfarin chronic treatment

How successfully can open heart surgery be introduced to the developing countries?

Since the late 1960's the growth of cardiac surgery has received worldwide acknowledgement in the treatment of various heart diseases including valvular, congenital, as well as myocardial revascularization using the reversed saphenous vein and the internal mammary arteries. Operations for these various heart ailments is now a routine in the developed courtiers. In this paper, we examine the possibility of introducing open heart surgery to the developing countries. All the various difficulties involved, such as the huge cost of such gigantic project are discussed. We also look into ways and means of reducing the cost without effecting the standard by reviewing the Saudi Cardiac Airlift experience to the country of Mauritius. This is a typical example of where introduction of cardiac surgery was successfully carried out with minimal cost and complications in a country with limited financial resources

Locked-in syndrome caused by infective endocarditis

Locked-in syndrome with quadroplegia, loss of movement of the face and speech and of the horizontal eye movements with preservation of only the vertical eye movements has developed in a 25 years old female presenting with advance infective endocarditis of the aortic valve with severe aortic regurgitation which had earlier embolized to the spleen and left Kidney, and underwent open heart surgery for aortic valve replacement. Intraoperative embolization of the extremely friable vegetations occurred to the vertebrobasilar arterial system and led to de-efferentation state. Prolonged ventilatory support including tracheostomy, meticulous nursing care and antibiotic prophylaxis could not prevent death from generalized sepsis. As partial or full recovery from this syndrome has been reported using bromcriptine and sinemet, we do advocate use of such pharmacological agents