Un-ruptured non-coronary sinus of valsalva aneurysm with complete heart block

Sinus of Valsalva aneurysm is a rare cardiac anomaly with wide spectrum of clinical presentation ranging from asymptomatic state to dreadful complications due to compression of vital surrounding structures or aortic dissection. There are only few reported cases of sinus of Valsalva aneurysm presented with cardiac arrhythmias including complete heart block. We herein, present a case of a 50 year male who presented with complete heart block. A large noncoronary sinus of Valsalva aneurysm compressing the surrounding atrioventricular junctional tissue was detected incidentally during echocardiographic study, which was considered to be the cause of patient's complete heart block. This case report implies the importance of clinical suspicion of secondary causes like sinus of Valsalva aneurysm in patients with complete heart block and utility of echocardiography in the evaluation of heart block patients

clinical study of pulmonary mycosis at Multan

Beside tuberculosis, awareness about chest diseases is increasing and more non-tuberculosis lung infections are being recognized. Pulmonary mycosis is not uncommon. A clinical study of pulmonary mycosis was undertaken in Nishtar Hospital Multan, Pakistan. In our study the prevalence of pulmonary mycosis was 8.2 percent among the patients suffering from respiratory, diseases, whereas this prevalence was higher in males [10.3%] as compared to females [5%]. The peak prevalence was observed in the age group of 21-30 years [22%], however, 82 percent patients of mycosis lie in 3rd to 7th decades. No significant relation of occupation to pulmonary mycosis was detected in the present study. The disease was higher in urban population as compared to rural inhabitants and it was more in people with low income and having poor living conditions. Candidiasis and Aspergillosis were found predominant in lower income group. All the three pulmonary mycosis [detected in this study] have higher relationship with pulmonary tuberculosis, and it was observed that Aspergillosis was relatively more common in lung abscess and cavitary lesion. Majority of patients had the symptoms of cough, sputum, fever, dyspnoea, chest pain and haemoptysis. The clinical examination showed anemia, enlarged liver, pleural effusion, clubbing, oedema feet, lymph node enlargements and cyanosis in these patients. Sputum culture for fungus was helpful in diagnosing the cases and repeated growth was significant. Out of 35 patients of Candida Albicans, 17 were living, while 18 had died due to associated diseases and the cause of death in 15 cases was advanced pulmonary tuberculosis, lung abscess in 2 and pneumonia in 1 case. Out of 11 cases of Aspergillosis, 9 were living and 2 had died due to associated disease and the cause of death in 1 case was lung abscess and 1 was pneumonia, while in mucormycosis 2 were living, 1 died due to pulmonary tuberculosis and 1 patient was not traceable. Steroids were added in acute stage along with antifungal drugs for 6 weeks, The patients were symptom free after 6 weeks, the sign disappeared but the lesion of associated disease persisted. Fungus ball in the cavity persisted even after the treatment. Surgery was advised but not done due to non-cooperation of patients. Follow up was made and it was observed that 21 cases expired, 28 were known to live at the end of study, while fate of 1 case was not known

Endoscopic sinus surgery: outcome in 45 cases

Functional endoscopic sinus surgery is an effective treatment for chronic or recurrent sinusitis, resistant to medical treatment. The endoscopic sinus surgery enables one to have direct visualization of the diseased tissue, facilitates to remove almost all of it and helps in restoration of physiologic mucocilliary clearance system enabling the sinus mucosa to return to its normal condition after the procedure. 45 patients, who underwent FESS from April 1997 to December 1998, were closely monitored. Outcome was assessed by the physician as well as by patients. Seventy five percent of the patients showed complete resolution of symptoms with another fifteen percent improved with additional medical treatment. Based on our experience from 45 patients, FESS is currently recommended, as the surgical procedure of choice for chronic or recurrent sinusitis after medical treatment has proven ineffective

Heart rate and quality of garments

The relationship of heart rate with the type of garments was evaluated in 399 young school going children, 135 wearing cotton, 138 mixed and 126 wearing synthetics. Initial heart rate measurements were made without referring to the specific blend of garments, whereas four subsequent determinations were made wearing cotton, mixed and synthetics. The mean age was 12.62, 13.17 and 11.96 years respectively with cotton, mixed and synthetic. The mean heart rate at the end of study was 80.63, 83.53 and 90.38 per minute with cotton, mixed and synthetics and their respective 95% confidence limits were 79.47-81.79, 82.38-84.68 and 89.18-91.58.The percentage of respondents with a heart rate of 100 or above with cotton garments dropped by a margin of 15% and rose by about 7 per cent with synthetic garments. The value of 'F' was 291.37 and the contribution of the quality of garments was 26.47%. Hieight did not seem to have an effect on heart rate, whereas weight adjusted value was 25.46%. We conclude that mean heart rate was 8.08 to 11.42 per minute higher with synthetic garments as compared to cotton, when the effect of other confounders like weight is removed