clinical value of immediate second transurethral resection in patients with high grade non-muscle inasive bladder Cancer [HG-NMIBC]

Objectives: this study was designed to estimate the value of a second transurethral resection of bladder tumor in patients with initially diagnosed T1 High-grade bladder cancer

Material and Methods: between October 2008 and November 2015, a total of 350 patients were diagnosed with T1 high grade non-muscle invasive bladder cancer. These patients were divided into two groups. Group A: 150 patients who underwent an early reresection. Group B: 200 patients who did not undergo early re-resection. Data were collected retrospectively which included patient's history, physical examination, and investigation, histological parameters including presence of detrusor muscle at initial TUR and at second TUR, recurrences and progression rates

Results: the detrusor muscle was present in 90 patients out of 150 patients [60%] in Group A and in 158 patients out of 200 patients [79%] in Group B, at initial TUR. At early re-resection, detrusor muscles were present in 76.67% of patients. The residual tumor was present in 55% of re-resected patients. The overall incidence of tumor recurrence was 34.66% and 42% in Groups A and B, respectively. There was a significantly higher rate of tumor progression in patients who did not undergo early re-resection during follow up. [Group 14.28% v. s. Group 3.85% P<0.05]

Conclusion: a second TUR should be routinely advised in all patients with T1 high grade bladder cancer, to achieve a complete resection and to identify patients who may need to undergo radical cystectomy

Dyspepsia and upper gastrointestinal endoscopy; Multan experience

To find out causes of dyspepsia on upper gastrointestinal endoscopy. Endoscopy unit of Nishtar Hospital Multan. May 2005 to August 2007. Patients suffering from dyspepsia were referred by consultants of Nishtar Hospital Multan and doctors working in the periphery for endoscopy. 502 patients were scoped for dyspepsia; 254 [50.6%] were male and 248 [49.4%] were female. Mean age was 42.5 years and age range was 7-95 years. Most common lesion was gastroduodenitis [20% cases] followed by gastric ulcer [5.4% cases]. Ratio of duodenal ulcer to gastric ulcer was 1:2.56% patients had no pathology; females were more likely to have normal endoscopy. Gastroduodenitis is the most frequent organic cause of dyspepsia. Functional dyspepsia is more common among females

Symptoms of deperession and anxiety in post-myocardial infarction patients

To assess the frequency of symptoms of depression and/or anxiety following acute myocardial infarction [AMI] and to analyse their association with demographic variables. Design: A cross-sectional analytical, non-interventional hospital based study. Place and Duration of Study: The study was carried out at Punjab Institute of Cardiology [PIC], Lahore, from January 2000 to January 2001. Patients and A total number of 100 inpatients suffering from AMI were studied. After a careful selection of the subjects the Urdu version of Hospital Anxiety and Depression Scale [HADS] was administered to each patient during the period of 5-7 days following AMI to assess symptoms of depression and anxiety. A semi-structured clinical interview was also conducted which included demographic information, psychiatric history and other variables. Results were analyzed by using Statistical Package for Social Sciences [SPSS version 8.0]. Out of 100 subjects, 80 [80%] were males and 20 [20%] were females. Their ages ranged from 30-60 years [mean age, 50.92+8.53]. Overall, symptoms of anxiety and/or depression were found in 50 [50%] patients. More specifically, symptoms of depression were found in 14%, anxiety symptoms in 18% and mixed symptoms [anxiety and depression] in 18% of the patients. Results revealed that patients above 45 years of age [i.e. 46-60 years] were more likely to experience symptoms of depression and/ or anxiety following AMI. A significant association was also found between female sex [p <0.02], lower socioeconomic status [p <0.05] and symptoms of depression and/ or anxiety in these patients. However, no significant association was found in relation to educational status, marital status and origin [urban/rural]. The high proportion of patients with AMI found to be suffering from symptoms of depression and/ or anxiety one week after AMI highlights the essential need to assess these symptoms in all such patients during the post-MI period as they merit appropriate treatment alongwith the other complications of AMI

Vogt-koyanagi-harada syndrome: a case report and review of literature

Vogt-Koyanagi-Harada [VKH] syndrome is a rare multisystem disorder in which cell-mediated autoimmunity against melanocytes affects the eyes, inner ears, central nervous system and skin. Alopecia, poliosis and vitiligo are the cutaneous manifestations. Visual and hearing loss is the important complications which can be prevented by early diagnosis and aggressive systemic therapy. We report a case of VKH syndrome in which alopecia was the only cutaneous manifestation and early diagnosis and prompt systemic corticosteroid therapy prevented the visual loss and reduced the morbidity