Hypokalemic periodic paralysis

A case of 35 years old diabetic woman who presented to us with weakness of both arms and legs for past 3 days. Laboratory investigations showed potassium of 3.1mg/dl with no other prominent positive findings. After the diagnosis of hypokalemic periodic paralysis she was managed with potassium chloride to which she responded well

Early surgery for pulmonary tuberculosis

The purpose of our study was to analyze current indications for surgery in tuberculosis and evaluate the outcome of early surgical intervention. Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from June 2000 to July 2004. Total number of cases was 132; M: F 105: 27. Age range was 20 to 79 years. Mean age was 48.4 years. The indications for surgical intervention included 5 cases of pulmonary aspergillioma, 9 cases of pneumothorax; 3 cases of pulmonary nodes and masses without histological diagnosis, 15 cases bronchiectasis, 12 cases of massive hemoptysis and 82 cases of pleural empyema while six patients with multi drug-resistant tuberculosis required surgical intervention. The techniques utilized included lobectomy in 45 cases, pleural drainage in 20 cases, segmented pulmonary resection in 32 cases, surgical procedures on the chest wall in 17 cases, pneumonectomy in 10 cases, decortication in 8 cases. In 22 cases two or more procedures were performed on the same patient. In 26[19.6%] cases various complications were noted of which wound infection was the most frequent. There was a mortality rate of 3.3% [4 cases]. Surgical treatment is indicated for the complication of TB and management of MDR TB. Early surgery is beneficial in patients whose disease is still localized and who can tolerate resection surgery; of particular importance is a healthy opposite lung, on which the patient would be dependent during and immediately after surgery

Role of tube cecostomy in preventing post appendectomy abscess and fistula formation

To evaluate tube cecostomy as a surgical procedure in preventing post appendectomy abscess and fistula formation in selected individuals having severe periappendicitis, involving the base of the appendex and adjoining caecal wall. It is a prospective study carried out on 50 patients during 4 years times. Tube cecostomy, instead of primary closure of the appendicial stump, was carried out in patients meeting the selection criteria. This procedure was carried out in patients meeting the selection criteria admitted at Field Hospital, Forward Kahutta, Azad Kashmir and Combined Military Hospital Multan. Fifty patients having acute appendicitis with oedema and inflammation of the base of the appendex and adjoining caecal wall were selected for the study. Assessment of tube cecostomy as an operative procedure in selected patients to prevent serious complications such as post appendectomy intra abdominal abscess and fistula formation. All 50 individuals excellent recovery with least procedure related morbidity. Average stay was 5-6 days, compared to an upredictable prolonged stay if a patient develops serious complications like intra abdominal abscess/ fistulae formation. Tube cecostomy is a relatively simple and effective procedure in preventing serious complication like post appendectomy abscess and faecal fistula formation in selected individual having severe periappendicitis involving base of the appendex and caecal wall

Proximal leinorenal shut: an effective treatment of bleeding esophageal varices

This is a prospective study of 23 patients of portal hypertension who were managed by proximal leinorenal shunt. Out of 23 patients, 14 patients were in Child's B, 6 patients were in Child's A and only 4 patients were categorized as Child's C. Only two patients had non cirrhotic portal hypertension and rest of them were post-infective cirrhotic, one being alcoholic. All cirrhotic patients were HBsAg positive and 3 were hepatitis C positive. Fourteen had associated hypersplenism. All patients were managed by proximal leinorenal shunts. Ten patients had emergency surgery and 13 had elective shunts. Mean operative time was five hours and average peroperative blood loss was 1500 ml. Average post- operative hospital stay was 18 days. Maximum follow-up of two years is available. Re-bleeding rate was 17.3%. Post shunt encephalopathy developed in 8.14% patients. One mortality was due to overwhelming sepsis, ten days after surgery and he was in Child's grade B. Remaining three deaths were among Child's grade C. We believe that proximal leinorenal shunt is a good alternative to distal splenorenal shunt. This shunt while preserving the liver perfusion affords adequate decompression

Magnetic resonance imaging: diagnostic criteria for tuberculous spondylitis

This retrospective study analysed the spectrum of Magnetic Resonance Imaging findings of tuberculous spondylitis in order to establish a diagnostic criteria. The MRI of 46 vertebrae in 19 patients with proven tuberculosis were reviewed. The number, anatomical distribution, pattern of vertebral involvement and soft tissue features were evaluated. An average of 2.4 vertebrae were involved per patient with 79% of patients having contiguous vertebral disease. The majority of vertebral lesions occurred in the thoracic spine [56.5%]. Most vertebrae [61%] showed partial involvement. Soft tissue parameters identified were paraspinal abscess, epidural and disc involvement, longitudinal ligament thickening and cord compression. Presence of at least 4 of these features as well as contiguous vertebral involvement is highly suggestive of tuberculous spondylitis and was seen in 74% of patients

Rett syndrome

A 9 year old girl presented with gradual regression of both motor and language skills. She was a full term normal baby and early developmental milestones were normal. She gradually developed spastic paraparesis with loss of speech appearance of stereotype wringing movements of both hands generalized tonic clonic and myoclonic seizures. There was no family history of any neurological or metabolic disorder. All investigations including a CT. brain, CSF examination, urinary protein and amino acids screening, serology for toxoplasmosis cytomegalovirus and herpes simplex and chromosomal analysis was normal. EEG revealed slight slowing of background activity in posterior leads. Overall clinical picture was consistent with Rett syndrome. We describe the clinical presentation course and results of the investigations in this case report

Preoperative myelographic evaluation of lower spinal lesions

One hundred patients underwent myeolgraphy for low back pain. Twelve had normal myelograms. The accuracy of myelography in predicting diagnosis of different causes of low back pain was evaluated in 88 patients. These patients later underwent surgical procedure and final diagnosis was made at operation. On myelography the prolapsed intervertebral disc [PID] was suspected in 59 [67.1%], spinal stenosis [SS] in 15 [17.0%], tumour in 12 [13.6%] and abscess in 2 [2.3%] cases, while at surgery PID was found in 51 [57.9%], SS in 18 [20.5%], tumour in 14 [15.9%] and abscess in 5 [5.7%]. In 8 false positive cases for PID, 3 were spinal stenosis, 2 were tumour and 3 were abscesses. Accuracy rate of myelogram was 88% and sensitivity for PID, SS, Tumour and abscess were 86.4%, 83.3%, 85.7% and 40% respectively. Myelography seems to be a safe and fairly accurate test in diagnosing the different causes of low back pain

Cerebrovascular accident pattern and distribution of different types based on computed tomography

This study was undertaken to determine the pattern and distribution of various types of C. V.As in 110 patients who underwent C.T. for suspected C.V.A. The percentage of all C.V.A. by pathological type was: Ischaemic cerebral infarction [I.C.I.] 55.4% localized primary intracerebral haemorrhage [P.l.C.H.] - 37.3% generalized subarachnoid haemorrhage [S.A.H.] 5.5% and cerebellar haematoma 1.8%. Right side was affected in 33 patients [30%] and left in 52 [47.2%]. Seventeen patients [14.6%] had multiple areas involved. It was also noted that ischaemic stroke was common in older age group [70-85%]. The most common area of brain involved for all types of C. V.A. was internal capsule and basal ganglia 31 [28.1%] followed by parietal region 17 [15.4%]. frontal region 7 [6.36%], frontotemporal 3 [2.7%], frontoparietal 12 [10.9%], temporal 4 [3.6%], temporoparivtal 10 [9%], parietooccipital 8 [7.2%] and occipital 2 [1.8%]. We recommend C.T. scan of all patients with C.V.A. for proper assessment. A national project to determine its incidence, risk factors, pattern and complications should be undertaken

Degenerative lumbar spinal stenosis; Results after surgery

50 patients with degenerative lumbar spinal stenosis underwent decompressive laminectomy, 18 with one level, 9 with two level and 23 more than 2 levels. The average age was 57 years [45-65]. Male to female ratio was 3:2. 5 patients were lost in follow up. Out of 45 patients 23 had excellent improvement, 14 had fair recovery, 6 remained unchanged, 2 deteriorated as compared to pre-operative status. No patient had revision surgery. There were two dural leaks which healed spontaneously. Decompressive laminectomy is safe and effective procedure for degenerative spinal stenosis

Survey of 100 epileptic cases seen at the epilepsy clinic

One hundred random cases of epileptic patients visiting the epilepsy clinic of Ibn-Nafees [Central] Hospital, Tripoli, are surveyed. 82 patients were diagnosed as suffering from grand mal, 9 from petit mal, 7 from partial seizures and 2 from temporal seizures. The ratio of male to female patients more than fourfold. With the exception of petit mal, a higher proportion of males in their early age suffered from the disease. The importance of EEG recording and CAT scanning in confirming the clinical diagnosis as an indicator of etiology and a guide to therapy, is emphasized. Six types of drugs were prescribed, singly or in combination, after through investigation. The frequency of their prescription was subject to their toxicity