Hydatid cysts of the brain

Brain involvement with hydatid disease occurs in 1-2% of all Echinococcus granulosus infections. Cerebral hydatid cysts are usually supratentorial, whereas infratentorial lesions are quite rare. Objective of the study was to determine the clinical presentation and surgical outcome of cranial hydatidosis. This retrospective study was performed in the department of neurosurgery LRH Peshawar from December 2000 to Oct 2007. Twenty one cases with intracranial hydatidosis were operated. The patients were either admitted through OPD or referred from other units. CT and/or MRI were the imaging modalities to reach the diagnosis in addition to serological and haematological tests. Surgery was the only treatment option used. Pericystic hydraulic method was the technique used for the excision of the hydatid cyst of brain. There were 9 males and 12 females with male to female ratio of 1:1.3. All patients belonged to paediatric age group with age range of 3-14 years and mean age of 7.42 +/- 3.2 years. Headache, vomiting, papilloedema were present in all the patients while seizures were the present in 16 patients. The lesion was removed surgically by adopting pericystic hydraulic method during craniotomy in all cases. There was no intra-operative morbidity except that the cyst ruptured in one case. No postoperative complications were noted and there was no mortality. Hydatid cyst of the brain presents clinically as intracranial space occupying lesion and is more common in children. Surgery is the treatment option with affordable morbidity and low mortality

Extensive spinal epidural abscess

Spinal epidural abscess [SEA] is a rare clinical entity associated with a high morbidity and mortality. It usually spans 3-4 levels. The literature contains very few reports of extensive or panspinal epidural abscesses and hence there is no consensus on management of such cases. We describe a case of 56 years old male presenting with a posteriorly located SEA extending from the Foramen Magnum to thoracolumbar junction. The abscess had led to quadriparesis for the last 24 hours. This abscess was treated operatively by performing noncontiguous minimally invasive decompressions of the cervical and thoracic spine. The patient showed progressive improvement in neurologic status and was walking with minimal support at 4 months of follow-up

Dr. Elisabeth Kubler-Ross' stages of dying and phenomenology of grief

Birth and death are both natural events but the emotional impact and the personal meanings of these events are vastly different. Birth may be anticipated with excitement and optimism, while the reality of death may be avoided and been denied. Elisabeth Kubler-Ross has been a pioneer in arousing popular and medical interest in the subject of death and dying. A physician who worked with dying patients and encouraged them to talk about themselves and their feelings toward their impending death. She found that most of the patients she had contact with welcomed the opportunity to speak openly about their conditions. After speaking with some 500 terminally ill patients, Kubler-Ross proposed that there were five stages in coming to terms with death: denial, anger, bargaining, depression and acceptance

Evaluation of C-reactiveprotein as early indicator of blook culture positivity in veonates

To determine the Sensitivity, Specificity and Predict values of C - reactive protein as an early indicator of Neonatal Sepsis. Design: It was an observational study of newborns suspected sepsis. Place and Duration of study: The study was carried out in the Department of Paediatrics, Karachi Medical Et Dental College and Abbasi Shaheed Hospital, Karachi over a period of eight months [March 1, 2001 to October 31, 2001]. Patient and Neonates admitted to intensive care nursery of the Abbasi Shaheed Hospital Karachi were evaluated for Neonatal Sepsis. C-reactive protein as screening test was performed along with blood culture from peripheral venepuncture. The gold standard for the Diagnosis of Sepsis was positive blood culture. Result: The positive C- reactive protein found in 14 of 21 episodes associated with the positive blood culture, but in 15 of 29 negative cases it was also found positive. The sensitivity and specificity are equal to negative predict value and positive predict value respectively i.e. 66.66% and 48.27%. CRP estimation have some value in early diagnosis of Neonatal sepsis but the frequent occurrence of raised CRP in sera of uninfected neonates eliminates it as a useful indicator of infection but may suggest an active tissue damaging process. We do not advocate to rely on the result of single test, even with the combination of test, we still stress the importance of correlating the clinical and laboratory data. We recommend that a scoring system should be designed for our setup, using those test that are easy to perform, economical, reliable, should have high predictive value and should ideally identify all infected infants [high sensitivity]

Spinal arteriovenous malformations: surgical outcome

Spinal arteriovenous malformations are relatively rare, being one tenth as common as cerebral AVMs and one tenth as common as primary spinal neoplasms. The aim of this retrospective study was to see distribution of this disease in spinal cord and analyse outcome of surgical treatment in our set-up. 5 patients with neurologic deficit due to spinal AVMs were operated upon from March 2000 to Feb 2005. Age ranged from 25-45 years with mean of 35 years. There were 2 females and 3 males with sex ratio of 1:1.5 respectively. Spinal AVMs were categorized as one of 4 types based on pattern of arterial and venous supply. We found that 60% [3 cases] in our series were intradural AVMs while 40% [2 cases] were dural type. We conclude that glomus variety of intradural AVMs was the commonest. The commonest presentation was acute spinal dysfunction and paraparesis. Selective spinal angiography can be negative in spinal AVMs, [20%] in our series, in which CT angiography provided clue to the feeding vessels

Frequency and clinical course of hepatitis E in tertiary care hospitals

To find out the frequency of hepatitis E virus as a cause of acute hepatitis and its clinical course in hospitalized patients. Design: Cross-sectional hospital-based study. Place and Duration of Study: The study was conducted in two tertiary care teaching hospitals i.e., Khyber Teaching Hospital and PGMI Lady Reading Hospital, Peshawar [Pakistan] from January to December 2002. Patients and Amongst the total number of 1922 admitted patients, 148 had history of nausea, vomiting and jaundice and raised serum bilirubin with raised hepatic transaminases [ALT], were screened for HBV [hepatitis B virus], HCV [hepatitis C virus] and subsequently for HEV [hepatitis E virus]. Acute hepatitis A, autoimmune hepatitis and Wilson's disease were excluded by doing appropriate test as and when required. The patients with hepatitis E were then monitored by checking their serial transaminases on day 1,4,8 and day 18 or until their transaminases dropped to normal. They were also clinically assessed and followed-up. Amongst the total admission of 1922 patients during one year period, 148 had acute hepatitis and out of these, 21 patients [14.189%] suffered from hepatitis E. Seventeen patients were below the age of 40. There were increased number of cases during the late summer and early winter seasons. Majority of the hepatitis E patients recovered during the short follow-up period of two weeks. Two patients had fulminant hepatitis. A four months pregnant young female died of her illness despite intensive treatment. Hepatitis E virus is fairly common cause of acute hepatitis in hospitalized patients. Most of the patients are having a benign self-limiting illness

Immunohistochemical determination of HER-2 / new overexpression in invasive ductal carcinoma of breast with cervical nodal metastasis

This study was designed to determine the frequency of HER-2/neu overexpression, in invasive ductal carcinoma of breast and correlate it with various standard prognostic parameters. This study was performed on formalin fixed paraf n embedded blocks of 72 diagnosed cases of invasive ductal carcinoma of breast. The blocks were retrieved and the staining was done to see the HER-2/neu overexpression. Sections containing > 50% of tumour cells showing intense circumferential cell membrane staining scored as positive. The HER-2/neu overexpression was seen in 31% of cases. A significant relationship [P<0.05] was found between HER-2/neu overexpression and lymphnode status and size of the tumour. The overexpressivity of HER-2/neu oncoprotein suggests that Herceptin can be used as therapeutic measure on these cases

Clinical presentation of patients with acute intermittent porphyria-our experience with 12 patients

Acute Intermittent Porphyria [AIP] presents as acute abdomen and implicates emergency and injudicious surgery. A clinical profile of AIP has been studied in 12 patients in order to raise a high suspicion index so that injudicious surgery is avoided. The study shows that the cases fell in 2nd and 3rd decade with a male preponderance of 11:1. Abdominal pain, tachycardia, hypertension and neuropsychiatric manifestationns were found in almost all the cases. Four out of 12 patients had underwent surgery as [acute abdomen] and three died with septicaemia. Three fourth of the cases belonged to Baiochistan

Mucin secreting carcinoid of appendix and small intestine

The mucin secreting carcinoid tumour resembles the mucin secreting adenocarcinoma of the appendix. This tumour has low grade malignancy and it rarely metastasizes. The recognition of this entity is important. Seven patients with mucin-secreting carcinoid tumours are described, and in six of them the tumours behaved non-aggressively. The histogenesis of mucin-secreting carcinoid tumours is discussed