Etiology of haemetemesis: a study of 350 cases

To find out the etiology of Haemetemesis. Design: A prospective study of consecutive patients admitted with haemetemesis during one year from 1.1.98 to 31.12.98. Setting: Medical Intensive Care Unit, Jinnah Postgraduate Medical Centre, Karachi. Subject 350 patients with haemetemesis admitted to Medical 1.C.U. in 1998. Main outcome measures: Oesophageal varices as a cause of haemetemesis is on rise. Leading causes of haemetemesis are oesophageal varices 39%, peptic ulcer 24% and superficial mucosal lesions 17%. Among cirrhotics, oesophageal varices were present alone in 61.3%, with portal hypertensive gastropathy in 21.9% with peptic ulcer in 7.3%, while among non cirrhotics, peptic ulcer was present alone in 77.3 8% with oesophogeal varices in 11.90%. Oesophageal varices contribute to most cases of haemetemesis and need measures for control and prevention

Clinical and endoscopic evaluation of haemetemesis

A study was undertaken at the Medical Intensive Care Unit of the Jinnah Postgraduate Medical Centre [JPMC], Karachi to assess the efficacy of oesophago-gastroduodenoscopy in 650 patients presenting with upper gastrointestinal bleeding. Clinical examination supplemented by endoscopic evaluation was helpful in identifying a cause in 91 percent of cases. Oesophageal varices, peptic ulcers and superficial mucosal lesions were the leading causes of haemetemesis occurring in 41 percent, 26 percent and 20 percent of cases respectively. Clinical diagnosis is very erratic and most of the cases presenting with upper gastrointestinal bleeding must be subjected to oesophago-gastroduedenoscopy

Risk factors in stroke

Stroke has remained a serious disease despite new post-stroke treatment strategies. This study was designed to identify risk factors for stroke. A hundred and one cases aged 18-87 years [60 male and 41 female] with first ever stroke where the lesion was confirmed by CT scan were studied prospectively. A detailed medical and family history was taken and general physical and neurological examination carried out according to the study protocol. Analysis of data showed that ischaemic stroke constituted 69.3% [n=70] of cases, intracerebral haemorrhage occurred in 27.7% [n=28] and subarachnoid haemorrhage was found in 2.97% [n=3] of cases. In both male and female groups the most likely stroke prone age was 50-70 years. Hypertension [56.4%], diabetes mellitus [27%], hyperlipidaemia [23%], I.H.D. [22%] and smoking [21%] were most commonly associated with increased risk for stroke. There was low frequency of cerebral haemorrhage in cases with diabetes mellitus and hyperlipidaemia as compared to cerebral infarction. Common risk factors in the present study were hypertension, diabetes mellitus, hyperlipidaemia, IHD and smoking

Thyrotoxicosis induced by metastatic gestational choriocarcinoma

We report our experience of dealing with a case of metastatic gestational choriocarcinoma with secondaries in the lungs, causing thyrotoxicosis and iron deficiency anaemia due to excessive bleeding per vaginum. The patient was managed successfully with methotrexate

Malaria trends in general practice in Karachi, Pakistan

Malaria has been a common protozoal disease since times prehistoric. It has regained global importance after the emergence of drug-resistant strains of plasmodia and resistance of mosquitoes to commonly used insecticides. This study was done to assess the magnitude of malaria as a cause of febrile illness in Karachi and trends of malaria treatment in general practice. The malarial parasite was found present in peripheral blood of 456 out of 50.000 febrile patients [0.91%] and plasmodium falciparum was the predominant species [52%]. Trends in general practice regarding treatment of malaria are inappropriate and need to be brought in line and practiced according to the recommendations of W.H.O. Pharmaceutical drug promotion pressures must not be allowed to influence the principles and practice of scientific medical care in clinical practice

Bacterascites: a variant of spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis is diagnosed when [a] the ascitic fluid culture is positive, [b] the ascitic fluid neutrophil count is > 250 cells/mm[3], and [c] there is no evident intra-abdominal surgically treatable source of infection. Few details are available regarding the variant of ascitic fluid infection in which the culture grows bacteria but the neutrophil count is < 250 cell/mm[3]. This prospective study includes 203 predominantly HBs Ag positive cirrhotic patients with ascites. Spontaneous bacterial peritonitis [SBP], culture negative neutrocytic ascites [CNNA], and bacterascites [BA] were identified in 12.81%, 5.42% and 6.40% patients respectively. Peritonitis-related signs or symptoms were present in 61.50% of patients with bacterascites. Clinical and laboratory data of patients with symptomatic BA, SBP and CNNA were almost similar. In contrast, patients with symptomatic BA had significantly higher levels of serum total bilirubin and prolonged prothrombin time and lower levels of ascitic fluid total protein than asymptomatic BA. There was no statistically significant difference between SBP and bacterascites regarding bacterial flora. All patients with SBP, CNNA or symptomatic BA received antibiotic treatment immediately after paracentesis while patients with asymptomatic BA were followed up clinically without treatment. Repeat paracentesis revealed no evidence of SBP or CNNA. In conclusion, 6.40% of cirrhotic patients with ascites developed bacterascites, 61.50% were symptomatic and 38.50% were asymptomatic. Symptomatic BA might be a SBP variant, while asymptomatic BA might represent transient colonization of ascitic fluid with bacteria