Follicular dendritic cell sarcoma of the neck with pulmonary metastases

We present a case of follicular dendritic cell sarcoma in a 48 years old Saudi female who reported with slowly progressive right sided extranodal neck mass associated with pulmonary metastasis. Clinical examination, histopathologic features including distinct immunostains combine together to make the rare diagnosis of follicular dendritic cell sarcoma. This entity is often misdiagnosed due to non-consideration in differential diagnosis of sarcoma. It carries a significant potential for regional as well as distant spread and hence categorized as intermediate risk malignancy. Clinical, histopathological and immunohistochemical aspects and therapeutic options of this unusual case are discussed

Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25G Quincke, 27G Quincke and 27G whitacre spinal needles

To compare the frequency and severity of post dural puncture headache in obstetric patients using 25G Quincke, 27G Quincke and 27G Whitacre spinal needles. Comparative, randomized, double-blind, interventional study. Liaquat University Hospital Hyderabad from October 2005 to December 2006. 480 ASA I-II full term pregnant women, 18 to 45 years of age, scheduled for elective Caesarean section, under spinal anaesthesia, were randomized into three groups: Group I [25G Quincke spinal needle: n=168], Group II [27G Quincke spinal needle: n=160] and Group III [27G Whitacre spinal needle: n=152]. Spinal anaesthesia was performed with 1.5-2.0 ml 0.75% hyperbaric bupivacaine using 25G Quincke spinal needle [Group I], 27G Quincke spinal needle [Group II] and 27G Whitacre spinal needle [Group III] at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Frequency and severity and of postdural puncture headache [PDPH] were recorded. Data were analyzed using SPSS-11. Frequency of PDPH following the use of 25G Quincke [Group I], 27G Quincke [Group II] and 27G Whitacre [Group III] spinal needles was 8.3% [14/168], 3.8% [6/160] and 2.0% [3/152] respectively. In Group I, PDPH was mild in 5 patients, moderate in 7 patients and severe in 2 patients. In Group II, it was mild in 2, moderate in 3 and severe in 1 patient. In group III, it was mild in 2 and moderate in 1 patient. Severe PDPH did not occur in Group III. Most of the patients with PDPH developed it on first and second postoperative day. When using a 27G Whitacre spinal needle, the frequency and severity of PDPH was significantly lower than when a 25G Quincke or 27G Quincke needle was used

Radiation induced esophageal cancer in Hodgkin's disease

An interesting case was found while audit / computation of previous medical record during last year at Nuclear Institute of Medical Radiotherapy Jamshoro - Pakistan. Case was a young lady who presented with upper third esophageal carcinoma some 14 years, after the patient had external beam radiotherapy by upper mantle field set up for stage I-A Hodgkin's disease. Long latent period, site of the second cancer at the most in-homogenous dose distribution during previous radiotherapy and deviation of age at presentation from standards seem the previous radiotherapy as cause of this second primary cancer. This case report will help to identify the factors / tools responsible for this deadly complication and for improvement in the management profile of such patients

Antenatal screening for hepatitis B and C virus carrier state at a University Hospital

To determine hepatitis B virus [HBV] and hepatitis C virus [HCV] carrier state among pregnant women at gynaecology and obstetrics department of Liaquat University Hospital, Hyderabad -Sindh. A descriptive study. Maternity units of Liaquat University Hospital, Hyderabad - Sindh from January 2003 to December 2003. One hundred and three pregnant women with 35 to 40 weeks of pregnancy admitted in maternity units due to obstetrical reasons were screened for hepatitis B and C seropositivity after they gave informed consent. Immuno- chromatography and ELISA technique were used for blood testing. Pregnant women with symptomatic liver disease were excluded from the study. Convenient sampling approach was adopted for the data collection. Among screened population, 29.1% of pregnant women were found positive for HBV or HCV. Out of these, 16.5% women were positive for HCV where as 12.6% for HBV. All women had history of injections and ear and nose prick where as 20% had positive history of blood transfusions, followed by history of jaundice among them or with their partner. In our set up, frequency of 29.1% sero-positivity for HBV and HCV among pregnant women is alarming. These sero-positive mothers are not only at risk of having cirrhosis and liver cancer later on, but also are a continuous threat to their offsprings and care providers. Hence, there is a dire need to conduct more epidemiological studies on this problem and take measures for prevention and control of the disease

Pattern of spinal tuberculosis at Liaquat University hospital, Hyderabad/Jamshoro

To find out the pattern of spinal tuberculosis [TB] presenting as paraplegia/ paraparesis in our set up. A descriptive study. Department of Medicine, Liaquat University Hospital Jamshoro/Hyderabad - Sindh from July 2003 to August 2004. In this study, 44 patients having TB spine presenting as paraplegia/paraparesis were evaluated by haematology, sputum examination, urine analysis, biochemistry and imaging. These patients also underwent a detailed history and clinical examination. Patients having non-tubercular cases of paraplegia and children were excluded from the study. Age range of the patients was 18-62 years. Among study participants, there was male dominance [61.36%] as compared to females [38.64%]. Pott's disease was present in 26 [59.09%] cases, paravertebral abscess with vertebral body destruction in 2[4.54%] cases, without body destruction in 4[9.09%] cases and spinal stenosis in 2[4.54%] cases. Arachnoiditis was seen in 10[22.73%] cases while spinal ischaemia in 2[4.54%] cases. In region-wise distribution, thoracic was involved in 20[45.45%]cases, lumbar 12[27.27%] cases, diffuse 10 cases [22.73%] and cervical 2[4.54%] cases. Thirty [68.18%] cases improved neurologically after medical and surgical treatment while 14[31.82%] cases did not improve because of delay in the diagnosis and treatment. In our set up, TB spine is more common in males than females and mostly presents with history of fever and backache resulting into paraplegia and paraparesis. Thoracic region is more common area of involvement. Most common pattern of TB spine is Pott's disease. Recovery among these patients is remarkable if diagnosed earlier