Efficacy of external dacryocystorhinostomy [DCR] with and without mitomycin-C in chronic dacryocystitis

To compare the efficacy of external dacryocystorhinostomy [DCR] with and without intraoperative application of mitomycin-C in patients with chronic dacryocystitis. An experimental study. Department of Ophthalmology, Bahawal Victoria Hospital [BVH], Bahawalpur, from September 2009 to December 2010. One hundred and sixty patients with chronic dacryocystitis undergoing external DCR were divided into two groups comprising of 80 patients each. Group A included patients, who underwent external DCR with intraoperative use of mitomycin-C. Group B included those patients who were not administered intraoperative mitomycin-C. Sociodemographic information and the data regarding the patency of the lacrimal drainage system by irrigation with normal saline were collected at the end of the third month after the surgery. Chi-square test was used, at 95% confidence level, as the test of significance to compare the success of surgery between the two groups. Surgical success rate [efficacy] in group 'A' was found to be 97.5% and 86.25% in group 'B'. The difference in success rate was statistically significant [p=0.017]. External dacryocystorhinostomy with intraoperative mitomycin-C is more efficacious in achieving lacrimal system patency than external dacryocystorhinostomy without mitomycin-C

Mitomycin C instillation following ureterorenoscopic laser ablation of upper urinary tract carcinoma

Instillation of Mitomycin C [MMC] should prevent implantation of cancer cells released during endoscopic treatment and prevent recurrences as seen in carcinoma of the bladder. To develop and evaluate a protocol for a single dose MMC instillation following Holmium: YAG laser ablation of upper urinary tract transitional cell carcinoma [UUT-TCC]. A single institute prospective study. MMC instillations protocol was designed and offered to patients between August 2005 and April 2011. Following tumor ablation, MMC was instilled into upper urinary tract [UUT] over 40 minutes. All the patients were regularly followed up. Twenty UUT units [19 patients] were managed for UUT-TCCs using our MMC protocol. Two UUT units had G1pTa tumors, 14 had G2pTa, 2 had G3pTa, and 2 had G3pT1. At a mean follow-up of 24 months [range 1-72 months], 13/20 [65%] of the UUT units remained cancer-free, 3 [15%] UUT units developed stricture and were treated with endoscopic dilatation, only 1 [5%] of these developed long-term complications. None of the patients developed postoperative renal impairment or systemic side-effects. Using a set standard protocol, MMC can safely be instilled into the UUT after TCC ablation with minimal complications or side effects, good preservation of renal function, and with a low recurrences rate comparable to the literature.

Pathomorphological effects of alloxan induced acute hypoglycaemia in rabbits

Alloxan is one of the frequently used beta-cytotoxic agents for the induction of Type-1 diabetes mellitus in animal models and is the drug of choice in rabbits. Its beta-cytotoxic action results in a sudden release of insulin leading to severe hypoglycaemia and even mortality if glucose therapy is not given. In the present investigation the pathological effects of alloxan induced acute hypoglycaemia were studied in rabbits. New Zealand White rabbits, 1-1.5 kg body weight, were administered alloxan@100 mg/kg b.w., as a single intravenous dose. Blood glucose levels were monitored [0 h, 20 min, 1 h, and then hourly up to 5 h] and clinical signs noted. Rabbits dead due to hypoglycaemia were necropsied and histopathology performed. Severe histopathological changes were observed especially in the brain [neuronal degeneration and necrosis], kidneys [nephrosis, nephritis] and liver [hepatosis, hepatitis] and also, other organs. Histopathological observation of beta-cytolysis was suggestive that the drug induced hypoglycaemia is insulin mediated. It was concluded that acute hypoglycaemia causes severe pathological changes and the alloxan induced immediate hypoglycaemia if not managed in time, might exacerbate the pathological effects of hyperglycaemia in the induced diabetic models

Helicobacter pylori infection in patients with calcular cholecystitis: a hospital based study

Helicobacter pylori, a gram negative bacillus has been recognised as a public health problem and approximately half of the world population has H. pylori infection causes chronic gastritis, peptic ulcer disease and gastric malignancies. Objective of this study was to determine the frequency of H. pylori infection in patients of chronic calcular cholecystitis. This cross-sectional descriptive study was conducted at Liaquat University Hospital, Hyderabad, Pakistan from April 2010 to September 2010. All patients with history of gallstone presented with acute abdominal pain, dyspepsia, bloating and epigastric discomfort and diagnosed as calcular cholecystitis were further evaluated for the detection of H. pylori by serology and histopathology. Frequency and percentage of H. pylori infection in patients with calcular cholecystitis was calculated. Total 100 patients of cholelithiasis underwent laparoscopic cholecystectomy were recruited. The pain in upper right part of the abdomen was observed in all 100 patients, fever in 75%, nausea and vomiting in 68%, loss of appetite in 45%, feeling of tiredness or weakness in 22%, headache in 38%, chills in 52%, backache in 58%, pain under the right shoulder in 45%, heartburn in 67%, belching in 54%, indigestion in 80%, dyspepsia in 90%, bloating in 88%, and epigastric discomfort in 85% patients. Eighty-two percent patients had family history of gallstones. The mean age of overall study population was 48.72 +/- 8.78 years and mean age of H. pylori infected calcular cholecystitis patients was 47.98 +/- 5.43 years in male and 48.76 +/- 6.68 years in females. The H. pylori infection was identified in 55% patients with calcular cholecystitis, of which 32.7% were males and 67.3% were females [p=0.03, statistically significant]. Majority of females [60%] had >/= 40 U/ml antibody titre [p=0.917, non-significant]. A possible relationship was identified between Helicobacter pylori and calcular cholecystitis

Gastro esophageal reflux: an over investigated entity in neonates and infants

To determine the outcome of clinically suspected gastro esophageal reflux in neonates and Infants. To find a protocol for evaluation of these patients in order to reduce unnecessary radiation to neonates and infants. Fifty three neonates and infants of up to 1 year of age with clinical suspicion of gastro esophageal reflux [GER] were referred for Upper gastro intestinal barium studies. This retrospective descriptive case study was carried out over a period of one year starting from October, 2006 to September, 2007. Positive cases were followed for another one year to see the final outcome. The neonate and infants of upto one year of age, referred from Neonatal intensive care unit [NICU], Paediatric ward and Out Patient Department [OPD] were included in this study. Out of 53 cases 32 were positive for G.E.R and no reflux could be identified in rest of the patients. Out of these positive cases only 4 had massive or severe G.E.R. These patients were prescribed conservative and medical treatment and were advised to follow up in the O.P.D where on subsequent follow ups the medical treatment was stopped as there were no further complaints These patients showed normal weight gain on subsequent O.P.D visits. Other positive cases only had mild to moderate G.E.R and they were managed conservatively. These patients showed normal weight gain on subsequent O.P.D visits with complete resolution of symptoms. Regurgitation or gastro esophageal reflux is a common finding in the first 3 months of life [especially in preterm infants] and usually resolves by 6-12 months of age and should not be over investigated

Modulation of serine proteases-mediated platelet activation by novel direct thrombin inhibitors

Novel direct thrombin inhibitors [DTIs], such as bivalirudin, are replacing heparin in several clinical scenarios. In particular, DTIs are indicated for the treatment and thromboprophylaxis of patients with heparin-induced thrombocytopenia [HIT]. In interventional cardiology, DTIs have several advantages over heparin, and offer a clinical benefit equivalent to that of a combination of heparin and antiplatelet agents. We hypothesize that this benefit results from the ability of DTIs to inhibit platelet activation by activated serine proteases. This study represents the development of a modified [14]C-serotonin release assay [SRA] to investigate the relative inhibitory effects of three DTIs [argatroban, bivalirudin and hirudin] on thrombin- and factor Xa-mediated [14]C-serotonin release [SR] in plasma-free systems. Washed platelets were isolated from blood of healthy volunteers. The [14]C-SRA test was similar to that used to detect heparin-PF4 antibody-mediated platelet activation, except that it was used to evaluate the ability of DTIs to modulate protease-induced SR responses. The inhibitory effects of DTIs were determined at protease concentrations that induced >/= 50% SR. Serine proteases induced SR from platelets in a concentration-dependent manner. Human thrombin was found to be more potent than bovine thrombin [2-3 times for 50-80% SR]. Bovine factor Xa [>/= 0.2 nKat/ml] produced a comparable [50- 80%] SR response. All three DTIs effectively blocked serine protease-mediated platelet activation in a concentrationdependent manner. The optimum inhibitory concentrations of bivalirudin on SR was tilde100 nM for human thrombin and bovine factor Xa and almost double for bovine thrombin; well below plasma concentrations necessary for effective anticoagulation for percutaneous coronary interventions. Wide variations in the inhibitory effects of each DTI on thrombin- and factor Xa-mediated platelet activation were noted, which was partly dependent on the donor platelets and stability of the proteases/inhibitors. It is concluded that DTIs can directly inhibit serine proteases- mediated platelet activation responses

Combined intrauterine and bilateral tubal pregnancy

A rare case of combined intrauterine and bilateral tubal pregnancy [heterotopic pregnancy] in a young woman is described, who took a single dose of ovulation inducing drug [ART assisted reproductive techniques]. The possibility of heterotopic pregnancy should be considered and meticulous effort should be made to search for coexisting extrauterine gestational sac especially in patients who are on ovarian stimulation drugs in whom sonographically intrauterine gestation has been confirmed

Primary anastomosis in the management of acute sigmoid volvulus with out colonic lavage

The objective of this study was to evaluate the safety of single stage resection and anastosis for acute left sided colonic obstruction due to sigmoid volvulus. This study was conducted in the department of surgery Hayatabad Medical Complex and Lady Reading Hospital Peshawar Pakistan from January 2002 to Jun 2007. It included cases who presented with sigmoid vulvolus in emergency. All cases were operated by surgeons at senior registrar or above level. Resection of the sigmoid colon followed by primary anastomosis after simple manual decompression with out ontable colonic lavage or diverting stoma were carried out. Total number of patients who underwent bowel decompression, resection and primary anastosis was 80. Superficial wound infections occurred in 20% [n=16]. No death or clinical anastomotic failure was recorded. Hospital stay was 11.4 + 4.3[SD] days. Resection of acute sigmoid volvolus and primary anastomosis after decompression alone can be carried out safely in reasonably fit patients

Acetylcholinesterase and butyrylcholinesterase inhibitory potential of some Pakistani medicinal plants

The crude extracts of some selected Pakistani medicinal plants, namely, Acacia modesta, Buddleja crispa. Carthamus oxycantha, Conyza bonariensis and Tanacetum artemisioides were assessed for their inhibitory activities against acetylcholinesterase [AChE] and butyrylcholinesterase [BChE]. All the tested plant extracts exhibited dose dependent [0.25 - 1.0 mg/ml] inhibitory effects against both these enzymes with more selectivity for BChE. A. modesta and C. bonariensis showed activity against BChE only. The plant extracts of B. crispa C. oxycantha and T. artemisioides caused maximum inhibition of AChE at 1.0 mg/ml with% inhibition of 28, 34 and 48 respectively. In the BChE inhibitory evaluation all the tested plant extracts at 1.0 mg/ml produced marked inhibition [68-80%] of the enzyme activity. The results show the presence of selective BChE inhibitory constituents in the aforementioned plant extracts

Frequency of thyrotoxicosis in fifty patients previously treated for anxiety neurosis

To determine the frequency of thyrotoxicosis in 50 consecutive patients presenting with anxiety as chief complaint, who have been previously treated with anxiolytics and anti-depressants. This prospective analytical study was conducted in the medical OPD of Hayatabad Medical complex Peshawar from Jan 2004 to June 2004. Patients with symptoms of palpitations, sweating, tremors, anorexia and weight loss and those experiencing periods of intense fear and who were previously treated with anxiolytics were included in the study. All those patients who had diagnosed thyroid disease, were being treated for thyroid disease or had undergone thyroid surgery or radioablation of thyroid gland were excluded. In addition patients who had anxiety with concomitant medical disease, as tuberculosis, hepatitis, diabetes or hypertension etc and those on anti-arrythmic drug amiodarone and interferon therapy for hepatitis were also excluded from the study. After a detailed history and clinical examination, thyroid function tests, E.C.G was performed in all patients. Out of fifty patients, 35 [70%] patients were females and 15 [30%] were males. Age range was 20-45 years, with a mean of 32.5 +/- 4.3 years. Eleven patients [22%] were found to have thyrotoxicosis, the rest 39 [78%] were euthyroid and were labelled as primary anxiety disorder. Thyrotoxicosis is a common cause of anxiety neurosis in patients treated with anxiolytics. should be excluded before a diagnosis of anxiety disorder is made

Functional anti-heparin-platelet factor 4 antibody-mediated platelet activation is associated with intraplatelet Ca2+ signaling

Molecular heterogeneity in unfractionated heparin [UFH] and low-molecular-weight heparins [LMWHs] results in the formation of multiple complexes with platelet factor 4 [PF4] leading to the generation of heterogeneous group of antiheparin-PF4 [AHPF4] antibodies involving multiple mechanisms, which are responsible for heparin-induced thrombocytopenia [HIT] syndrome. This study evaluated the differences between the ELISA-detectable AHPF4 antibodies present in patients treated with UFH and a LMWH [Clivarin; Reviparin [R]] and the functionality of these antibodies in terms of platelet activation [mainly 14 C-serotonin release response] and its relationship with intraplatelet Ca [2+] signaling in human platelets. Plasma samples were tested for their AHPF4 antibody titer and the functionality was ascertained utilizing the functional assays of laboratory diagnosis of HIT. In a substudy, AHPF4 antibody positive samples were pooled and total IgGs [including AHPF4] were isolated. In comparison to IgGs from UFH-treated patients, LMWH-treated patients showed markedly decreased functional responses in all the HIT assays [p< 0.001]. A significantly higher increase in intraplatelet Ca [2+] mobilization was also noted in UFH group as compared to clivarin group [p < 0.01]. These results demonstrate that the functionality of AHPF4 antibodies in terms of Ca [2+] signaling could also be associated with the pathogenesis of HIT syndrome

Don't let me die Galactography the art is dying

The fancied and sophisticated investigations always catch the eye of the patient and the mind of clinicians. We are living in an era, which is certainly making headways in the field of medicine. The inventions like the state of art MRI, Computed Tomography and the newer modality of PET scanning certainly do help. For the sake of breast, the screening via mammography still remains the prime investigation but the frequently used method of investigating the ducts i.e; galactograhy or the commonly called Ductography is these days not the favorite of most clinicians these days. This article is a very limited study but it might be helpful in reviving the confidence of the clinicians in the art of Galactograhy