Perceived benefit of antibiotics irrigation before pharyngeal repair of severe cut-throat injuries.

INTRODUCTION: Wound irrigation has been employed as an important surgical step to remove bacteria, devitalized tissues, and foreign bodies from surgical sites to prevent infection and confer to the wound maximum potential of healing. METHOD: A prospective study was conducted at Federal Medical Centre, Gusau, between January 2019- August 2023 to assess the benefit of antibiotics as additives in irrigation of dirty wounds. Seven (7) patients in total were presented with severe cut-throat injuries that require laryngopharyngoplasty. A combination of injection ciprofloxacin and metronidazole were used as additives into 1 L of normal saline, low pressure irrigation was done using 20mls syringe fitted to a broken needle or canular. Dysphagia Outcome and Severity Scale (DOSS) was used to assess return of pharyngeal function. RESULT: The mean time of presentation of the patients was 34 ± 29 h (µ ± standard deviation) and a range of 6-72 h. The mean repair time was 58.3 ± 38.4 h with a range of 24-120 h. Most of the patients (85.7 %) had dysphagia outcome and severity scale of level 5 when per oral feeding was started with steady progress until discharge day. CONCLUSION: Wound irrigation is one of the most crucial steps in treating severe cut-throat injuries. Based on our experience, adding antibiotics to the irrigant has shown potential in the control of local infection, particularly where patients present late.

Audit of Adenotonsillar surgeries in a Tertiary Facility in Uyo, South-south Nigeria

Background:Adenoid and tonsils are lymphoid tissues that occupy the nasopharynx and tonsillar fossae and serve as the initial site of immunological contact for inhaled and ingested antigens. Adenoidectomy, tonsillectomy or adenotonsillectomy is a lifesaving surgical procedure and remains a leading reason of surgical admission in general otorhinolaryngological practice both in developed and developing countries.The study aims to audit adenotonsillar surgeries in the Department of Ear, Nose and Throat in University of Uyo Teaching Hospital, and compare findings with similar studies.Method:This is a retrospective study of patients who had adenoidectomy, tonsillectomy, or adenotonsillectomy over 5 years from January 2015 to December 2019 at the Department of Ear, Nose, and Throat, University of Uyo Teaching Hospital, Uyo, Akwa Ibom state, south-south Nigeria.Results:Atotal of 526 patients were recruited, and this accounted for 38.7% of the total ENTsurgeries performed within the study period. Ages ranged from 6 months to 72 years, with a mean age of 11.89+1.03. The majority of the patients were aged between 1-5 years and the commonest presenting symptom was snoring and mouth breathing (79.5%). Sleep-disordered breathing (55.7%) was the main indication for the surgeries. Adenotonsillectomy (61.0%) was the commonest surgery performed. About 1.0% of the patients had recurrent adenoids. Conclusion: The surgeries were of immense necessity to the patients as all presenting complaints and pre-operative diagnoses became completely resolved.

Macroglobulinemia and membranoproliferative glomerulonephritis in a hepatitis C virus-positive patient.

A 72-year-old female was admitted to our hospital for massive proteinuria. She had previously been diagnosed with hepatitis C virus (HCV) infection and macroglobulinemia. Renal histological examination demonstrated membranoproliferative glomerulonephritis (MPGN), and type 2 cryoglobulinemia was positive in her serum. It is generally recognized that MPGN is the most common nephritis associated with HCV infection and cryoglobulinemia, but this is the first report of an HCV-infected patient with macroglobulinemia associated with MPGN. After treatment with prednisolone and melphalan, proteinuria disappeared, but macroglobulinemia and cryoglobulinemia were not improved.

Evaluating systemic lupus erythematosus disease activity using molecular markers of hemostasis.

OBJECTIVE: To determine the usefulness of measuring sensitive markers of the coagulation-fibrinolysis system (i.e., thrombin-antithrombin III complex [TAT], D dimer fragments [DD], and plasmin-alpha2-plasmin inhibitor complex [PIC]) for evaluating disease activity in patients with systemic lupus erythematosus (SLE). METHODS: We studied 57 SLE patients. Plasma concentrations of DD were measured by latex agglutination using monoclonal antibodies; TAT and PIC were determined by sandwich enzyme-linked immunosorbent assay. Disease activity was determined by using the SLE Disease Activity Index (SLEDAI). RESULTS: Levels of TAT, DD, and PIC were higher in SLE patients than in healthy controls (P<0.05). Levels of TAT and DD showed good correlations with SLEDAI scores (for TAT r=0.66, P<0.001; for DD r=0.50, P<0.001). Elevated levels of TAT, DD, and PIC were decreased following treatment. CONCLUSION: These results strongly suggest that measurement of molecular markers of hemostasis is useful for evaluating disease activity in patients with SLE.

[A case of sarcoidosis with renal failure as the main manifestation in granulomatous interstitial nephritis].

A 39-year-old woman was consulted to our hospital because of renal failure on October 1992. A chest X-ray showed no abnormal shadow. Subsequently, she was under conservative treatment until December 1993, when she began to notice clouded vision. The iridocyclitis in both eyes was diagnosed by a ophthalmologist. She was admitted to our hospital for the purpose of a renal biopsy. Laboratory tests revealed renal failure: a creatinine clearance of 24.5 ml/min, a serum level of creatinine of 3.2 mg/ml and blood urea nitrogen of 38.7 mg/dl. The angiotensin converting enzyme was 17.6 IU/ml (normal 8.3 approximately 21.4 IU/ml), but lysozyme was 49.5 micrograms/ml (normal 5.0 approximately 10.2). Mantoux's reaction was negative. 57Ga scintigram showed abnormal uptakes on eyes, bilateral salivary gland, both thighs, both kidneys, and in a part of lung field. A percutaneous renal biopsy revealed non-caseating histiocytic granulomas with diffuse infiltration of lymphocytes and neutrophils into interstitium. Glomeruli were ischemic and mild endocapillary proliferations with pericapsular fibrosis were seen. Both of transbronchial lung biopsy (TBLB) and skin biopsy also revealed non-caseating histiocytic granulomas. Oral administration of prednisolone, 40 mg/day, improved the level of serum creatinine and lysozyme. Sarcoidosis is a granulomatous disease of unknown etiology that may involve any organ or tissue of the body. The clinical picture dominating in adults is the one with pulmonary and mediastinal lymph node involvement, eye and skin lesions. Although the renal involvement were rarely encountered, the present case showed that the renal failure was one of the most important clinical feature in patient with sarcoidosis.

An outbreak (159 cases) of transient thyrotoxicosis without hyperthyroidism in Japan.

We report an outbreak of transient thyrotoxicosis that occurred between June and September 1993, in Matsuyama City, Ehime Prefecture. One hundred fifty-nine cases of thyrotoxicosis were identified, all in individuals without goiter. Thyroid autoantibodies were absent, and the serum thyroglobulin level was depressed. Ultrasonography of the thyroid disclosed no abnormal findings, while scintigraphy of the thyroid with 99mTc revealed poor uptake. About ten days after the onset, the serum thyroid hormone levels were normalized. No significant elevation of serum viral antibodies was found. These observations suggest that a thyrotoxicosis factitia may have been the cause of the present outbreak.

[Multiple colonic ulcers in a patient with Sjögren's syndrome].

A 25-year-old female with Sjögren's syndrome was admitted to our hospital because of fever and abdominal pain. Multiple colonic ulcers were demonstrated by gastrographin enema and colonoscopy. Histological examination revealed the presence of necrotizing vasculitis in the submucosal region. Large dose of prednisolone (60 mg/day) brought a prompt relief of her symptoms and an improvement of positive inflammatory signs. Pseudoaneurysm in the arteria colica media, which had been demonstrated by abdominal selective angiography at the time of diagnosis, became extinct after the steroid treatment. Healing of ulcers were also noted by colonoscopy. A variety of extraglandular symptoms has been reported in Sjögren's syndrome. Multiple colonic ulcers due to vasculitis are rarely complicated but may have a great impact on the prognosis of the disease.

[A case of Felty's syndrome with marked thrombocytopenia and severe hypocomplementemia].

Felty's syndrome is diagnosed when a patient shows both splenomegaly and leukocytopenia of various degree during the course of rheumatoid arthritis (RA). The accompanying immunologic abnormalities (e.g., antinuclear antibody, antiplatelet antibody, and hypocomplementemia) also characterize Felty's syndrome, but some authors may regard these abnormalities as a transitional form into overlap syndrome [RA + systemic lupus erythematosus (SLE)]. Here we reported a female case of Felty's syndrome who showed marked thrombocytopenia and severe hypocomplementemia. Thrombocytopenia had been refractory against several forms of therapies including high-dose methylprednisolone. Simultaneously, she had various autoantibodies (i.e., antiplatelet antibody, positive Coombs' test, antithyroglobulin antibody, antimicrosome antibody and anti-RNP antibody). Although she did not fulfill the ARA diagnostic criteria for SLE, the degree of thrombocytopenia as well as that of hypocomplementemia argued in favor of the overlap of SLE in this patient. Low-dose cyclosporin A (CsA) combined with small dose of prednisolone could increase both platelet count and level of complement. Notably, the titers of several autoantibodies dropped after CsA was started. These findings might suggest that CsA could normalize the underlying immunologic abnormalities in this patient. However, the disease activity of RA could not be decreased without a help of low-dose methotrexate.

Effect of low-dose cyclosporin A on systemic lupus erythematosus disease activity.

OBJECTIVE: To determine the effect of low-dose cyclosporin A (CSA) treatment on disease activity in systemic lupus erythematosus (SLE). METHODS: All patients in the study had active disease as defined by at least the presence of a low CH50 level. Patients were initially given 3 mg/kg/day of CSA. Dosages were adjusted individually at every visit, according to both clinical and laboratory data. RESULTS: Eleven women with SLE were enrolled in the study; 10 were evaluable. After 20 weeks of CSA treatment, the mean score for disease activity on the SLE Disease Activity Index decreased significantly, from 10.6 to 3.8 (P = 0.02). The titer of antinuclear antibodies decreased in 8 patients and the level of anti-DNA antibodies decreased in 5. Side effects included hypertension (40%), hypertrichosis (30%), gingival hypertrophy (10%), and a rise in the blood urea nitrogen level. Serum creatinine levels remained unchanged. CONCLUSION: The favorable responses observed in our patients strongly suggest that low-dose CSA can reduce the disease activity of SLE.