Gujjar lung: a disease mimicking miliary tuberculosis.

Gujjar lung is a chronic lung disease caused due to the long-term exposure to pinewood smoke inhalation in Gujjar community and the people residing at the hilly regions of the Indian sub-continent. This is characterized clinically by progressive cough and dyspnea, distinct radiological patterns and pathological features of anthracotic nodules and fibrosis. A typical case with miliary mottling on chest radiograph is presented and the relevant literature reviewed.

Salmonella typhi endocarditis: a case report.

Salmonella are a rare cause of infective endocarditis. This report describes a case where Salmonella typhi was isolated from the blood and urine of a patient with echocardiographically documented aortic valve disease and endocarditis. The patient was treated with two weeks of ceftriaxone (3 g/day) and amikacin (15 mg/kg/day), followed by a further two weeks of ceftriaxone (3 g/day) alone. He made a complete recovery.

Transient complete heart block complicating acute rheumatic fever.

First-degree heart block is a common electrocardiographic manifestation of acute rheumatic fever and is included in Jones' diagnostic criteria. Other electrocardiographic changes such as sinus tachycardia, bundle branch blocks. nonspecific ST-T wave changes, atrial and ventricular premature complexes have been reported with variable frequency. However, complete heart block is an exceptionally rare manifestation of acute rheumatic fever. We report the clinical course of a 16-year-old boy with acute rheumatic fever who had prolonged P-R interval in the electrocardiogram on admission which subsequently progressed to complete heart block. The patient regained normal sinus rhythm within a few minutes without any pharmacologic or electrical intervention.

Waldenstrom's macroglobulinaemia with intracerebral haemorrhage.

A 65-year-old male was admitted for evaluation of severe anaemia, recurrent epistaxis, axillary lymphadenopathy, and hepatomegaly. The diagnosis of Waldenstrom's macroglobulinaemia was made on the basis of clinical and laboratory findings. The patient developed intracerebral haemorrhage without associated hypertension and with normal coagulation profile.

Cockayne syndrome.

We report four cases of Cockayne Syndrome in a family of seven children. Apart from the usual clinical and laboratory features, sparse eye lashes and high arched palate in two patients, conjunctival and corneal edema in one, and proximal muscle weakness in one patient were noticed as additional findings.

Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial.

OBJECTIVES: Our purpose was to compare the controlled cord traction technique with the minimal intervention technique for delivery of the placenta. The primary outcome was the incidence of postpartum hemorrhage. Secondary outcomes included duration of third stage of labor, frequency of retained placenta, hemorrhagic shock, the need for blood transfusion, and the need for uterotonic agents to control postpartum hemorrhage. STUDY DESIGN: A total of 1648 women who were delivered vaginally were randomly allocated during labor to the controlled cord traction group (n = 827) or the minimal intervention group (n = 821). In the controlled cord traction group women received oxytocin, 10 units intramuscularly, with delivery of the baby's anterior shoulder, after which the placenta was delivered actively by controlled cord traction (Brandt-Andrews method). In the minimal intervention group the placenta was delivered by maternal pushing. Continuous intravenous oxytocin was given after delivery of the placenta. Odds ratios with 95% confidence intervals were calculated for each variable. RESULTS: The overall incidence of postpartum hemorrhage was significantly lower in the controlled cord traction group (5.8% vs 11%; odds ratio 0.50, 95% confidence interval 0.34 to 0.73). The incidence of retained placenta (> or = 30 minutes) was 1.6% in the controlled cord traction group and 4.5% in the minimal intervention group (odds ratio 0.31, 95% confidence interval 0.15 to 0.63). Significantly more patients in the minimal intervention group required additional uterotonic agents to control hemorrhage (5.1% vs 2.3%; odds ratio 0.44, 95% confidence interval 0.24 to 0.78). CONCLUSION: The controlled cord traction technique for delivery of the placenta results in a significantly lower incidence of postpartum hemorrhage and retained placenta, as well as less need for uterotonic agents, compared with the minimal intervention technique.

Abu Dhabi third stage trial: oxytocin versus Syntometrine in the active management of the third stage of labour.

OBJECTIVE: To compare the effect of oxytocin and Syntometrine when used as part of active management of third stage of labour on postpartum haemorrhage, hypertension, nausea/vomiting and retained placenta. STUDY DESIGN: A randomised double blind trial was conducted in the Obstetric Unit of Corniche Hospital, Abu Dhabi in the United Arab Emirates. Between 1 January 1991 and 30 June 1991, 2040 women were randomly allocated either to the oxytocin (n = 1017) or the Syntometrine (n = 1023) group. Twelve patients had to be excluded from the trial (oxytocin, 5; Syntometrine, 7) after randomisation because they no longer fulfilled the inclusion criteria. All women in the trial received either oxytocin 10 units or Syntometrine 1 ml (oxytocin 5 units+ergometrine (ergonovine) 0.5 mg) by intramuscular injection with delivery of the anterior shoulder of the baby. Relative risk with 95% confidence intervals was calculated for each variable. RESULTS: Oxytocin (10 units) alone was as effective as Syntometrine (1 ml) in preventing post-partum haemorrhage without an increase in the incidence of retained placenta. Median blood loss was similar in both groups. The incidences of nausea, vomiting and headache were significantly lower in the oxytocin group, as was the occurrence of a mean rise in diastolic and systolic blood pressures of 20 and 30 mmHg or more, respectively. CONCLUSION: Prophylactic administration of oxytocin 10 U in the third stage of labour, as part of active management, reduces the incidence of maternal nausea, vomiting, headache and rise in blood pressure than does Syntometrine 1 ml without adversely affecting the rate of post partum haemorrhage.

Wound pain may be reduced by prior infiltration of the episiotomy site after delivery under epidural analgesia.

Local infiltration is seldom used during episiotomy repairs in patients who have been delivered under an effective epidural block and increased post-episiotomy pain has been found in association with epidural analgesia. The hypothesis that this leads to tight wound closure and thereby causes increased perineal pain was examined in a double-blind randomized trial in patients who had normal deliveries and mediolateral episiotomies. Mean pain scores on the day after delivery were significantly reduced from 4.5 to 3.6 and analgesic requirements were also diminished by local infiltration with saline before the episiotomy repair. It is postulated that the oedema of inflammation can be accommodated under less pressure if 'slack' is created by prior distension of the tissues.