Pulmonary artery catheter induced pulmonary haemorrhage.

Since its introduction three decades ago, the pulmonary artery (PA) catheter has brought insights into pathophysiology of many diseases enabling intensivists to treat critical conditions much more precisely and securely. PA indications are widening, and those working in an intensive care environment feel more secure in handling critical conditions with objective data. However, PA-induced pulmonary haemorrhage is a well-recognised, uncommon, yet potentially lethal, complication of PA catheter. We report a case with PA haemorrhage induced by placement of the PA catheter during coronary artery bypass surgery. A contrast-enhanced CT scan of the chest confirmed spontaneous remission of the haemorrhage after 7 weeks of the injury without the need for any intervention.

Urinary tuberculosis: experience of a teaching hospital in Syria.

This study was designed to show our experience of urinary tuberculosis in one of the large teaching hospitals in Syria. It was a prospective study involving 48 patients (29 males and 19 females) with confirmed tuberculous lesions in the urinary tract. The study period was between 1982-1987. The presenting symptoms were protean, and there were often delays between onset of symptoms and eventual diagnosis. The highest age incidence was in the second and fourth decades. Beside the suggestive clinical manifestations, final diagnosis was reached by various means. Repeated examinations of EMU smears were positive in about 20% of cases. Urine culture was positive in 33.3%, while varied percentage of cases showed some radiological changes suggestive of tuberculosis. Other investigations included cystoscopy and biopsy of suspected lesions. Treatment was conservative by chemotherapy in 45% of cases, with complete recovery in about 33%, while acceptable results were shown in congruent to 19%, and failure of treatment or recurrence of active disease in 48% of cases. Some forms of surgical intervention were carried out in 55% of patients. Cure was seen in 50% of them, while 25% had acceptable results and failure was shown in the remaining 25%. It is concluded that urinary tuberculosis remains an important infectious disease problem in our country. The high rate of failure of both medical or surgical treatment is mainly due to late diagnosis.

Acute renal failure among a Syrian population. Incidence, aetiology, treatment and outcome.

This prospective study involved 102 patients who had acute renal failure and were treated at Aleppo University Hospital during the period 1980-1986. Acute renal failure in this group was categorized, according to the aetiology, into 12 causes. Obstructive uropathy, surgery, and crush injuries constituted 64% of all cases in males. In females, 56% of all cases were due to obstetrical trauma, acute glomerulonephritis and eclampsia. Haemodialysis was used for the treatment of 77 patients, with 65% cure, and 33% mortality. Conservative treatment was adopted for 21 patients with 62% cure, and 38% mortality. Four patients were treated by peritoneal dialysis, and they all survived. The prognosis in the studied group depended on the aetiology of acute renal failure, and accompanying risk factors such as infection, electrolyte disturbances, encephalopathy, failure of other end organs, etc. It was also found that patients presenting with anuria or oliguria had worse prognosis when compared with patients who had normal urine output.

Some features of paediatric urolithiasis in a group of Syrian children.

A group of 28 Syrian children (19 males and 9 females; age ranging from 2.5 to 12 years) were diagnosed clinically and radiologically to have upper urinary tract stones. The commonest presentations were renal colic, vomiting, haematuria, pyrexia and vague abdominal pain. Family history of renal stones was present in 21% of cases. Haematological picture and chemical analysis of blood were within the normal limits for their age and sex. Urine analysis, however, showed significantly marked increase in the 24-hour excretions of calcium and uric acid. Microscopic examination showed haematuria and pyuria in 72% of the children with urolithiasis. Chemical analysis of removed stones revealed that most of them were mixed stones of calcium oxalate and urate or/and phosphate. Pure stones of calcium oxalate or calcium phosphate were less common. Radiologically, about 95% of all stones were demonstrated by plain X-ray, while 5% only after IVP.

Genetic and immunological aspects of familial chronic active hepatitis (type B).

Thirteen family members of a patient with chronic active hepatitis type B were investigated. The family included both parents, 6 sons, and 5 daughters. The parents were second cousins. HBsAg, liver tests, immunological evaluation, and HLA typing were performed on all subjects. Percutaneous liver biopsies were done on the mother and 5 of the 6 sons. The mother and all 6 sons had HBs antigenemia. The mother was free from any evidence of liver disease whereas all 6 sons had abnormal liver and immunological tests. The liver biopsies of 5 sons showed chronic active hepatitis with variable degrees of progression toward cirrhosis. The 6th son could not be biopsied in view of his prolonged prothrombin time. The father and the 5 daughters were HBsAg negative and had no evidence of liver disease. Immunological abnormalities were present in all of the effected children and in the mother and 3 daughters. This is the second report in the English literature on the familial occurrence of chronic active hepatitis type B. It emphasizes the predominance of this entity in the male offspring and confirms the presence of immunological abnormalities in the relatives of such patients. There was no evidence to link the inheritance of an immunological abnormality to clear the HBsAg to the histocompatibility complex.