Leberwerterh?hung bei einem Intensivpatienten

In patients with increased liver function test values, who had been prescribed catecholamines and invasively ventilated, a secondary sclerosing cholangitis should always be suspected in the critically ill. In the case discussed here the normally rapid progression of this special form of secondary sclerosing cholangitis could be clearly retarded by biliary sphincterotomy with cast extraction and antibiotic treatment.     

Knowledge and risk factors of intestinal parasitic infections among women in Makurdi,Benue State

ObjectiveTo assess women's perceptions and risk factors that could expose them to intestinal parasitic infections in Makurdi, Benue State, Nigeria.MethodsA total of 750 faecal samples were collected from women at different reproductive stages (pre-menstrual, menstrual and post-menstrual), and the faeces were tested by the formol ether concentration technique.ResultsA total of 426 (56.8%) samples were found positive for various intestinal parasites with hookworm (4.8%), Ascaris lumbricoides (9.3%), Taenia sp (2.1%), Entamoeba histolytica (18.9%) and Entamoeba coli (21.6%). Women at pre-menstrual and post-menstrual stages recorded higher prevalence rates with 72.8% and 63.9%, respectively. No significant difference in prevalence was observed between women at different reproductive stages and women infected by different parasites (χ² = 30.6, P > 0.05). Sweet things, rotten fruits and improperly cooked meat were perceived as the causes of intestinal parasitic infections among the pre and post menstrual women. Sources of drinking water like river, well, water bought from vendors and patronizing food vendors were observed as risk factors contributing to the prevalence of intestinal parasitic infections among women. Factors like not washing hands before eating and after defaecation, use of leaves and ordinary papers for cleaning after defaecation were also observed to be contributing to the prevalence of intestinal parasitic infections.ConclusionsPersuasive health education and rigorous hygiene measures should be employed in schools, maternity clinics and among the populace to reduce transmission and infection with intestinal parasites.     

Bullet and Blast ENT Injuries in Counter-Insurgency Area

Background

Many ENT injuries are not recognized easily, but they have the potential of increasing the morbidity.

Methods

ENT injuries managed in two tertiary care Level-IV hospitals between 2006 and 2007 were studied with a view to formulate strategy in efficient management of these cases.

Result

Emergency bags did not carry readymade packs to control nasal bleeds. Routinely screening of ears in all blast injury cases in the ‘Blast Injury Program’ helped in early identification of hearing loss. Lack of sufficient stenting of nasal cavities resulted in severe nasal stenosis which was difficult to repair. Splinters lodged in pharyngeal wall escaped detection, resulting in concealed haemorrhage and shock.

Conclusion

Nasal packs and epistaxis catheters must be included in emergency bags to minimize blood loss at first contact. Screening for ear trauma in all blast injuries increases detection rate and is beneficial to the soldier. Stenting of injured nasal cavities and early transfer to a tertiary care hospital could reduce morbidity. Plain radiography of head and neck areas could help detect splinters in vital areas and guide management.Key Words: Combat injuries ENT, Blast injuries ear     

Impact of Endoscopic Sinus Surgery on Symptom Manifestation of Chronic Rhinosinusitis

Background

Rhinosinusitis is a significant health problem which results in large financial burden on society. The study evaluated the prevalence and severity of individual symptoms of chronic rhinosinusitis (CRS) and the impact of endoscopic sinus surgery (ESS) on the symptoms and medication used in patients with CRS.

Methods

Patients with refractory CRS were assessed prospectively with ESS intervention. We studied the symptoms, change in medical therapy, complications of surgery and effect of other factors like smoking, polyposis and asthma on endoscopy and computed tomography scan scores.

Result

A total of 81 patients underwent ESS for CRS. Post nasal drip (95%), headache (91%), nasal discharge (90%) and nasal obstruction (86%) were the commonest symptoms. Postoperatively, the highest improvement was seen in nasal blockage (87.2%), postnasal drip (84.4%) and headache (82.4%). Endoscopy scores were significantly worse in patients with polyps, asthma and smoking. A significant reduction in use of antibiotic and antihistaminics was seen post surgery. Seven patients who had extensive polyposis preoperatively, had recurrence and required revision surgery. Nasal synechiae formation and mild bleeding were the minor complications.

Conclusion

Endoscopic sinus surgery results in significant improvement in the symptoms of patients with CRS alongwith a definitive decrease in antibiotic and antihistaminic requirement. We conclude that ESS is an effective treatment for CRS in those who fail to respond to medical treatment.Key Words: Chronic rhinosinusitis, Endoscopic sinus surgery     

Nephrotic syndrome in infancy can spontaneously resolve

Nephrotic syndrome in the first year of life (NSFL) is a heterogeneous group of disorders, the management of which is supportive, as most patients do not respond to immunosuppression. Prognosis is guarded, as the syndrome tends to lead to end-stage renal failure. We describe four cases, all of which went into spontaneous remission. These patients had severe nephrosis that began postnatally at ages 15 days to 7 months and had preceding symptoms of viral infections. One infant had proven pertussis and required ventilation for respiratory failure. Renal biopsies showed varying degrees of mesangial expansion and increased cellularity. Two biopsies showed mild mesangial sclerosis and the other two only scattered globally sclerosed glomeruli. Supportive treatment was started with 20% albumin infusions, diuretics, penicillin, and thyroxine. Angiotensin-converting enzyme (ACE) inhibitors were used to reduce proteinuria in all infants, and one was also treated with indomethacin. The nephrosis gradually resolved, and protein-lowering medications were successfully weaned completely 5–30 months after presentation. The patients were protein free with normal renal function at last follow-up. Investigations including viral studies and autoimmune profiles were negative. Genetic studies for NPHS1, NPHS2, WT1, and LAM-β were negative. We therefore describe a subgroup of NSFL with good prognosis associated with infectious prodromes. This is also the first-described case of pertussis causing nephrotic syndrome.     

Angiographic morphology impacts outcomes in STEMI patients with LAD occlusion

Objectives and background: Acute proximal occlusion of the left anterior descendent coronary artery (LAD) is a critical medical condition often leading to heart failure and death. Our objective was to investigate how additional angiographic findings might influence prognosis. Methods: In a single center setting by using consecutive data from the Swedish angiography and angioplasty registry (SCAAR), we identified all patients with acute myocardial infarction (AMI) related to the proximal LAD referred for primary coronary angioplasty. Clinical and angiographic data were collected from January 2004 to December 2008. Results: In the study period, 359 patients (mean age 67.9 ± 12.3 years, 111 women) were identified as having proximal LAD‐related culprit lesion. Follow‐up was up to 5.5 years. Compared to patients with LAD occlusion only, having both a small conus branch (<0.5 mm in diameter) and an occluded first septal perforator was associated with increased risk of death after adjustment for age, diabetes mellitus and prior AMI (hazard ratio 4.5, 95% CI; 1.1–18, P = 0.033). A small conus branch in itself was not important. Multivessel coronary artery disease in addition to occlusion of the first septal perforator branch and having a small conus branch was also associated with increased risk of death (hazard ratio 5.2, 95% CI; 1.3–20), P = 0.018). Conclusions: In patients with STEMI because of a proximal LAD lesion treated by primary PCI, the combination of a small conus branch and an occluded first septal perforator branch is associated with a poorer outcome. Additional presence of multivessel coronary artery disease further aggravates outcome. © 2010 Wiley‐Liss, Inc.