Incidental Findings Of Polypoid Cystitis In A 6-Year Old Child Without Any History Of Lower Urinary Tract Symptoms And Previous Urinary Catheterization.

A 6-year-old boy presented to ER with acute pain in right iliac fossa without any history of lower urinary tract symptoms, haematuria and urinary catheterization. Ultrasound showed loculated cystic area in pelvis with non-visualized appendix. A CT scan abdomen and pelvis revealed loculated, multi-septated cystic lesion in right hemipelvis thought to be a collection from possible appendicular inflammation / perforation. The laboratory findings revealed raised CRP and normal urine routine examination and culture. Exploratory laparotomy revealed cystic urinary bladder growth involving dome with normal appendix, partial cystectomy was done. Histopathology confirmed polypoid cystitis with no evidence of malignancy. This is a very rare presentation of polypoidal cystitis, not previously reported in literature.

Lhermitte-Duclos Disease with Cervical Arteriovenous Fistula.

Lhermitte-Duclos disease is a rare condition with less than 250 cases reported in the literature. It was considered a neoplastic or hamartomatous growth in the cerebellum. It commonly presents with symptoms of high intracranial pressure or obstructive hydrocephalus. Surgical resection is often curative. The lesion is associated with PTEN gene mutation, and it is considered to be one of the diagnostic criteria of Cowden's syndrome. Vascular tumors are reported in this syndrome, including glioblastomas and meningiomas. Furthermore, central nervous system vascular lesions were also reported in Lhermitte-Duclos disease, such as deep venous anomalies and brain arteriovenous fistulas. A report of an asymptomatic spinal cervical AVF in a patient with Lhermitte-Duclos disease was published in 2006. We present the second case of Lhermitte-Duclos disease associated with an asymptomatic spinal cervical AVF in a 17-year-old young woman with literature review of central nervous system vascular lesions in Lhermitte-Duclos disease.

Comparison of Enteral versus Intravenous Potassium Supplementation in hypokalaemia in postcardiac surgery paediatric cardiac intensive care patients: prospective open label randomised control trial (EIPS).

BACKGROUND: Hypokalaemia is frequently encountered in the daily clinical practices of a paediatric cardiac intensive care unit (PCICU). It is a strong independent predictor of mortality in patients with heart failure. Thus, prompt potassium replacement therapy holds pivotal importance in therapy for hypokalaemia. Although intravenous potassium replacement (IVPR) in hypokalaemia is the preferred route in most intensive care settings, it is associated with known safety risks and can lead to arrhythmias, cardiac arrest and death if inappropriately administered. Enteral potassium replacement (EPR), with its superior safety profile, may be a better alternative to IVPR. OUTCOME: Primary outcome To compare the efficacy EPR and IVPR for treatment of hypokalaemia. Secondary outcome measures include a comparison of adverse effects (hyperkalaemia, diarrhoea, gastrointestinal bleeds, nausea and vomiting) after EPR and IVPR and a comparison of the number of dose/s required to achieve resolution of hypokalaemia for each episode of hypokalaemia. METHODS AND ANALYSIS: The Enteral Versus Intravenous Potassium Supplementation trial is designed as a randomised, controlled, non-blinded trial with two arms. Intervention arms will be block randomised on alternate weeks for IVPR and EPR. Recruited patients will receive treatment accordingly. For analysis, the percentage change in serum potassium levels in mEq/L after each event of potassium replacement in both arms will be used as an end point to compare the efficacy EPR and IVPR for treatment of hypokalaemia. STUDY SETTING: The study will be conducted at the PCICU at the Aga Khan University Hospital, Karachi. ETHICS AND DISSEMINATION: This study has been approved by the Ethics Review Committee and Clinical Trials Unit at The Aga Khan University with respect to scientific content and compliance with applicable research and human subjects regulations. TRIAL REGISTRATION NUMBER: This trial is registered at Clinical Trials.Gov. REGISTRATION NUMBER: NCT02015962.

Multiple myeloma in younger age.

A Multiple Myeloma (MM) is rare in younger age group. We report MM in a 30-year-old female, who presented with multiple lytic areas upon skeletal survey, but with negative Bence Jones protein. Bone marrow biopsy confirmed it to be a case of multiple myeloma. Patient was put on chemotherapy and radiography to which she responded and now is ambulatory.

Role of hysterosalpingoscintigraphy in the workup of infertility.

OBJECTIVE: To assess the role of hysterosalpingoscintigraphy (HSSG) in the evaluation of fallopian tube patency and function and compare the results with hysterosalpingography (HSG) and laparoscopy (LS). DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: The study was conducted at Multan Institute of Nuclear Medicine and Radiotherapy (MINAR), Multan from August 2004 to February 2005. PATIENTS AND METHODS: HSSG was performed after instillation of 4mCi (148 MBq) 99mTechnetium-macroaggregated albumin (99mTc-MAA) in posterior vaginal fornix in 65 patients. Serial static images were acquired in supine position at 1 hour, 2 hours, 3 hours and, if needed, at 24 hours. The results were compared to the findings on LS and HSG. RESULTS: Out of 65 patients, 37 (56.9%) patients had bilateral blocked tubes, 17 (26.1%) patients had bilateral patent tubes, 6 (9.2%) patients had blocked left tube and 5 (7.1%) patients had blocked right tube. The calculated sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV) and accuracy for HSSG were 90%, 83%, 90% and 90% respectively. The agreement between HSSG and LS was found in 32 out of 35 patients and agreement between HSG and HSSG was found in 24 out of 30 patients. CONCLUSION: This simple procedure can delineate tubal physiology; in selected cases it can replace HSG and in others augment the information gathered by HSG. HSSG should be part of the infertility workup algorithm.

Computerized stereotactic brain biopsies: an experience of 15 patients at Ayub Teaching Hospital.

BACKGROUND: Deep seated lesions of the brain cannot be approached by conventional neurosurgical approach stereotactic system offers minimally invasive and accurate approach to such lesions. This study was carried out with an objective to determine the safety, efficacy and diagnostic yield of stereotactic biopsies of brain lesions using Brown-Roberts-Wells (BRW) system. METHODS: This study was carried out in patients with intracranial lesions at Ayub teaching hospital Abbottabad from September 1999 to October 2003. Suitable patients with intra cranial lesions underwent computerized stereo tactic biopsy with BRW system. Tissue specimens were analyzed in histopathology department of the Ayub Medical College and results were obtained. Data was analyzed via computer software SPSS 8.0 version for windows. RESULTS: Fifteen patients were selected for stereotactic brain biopsy. Age ranged from 15 years to 54 years. Among them 09 (60%) were male and 06 (40%) were female patients. Out come of the procedure was highly promising in terms of safety and positive diagnostic yield in 14 patients (93.3%), and histopathalogical validity of results (93.3%). Only one patient suffered mild neurological deficit (6.7%), one patient had inconclusive tissue diagnosis and invalid result (6.7%). biopsy proven lesion was astrocytoma in 04 patients (26.7%), anaplastic astrocytoma in 04 (26.7%), gliomatosis in 02 (13.3%), tuberculomas in 03 (20.0%). metastatic adenocarcinomas in 01 (6.7%) and lymphoma in 01(6.7%). CONCLUSIONS: We conclude that computerized stereotactic brain biopsy is safe and effective procedure with a high diagnostic yield at our center.

Anterior sacral meningomyelocele with sacrococcygeal teratoma.

Anterior sacral meningocoele with sacrococcygeal teratoma is a rare entity. The cystic mass arising from anterior sacral and coccygeal defect, lies in the retrorectal space between the rectum and sacrum. It produces a variety of symptoms depending on its size and contents and constitutes a diagnostic problem. Such a rare association of two pathologies is presented, with review of literature, in an infant who had an anterior meningocoele with sacrococcygeal teratoma. Both the pathologies were surgically corrected individually, about a month apart.

Separation of xiphi-omphalo-ischiopagus tetrapus twins with favorable internal anatomy.

Conjoined twinning is a rare occurrence, and ischiopagus variety is even more rare. So far, only 20 cases have been reported. The incidence is 1 in 500,000. Because of its rarity and variable anatomy, no definite line of treatment can be adapted. Time of operation and mode of treatment have to be tailored according to the local circumstances and organ sharing in each individual pair. The twins in this report were xi phi-omphalo-ischiopagus tetrapus conjoined twins. Although several internal organs were fused and shared, they were complete mirror image sets for each twin. In this case report, details of anatomy and more importantly, preoperative investigations, preparations, and organizational aspects that were designed to suit local conditions are described. Operative details, postoperative care, and short and long-term progress also has been highlighted.