Fungal esophagitis in a child with insulin dependent diabetes mellitus

Esophagitis in children is not uncommon, mostly due to gastro-esophageal reflux. Other conditions like eosinophilic and infective esophagitis need to be elucidated in differential diagnoses. Fungal or Candida esophagitis usually occurs in high risk children who are immune-compromised, malnourished, on steroid therapy or have uncontrolled diabetes mellitus. An eleven-year girl presented with uncontrolled type I diabetes mellitus and recurrent epigastric pain with vomiting. Her oral intake was satisfactory. There was no dysphagia and odynophagia. Physical examination was normal with good oral hygiene. Failure in responding to conventional medications led to endoscopic evaluation, which revealed white patches and esophageal inflammation and diagnosed as fungal esophagitis on histopathology. Although infective esophagitis is encountered sporadically in pediatric age group, but it should always be considered in high risk individuals and when conventional medication fails to resolve the symptoms

Adrenocortical oncocytoma

Adrenocortical oncocytoma is an exceedingly rare pathological variant of an adrenal neoplasm. The pathogenesis of oncocytic neoplasms is poorly understood. Females have been reported to be affected 2.5 times more frequently than males, and left-sided lesions are more common than those on right side. This case describes a 20 years old female with right lumbar pain. She found to have a right adrenal gland mass measuring about 6 x 5 cm. A computed tomogram showed hypodense mass lesion 6 x 4.2 cm involving right adrenal gland. Differential diagnosis of non-functional adrenal adenoma was made. A laparoscopic right adrenalectomy was performed using the 3-ports lateral transperitoneal approach. Histopathology showed adrenocortical oncocytoma of adrenal gland

Ureteroscopy under spinal versus general anaesthesia: morbidity and stone clearance

To compare morbidity and stone clearance by ureteroscopy carried out under spinal anaesthesia with that carried out under general anaesthesia. Quasi-experimental study. The study was conducted at the Kidney Centre, Postgraduate Training Institute, Karachi, from September 2005 to December 2006. A total number of 60 patients were enrolled for the study. All patients underwent ureteroscopic procedure for a calculus disease, using a semi-rigid ureteroscope of 10 Fr. These patients were divided in 2 groups of 30 patients, receiving general or spinal anaesthesia. Operative time, stone clearance, hospital stay, intra- and postoperative complications and visual analogue score for pain were noted in each case. There were 30 patients each in both groups, with 73% males and 27% females in group A [general anaesthesia] and 93% males and 7% females in group B [spinal anaesthesia]. Mean age of the patients were 33.9 and 36.9 years in groups A and B respectively. The average stone size was 0.79 cm in group A and 1.14 cm in group B [p=0.001]. Duration of surgery was 41.4 +/- 1.29 minutes in group A and 30.5 +/- 2.13 minutes in group B [p=0.033]. Mean hospital stay was 21.6 and 18.1 hours in group A and B respectively [p= 0.073]. Mean visual analogue score for pain in group A was 3.1 and group B was 1.8. Ureteroscopy under spinal anaesthesia resulted in decreased length of operative time and shortened hospital stay in this series and did not carry any additional risk of major complications

Plain abdominal radiographs and acute abdominal pain

In this study we audited one district general hospital's current practice of performing abdominal X-ray [AXR] in adult patients with acute abdominal pain. Data was collected from patients' notes one day post-admission and a total of 100 consecutive cases were reviewed in a two month period. AXR were deemed unnecessary in 53% of these in view of the patients' clinical presentation. Inappropriate use of AXR is a source of preventable radiation, patient discomfort and also an aspect of financial burden on the NHS. By educating staff, introducing an A and E poster and departmental protocol, the use of AXR can be restricted to necessary cases only

Pregnancy after augmentation cystoplasty

We report a case of 26 year old female who underwent ileo-cystoplasty for interstitial cystitis and two years later delivered a live baby through a lower segment caesarean section [LSCS] at 36 weeks

Laproscopic assisted percutaneous nephrolithotomy [PCNL] in ectopic pelvic kidney

We report the case of a patient with pain and an abdominal palpable mass whose tests showed a right pelvic kidney with a 4-cm stone in the renal pelvis. We describe the successful management through laparoscopic assisted percutaneous nephrolithotomy [PCNL] in ectopic pelvic kidney, stressing that this method is a minimally invasive therapeutic option in such cases

Bed wetting in School Children of Karachi

To estimate the frequency of primary nocturnal enuresis [PNE] in Pakistani children and to examine the factors associated with it. A randomly selected cross-sectional study was conducted in five elementary schools, one in each of five districts of Karachi. The parents of 5000 children age between 3-13 years were asked to complete a questionnaire which included items about the frequency of daytime wetting and nocturnal enuresis, family history, urinary tract infection, parents and child's own concern about this problem and acquisition of treatments. Over all corrected response rate to the questionnaire was 69% [3395]. Enuresis was present in 9.1% [308]. There were 166 [53.9%] boys and 142 [46%] girls with a median age of 7 years. Only 54% [166] children sought help for their problem of which 26% consulted doctors, 16% visited homeopaths while 11% used hakeems and home remedies. Of the bed wetters, 30% were wet every night, 30% for more than three nights a week and 40% for less than three nights every week. Parents of 68.5% [211] children reported concern for the problem while 69.8% [215] children were also anxious about their enuresis. Among the concerned children group, 22% parents were not concerned about their child's problem. Family history of enuresis was present in 25.6% [79] children. The frequency of enuresis among the school going children in Karachi is 9.1% and is similar to that reported in European countries and other Asian countries including Korea and Taiwan. Enuresis causes concern to both parents and children, but only a small percentage of parents seek medical help for this problem

Comparison of 24 hours urinary citrate levels in urolithiasis patients and healthy controls

To identify the difference in urinary citrate excretion between Stone Formers [SF] and Healthy Volunteers [HV] as a metabolic risk factor, that predisposes to urinary stone formation and to compare levels of urinary citrate in [HV] with reference values. The 24 hours urinary citrate was evaluated in 40 patients treated for renal citrate and declared stone free, and 40 age matched healthy adults taken as controls. Both the groups had a similar living environment, extrinsic factors, diet and similar genetic descent. There was no significant difference in urinary citrate excretion level among stone formers [mean 262 SD 197] and normal volunteer subjects [mean 269 SD 140]. Using the previously defined normal values [200] of urinary citrate in the local population, 55% of stone patients in our study group were hypocitric. While using the same value, 45% of our normal volunteers were also hypocitric. If 320 was taken as normal limit, 70% of the patient's population and 72% of controls were hypocitric. The prevalence of hypocitraturia was similar in the age matched adult groups. Certain intrinsic factors in our local subjects may account for the high prevalence of urolithiasis than in western population. Although the urinary citrate excretion of stone patients is similar to normal volunteers, uniformly low urinary citrate excretion may be a feature as a nation and not a predisposing factor for the lithogenesis. This supports the view that there may be more often prominent influences in stone formers possibly of genetic origin