Diagnosis of tuberculous peritonitis.

The diagnosis of tuberculous peritonitis may be difficult and elusive. The patient may present with non-specific symptoms of fever, general ill-health or vague abdominal pains. There may be no pulmonary symptoms and the chest X-ray may be normal. The CT scan of the abdomen is sometimes helpful in suggesting the diagnosis. We have found that laparoscopic examination of the abdominal contents and the peritoneum is an effective way to obtain a conclusive diagnosis.

Paraganglioma with pulmonary metastases: a case report.

Distant metastases due to paraganglioma are a rare occurrence. We report a case of paraganglioma with pulmonary metastases and review the literature on paragangliomas. A 29-year-old female presented with cervical lymphadenopathy, excision biopsy of which confirmed the diagnosis of paraganglioma. She subsequently underwent tumour embolisation and received a course of radiotherapy. Seven years later, she was investigated for multiple pulmonary nodules noted on her chest roentgenogram. Histology of the wedge excision of the lung showed metastatic paraganglioma. Increased catecholamine production was documented; this was however not associated with symptoms of catecholamine excess. Reports concerning the treatment of paragangliomas with pulmonary metastases are few, given their rarity.

Pasteurella multocida septicaemia following a dog bite.

Bite wounds are often mistakenly considered innocuous. However, they are frequently complicated by infection which may be serious. We describe a case of Pasteurella multocida septicaemia with myopericarditis following a dog bite. Treatment of the infection as well as active support of myocardial function led to a successful outcome.

Fasting blood sugar level: a determinant for in-hospital outcome in patients with first myocardial infarction and without glucose intolerance.

The body responds to stress, e.g. during infections or acute illnesses, by a variety of neurohormonal mechanisms. Some of these physiological responses sometimes lead to an elevation of the blood sugar level (BSL). BSL is a biochemical parameter which is readily and rapidly assayed. The aim of our study was to determine whether the glycaemic state of patients with their first myocardial infarction and without previous glucose intolerance was of predictive value for the type of outcome during the in-hospital and post-hospitalisation periods. We also delineated the factors which determined subsequent glucose tolerance in this group of patients. Forty-four consecutive patients were studied and those with complicated in-hospital outcome had a significantly higher mean BSL at admission (ABSL) and fasting BSL (FBSL). FBSL was shown to be a predictor for in-hospital outcome. The odds ratio for a complicated in-hospital outcome was 3.3 times for patients with a FBSL of greater than 6.7 mmol/l (120 mg/dl) than those without (p = 0.0175). We could not identify a predictor for an adverse outcome in the post-hospitalisation period. Oral glucose tolerance test was performed on twenty-seven patients at least six weeks after the infarction. Twelve were normal and fifteen were abnormal (six were diabetic and nine had impaired glucose tolerance). The odds ratio for patients with glycosylated haemoglobin level (HbAlc) between 7.5 and 9.5% was 2.19 higher than those less than 7.5% (p = 0.049). In conclusion, the FBSL is a determinant for the outcome for these patients during the in-hospital and not the post-hospitalisation period.(ABSTRACT TRUNCATED AT 250 WORDS)

The use of intravenous streptokinase (SK) in a peripheral hospital in the treatment of acute myocardial infarction.

We report our early experience in the use of intravenous Streptokinase in acute coronary occlusion in a peripheral hospital. From 1st November 1988 to 20th July 1989, 30 patients were treated with Streptokinase. The hospital mortality was 1/30 (3.3%) from a non-streptokinase related event. The commonest complication following streptokinase infusion was transient hypotension, affecting 10/30 patients. From a total of 30 patients, 3 had transient bleeding complications and was self limiting. Follow up coronary angiograms were performed on 17/30 patients, demonstrating a patent infarct related artery in 12/17 patients (70.6%). We concluded that it is both feasible and safe to use intravenous streptokinase in a peripheral setting in the treatment of acute myocardial infarction.

Musical murmur and cardiac shudder.

When echocardiographic studies show several structures vibrating at a similar frequency to an associated musical cardiac murmur, the structure vibrating most strongly may localize the origin of the murmur.

Pyogenic hepatic abscess and diabetes mellitus--a probable association.

Four patients with pyogenic hepatic abscesses are reported. There were three females and one male with an age range of 36-75 years. In all the cases, diabetes mellitus was associated. Confirmation of the abscesses was obtained by liver scanning or ultrasonography, or both. In one patient, the clinical course was complicated by sympathetic pericardial effusion with right heart failure. Two patients had percutaneous transhepatic drainage of the abscesses under fluoroscopy. All four patients eventually required laparotomy and open drainage of the abscesses. Diabetic control was achieved with insulin therapy. The common causative organism in all instances was the Klebsiella species. Three patients recovered. The remaining one developed hypotension post-operatively and died of brain-stem infarction and the hepato-renal syndrome.

Infective endocarditis in Singapore: a six year survey.

Much has been written about the changing clinical spectrum of infective endocarditis. However our survey shows that the classical text book descriptions still hold good. The majority of our patients were young with 79% either 30 years or below. Fever was present in 93%, splenomegaly in 50% and cerebral embolism in 43% of our patients. Twelve patients had valvular heart disease and 2 patients had a ventricular septal defect. Eleven out of 14 patients had a positive blood culture. Echocardiography detected definite or probable vegetations in 66% of the examinations. Five patients responded satisfactorily to antibiotic therapy, 2 patients discharged themselves from hospital against medical advice, and 4 patients underwent successful cardiac surgery. Three patients died during medical therapy.

Cardiac tamponade in acute rheumatic carditis.

In patients with valvular heart disease, fever, and cardiomegaly echocardiography is an invaluable noninvasive tool. In this report we describe a young female presenting with cardiac tamponade due to acute rheumatic carditis. Echocardiography showed an exudative pericardial effusion which was haemorrhagic on pericardiocentesis. She responded to steroid therapy with resolution of carditis and pericardial effusion.

Diffuse conduction abnormalities in an adolescent with familial sinus node disease.

We report a case of familial sinus node disease with associated conduction abnormalities in the atrioventricular node and distal conduction system Spontaneous atrial pacemaker activity was absent though the atrium could be depolarized. The pacemaker activity of the heart resided in the atrioventricular junction. The AV node showed impaired automaticity and abnormal conduction properties which partially improved after vagal blockage.

Successful outcome in antepartum pulmonary embolism--a case report and review of incidence, diagnosis and management.

Antepartum pulmonary embolism is a condition carrying a high maternal mortality, yet treatment with anti-coagulation can reduce the mortality to less than 1%. The true incidence is difficult to establish because of problems in confirming the clinical diagnosis. We report here a case of maternal pulmonary embolism complicating pre-eclampsia and hypertension. The difficulties in establishing a firm diagnosis are high-lighted. A brief review of the incidence, predisposing factors, diagnosis and management is presented. The total management of the patient is discussed in some detail.