Biomedical subjects
Publications and source records attributed to A Hilal.
A case of completed suicide committed by a 46-year-old male by inserting a tapestry needle in his heart is described. Scene investigation findings and autopsy examination revealed signs of self-harm efforts as well as punctures at both forearms and the right and left sides of the neck. The deceased caused a penetrating cardiac injury which resulted in cardiac tamponade.
OBJECTIVE: To establish the frequency of occurrence of delayed facial nerve paralysis following tympano-mastoid surgery in our department and to determine the aetiological factors and long term prognosis. SETTING: Tertiary care academic centre. MATERIALS AND METHODS: A retrospective review of all patients who had undergone tympano-mastoid surgery in our department over the previous five years was carried out. A total of 219 patients were included in the study. Only two patients were identified as having delayed onset facial nerve palsy over this period of time. The patients' medical records were reviewed and the patients clinically assessed. RESULTS: The frequency of delayed onset facial nerve palsy following tympano-mastoid surgery in our series was 0.91 per cent. Facial weakness set in on day eight and day 14 in the two patients. Serological investigations in both patients revealed raised titres of immunoglobulin (Ig) M and IgG to varicella-zoster virus, confirming the presence of varicella-zoster infection. In our experience, the combined use of prednisone and acyclovir was an effective form of treatment for both patients, whose facial nerve function fully recovered within six months of onset. CONCLUSION: The incidence of delayed facial nerve palsy following tympano-mastoid surgery is low. It can occur up to two weeks after the surgery. Our two cases confirm viral reactivation to be an important aetiological factor in the development of delayed onset facial nerve palsy. The overall prognosis for delayed facial nerve palsy following tympano-mastoid surgery appears to be good.
It has been suggested recently that acute intussusception should only be managed in a specialised paediatric centre. The aim of this study is to assess the incidence and outcome of acute intussusception in a comprehensive paediatric unit in Waterford Regional Hospital. It is a retrospective medical records study over a ten year period from June 1990 to June 2000. Our results showed that we had 24 cases giving an incidence of 2.4 cases per year. Contrast enema was performed in 23(95%) cases, successfully reduced in 14(61%) cases, unsuccessfully reduced in 7(30%). Surgical intervention was necessary in 7(30%) cases. Three (12.5%) cases were transferred to a specialised paediatric surgical centre. There were no perforation or death. We conclude from this study that management of acute intussusception can be successfully undertaken in a regional paediatric centre. It requires adequate throughput of cases and close co-operation between paediatrician, radiologist, anaesthetist, surgeons and of course a dedicated paediatric nursing staff.
The value of red blood cell (RBC) sodium/potassium ratio in diagnosing digitalis toxicity was studied in 60 adult patients. The normal ratio was established in 34 healthy volunteers and in 10 patients with heart disease not receiving digoxin (group I). During chronic digoxin therapy, RBC sodium/potassium (Na/K) ratio and plasma digoxin were measured in 50 nontoxic patients (group II), in 10 toxic patients (group III), and in 9 of these 10 toxic patients after resolution of digoxin toxicity. Red cell sodium and RBC Na/K ratio in nontoxic patients were significantly greater than in the control group. Red cell sodium and the RBC Na/K ratio in toxic patients were significantly greater than in nontoxic patients. Despite significant group differences in these variables, however, there was considerable overlap among the subjects studied. After resolution of toxicity, red cell sodium and the RBC Na/K ratio fell to values indistinguishable from those in the nontoxic group. Although there was a statistically significant positive correlation between RBC Na/K ratio and plasma digoxin level, the RBC Na/K ratio had weak predictive value (33%) in determining digoxin toxicity. Plasma digoxin was a better predictor of digoxin toxicity (60%). The combination of plasma digoxin concentration and of RBC Na/K ratio had a higher calculated predictive value (75%), and may be more useful as an indicator of digoxin intoxication.
A case of limited Wegener's granulomatosis is presented with unusual black linear and circular digital infarcts, unilateral bursitis and subcutaneous nodules, interstitial pneumonitis, and unusual pulmonary pathology. Response to cyclophosphamide was curative.
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To test the hypothesis that orthostatic hypotension could represent an alternative mechanism contributing to the symptoms of mitral valve prolapse, the systolic and diastolic arterial blood pressures were measured in the supine and standing positions in 86 patients with the diagnosis confirmed by echocardiography. Orthostatic hypotension was demonstrated in 12 patients. Ten of them presented with a history of recurrent lightheadedness, dizziness or syncope and constitute 59 percent of the total number of patients with such symptoms in this series. Although nine of these 10 patients reported transient lightheadedness or dizziness during periods of ambulatory electrocardiographic recording, in only one were the symptoms chronologically related to cardiac arrhythmias. On the other hand, eight of them described lightheadedness and two experienced near-syncope during the postural test in association with the orthostatic drop in blood pressure. Improvement in symptoms and correction of the orthostatic hypotension were demonstrated in seven patients after beta-adrenergic blockade with propranolol. Before therapy, the mean systolic blood pressure dropped from 114 +/- 3 mm Hg in the supine position to 78 +/- 1 mm Hg upon standing (p less than 0.001). In repeated postural tests performed after four weeks of treatment, the systolic blood pressure changed from 120 +/- 3 mm Hg supine to 115 +/- 1 mm Hg upon standing (p greater than 0.01). We conclude that orthostatic hypotension is a commonly unrecognized mechanism responsible for some of the symptoms of mitral valve prolapse, particularly in patients affected by recurrent lightheadedness, dizziness or syncope.
The haemodynamic dose-response effects of intravenous oxprenolol over the range of 2--64 mg were measured in 28 patients with coronary heart disease. At rest there were statistically significant dose-response trends, linear or quadratic, between the cumulative doses of oxprenolol and reductions in systolic pressure, heart rate, and cardiac output and increases in stroke volume and pulmonary wedge pressure. The magnitude of the changes was uninfluenced by the degree of left ventricular functional disability as judged by the level of the pulmonary wedge pressure. During dynamic exercise the haemodynamic changes induced by oxprenolol were significantly greater in patients with more marked left ventricular disability than in those less severely affected. These observations define the immediate effects of intravenous oxprenolol over a relatively wide dose range and confirm its relative haemodynamic safety in patients with stable coronary heart disease.