The subluxated lens: a patient's perspective.
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Attitude to Health↗
Biomedical subjects
M Mughal
Publications and source records attributed to M Mughal.
Metastatic cervical cancer with unusual presentation: a case report.
Carcinoma of the cervix is rare in the United States thanks to widespread use of screening Pap smears. A 60-year-old female with right upper quadrant pain, diarrhea, and urinary incontinence was found to have stage IV B cervical cancer. Computerized tomography (CT) was of value in diagnosis. Like mammography, which improves survival by detecting malignant disease at an early stage, the Pap test is central in preventing the development of invasive cervical cancer.
Abdominal Pain↗
Severe hepatitis due to HBV-HDV coinfection.
Quadruple hepatic infections are not uncommon in human immunodeficiency virus (HIV) infected patients. Hepatotropic viruses behave differently in immunocompromised patients resulting in varied clinical and serological outcomes. Delta hepatitis, an important cause of acute hepatitis in intravenous drug abusers (IVDAs) and HIV-infected patients, can present as coinfection or superinfection clinically, which influences the prognosis. Prevention of hepatitis D virus (HDV) coinfection is possible with hepatitis B virus (HBV) vaccination. No definitive medical treatment for HDV infection is known to be successful. Interestingly, liver transplantation carries a higher success rate in HDV/HBV infection then in HBV infection alone.
Adult↗
Effect of anorectal eversion on long-term clinical outcome of restorative proctocolectomy.
Eversion of the rectum during restorative proctocolectomy with stapled ileal pouch-anal anastomosis (IPAA) remains a controversial surgical manoeuvre because of concern that it may impair anal sphincter function and adversely affect outcome. We have reviewed the long-term results in 41 patients whose operation included formation of a 20 cm J-pouch with stapled IPAA by the technique of rectal eversion. At median follow-up of 4 years (range 1-6 years), 4 pouches (10%) had been removed (2 for pelvic sepsis, 1 for rectovaginal fistula and 1 for Crohn's disease). In 34 patients with functioning pouches in situ, median stool frequency was 5 per 24 h (range 2-10). 11 patients (33%) regularly had to evacuate their pouch at night and 4 (12%) used antidiarrhoeal medication. No patients reported major incontinence; 2 (6%) had minor leakage, and in another 2 minor leakage had now ceased. 4 patients had had episodes of pouchitis. These favourable results offer no support for the contention that rectal eversion substantially worsens the long-term results of restorative proctocolectomy.
Adolescent↗
Total parenteral nutrition modifies the acute phase response to Crohn's disease.
Measurements of the acute phase proteins, C-reactive protein (CRP) and orosomucoid are widely used to monitor the activity of Crohn's disease. The effect of TPN upon the levels of acute phase proteins is unknown. Serum levels of CRP and orosomucoid were measured simultaneously over a four year period in 13 patients receiving TPN for Crohn's disease, nine patients with noninflammatory causes of intestinal failure, and 16 patients with Crohn's disease treated without TPN. An acute phase response was found with a similar frequency in both groups of patients with Crohn's disease (73.6% and 83.9% for Crohn's with and without TPN respectively), but was less prevalent in patients receiving TPN for non-inflammatory causes of intestinal failure (56.1%, P < 0.01). In this latter group, the acute phase response consisted primarily of an isolated elevation of orosomucoid (78.4%), compared with patients with Crohn's disease alone (21.1%, P < 0.001) and with Crohn's disease and TPN (46.6%, P < 0.05). Liver function abnormalities were seen on 68.8% of occasions in patients with noninflammatory causes of intestinal failure who had elevated levels of orosomucoid, compared with 34.9% of occasions on which orosomucoid levels were normal (P < 0.001). TPN may lead to isolated elevation of serum levels of orosomucoid, reducing the value of this acute phase protein in monitoring the activity of Crohn's disease in patients receiving TPN.
Acute-Phase Proteins↗
Appraisal of percutaneous tracheostomy.
Two commercially available kits have been used to create 25 percutaneous tracheostomies, 20 using the Cook system and five using the Rapitrac system. The operation time and complication rates of these tracheostomies have been compared with those for 16 conventional tracheostomies performed for similar indications. Median operating times were 60 (range 30-105) min for conventional tracheostomy, 15 (range 8-70) min for Cook and 5 (range 3-15) min for Rapitrac systems (P less than 0.001). A significantly higher proportion of patients in the Rapitrac group had complications compared with the other two groups (P less than 0.05). The complication rate for the Cook group compared favourably with that for the conventional tracheostomy group. The Cook system of percutaneous tracheostomy is a simple, rapid and safe alternative to conventional tracheostomy.
Adult↗
Hypogastrinemia and esophageal atresia.
To investigate extraesophageal anomalies in infants with esophageal atresia, preoperative plasma gastrin was measured in 12 infants. The median plasma gastrin was 32 ng/L (interquartile range, 24 to 44). There was significant correlation with birth weight (rs = .73, P less than .05) and gestational age (rs = .74, P less than .05). Within this group 9 infants of greater than 36 weeks' gestation were matched to a group of 20 control infants without esophageal atresia. Infants with esophageal atresia had a significantly lower median plasma gastrin (38 ng/L v 55 ng/L, P less than .05). This may indicate preexisting vagal abnormalities in esophageal atresia unrelated to surgical intervention.
Birth Weight↗
A cheap laparoscopic surgery trainer.
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Cholecystectomy, Laparoscopic↗
The lower oesophageal sphincter after floppy Nissen fundoplication.
The pressure and intra-abdominal length of the lower oesophageal sphincter (LOS) were measured by oesophageal manometry before and after floppy Nissen fundoplication (FNP) for intractable gastrooesophageal reflux. Control of reflux was assessed by 24 h pH recording and endoscopy. It was complete in 67 cases (84.8 per cent) in this non-consecutive series. In the group as a whole LOS pressure increased significantly after FNP, but the intra-abdominal length did not. LOS pressure decreased in 21 cases of whom 16 (76.2 per cent) still had perfect reflux control. Likewise, intra-abdominal length decreased in 41 cases of whom 36 (87.8 per cent) had good reflux control. There was no evidence of a compensatory increase in length to account for reflux control when LOS pressure decreased. When a length-pressure diagram was plotted for the postoperative measurements no clear separation of those with persistent reflux could be seen. These results suggest that the measured changes in LOS pressure and length following FNP are an artefact of surgery rather than the means by which the operation controls gastro-oesophageal reflux.
Adult↗
Home parenteral nutrition in the United Kingdom and Ireland.
Between January, 1977, and March, 1986, 200 patients were registered as receiving home parenteral nutrition (HPN) in the UK and the Republic of Ireland. Although 28 centres contributed case-reports, 75% of the cases were registered by 7 centres. Most patients started treatment between the ages of 10 and 40 years, a reflection of the high incidence of Crohn's disease during these decades. The three main indications for HPN were Crohn's disease (90 patients), mesenteric vascular disease (27), and extensive small-bowel resection for volvulus or other benign enteric disease (14). 85 patients required treatment for less than 1 year and 17 have been on treatment for more than 2 years. Patients whose indication for HPN was a primary intestinal disease had a better quality of life than did those in whom the intestinal failure was secondary to a systemic disorder. Of the 108 patients who have completed treatment 56 have been able to resume enteral nutrition through adaptation of the remaining bowel, or closure of a fistula. 34 have died, 19 as a consequence of the underlying disease and 10 of complications of treatment. The incidence of catheter-related sepsis varied between 0.2 and 0.9 episodes per year of treatment (overall 0.35) depending on the length of experience of the supervising centre.
Adolescent↗
Accidental ingestion of a toothbrush!
A case is reported of a 16-year-old girl who accidentally swallowed a toothbrush, which was safely extracted under local anaesthesia using a fibre-optic endoscope. The technique described is safe, and can be adapted for the extraction of a variety of foreign bodies from the oesophagus and the stomach. Guidelines are presented for the management of ingested foreign bodies, based on a review of the literature.
Accidents, Home↗
An atraumatic method of tunnelling cuffed central venous catheters.
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Catheterization↗
Endocarditis complicating parenteral nutrition: the value of repeated echocardiography.
Cardiac complications of parenteral nutrition are well recognized but the diagnosis of such complications may be difficult. Two-dimensional echocardiography has been shown to be of value in establishing the diagnosis of valvular vegetations and right atrial thrombus. We describe two patients who developed endocarditis while receiving parenteral nutrition via central venous catheters. In both cases initial echocardiography was normal and the tricuspid valvular vegetations were only picked up after one or more additional echocardiograms. This highlights the necessity for repeated echocardiography in patients receiving parenteral nutrition in whom infective central venous catheter complications fail to resolve quickly after appropriate treatment.
Aged↗