Biomedical subjects
Publications and source records attributed to M Omar.
We present the case of a 52-years-old patient which was diagnosed of septic primary meningococcal arthritis, being acute arthritis the only form of presentation without any other manifestations of the meningococcal disease. We want to stress that despite the low frequency of this disease, especially in the adult, it must be taken into account for the assessment of acute mono-oligoarthritis.
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A case is presented of a woman who developed obstructive jaundice secondary to dysplastic mucinous papillomatosis two years after she had undergone cholecystectomy and exploration of the common bile duct. The gall bladder was dysplastic. It is suggested that the dysplastic glands removed from the common bile duct at the second operation either represented seedlings from dysplastic areas of the gall bladder or were a manifestation of dysplastic field change.
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Systemic mastocytosis is a rare disease, with symptoms produced by the accumulation of mastocytes on skin and other tissues as well as the release of biologically active substances. Bone is the more frequent extracutaneous involvement, its being clinically difficult to detect, even though the radiological findings detects them in at least 70% of the cases. It is necessary to notice the great variety of presentation, from localized to disseminated and osteoporotic to condensed or mixed as it is in this cases. These are reasons for diagnosis delay. The elective test in those cases with general involvement is bone biopsy; its processing the sample with blue toluidine.
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A brother and sister (the latter having been resident in Ruanda for three years) fell ill with African trypanosomiasis (sleeping sickness) after a two-day safari in the Akagera National Park. Cardinal symptoms were fever, lymphadenopathy and the typical primary lesion (trypanosomal chancre). The diagnosis was confirmed by demonstrating trypanosomes in the peripheral blood. There was no CNS involvement in either case. Administration of suramin, 1 g weekly intravenously for six weeks, quickly brought about regression of the symptoms and the parasitaemia. According to the number of cases reported since 1970, the risk for German travellers to certain African areas of contracting trypanosomiasis is about 0.3 per 100,000. Since in Africa the incidence of the disease is increasing, in some parts considerably, one must reckon with an increasing risk for tourists.
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The experience of the senior author in the management of biliary tract lithiasis and/or associated pathology is analyzed, retrospectively until 1976 and prospectively from then on, in an attempt to ascertain the most efficient manner of handling a duct requiring surgical exploration. Primary surgery was done on 245 patients, while 22 common bile duct reoperations were carried out on 20 patients. In the primary surgery group, 177 simple cholecystectomies were undertaken, and an indication for duct exploration was present in the other 68. Out of 90 common bile duct explorations, 68 primary ones plus 22 reoperations, two operative deaths occurred (one in each group). Fifteen patients had a choledocholithotomy with temporary T-tube decompression, with "normal' postexploratory and predischarge tube cholangiograms. Six of these (40%) required reoperation (recurrent stones in three, residual calculus in two, stenotic papilla in one). Of 70 ducts definitively drained (60 choledochoduodenostomies, nine sphincteroplasties, one Y-loop hepaticojejunostomy) only one (1.4%) of the patients who had a sphincteroplasty has had an episode of jaundice and cholangitis, a highly significant difference (p = 0.001). This experience suggests that a correct biliary fenestration, permanently decompressing the biliary tree, performed during the initial operation will avoid many unnecessary hospital admissions and should, therefore, be seen as the procedure of choice in the overwhelming majority of situations when a pathological common bile duct is encountered.
Twenty-two women with galactorrhea and/or amenorrhea were evaluated. Thyroxine (T4), thyroid-stimulating hormone (TSH), and visual fields were normal. Hyperprolactinemia (22 to 440 ng/ml) was present in 19 patients. Evidence of tumor was found in 73.7% of the woemn, whereas 26.3% were classified as functional. Three patients with empty sella syndrome showed normal prolactin levels (12.2 to 18.5 ng/ml). There was a significant negative correlation between prolactin levels and follicle-stimulating hormone (FSH) (P less than 0.05), but not between prolactin and luteinizing hormone (LH) levels. Hypocyloidal polytomography was better than plain x-ray films in detecting early prolactin-secreting pituitary tumors (14 patients). Pituitary testing using an insulin tolerance test showed a statistically significant difference in human growth hormone (hGH) reserve between tumor and functional groups (P less than 0.0005), and none for the cortisol response. The 17-hydroxycorticoid response to metyrapone was impaired in the tumor patients (group 1). Serum prolactin levels showed various degrees of suppression with L-dopa (9.3 to 98.8%), with no significant difference between the various groups.
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We have described a patient with gallstone ileus who was initially believed to have a gastric outlet obstruction. Roentgenogram of the abdomen revealed a markedly distended stomach. None of the classic roentgenographic signs of gallstone ileus were present. Old age and diabetes mellitus probably contributed to her severe gastric retention.
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