Cases Seen Research Articles

Tetanus: An Analysis of the Prognosticating Factors of Cases Seen in a Tertiary Hospital in a Developing African Country between 1990 and 2000

This is an analysis of the effects of prognosticating factors on the outcome of a case series of 66 patients with tetanus, presenting between 1990 and 2000. The mortality rate was 26.2% with a fatality rate of 16.2% for those under 40 years of age. This increased to 75% for those patients above 70 years of age. The socioeconomic status, immunization status, the incubation period, and age of the patient together with the severity of the spasms, duration of hospital stay, type of treatment received and time of onset were found to affect the outcome of the patients.

Does Pre-Hospital Care Affect the Outcome of Tetanus Patients? - An Analysis of cases Seen At a Tertiary Hospital in Nigeria.

Tetanus remains one of the major public health hazards of the developing world. It is an infective, but potentially preventable, disease caused by Clostridium tetani. Majority of affected persons in developing countries commonly seek medical attention with care providers before coming to the secondary or tertiary health institutions. This is particularly prevalent in Africa, and Nigeria is not an exemption. We sought to determine the effect of the care given to tetanus patients on their outcome, prior to their presentation at our Teaching Hospital. The data for all tetanus cases seen between 1990 and 2000 were collected prospectively. Forty-eight (82.8%) of the 66 patients received one form of care before presenting to us. Most of the patients were first seen at private clinics and these cases were noted to be severe, with an attending higher mortality. All cases seen at the traditional homes were mild. We recommend the introduction of health education seminars on wound care and prevention of tetanus for the different cadres of personnel involved in the primary health care delivery. Key Words: Tetanus, Outcome, Mortality, Pre-Hospital, Care. Nigerian Medical Practitioner Vol.44(1) 2003: 19-21

Advanced Abdominal Pregnancy: A Study of 13 Consecutive Cases Seen in 1993 and 1994 at Komfo Anokye Teaching Hospital, Kumasi, Ghana

Thirteen cases of advanced abdominal pregnancy (AAP) managed at the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana, over a two-year period (1993-1994) are presented. An incidence ratio of one advanced abdominal pregnancy to 1,320 deliveries occurred during this period. The ratio of advanced abdominal pregnancy to ectopic pregnancy was 1:43.7. The perinatal mortality rate and maternal case fatality rates were 69.6% and 15.3% respectively. Recurrent abdominal pains in the gravid patient with abnormal fetal lie and prior history of tubal pregnancy and/or previous abdominal surgery were significant findings in the cases reviewed. These findings should, therefore, always prompt lucid and elaborate ultrasound examination of a pregnancy to exclude abdominal pregnancy.

Imaging changes in the pancreas in cystic fibrosis: a retrospective evaluation of 55 cases seen over a period of 9 years.

Pathologic changes of the pancreas have been observed as early as the recognition of the disease termed initially "cystic fibrosis of the pancreas". Atrophy of the gland and its fatty infiltration were considered as usual features. The aim of this study was to follow-up the evolution of cystic fibrosis pancreas and to define its successive stages in correlation with the clinical, biochemical, and imaging findings. Fifty-five patients were followed up during 9 years. The patients' genetic backgrounds were systematically performed. Blood lipase levels were analyzed systematically at each consultation of the patients and in the event of bouts of abdominal pains. Imaging using mainly echograms and tomodensitometric scans were regularly performed: echograms every 6 months, and tomodensitometric scans every 1 to 2 years. Magnetic resonance imaging was performed in four patients. Five groups of patients were identified on the basis of tomodensitometric scan findings: normal pancreas (n = 4), incomplete lipomatosis of the pancreas (n = 9), complete lipomatosis of the pancreas (n = 23), cystic pancreas (n = 5), macrocystic pancreas (n = 1), atrophic pancreas (n = 13). Pancreas exocrine function was not correlated with findings. Forty episodes of pancreatitis were observed in seven patients. They had bouts of abdominal pain and elevation of lipase levels. Five of these patients were composite heterozygotes (D508/other). Incomplete lipomatosis represents an intermediate stage leading toward complete lipomatosis or toward atrophy after pancreatitis. Studies of pancreatic function should be performed routinely in cystic fibrosis, especially in pancreatic sufficiency or in patients with normal pancreas images. Acute pancreatitis should be diagnosed and properly identified to be differentiated from other acute abdominal syndromes occurring in cystic fibrosis.

Meningococcal pneumonia: characterization and review of cases seen over the past 25 years.

Fifty-eight cases of meningococcal pneumonia were included in this review. Fifty cases previously described in the literature from 1974 through 1998 and 8 new cases were included in this series. The median age of patients was 57.5 years, and pleuritic chest pain was described in 21 (53.9%) of 39 cases. Blood cultures were positive in 42 (79.3%) of 53 cases for which results were mentioned. Despite the presence of bacteremia, patients did not develop the syndrome of meningococcemia with its associated complications. Serogroup Y meningococci were most commonly recovered and accounted for 44.2% of identified isolates. Therapy has dramatically changed over the past 25 years; prior to 1991, penicillin antibiotics were most often used. Since 1991, 12 (80%) of 15 patients received cephalosporin antibiotics. Only 5 (8.62%) of 58 patients died. Secondary cases of meningococcal infections following exposure to patients with meningococcal pneumonia were noted in 2 instances.

Developing an Autism Assessment Service II: Analysis of the First 81 Cases Seen

This paper presents an analysis of the first 81 cases seen in the recently established assessment service for children with autism and related disorders in Southampton. The children presenting for assessment are described in terms of a number of biographical, educational, behavioural, and medical features and the characteristics of our sample are compared with published findings. The future development of the service is considered in the light of current developments and common features and concerns of the families seen.

Developing an Autism Assessment Service II: Analysis of the First 81 Cases Seen

This paper presents an analysis of the first 81 cases seen in the recently established assessment service for children with autism and related disorders in Southampton. The children presenting for assessment are described in terms of a number of biographical, educational, behavioural, and medical features and the characteristics of our sample are compared with published findings. The future development of the service is considered in the light of current developments and common features and concerns of the families seen.

Alcohol in medicolegal cases seen at Jordan University Hospital.

The magnitude of alcohol-associated incidents in relation to medicolegal cases, including road traffic accidents and acts of violence, has not been evaluated in Jordan. Between 1993 and 1995, 825 such cases received at Jordan University Hospital were screened for the presence of alcohol. Blood alcohol was positive in 9.1% of vehicle passengers, 9.6% of pedestrians, 12.4% of cases involving violence, 13.6% of drivers, 65% of cases brought by police and in 12.5% of other cases. Blood alcohol concentrations (BAC) ranged from 10-350 mg/dL. BAC of more than 50mg/dL was found in 65% and 55% of driver and violence cases respectively, and in 33% to 69% of the other categories. Alcohol may have contributed to some of these incidents. In cases with positive BAC, prior alcohol intake was frequently denied. There was no association between cases with positive BAC and a particular time, date or occasion.

Cutaneous leishmaniasis: review of 59 cases seen at the National Institutes of Health.

Fifty-nine cases of cutaneous leishmaniasis seen at the National Institutes of Health in Bethesda, Maryland, are reviewed. The group of patients involved was unique in that the majority were American civilians, their disease was acquired in many different endemic areas of the world, and their illnesses represented all points on the clinical spectrum of cutaneous disease. The majority of American patients acquired leishmaniasis while engaging in activities related to their occupations. Cutaneous disease acquired in the New World usually consisted of one or two lesions, while multiple lesions often characterized Old World infections with Leishmania major. Patients with chronic relapsing or diffuse cutaneous leishmaniasis were native to endemic areas and were infected at an early age. Even the localized form of cutaneous leishmaniasis was often extensive and difficult to treat. Diagnosis with culture and identification of the parasite to the subspecies level is instrumental in the selection of optimal therapy. Cutaneous leishmaniasis may be encountered increasingly often in the United States because of the frequent international travel of U.S. residents and the influx of immigrants from endemic areas of the world.

Wegener's Granuloma. A Series of 265 British Cases Seen Between 1975 and 1985. A Report by a Sub-committee of the British Thoracic Society Research Committee

In order to describe the British experience of Wegener's granulomatosis Hospital Activity Analysis was used to collect cases diagnosed in England, Wales and Scotland between 1975 and 1985. Where possible clinical details, histological material and chest radiographs were obtained. Two hundred and sixty five patients were considered to have Wegener's granulomatosis. In 109 a single pathologist confirmed the diagnosis by finding both granulomas and vasculitis in biopsy material. The diagnosis was made on clinical grounds or clinical grounds together with histological diagnosis in the local hospital in 156 patients. Wegener's granulomatosis was confined to the lung or upper respiratory tract in 22 per cent of patients and renal disease occurred in 58 per cent. Laboratory tests showed a pattern of mild anaemia, polymorph leucocytosis, eosinophilia and an elevated ESR and hypergammaglobulinaemia, with no specific pattern of changes. Histological confirmation was most frequently obtained by examination of nasal biopsy specimens, but multiple biopsies were often required. Renal biopsies showed focal proliferative glomerulonephritis but granulomatous glomerulonephritis was uncommon. Of available chest radiographs 61 per cent were abnormal, large opacities being most common. Small irregular opacities were found less often and other abnormalities were uncommon. Treatment varied widely and 10 per cent of patients received no drug therapy. This large series illustrates that even without specific treatment, patients with Wegener's granulomatosis can survive for several years and with modern treatment survival for more than a decade is possible. Conclusions about the effectiveness of the various therapies cannot be drawn from this retrospective study. Renal failure and disseminated vasculitis were the commonest causes of death; death was considered to result from complications of treatment with cytotoxic drugs or prednisolone in 6 per cent of patients.

Analysis of all new cases seen in a busy regional centre ophthalmic casualty department during 24-week period.

A prospective study to record numerical data pertaining to diagnosis, aetiology, modes of referral and disposal of all new cases presenting to a busy city-centre ophthalmic casualty department was carried out between February and July 1981. No restrictions of access were imposed on individuals seeking medical advice. Of the 10 575 patient visits, 7113 were classified as new cases, of which 45% were traumatic in origin, 35% the result of inflammatory processes and 6% of an iatrogenic nature; many of this last group had contact lens-induced disease. An average of 63 patients was seen daily during the study period, although the variation was from 33 to 141. It is suggested that such a service can be highly efficient in terms of man hours per patient in the management of acute ophthalmic problems.

Drug-induced fever: cases seen in the evaluation of unexplained fever in a general hospital population.

This study involved cases of unexplained fever for which an infectious disease consultation was requested and for which an untoward drug reaction was thought responsible. Twelve cases that met strict criteria for drug-induced fever are presented. Antimicrobial agents were responsible for eight cases; other causes included antihypertensive and anticonvulsant drugs and allopurinol. The duration of drug administration before fever appeared was highly variable. Most patients had no history of previous drug reaction. Seven patients had fever with on other symptoms or signs that would suggest a diagnosis of drug-induced fever. Consultations are generally not requested for adverse drug reactions with more typical findings, such as skin rashes and eosinophilia; therefore, the true incidence of drug-induced fever is probably greater than indicated by the 12 definite cases seen in this general hospital during a six-year period.

1.2 Million, Not 12 Million, Units

A dosage error occurred in the ORIGINAL CONTRIBUTION, "Rheumatic Fever in Mississippi: 104 Cases Seen Over a Decade," published in the March 8 issue (<b>215</b>:1626-1630, 1971). In column one, page 1629, under the side headPROPHYLACTIC Therapy, the correct monthly intramuscular injection of benzathine penicillin G was<b>1.2</b>million units (not 12 million units, as published).

Depression and attempted suicide: a study of 91 cases seen in a casualty department.

In recent years there has been a steady and alarming increase in the prevalence of attempted suicide (Aitken, Buglass and Kreitman, 1969). Though all cases of attempted suicide may be regarded as a distress signal, only a proportion of such cases are seriously mentally ill. The problem of their assessment and organization of appropriate treatment is becoming an increasing burden on the psychiatric services. The Hill Report (1968) recommended that all cases should be admitted to special poisoning treatment centres which have continuous psychiatric cover. In towns where there are medical schools this may be a feasible proposition, and such a centre has been in operation in Edinburgh for a number of years (Matthew, Proudfoot, Brown and Aitken, 1969). In the Aberdeen region all cases are treated in the city casualty department and are assessed by the staff of the Professorial Psychiatric Unit, which is less than a mile away. Seven day cover is provided by a duty rota, each doctor being on call for a period of twenty-four hours. In a non-university town with less staff available such an efficient service may not be possible, and Crammer (1969) has suggested that a questionary administered by the house officer in the casualty department might serve as a satisfactory screening procedure.

Radiotherapy and TNM Classification of Cancer of the Larynx: A Study Based on 1447 Cases Seen at the Radiotherapy Clinic of Helsinki During 1936–1961Radiotherapy and TNM Classification of Cancer of the Larynx: A Study Based on 1447 Cases Seen at the Radiotherapy Clinic of Helsinki During 1936–1961. TaskinenPentti J.. Paper, Sw Kr 35. Pp. 122, with 13 figures and 45

Radiotherapy and TNM Classification of Cancer of the Larynx: A Study Based on 1447 Cases Seen at the Radiotherapy Clinic of Helsinki During 1936–1961Radiotherapy and TNM Classification of Cancer of the Larynx: A Study Based on 1447 Cases Seen at the Radiotherapy Clinic of Helsinki During 1936–1961. TaskinenPentti J.. Paper, Sw Kr 35. Pp. 122, with 13 figures and 45

Idiopathic cardiomegaly in African children. Further experience with cases seen in Nigeria.

Idiopathic cardiomegaly in African children. Further experience with cases seen in Nigeria.

SUBCUTANEOUS PHYCOMYCOSIS: A REVIEW OF 31 CASES SEEN IN UGANDA.

Case 10 (19 October 1962) ; Case 12 (24 February 1964) ; Case 14 (9 September 1962) ; and Case 16 (17 February 1963). Case 5 received 10 further courses of melphalan, and the disease remained well controlled until the last 10 weeks of life, when the growth extended extremely rapidly. He received one further course of radiotherapy for local pain. Case 9 received eight further courses of melphalan, and the disease was well controlled except for local pain from pathological fractures of ribs which was relieved by irradiation. At post-mortem examination a gastric carcinoma, suspected in the last three months of life, was found. Cases 8, 9, 12, 14, and 16 did not benefit from melphalan therapy. Seven further patients have been treated, four of whom obtained relief of pain for periods up to 16 months ; one did not respond to melphalan or to cyclo phosphamide, and required repeated courses of local irradia tion ; two patients in renal failure failed to respond, and in one case profound and prolonged neutropenia and thrombocyto penia followed each of two courses of melphalan lasting 14 and 7 days at a daily dose of 5 mg. REFERENCES

Primary myoglobinuria and exercise-induced secondary myoglobinuria: a report of 7 cases seen at an army basic training center.

No doubt this condition is more frequent than recognized. Though in its subclinical forms it may be of no significance, when it rises above the clinical horizon it should be recognized for what it is, for analysis, reassurance and for advice as to prophylaxis.

Homosexuality: an analysis of 100 male cases seen in private practice.

Amongst the reasons why facts about homosexuality are so hard to come by are: (1) the problem of definition. What are the criteria for homosexuality ? Should the emphasis be on preference or performance ? How widely should the net be cast ? Thus, according to the psycho-analysts, a homosexual component (sometimes conscious but often not) exists in everybody ; and if this is correct homosexuality in this sense is universal. (2) The natural reluctance of individuals to admit to a component or preference which is socially condemned or to acts that are illegal and liable to heavy penalty. But we can probably all agree (a) with the general definition?namely, that homosexual means having a sexual propensity for members of one's own sex (O.E.D.) ; (b) that this propensity varies quantitatively in different individuals and can also vary quantitatively in the same individual during different epochs in life ; and (c) that, as in other fields of experience and be haviour, introspection being neither exhaustive nor in fallible, the individual may quite genuinely not be fully aware of either the existence or the strength of his moti vations or propensities ; and of course he can lie about them.

Viral Hepatitis: Summary of Present Concepts and Review of 83 Cases Seen at the Guthrie Clinic and Robert Packer Hospital

Viral Hepatitis: Summary of Present Concepts and Review of 83 Cases Seen at the Guthrie Clinic and Robert Packer Hospital