Qatar Medical Journal - Volume 2002, Issue 1

Spontaneous rupture of the spleen is a rare complication of Plasmodium vivax malaria which may be under diagnosed. Recently we encountered such a case in an expatriate a few days after arriving from his country. The presentation was of fever; abdominal pain and vomiting. Computed tomographic scan and ultrasound were not helpful in making an initial diagnosis but the development of hypotension and a significant drop in hemoglobin later pointed to the diagnosis. The rupture was sufficiently severe to necessitate splenectomy. The case is described, treatment options are discussed and pertinent literature is reviewed.

Opsoclonus myoclonus syndrome (OMS) is a very rare syndrome which presents with ataxia, opsoclonus and myoclonus. We report the combined treatment of immunoglobulins and prednisolone compared to prednisolone alone in two patients. The diagnosis was based on the clinical findings. Work up for neuroblastoma was negative in both patients. Prednisolone treatment in the first patient was associated with slow response, relapses and toxic side effects. Immunoglobulins combined with prednisolone in the second patient were effective with neither relapse nor drug side effect. The clinical findings, differential diagnosis and the management are discussed. It appears that combined therapy with prednisolone and immunoglobulin gives better results. To the best of our knowledge this is first paper from the Middle East reporting this syndrome.

Intermittently draining cutaneous sinus tracts in the area of the face and neck may be caused by chronic dental infection. Diagnosis of the causes may be challenging but is the key to successful therapy. A case of cutaneous facial sinus tract related to a mandibular molar is presented. Non-surgical endodontic treatment was performed. Healing was rapid and uneventful

Electrocution is a well known cause of cardiac arrest, mostly secondary to ventricular fibrillation. Acute myocardial infarction has been reported in a few cases although the pathogenesis is not clear. We report two cases of acute myocardial infarction after electrocution, both confirmed by electrocardiography and markedly elevated cardiac enzymes. Echocardiography showed cardiac damage evidenced by hypokinesia.

Enchinococus granulosus is endemic in many parts of the world where sheep and cattle are raised with the help of dogs. Dogs are the principal host and sheep are the most common intermediate host, Dogs acquire the infestation by ingesting hydatid scolices from infected sheep organs. The parasite develops into a tapeworm in the dog intestine and tapeworm eggs are then excreted in dog feces and transmitted to humans via the fecal-oral route. Ingested eggs develop into hydatid cysts in the intermediate host to complete the life cycle of the parasite. The patient in this study lived next to a sheep ranch

The overall incidence of lymphoma during pregnancy has not been established accurately. Hodgkin's disease is the fourth most frequently diagnosed cancer in pregnancy (1 in 1000 to 1 in 6000 pregnancies). In contrast, the incidence of non-Hodgkin lymphoma during pregnancy is rare, with fewer than one hundred cases reported(2). A case of small intestinal lymphoma in association with pregnancy is presented, with emphasis on the major clinical issues involved in the approach to the management of such cases.

This study aimed to investigate the effect of oral pilocarpine (OP) in reducing the incidence of chemotherapy-induced oral mucositis. Thirty two adult patients completed a total of 82 courses of chemotherapy in which either OP or placebo was given pro-phylactically in a double-blind cross-over design to prevent mucositis. Mucositis was documented in 20 out of 41 courses in which patients were given placebo, whereas mucositis was documented in only six out of 41 courses when patients were given OP (P<0.005). OP treatment was found to significantly reduce the mucositis score when assessed by the method of Donnelly and colleagues (Donnelly JP, Muus P, Schatttenberg A, De Witte T, Horrevorts A, De Pauw BE. Bone Marrow Transplant 1992, 9, 409–413). Using this score, all patients scored a total of 52 when they were given the placebo versus eleven when they were treated with OP (P<0.001). A similar reduction in mucositis score was noticed using the World Health Organization (WHO) mucositis score; the total patient score was 25 for the placebo-treated group versus 6 for the OP group (PcO.OOl). We therefore conclude that oral pilocarpine is highly effective in the prevention of oral mucositis when given prophylactically to adult patients receiving a variety of cancer chemotherapy regimens

Background: The analgesics used for pediatric tonsillectomy may be associated with side-effects such as sedation, respiratory depression and vomiting (opiods) or increased bleeding [non-steroidal anti inflammatory drugs (NSAIDs)]. In our institution, we employ a combination of paracetamol, NSAID and opioid, although there is no published evidence of analgesic benefits from adding NSAIDs to paracetamol in children.