By Author
  By Title
  By Keywords

April 1996, Volume 46, Issue 4

Review Articles

Abstracts from the Journals of the East

Fatema Jawad  ( 7/6, Rimpa Plaza, M. A. Jinnah Road, Karachi. )

Ischemic Heart Disease in the Young Population (35 Years). A Clinical Profile. Virk, Z., Khan, A.A., Bokari, A.M. Pak. J. Cardiol. 1995;6:63-63.
A study was conducted concurrently at two centres in the years 1992-1993, to determine the prevalence of acute coronary artery disease in patients upto 35 years age. The selection criteria in the first centre was patients admitted with acute myocardial infarction (MI) or unstable angina with atypical history, ECG changes and enzyme elevation. At the second centre data was retrospectively analyzed on the same criteria. Of the 415 patients hospitalized with acute MI in centre I, 15(3.65%) patients were inthe age group 20-35 years. There were 14. males and one female and 13 had anterior wall involvemcnt. Ten subjects were smokers, 3 were hyperten­sive, 2 had a family history of heart disease, one was a diabetic, one obese and 7 out of 9 cases had dyslipidaemia. It was also noted that 5 of these patients were professional drivers.
In Centre 2 there were 372 patients admitted with AMI of which 22 (5.9%) were in the below 35 years age group. There were 20 males and 2 females, 13 had anterior wall infarction, 70 percent were smokers and 30 percent commer­cial drivers. Locally manufactured alcohol was consumed by 70 percent patients in this group.
The study concluded that Ischacmic heart disease is prevalent in a relatively high frequency in the younger age group patients compared to the western world. The risk factors which could be identified are smoking, dyslipidaemias and conmiercial driving. The increasing atmospheric pollution with automobile exhaust fumes causing prolonged exposure to the professional drivers may be a possible factor for increasing coronary artery disease in this group of people.
Infantile Colic: Randomised Controlled Trial of Non-Pharmacologic Approach. Haq, A. Pak. Paed. J. 1995;19:151-152.
Twenty-eight infants less than 6 weeks age were managed for abdominal colic either with non-phannacologic methods of abdominal massage and kneading for 15 minutes orw ith Anapas drops - 1 drop/kg perdose orally. These infants had no organic disease and they cried excessively between 3 pm and 12 mid night. Of the 15 cases who received the antispasmodic drops, 8 improved. Of the 13 infants in the non drug group, 8 were better. The improvement was judged as decreased crying and fussing within 15- 20 minutes of intervention.
The exact etiology of infantile colic is not universally agreed upon. The effect of abdominal massage and kneading has been used as an effective form. of therapy. This presented study did not show a significant difference in the pharma­cological and non- pharmacological modes of treatment.
Individualised approach is more needed in cases of infantile colic. The family require sympathy and re-assurance to ease their distress.
Incidence of Well Differentiated Thyroid Carcinoma Be­low the Age of 40 Years. Yasmeen, S., Ahmed, F., Ah­mcd, T., Siddiq, S.K, Hussain, EA., Dey, S.K., Hoque, R. Bangladesh Med. J. 1993;22:3- 5.
The analaysis of 120 cases with well differentiated carcinoma of the thyroid, during the period 1984-1992, is presented. The age at onset ranged between 12 and 70 years, with 70.8 percent patients being below 40 years age. There were 72 females and 48 males. The below 40 years age group had 45 cases with papillary carcinoma, 36 with Follicular Carcinoma and 4 had a mixed tumour. In the above 40 years age range, 18 had papillary and 7 Follicular Carcinoma whereas 10 had a mixed type. Of the 85 subjects below 40 years of age, 80 received I31 therapy. There was no mortality. The treatment instituted was near total thyroidectomy or lobectomy and a block dissection of lymph nodes if enlarged.
It was observed from the analysis that the age of presentation of well differentiated Thyroid tumours was lower than that in the Western countries where careinomas are encountered more in the fifth and sixth decade. Environment, nutritional status and food habits may be influencing factors. It was also noted that patients in the younger age group had a more favourable prognosis.
Appendix Mass: Aggressive Surgical Management. Jamal, A. Specialist. Pak. J. Med. Sci., 1995;12:51-54.
The results of immediate appendectomy within 36 hours of admission to hospital, on 45 patients. 34 males and 11 females, with appendiceal mass, are presented. In 38 subjects the mass could be palpated and in 7 cases it could be felt after anaesthesia. Blood picture, urine analysis and blood urea level was done in all patients whereas plain X-ray abdomen and ultrasound examination was performed in selected cases. Intravenous fluids, cephalosporins and metronidazole was started pre-operatively. A McBumey’s incision was employed over the mass and the appendix excised. Adhesions when present were removed by finger dissection. The redundant omentum was cut Out. The stump was buried in some cases only having a healthy caecum. A soft tube drain was left in place. Pus was sent for culture and sensitivity. For the first 48 hours intravenous fluids were given and antibiotics continued till the infection subsided.
Surgical complications were encountered in 12 patients, in the form of wound infections in 8, paralytic ileus in 3 and intestinal obstruction in one case. The hospital stay ranged from 5 to 20 days and it was observed that subjects with large abscesses had more severe signs and sv mptoms with a longer duration, prolonged hospitalization and more complications.
Management of an appendicular mass still remains a controversy. Some surgeons prefer interval appendectomy whereas others perform immediate appendectomy after cor­recting the fluid and electrolyte balance. The presented study achieved good results with a fairly short hospital stay. no serious complications and no mortality.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: