Fatema Jawad ( 7/6, Rimpa Plaza, M. A. Jinnah Road, Karachi. )
Carcinoma Gall Bladder - A Study of 73 ConsecutIve Cases at Rawalpindi/Islamabad. Rashid, A., Hassan, H. Pak.J.Pathol., 1993;4:53-55.
A retrospective study on primary carcinoma of the gall bladder was conducted in the cases diagnosed in the various hospitals of Rawalpindi and Islamabad region during the period 1986-1992. The carcinoma gall bladder cases numbered 73 from the total 1180 patients with hepato-biliary disease. The age range was 40-78 years and the male to female ratio was 1:2.6. Ultrasonography revealed 31 gall bladder cancer from the 37 patients who underwent the procedure. Surgery showed a tumour extension to liver, porta hepatis, omentum and colon in 64 cases. Adenocarcinoma was diagnosed histologically in 70 cases whereas 3 had squamous cell carcinoma. A followup was possible in 46 cases, of which 27 received chemotherapy. All 46 patients died within 6 months. Initial studies on gall bladder cancer done in Pakistan indicate it to be one of the ten commonest malignancies in females. In the presented study, 5.8% of the hepatobiliary diseases proved to be cancers which is a high figure but comparatively a lower incidence than that reported from India. All the cases in this study had gallstones. The frequency ofcholelithiasis in gall bladder cancer has been reported by other workers too, Clinically symptoms were vague and most of the subjects were investigated when they developed a mass in the right hypochondrium. Ultrasonography proved to be an accurate and helpful test. The spread of the tumour at the time of surgery! was attributed to the delay in reporting. It is thus concluded that carcinoma of the gall bladder is a common tumour in females and even vague prolonged symptoms of the upper G.l. tract should be investigated properly. Cholecystectomy should be performed on all cases with gall stones.
Correlation of Dyspepsia with Upper Gastrointestinal Pathology in the Northern Areas of Pakistan. Mannan, A. J. Ayub Med. College, 1992;5:30-32.
A study was conducted on 400 patients complaining of persistent dyspepsia. They were all attending the outdoor clinic of the DHQ Hospital Abbottabad and had symptoms related to the upper gastrointestinal tract, Upper G.I. endoscopy was performed and biopsy taken for histopathological examination. There were 264 males and 136 females with an average age of 41.5 years. Of the 400 patients 189 had gastritis. Erosions with gastritis was present in 52 cases, oesophagitis in 100, duodenal ulcer in 59, gastric ulcer in 20, oesophageal carcinoma in 12, gastric carcinoma in 7 and 78 subjects had no positive findings. The study suggests that patients with prolonged dyspepsia tend to have some upper gastro-intestinal pathology. The commonest lesion seen in the study was gastritis followed by peptic ulcer and carcinoma. As the management of all these cases varies, it is important that a confirmed diagnosis should be made. Endoscopy is the investigation of choice as it detects mucosal lesions more accurately and a biopsy can be taken.
Coeliac Disease in Pakistani ChildrenVohra, N.A., Maqbool, S., Mehmood, R. Pak.J.Med.Sci., 1993;9:319-322.
Of the 84 cases ofmalabsorption in children, 8 were diagnosed as coeliac disease. These patients were admitted in the department of Paediatrics in the Shaikh Zayed Postgraduate Medical Institute Lahore from November 1988, to October, 1992. A detailed history was recorded alongwith the diet given and initial baseline laboratory tests performed. Upper jejunal peroral suction biopsy was performed by the Watson-Crosby paediatric capsule. The diagnosis was confirmed by the typical histology of crypt hyperplastic villous atrophy. A gluten free diet was instituted and iron and multivitamin supplements given for 3 months. The sex ratio of the 8 children was equal and the mean age was 78 months with the mean period of symptoms being 40 months. All had chronic diarrhoea and failure to thrive. Wasting was present in 6, abdominal distension in 4, anaemia in 5 and 2 presented with vomiting. An excellent response was had in all children to the gluten free diet. The number of stools decreased, appetite improved, weight gain was noted and the children became lively and active within days. A long term follow up was not possible. Coeliac disease has been documented in Asian children and is rare in Africans, Japanese and Chinese. It is a possibility that the disease is being under-diagnosed in Pakistan. The diagnosis of coeliac disease is confirmed by the flat small intestinal mucosa and a full remission on withdrawing gluten from the diet. Cow’s milk sensitive enteropathy and giardiasis should be excluded. Health education of the parents is essential to manage successfully children with coeliac disease. Observations suggest that coeliac disease is not rare in Pakistani children. Although classical symptoms are present yet many cases are missed. Late presentation is another feature in our children.
Chronic Arsenic Poisoning. Kazmi, S.AH, Bajwa, U.M., Shabbir, S.G. Pak.J.Med.Res., 1992;31:185-190.
A survey was conducted in the village Badarpur on receiving reports stating the incidence of a mysterious disease manifesting as gastrointestinal disturbances, weakness, dew drop hypo and hyper-pigmentation of the skin and hyperkeratosis of the palms and soles. The 28 subjects investigated had symptoms with positive physical findings. There were 16 males and 12 females. The mean age of the males was 29.68 years with that of the females being 26.21 years. The average duration of symptoms was 3.06 years in males and 2.75 years in the females. The haemoglobin concentration was low 9. 7G to 12G in all subjects, alkaline phosphatase raised in 5 and slight ECG changes in 5 patients. Arsenic was detected in all the hair and nails tested and in the water obtained from the pumps bored upto 60 feet depth only. No arsenic was found in the soil, fruits, vegetables or the water from pumps with 90 feet boring depth. It was also observed that only a small number of families were affected with all the members being involved. All these house- holds had a water pump of 60 feet depth. No sporadic cases were seen and no subject usingwater from a pump with 90 feet boring was affected. Arsenic is the most common source of acute heavy metal poisoning. Chronic poisoning occurs after prolonged ingestion of the metal and involves mainly the skin, gastro-intestinal and nervous systems. Testing the hair, epidermis, nails and bones confirm the presence of arsenic. The present study revealed the source of arsenic to be drinking water drawn from shallow levels.