June 1993, Volume 43, Issue 6

Case Reports

Abstracts from the Journals of the East

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

Endemic Goitre: An Affliction of Young Females in Murree Hills. Zafar, A., Cheema, K., Akhtar, S.S., Latif, S. and Sadiq, F. J.Pak. Instit.Med.Sc., 1991;2:112-114.
A study of goitre patients undergoing surgery at the DHQ Hospital, Rawalpindi and a survey of goitre cases in the villages Phagwari and Charhan, Murree are reported. In the period January, 1987 to September, 1989, 139 cases operated for goitre were included. There were 128 females and 11 males with 58 percent being in the age group 11 to 30 years. Indications for surgery were cosmetic in 43.8%, pressure symptoms 38.8% and toxic complications 17.4% of cases. Transient tetany occurred in 3 patients in the postoperative period. There was no mortality and histopathology diagnosis was colloid ade­nomatous goitre in 136 patients and follicular carcinoma in 3 cases. The goitre cases were collected by conducting a survey at the villages of the Murree Hills with the help of the staff of the basic health units. 157 families reported for an interview and 106 families had one or more members affected. The study revealed a preponderance of females afflicted with goitre and usually in the age group of 11 to 30 years. Officially the Murree Hill areas have not been included in the endemic areas but the survey results gave a cause for them to be a part of the Iodine Deficiency Control Programme. It is also suggested that children and women of child bearing age should be injected with iodized oil which provides iodine for 3 years. Plans should be made to supply iodized salt in these areas and iodination of water supply can also help in solving the problem.
Oral Submucous Fibrosis - Some Clinical Observa­tions. Cox, S.C.J. Nepal Med. Assoc., 1992;30:42-47.
Oral submucous fibrosis, a debilitating disease of the oral cavity has been linked with the use of betel nut. It begins in the soft palate region and spreads to the adjacent tissues. Twenty-two cases with typical features of OSF were recorded. Of these, 5 had never used betel nut and two of them were regular smokers. A detailed history alongwith the family history was noted and the diagnosis of OSF was confirmed by histopathology. The most frequent presenting complaint was the limited ability to open the mouth followed by reduced tolerance to hot and spicy foods. There was no positive family history and clinically only the soft palate seemed to be affected followed by the pharyngopalatine arch and the retromolar region. The buccal pouch area, floor of the mouth, the tongue and the lower lip were next involved. The changes in these areas brought about a leathery appearance and eventually a loss of buccal vestibule and inability to open the mouth. The posterior portion of the mouth was occasionally found affected in isolation and the lips were involved when the entire buccal mucosa had undergone the change. The lower lip was found affected only in the regular betel nut users. The observations made after the study, concluded that OSF can develop without the influence of betel nut use but usually at a later age and they are more sensitive to spicy foods. The soft palate was the first site to be presented with OSF changes and the limitation of opening the mouth is seen after involvement of the buccal mucosa.
Crocodile Tear Syndrome in Leprosy affecting Facial Nerve. Soni, N.K., Prasad, B., Gupta, V.K. Pak.J. Otolaryngol., 1992;9:35-36.
Crocodile tear syndrome is an uncommon sequelae of facial nerve palsy. Excessive lacrimation occurs only during eating. The first case was described in 1913 by Oppenheim and Engelem. The case of a 34 year old male patient is presented. He complained of flowing of tears from the right eye during eating since 5 months. He had been diagnosed as leprosy with facial nerve palsy two and a half years back and was on anti-leprosy treatment. The facial nerve recovered after 2 years of therapy. Besides a slight incoordination of facial expression there was no other abnormality detected on examination. The modi­fied Schirmer’s test showed more lacrimation on the right side. Healed mucosal lesions in both nasal fossae were noted on anterior rhinoscopy. Atrophy of the mucosa was found in the nasal vestibule. Examination of the ears, pharynx, larynx and eyes was normal. The patient was asked to eat and irrespective of the taste there was excessive lacrimation from the right eye. Water drinking had no response. Crocodile tear is a well established complication facial nerve palsy. About 2 percent of leprosy patients have an involvement of the facial nerve. Usually the damage is irreversible but occasionally misdirected regenerating nerve fibres destined to the salivary gland in the greater superfacial petrosal nerve are misdirected to reach the lacrimal gland, which causes lacrimation during eating.
Glycosylated Haemoglobin in different Triinesters of Pregnancy. Munawar, F., Khan, S.J., Haider, Z., Janjua, I. and Khan, T.A. Pak. Armed Forces Med.J., 1992; 42:44-46.
Glycosylated haemoglobin (HbAIc) is a normal minor haemoglobin accounting for 3-6 percent of haemoglobin A. The glycosylation of this haemoglobin occurs during circulation of red cells and expressed as percentage of the total haemoglobin. It is dependent on the average concentration of glucose to which the red cell has been exposed.
A study was conducted to evaluate the levels of HbAIc in different trimesters of pregnancy in normal women and high risk pregnancies and with non-pregnant women acting as controls. One hundred and fifty volunteers were selected from the antenatal clinic of Sir Ganga Ram Hospital Lahore. 30 were non.pregnant women, 90 with normal pregnancy and 30 had a high risk pregnancy. The pregnant cases were 30 and 10 in each trimester. Venous blood samples were collected with EDTA and HbAIc estimated by ion exchange chromatog­raphy. The results obtained showed no difference in the HbAIc concentrations between the control group and all the three trimesters of normal pregnancy. The values ranged between 5.8 in third trimester and 6.65 percent in the first trimester. A significant difference was noted in these values and those of the high risk cases being 9.0 in the first and third trimester. The HbAIc values were found to be on the lower level in normal pregnant women which could be attrib­uted to the lower mean blood glucose concentrations and mean red blood cell age during pregnancy. The higher levels in the high risk pregnant women reflects a raised mean blood glucose level over the previous 6 to 10 weeks. This is not diagnostic of gestational diabetes but highly suggestive and for a confirmed diagnosis an oral glucose tolerance should be performed.

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