April 1989, Volume 39, Issue 4

Letter to the Editor


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

One hundred eggs of two different breeds of hens, domestic and layers were analysed for their cholesterol contents. Eggs are a rich source of cholesterol with one egg yielding about 300 mg in the yolk. This content in turn depends on the chicken feed which imparts considerable amount of cholesterol to the hens in poultry farms. These birds are also less active due to being confined in cages. Domestic hens consume garbage and get more exercise in the open air. Ten eggs of domestic hens were collected from five different villages each and ten eggs of layers (starcross) were obtained from five different poultry farms each. The whole eggs and yolks were weighed separately and then the cholesterol content was determined quantitatively by the method of Zak. The average weight of the domestic hen’s egg was 49.49G and that of the layer was 58.64G. The weight of the egg-yolk in the first group was an average of 14.83 Gm and in the second was 17.07 Gm. The cholesterol content per egg was 258.39 mg average in the domestic hen’s eggs whereas the layers eggs had a mean value of 295 mg. The quantity of cholesterol per unit gram of egg yolk was compared between the two groups and the difference was insignificant statistically. The conclusion drawn was that large sized eggs of layers contain more cholesterol than the small sized eggs of domestic hens. The cholesterol content was dependent on the weight of the egg yolk and not the quality. As the nature of the feed and sedentary life style of the layers is res­ponsible for the increased yolk size, the quantity of cholesterol contained in each egg is approxi­mately 50 mg higher. This excess along with other 4ietary lipids can cause an overload and raise the serum cholesterol levels.
Two cases of Embryonal Rhabdomyosa­rcoma of the temporal bone are presented. Both patients were males and five years of age. Both presented with blood stained otorrhoea and otalgia complete L.M.N. facial paralysis and aural polypi. Evolution of the disease was very rapid. Extensive bony destruction and soft tissue invasion was seen within 4 to 6 months of onset. Exploratory mastoidectomy was performed in both cases and revealed very extensive granulations and polypi in every direction and difficult to remove completely. There was minimum suppuration. The tissues removed were subjected to histopa­thology which confirmed the diagnosis of Embryonal Rhabdomyosarcoma. Both the patients were referred for radiotherapy and chemotherapy. Embryonal Rhabdomyosarcoma of the temporal bone is a rare, lethal malignant tumour. It is found in children and young adults. Only 72 cases have been reported in literature. The tumour is rapid growing and erodes and invades the surrounding structures. Treatment consists of surgery with radiotherapy plus chemotherapy. Drugs used are vincristine, cyclophosphamide and dactinomycin. The prognosis despite the treatment is unfavour­able.
ANGIOMYOLIPOMA OF THE KIDNEY Muhammad, G., Aurangzeb, Sultan, S. JAMC., 1988; 1: 28 - 30.
The case of an angiomyolipoma of the kidney in a 30 years old woman is presented. The main symptom was left loin pain since 11/2 years. She had low grade fever and burning micturition but no haematuria. Physical examina­tion revealed a big palpable mass in the left renal area, which was tender. Laboratory tests were normal but the IVP showed a grossly displaced left kidney by a soft tissue shadow. Both kidneys were functioning. Surgery was performed which revealed a haemorrhagic mass 12 inches X 6 inches arising from the upper pole of the left kidney, infiltrating the peritoneum and diaph­ragm. Left nephrectomy was performed due to a suspicion of renal carcinoma. Histopathology confirmed the diagnosis of angiomyolipoma. Angiomyolipoma, an unusual tumour, composed of mature adipose tissue, blood vessels and ;mooth muscles is regarded as a benign hamartoma. It is in most cases found in association with tuberous sclerosis. They are bilateral, multiple and asymptomatic. When not associated with tuberous sclerosis they are large, unifocal and symptomatic. Females have a preponderance with the peak incidence being in the fifth decade. It is a benign tumour with no evidence of metas­tasis. However, progressive destruction of renal tissue can lead to renal failure. Pre-operative diagnosis is often difficult. Angiography may reveal multiple grape-like aneurysms of the intermediate renal arteries, a whorl like appearance of the veins and lack of arterio-venous shunting. A frozen section biopsy wifi avoid radical surgery. If renal cell carcinoma cannot be ruled out then nephrectomy is justified.
HYDRONEPHROSIS CYST. Begum, N., JAMC., 1988; 1:31 - 33.
A 32 years old woman with a history of a stillbirth home delivery a week ago was admitted with severe abdominal pain and distension. She had these complaints since the onset of her pre­gnancy but did not go in for medical advice. On examination the Abdomen was uniformly enlarged. The left flank was resonant. Fluid thrifi and shift­ing dullness was present in the right flank. Pelvic examination was insignificant but the margins of the suspected ovarian cyst could not be palpated. The laboratory tests were within normal ranges except for the haemoglobin which was 9.2 grn%. Paracentesis was performed twice and the fluid analysis showed 125 cells/cmm with lymphocytes predominating and no organisms or malignant cells were seen. IVP and ultrasound facilities were not available. Laparatomy was performed which revealed a large cystic right kidney filling the entire abdominal cavity and pushing the large gut to the left. The right ureter was also dilated. Three litres of urine was aspirated from the right kidney and. right sided nephrectomy was performed. Post-operative period was uneventful. Abdominal swellings become difficult to diagnose if they grow to be of a large size. In our country the patients usually put off going to the hospital tifi an emergency arises. Hydronephrosis in adults usually causes loin pain, occasionally associated with vomiting. If infection occurs then pyonephrosis can be had. Renal function remains normal due to the contralateral kidney compensat­ing.

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