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April 1990, Volume 40, Issue 4

I Wnat To Say


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

HYPOSPPADIAS, INGUINAL HERNIA AND ABSENCE OF VAS DEFERENS. Bhatti, A.H., Chaudhry, A.R., Iqbal, M. R.MJ., 1989; 17:104405.
Of 50 children with hypospadias, 4 manifested an additional finding of Right Sided Inguinal hernia and absent vas deferens. IVP of these four children revealed unilateral renal genesis in one. Physical examination showed descended testes in all the four patients. The association of absent vas deferens with renal agenesis and cystic fibrosis is well known. In the cases presented, agenesis of vas deferens was seen along with hypospadias and  enal agenesis in one patient. This can be explained by the fact that at 4mm stage of development of the foetus, the ureteric bud is formed from the woiffian duct. Later at 60mm stage the cranial end of the mesonephric duct convolutes to form the duct of the epidydimus whereas the caudal end remains straight to differentiate into the vas deferens, seminal vesicles and ejaculatory duct. If the woiffian duct entry into the cloaca is disturbed, the uretric bud will not develop which will result in agenesis of vas deferens and ipsilateral renal agenesis. As the genital tubercle develops at the 4mm stage, it is possible that disturbed vascularity is the cause of hypospadias or absent vas deferens and weakness of inguinal canal resulting in hernia.
STRESS POLYCYTAEMIA A CASE REPORT. Umar, M., Bushra, H. R.M.J., 1989; 17: 108-109.
A 35 years old male presented with complaints episodic palpitations, non-specific chest pain, headache, restlessness, insomnia and inability to concentrate since 4 years. Symptoms became severe on stress. Clinical ex­amination revealed no abnormality. Laboratory tests showed Hb to be between 16.2G and 18.2G/dl on repeated estimations, PCV 0.5L, MCV 84, MCH27.6, MCHC 32.2 and Red Cell Count 5.73 million. The other parameters and biochemical tests were within normal limits. The bone marrow report gave increased iron with decreased siderocytes and sideroblasts. Thyroid profile, and blood gasses were normal. Ultrasonography revealed no vis­ceromegaly. Based on the interrogation and laboratory tests a diagnosis of chronic anxiety neurosis with stress Polycythaemia was made. The patient responded satisfac­torily to treatment for the anxiety neurosis. Polycythaemia is a condition where Red Cell count, haemoglobin concentration and haematocrit are in­creased above normal limits. Polycythaemia can be rela­tive or absolute, the latter being accompanied with hepato­splenomegaly. In the presented case there was a prolonged history of 4 years accompanied with anxiety and neurosis which was based as the diagnosis of Stress Polycythaemia. The postulated mechanism for this condition is reduced plasma volume due to excessive perspiration of antihyper­tensive therapy, or excess release of catecholamines and carboxyhaemoglobin.
THORACIC DISC HERNIATION - TWENTY CASES. Zaman, K. R.M.J., 1989; 17 : 85-91.
Of 1390 patients operated for disc herniation in Addenbrooke\'s Hospital, Cambridge from 1962 to 1987, 20 had a thoracic spine involvement. There were 13 females and 7 males with ages ranging between 18 and 68 years. 5 cases had a history of trauma. The onset was insidious and two had a rapid deterioration after the injury. Duration of symptoms were from 2 weeks to 3 years. 11 patients had pain as the initial symptom, 7 complained of sensory disturbances, 2 had an altered gait and 5 came in with a spastic paraparesis. Radiologically calcification in the disc space was found in 15 cases with narrowing of the disc space in 10 X’rays. Myelography demonstrated a complete block in 9 cases, partial block in 10 cases and one patient was given a normal report. Four patients were subjected to a CT Scan which confirmed the myelographic findings in 3 cases and was diagnostic in one negative case. Two cases underwent dorsal laminectomy of which one improved markedly. Six patients had laminectomy with disc excision extradurally. Two of these had early recovery, three improved later and one bad recurrent symptoms. Three patients had a laminectomy and facetectomy of which two showed good results. Six individuals were subjected to a costo- transversectomy. Four of these had a satisfactory progress. Two cases were treated with thoracotomy and anterolateral excision of the disc with rib graft and both had an excellent nemological recovery. It was concluded from the study that no clear cut symptom present in cases of thoracic disc herniation. Plain Xrays may be helpful in a small percentage of patients whereas myelography has a good diagnostic yield. CT
Scans give a 100 percent correct diagnosis. Spinal decompression is mandatory and posterolateral approach via costotransversectomy and the anterolateral approach via thoracotomy are the most rewarding surgical proce­dures.
RASPBERRY TUMOUR (UMBILICAL ADENOMA) A CASE REPORT. Zafar, A., Akhtar, S.S. R.M.J., 1989; 17: 106-107.
A 10 year old girl came into the DHQ Hospital Rawalpindi with swelling in the umbilical region since birth and watery discharge from it since 9 years. A raspberry coloured pedunculated mass was found at the umbilicus and it bled on touch. A minilaparotomy was performed through an incision encircling the umbilicus. A wide mouthed Meckel’s Diverticulum was found attached to the umbilicus by afibrousbandwith an adenomaat the end.All three structures were respected and end to end anastomosis was done. The patient made an uneventful recovery. The vitello-intestinal duct occasionally persists and gives rise to an umbilical fistula or sinus. There can be an intra-abdominal cyst when both ends of the duct close. If the lumen of the duct remains obliterated, aband is formed which can cause intestinal obstruction and finally a rem­nant band can contract and pull a Meckels Diverticulum into a congenital umbilical hernia. In the present case there was a combination of umbilical adenoma and Meckel’s Diverticulum which could have been managed by ligation of the pedicle but exploration was performed due to the long history.

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