Thursday, May 22, 2008

Case: Near Drowning

A boy of 13 months admitted in our hospital after 4 days of drowning with unconsciousness and repeated convulsion.

He was drowned in salt water pond four days back and stayed drowned for half an hour. After recovery from the pond, he was admitted in the local health centre but with no improvement.

On admission in our hospital he was unconscious and hypotonic. his GCS score was 4/15,
Hr-136/m, BP-120/70 mmHg, He was dysnoec but there was no other chest finding.
Opthalmoscope finding was normal.

His CBC, electrolytes was found normal.X-ray chest -normal.

He was labeled as a case of Near Drowning.

His convulsion was difficult to control. After repeated trial with Inj Phenobarbitone, Phenytoin and mannitol , it was controlled after after 2 days. By the next, few days though he regained his consciousness, but he developed spasticity of the limbs, visual impairment and hearing defect.

Dr. Badrud Doza
Dr. Fahim

Link: Drowning

Sunday, May 18, 2008

Case: Ectodermal dysplasia-anhydrotic type

The mother with worry in her face told me in the outdoor setting that the boy, 10 months old, has no sweating and shoots to high rise of temperature especially in hot environment.

He was normally delivered, breast fed, immunized with normal milestone development, first child of a non-consanguineous parents of a upper middle class family, had no other major illness in the past.
On examination, the child is otherwise healthy, alert, well nourished. But his hair is sparse, scant eyebrow, no eruption of tooth, dry skin, little deformed nail. IQ normal.
His systemic examination reveals normal.
Provisionally we diagnosed the patient as Ectodermal Dysplasia-anhydrotic type

His skin biopsy was done which indicates the absence of epidermis and absence of sweat glands that conforms to the diagnosis.

Badrud Doza

Selected links for ED : 1) National Foundation for Ectodermal Dysplasia

Thursday, May 15, 2008

Case: Spleenectomy with postoperative convulsion and impaired consciousness in a case of Thalassemia

A boy of 11 years was suffering from Thalassemia major. He was advised for spleenectomy as the huge spleen was causing respiratory embarrassment.

He was operated without any trouble. But he developed convulsion in the mid night which was focal in the right hand. He was given anticonvulsants and Inj Calcium. His electrolytes and the calcium show normal level. His convulsion was continuing intermittently. His convulsion become generalized and he GCS falls to 8. He was given Inj phenobarbitone and Sodium Valproate orally.

Convulsions were controlled and his consciousness was gradually improving. His speech was initially slurred which was also later improved.

We had a plan for CT scan but as the patient improved completely patient took the discharge.

We level the case as Thalassemia major with post operative convulsion due to emboli.

Dr. Badrud Doza
Dr. Shoma Chowdhury
Related link:
1) Thalassemia Foundation
2)International Thalasemia Foundation

Saturday, May 10, 2008

Case: Pulmonary atresia with VSD and PDA

A girl of 8 years admitted in our hospital with hyperpyrexia of 3 days duration.

She is well built, of good nutrition, no pallor, but had cyanosis and clubbing
Precordial examination reveals cardiomegaly and a murmur in the pulmonary area with both systolic and diastolic in component with radiation to the clavicle. Other systems found normal

Her X-ray shows cardiomegaly with right vetricular enlargement. ECG shows right ventricular hypertropy and Echo shows Pulmonary Atresia, VSD and PDA.

The patient traveled to India earlier and was seen by great cardiac surgeon Dr. Devi Sethi.
The fever was of viral origin. After it subsided, patient was discharged and the parents were taking preparation to have the operation done at Bangalore shortly.

Dr. Badrud Doza
Dr. Fahim

Link : Pulmonary Atresia