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

COAGULOPATHY IN ACUTE PROMYELOCYTIC LEUKAEMIA. Hassan, K., Ikram, N., Nur, S., Akhtar, MJ.Rawal Medi., 1990;18:82-85.
A retrospective study was conducted on 147 leukaemia patients to diagnose acute promyelocytic leukaemia. These patients were diagnosed between 1986 and 1989 in the pathology department of Rawalpindi Medical College. Nine cases were established as M3 type of Acute Promyelocytic leukaemia. There were 5 males and 4 females with ages between 40 and 60 years and two cases were below 25 years of age. Coagulation tests performed included P.T., APTT. T.T., Plasma Fibrinogen level and FDP level. Coagulopathy was considered to be present when PT was more than 12 seconds, APTT more than 45 seconds or fl more than 18 seconds. Fibrinogen level less than 150mg/dl and FDP level more than 10 ug/mi. Peripheral blood and bone marrow were examined under Giemsa stain. Bleeding manifesta­tions were present in all the cases with variable severity. Cerebral bleeding walls diagnosed in two cases.,both of whom died. All the coagulation tests gave a higher value with low platelet counts. All the 9 cases diagnosed as AML-M3 had a coagulopathy with marked thrombocytopenia. This in­cidence is considered high in comparison to patients with ALL and AML. It is therefore suggested that all patients with AML -m3 should be subjected to coagulation screen­ing tests for an early diagnosis because bleeding into vital organs can be fatal.
CUTANEOUS LEISHMANIASIS. Rashid, A., Khan, M.R., Jan, A., Ahmad, I. Pak.J. OtolaryngoL, 1990;6:135-138.
‘Rn cases of cutaneous leishmaniasis are presented. This disease was first described by Razi in Iraq around 1500 A.D. A severe outbreak occurred in Quetta in 1935. Of the ten cases presented 7were males and3 females in ages ranging between 3 and 45 years. Seven patients had lesions on the face, nose or cheek and one had it on the forearm. Diagnosis was made by smear test with geimsa stain when Leishmania Donovani bodies were found. Histopathology was performed in one patient. Leishmania Donovani is endemic in Baluchistan. It is also prevalent in the northern areas of Sind, Punjab, and NWFP. The vector is the sand fly of which P. Sergenitli is the most common. No effective treatment is available for cutaneous Leishmaniasis. Anti-malarial and cycloguanil pamoate have been recently introduced
SPECTRUM OF ORGANISMS ASSOCIATED WITH SUPPURATIVE OTITIS MEDIAAND THEIR ANTIBIOTIC SENSITWITY PAITERN. Farooqui, B. , Ashfaq, M.K, Khurshid, M., Jilani, S.A. Pak. J.Otolaryngol., 1990;6:99-104.
120 ear swabs from patients with middle ear infec­tions were processed at the Microbiology laboratory of the Aga Khan University Hospital. The eligibility criteria were history of ear achd and suppurative discharge from the ear. Samples were collected on a sterile cotton swab and transported to the laboratory within one hour. Each swab was cultured on two blood agar plates, one for anaerobic incubation, and a Mac Conkey’s agar plate. The plates were examined after 24 hours for growth. Fungal cultures were made on SDA and Mycosel agar and after 48 hours examined microscopically. Antibiotic sensitivity was per­formed by the Kirby Bauer method. Of the 120 specimens cultured, 85 gave a positive result and 35 were sterile. Of the 85 samples 72 had a single organism and 13 showed a mixed growth. Pseudomonas aeruginosa was the most common organism followed by staphylococcus aureus, proteus species, candida albicans, E. coli and other bacteria. All isolates of pseudomonas aerüginosa were sensi­tive to amikacin, azactum and ofloxacin.E. coli, Enterobac­ter species and Serratia species were sensitive to all antibiotics used. The proteus species exhibited a sensitivity to co-trimdxazolè and gentamycin of 75-90 percent. There were two isolates of Branhemella catarrhalis and they were sensitive to erythromycin, clindamycin and chloramphenicol. Two isolates of B-haemolytic streptococ­cus and streptococcus pneumoniae were sensitive to penicillin, erythromycin and ampicillin. Staphylococcus aureus isolates showed a sensitivity to cloxaciliin and amikacin. It was concluded from the study that pseudomonas aeruginosa was the predominant bacteria causing middle ear infection with the second major aetiologic agent being staphylococcus aureus. No anaerobe was isolated which could be due to a defective transport system. A higher incidence of candida albicans was noted in this study which could be attributed to the tropical climate Pseudomonas aeruginosa has a sensitivity to amika­cin, azactum and oxfloxacin. Staphylococcus aureus isolates showed a sensitivity to cloxacillin and amikacin. As 80 percent of the gram negative bacilli were sensitive to cotrimoxazole so this remains to be the drug of choice for the treatment of otitis media. Also topical antibiotics should be avoided as bacteria acquire resistance to them more rapidly.
HAEMANGIOBLASTOMA OF THE CENTRAL NERVOUS SYSTkM IN CHILDREN LESS THAN 10 YEARS OF AGk - REPORT OF TWO CASES. Zaman, K., Qadri P. Rawal MedJ., 1990;18:99-102.
Two cases of haemangioblastoma a benign, non metastasizing tumour are presented. A nine year old girl was brought in with headaches and vomiting of six months duration and difficulty in walking since two months. Blurred vision was noted since 2 weeks. Examination revealed truncal ataxia, positive Romberg’s sign and right sided limb in coordination. Bilateral papilloedema was present. Skull x-rays showed evidence of intracranial hypertension and a CT Scan presented amid line cystic lesion. Acute hydrocephaluswas present. A large cyst was drained and a solid component excised through a posterior fossa craniectomy. Postopera­tive recovery was uneventful. Histology gave a diagnosis of haemangioblastoma. A complete screening was done and von-Hippel Lindau syndrome was excluded. As excision was complete radiotherapy was not carried out. The second case was of a six year old boy with headache and vomiting of six months duration and a swelling in the right temporal region since three months and left hemiparesis. A pulsatile swelling was present on the right temple, right sided facial weakness and left sided hemiparesis of grade 3 was observed. Bilateral papil­loedema was found and the skull x-ray depicted a defect in the squamous part of the temporal bone. The CT Scan showed a cystic space occupying lesion in the right hemi­sphere. Craniotomy was performed and the tumour was removed piece meal. The histological diagnosis was of haemangio blastoma. Postoperative complications in­cluded a CSF leak for which repeated lumbar punctures were performed because surgical closure failed and infec­tion for which appropriate antibiotics were administered. Haemangio blastomas occur either as an isolated tumour or as a part of von-Hippel-lindau Syndrome. The CT Scan and angiography compliment each other in making an accurate diagnosis. Excision should be per­formed as piecemeal removal can cause excessive bleeding. Radiotherapy is used after piecemeal removal or recur­rence where it gives good results.