Showing papers by "Khulna Medical College published in 2005"

Levofloxacin-Induced Fatal Toxic Epidermal Necrolysis

Abstract: TO THE EDITOR: Chronic critical limb ischemia results from chronic underperfusion of a limb. This is typically manifested by ischemic pain at rest, nonhealing ulcerations, or gangrene of the affected limb.1 As many as 20% of patients with chronic critical limb ischemia die over 6 months, mainly of vascular disease, and only 45% will survive without having an amputation.2 We present the case of a man whose lower extremity vascular disease deteriorated into chronic critical limb ischemia with ischemic pain at rest. Our case suggests the potential utility of gabapentin in the symptomatic management of pain and functional decline in chronic critical limb ischemia. Case Report. A 56-year-old man with an anxiety disorder complicated by abuse of nicotine, alcohol, and cocaine; coronary artery disease; and peripheral vascular disease developed severe left lower leg pain. He stopped using alcohol and cocaine and cut back on his smoking, but despite these lifestyle changes, the pain progressed. At first, the patient experienced leg pain only while walking, but after stopping exercise, he then developed leg pain at rest. Doppler ultrasound studies revealed marked bilateral femoropopliteal occlusive disease, more pronounced in the left. Leg pain at rest disrupted the patient’s sleep, and he became clinically depressed. He was admitted to a psychiatric inpatient service and continued on his home medications: venlafaxine 300 mg/day for depression, aspirin 325 mg/day, atenolol 50 mg/day, quetiapine 50 mg in the morning and 400 mg at night, trazodone 100 mg at night, and acetaminophen 1000 mg with hydrocodone 10 mg/day. After a week without change in his pain or mood, the patient was started on gabapentin 600 mg 3 times a day. This was increased over one week to 1200 mg 3 times a day. At this dose, the pain was significantly reduced. The patient no longer had rest pain, was sleeping well at night, and was spontaneously ambulating and participating in physical therapy. As his pain lessened, the patient’s mood improved. By the time of discharge from the hospital, he no longer had subjective evidence of chronic critical limb ischemia. Doppler ultrasound was not repeated prior to or immediately after discharge. Discussion. Chronic pain itself may accelerate decline in chronic critical limb ischemia and can precipitate or worsen major depressive disorder.3 Major depressive disorder can cause abnormal arterial vasoconstriction and increased platelet aggregation, exacerbate ischemia, and reduce a patient’s self-care.4,5 Reduced aerobic activity has a critical impact on the course of vascular disease. In our case, the symptomatic pain relief the patient obtained from a trial of gabapentin was striking and allowed a marked functional improvement. As of April 17, 2005, gabapentin had not been reported as a treatment for rest pain in chronic limb ischemia. The safety of gabapentin alone and in combination with other agents, and the patient’s marked improvement in response to gabapentin, suggest further investigation is warranted of the potential utility of gabapentin for patients with rest pain due to chronic critical limb ischemia.

Skin eruptions following treatment with Iodine-131 for hyperthyroidism: a rare and un-reported early/intermediate side effect.

Abstract: BACKGROUND : Iodine-131 ( 131 I) is a well-established method for the treatment of hyperthyroidism. Following such therapy, patients may experience symptoms relating to early or delayed side effects that can be prevented or minimized if necessary measures are taken. We have noticed an unusual side effect of 131 I therapy in the form of a skin eruption (iododerma) and aimed at assessing the frequency and severity of this side effect. MATERIAL AND METHODS : Retrospective review of 141 patients treated with 131 I between January 1994 to December 2000 (86 F, 55 M; mean age 41.35 ± 11.02 years) was performed. The dose of 131 I ranged from 250-500 MBq. Post therapy clinical and biochemical evaluation of thyroid function was done at 6 weeks, 3, 6, and 9 months then annually. RESULTS : Of the 141 treated patients, 3 patients (2.1%) presented with iododerma 4-6 weeks after 131 I therapy administration. Lesions were observed at both ankles & lower legs in all 3 cases. All lesions disappeared within 6 months with no residual effect. No other skin lesions were seen thereafter during the follow-up period. CONCLUSION : Iododerma is a rare complication of 131 I therapy that has not been reported before. It appears within 4-6 weeks after therapy and is a self-limiting condition.

Peptic ulcer perforation: management of high-risk cases by percutaneous abdominal drainage.

Abstract: Sixty-six patients were selected as high-risk cases of duodenal ulcer perforation. After resuscitation with intravenous fluids and nasogastric suction, a wide-bore percutaneous intra-abdominal drain was put in under local anaesthesia. There were three (4.5%) deaths; 58 (87.8%) patients improved satisfactorily. High-risk peptic ulcer perforation patients can be managed by putting in an intra-abdominal drain supported by conservative treatment.

Puffer fish poisoning (tetrodotoxin) in Bangladesh: clinical profile and role of anticholinesterase drugs.

Abstract: mimicking choledochal cyst. Renal hydatid cysts are also rare, with a reported incidence of about 2.5%. In summary, hydatid cyst is a differential diagnosis of cystic masses at various sites, especially in endemic areas. Clinical suspicion remains the mainstay of diagnosis, in combination with various biochemical and serological tests along with imaging modalities such as CT scan and ultrasonography.