Swyer Syndrome is a pure form of gonadal dysgenesis that although rare, should not be disregarded in the differential diagnosis of patients who present with primary amenorrhea and abdominopelvic mass. The dysgenetic gonads fail to produce antimullerian hormone in an individual with Swyer Syndrome who is genetically male, resulting in feminization and absence of virilization. Phenotypically female, they usually seek consult at a later time during their teenage years due to primary amenorrhea. Our index patient consulted due to a large abdominopelvic mass and primary amenorrhea. Hormonal assay showed a hypergonadotropic hypogonadism endocrinologic milieu, and on karyotyping, showed a genetically male individual. This paper shall discuss an in-depth pre-operative, surgical and post-operative management of patients diagnosed with Swyer Syndrome.

Human ; Female ; Adolescent ; Anti-mullerian Hormone ; Amenorrhea ; Feminization ; Diagnosis, Differential ; Gonadal Dysgenesis, 46,xy ; Turner Syndrome ; Gonadal Dysgenesis ; Karyotyping ; Virilism ; Hypogonadism ; Gonads

OBJECTIVE: To describe the clinical features, causative agents, management practices, and outcomes of preseptal and orbital cellulitis at a tertiary-care center in a developing country. METHODS: This is a retrospective case series of preseptal and orbital cellulitis seen at the Orbit Clinic of the Philippine General Hospital from January 1990 to December 1995. The medical records were reviewed and the following data obtained: age, gender, manner of disease presentation, causative agent, medical interventions, and outcomes. RESULTS: Fifty-six patients with preseptal cellulitis and 35 with orbital cellulitis were identified. Among the patients with preseptal cellulitis, the mean age at presentation was 12.6 +/- 17.0 years. No gender predilection was observed. The most common presenting signs were lid swelling (all patients), eye redness (34 %), fever (29%), and eye discharge (27 %). Bilateral involvement occurred in 9 patients. Among those with orbital cellulitis, 25 were classified as orbital cellulitis, 5 as orbital abscess, and 5 as cavernous sinus thrombosis. There were slightly more females than males (1.3:1). The mean age at presentation was 17.1 +/- 18.6 years. The most common symptoms were lid swelling (94 %), ophthalmoplegia (89 %), chemosis (77%), proptosis (71%), and decreased vision (51%). Both conditions were associated with antecedent infectious conditions such as skin and lid infection, sinusitis, dental abscess, respiratory-tract infection, and trauma. Staphylococcus was the most common organism isolated. The most common initial antibiotics used were beta-lactamase-resistant penicillins. Other antibiotics were added based on clinical response and microbial studies. Orbital cellulitis was associated with sight threatening complications such as glaucoma, retinal vascular occlusion, exposure keratitis, and optic-nerve compression. CONCLUSIONS: The etiology of preseptal and orbital cellulitis in this series differs from that in developed countries. Preseptal and orbital cellulitis should be distinguished early so that proper management can be instituted. Orbital cellulitis is associated with greater mortality and morbidity. CT scan and microbial studies are invaluable for appropriate diagnosis and management of orbital cellulitis.
Human ; Male ; Female ; Young Adult ; Adolescent ; ORBITAL CELLULITIS ; CASE REPORTS ;

Vaginismus is a sexual dysfunction which results from vaginal musculature spasm and makes the penetration almost impossible. It is commonly associated with significant emotional distress. On several occasions, fear of pain during sexual intercourse may perpetuate the sexual dysfunction. We report a case of primary vaginismus that was associated with psychiatric squeale of anxiety and depression psychopathology. It suggests that psychological problems related to a mentalhealth problem in vaginismus should be dealt adequately for a holistic approach. A combination of behavioural, psychological and pharmacological treatment is important to ensure a good prognosis outcome.
Vaginismus ; Sexual Dysfunctions, Psychological

Nutrition screening is recommended as a first step of nutrition care to allow early identification and intervention of malnourished patients. The present study determined the validities and reliabilities of two malnutrition screening tools namely, the Malnutrition Universal Screening Tool (MUST) and Malnutrition Screening Tool (MST) among adult patients at the Hospital Kuala Lumpur. Methods: The sensitivity, specificity and predictive value of MUST and MST were conducted against the Subjective Global Assessment (SGA), anthropometric parameters including body mass index (BMI), calf circumference (CC),mid-upper arm circumference (MUAC) and energy intake. Inter-rater reliability was evaluated using kappa value (κ) to determine the level of agreement between raters. Results: A total of 151 subjects with mean age of 45.2 ± 13.7 years participated in this study. Prevalence of malnutrition according to MUST, MST and SGA was 34.4%, 33.8% and 19.9%, respectively. As compared to SGA, MUST and MST had a sensitivity of 96.6% and 93.3% respectively, whereas the specificity was 80.9% for both tools. The sensitivity and specificity of MUST against the anthropometric parameters (BMI, CC and MUAC) were between 53.8% to 88.8% and 67.4% to 69.9%, respectively. The sensitivity values for MST were between 46.1% to 63.6% and specificity values were between 64.4% to 67.6%. The inter-rater reliability of MUST was higher (substantial, mean (κ) = 0.78) than for MST (moderate, mean (κ) = 0.52). Conclusions: In conclusion, MUST was found to have similar validity levels but higher reliability result than MST. Based on our result, MUST is recommended for use in identifying adult patients who are at high risk of malnutrition. It can be used as a malnutrition screening tool but there is a need to evaluate the cost effectiveness of its implementation.

A significant challenge after performing resection of the esophagogastric region, is the reconstruction that follows. Esophagogastrostomy is a simple and direct method to restore gastrointestinal continuity using a single anastomosis but is associated with reflux esophagitis and anastomotic stenosis. This case report presents a 29-year-old man with a bleeding gastroesophageal junction leiomyoma who underwent a proximal gastrectomy and an esophagogastrostomy reconstruction with a double H-flap technique to reduce the incidence of gastric reflux. This illustrative description of the double H-flap technique created a valve mechanism that mimicked the function of the resected sphincter and cardia. This antireflux adjunct technique is reproducible and effective in preventing gastroesophageal reflux symptoms after an esophagogastrostomy.

The objective of this case study is to present the anesthetic consideration of a patient with DIC for 'E' hysterotomy and the role of hemotherapy and its possible complications.
Human ; Adult ; LUNG INJURY ; DISSEMINATED INTRAVASCULAR COAGULATION

Phrenic nerve injury after cardiac surgery increases postoperative pulmonary complications. The purpose of this study was to analyze the causes and effects of phrenic nerve injury after cardiac surgery. Prospectively collected data on 2084 consecutive patients who underwent cardiac surgery from Jan. 1995 to Feb. 2002 were analyzed. Twenty-eight preoperative and operation related variables were subjected to logistic analysis with the end point being phrenic nerve injury. Then phrenic nerve injury and 6 perioperative morbidities were included in the analysis as variables to determine their independent predictive value for perioperative pulmonary morbidity. An identical approach was used to identify the independent risk factors for perioperative mortality. There were 53 phrenic nerve injuries (2.5%). There was no phrenic nerve injury in non-coronary surgery or coronary surgery using conduits other than the internal mammary artery. The independent risk factors for phrenic nerve injury were the use of internal mammary artery (Odds ratio (OR) = 14.5) and thepresence of chronic obstructive pulmonary disease (OR = 2.9). Phrenic nerve injury was an independent risk factor (OR = 8.1) for perioperative pulmonary morbidities but not for perioperative mortality. Use of semi-skeletonized internal mammary artery harvesting technique and drawing attention to possible vascular or mechanical causes of phrenic nerve injury may reduce its occurrence. Unilateral phrenic nerve injury, although rarely life-threatening, is an independent risk factor for postoperative respiratory complications. When harvesting internal mammary arteries, it should be kept in mind avoiding stretching, compromising, or inadvertently dissecting phrenic nerve is as important as avoiding damage of internal mammary artery itself.

The family practitioner plays an important role in the detection and treatment of mental disorders. It is said that over half of all persons affected with mental illness are initially seen and treated by the non-psychiatrist in the outpatient setting rather than in the specialty mental health clinic. Objective: This paper aims to evaluate perceived level of confidence and competence of the primary care practitioner in the recognition, diagnosis, and management of mental disorders. Methods: A survey of family physicians and general practitioners using a thirteen (13)-point questionnaire during an annual convention of the Philippine Academy of Family Physicians (PAFP) was conducted. The questionnaire included items that attempted to quantify: exposure to psychiatry during residency and current medical practice; proportion of mental illness cases among total patient load; signs and symptoms that would be associated with mental illness; familiarity with standardized criteria for diagnosing mental illness i.e. schizophrenia and depression; familiarity with therapeutic medications; and perceived level of confidence in treating psychiatric cases. Results and Conclusion: The study implies that the family physician, although aware of the general signs and symptoms indicative of mental illness, is still hesitant in formulating a definitive diagnosis. Possible reasons for this attitude may be inadequate training in psychiatry as well as unfamiliarity and perceived difficulty with the DSM-IV.
Human ; Male ; Female ; MENTAL DISORDERS ; DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS ; PHYSICIANS, FAMILY

We report a 21-year old female patient who presented with an 18-month history of a swelling in the distal phalanx of her right little finger. Although the history, clinical features and MRI were suggestive of a benign tumour or a tuberculous lesion, the histo-pathological examination of the swelling was reported as a conventional osteosarcoma. Osteosarcoma of the hand is very rare. This article highlights the possibility of a seemingly benign lesion seen in a routine clinic could well turn out to be malignant, and the need to maintain a high index of suspicion
Osteosarcoma

Introduction: Application of dynamic hip screw (DHS) implant for the treatment of unstable intertrochanteric fractures continues to raise concern related to risk of lag screw cut-out with or without subsequent damage to the acetabulum. Measurement of tip-apex distances (TAD) has been recommended to guide the optimal placement of lag screw and to predict subsequent risk of screw cut-out. In this study, the value of TAD was evaluated to verify its usefulness. Methods: This is a retrospective study of 33 consecutive patients with intertrochanteric fracture treated with DHS. Demographic data of the patients were traced from their case notes. Post-operative radiographs were reviewed by focusing on measurement of TAD on anteroposterior and lateral radiographs. Radiographs at one year follow-up were reviewed to depict any fixation-related failure or complication. Results: Fifty two percent of patients did not achieved the recommended TAD of ≤ 25mm. The mean post-operative TAD was 25.9mm and elderly patients were likely to achieve TAD of ≤ 25mm. The overall complication rate of 6% was attributed to screw cut-out in two cases. The unstable left-sided fracture was identified to be a potential risk for screw cut-out or migration. Conclusion: TAD is a valuable measurement to guide optimal placement of lag screw during DHS fixation of intertrochanteric fracture.