REPORTS of bilateral lesions causing auditory deficit in man are infrequent. 1 In 1967, for example, Jaffe reported 4 patients with bilateral deafness among 143 patients who developed sudden sensorineural hearing loss.1 Deafness of vascular etiology is stated to occur unilaterally and permanent impairment of hearing is a frequent sequel.3 In this paper we describe 2 patients with reversible, sudden bilateral deafness of vascular origin. Patient 1At age 50, a hypertensive black man developed dizzy spells. These spells occurred irregularly, 3 to 4 times a day and lasted 3-4 minutes. They were described as a "feeling of being drunk" and were associated with low-pitched tinnitus and slurred speech. Neurological examination, including visual fields and optokinetic nystagmus, was normal. Electronystagmography was normal and audiometry revealed mild, bilateral, high frequency sensorineural hearing loss with good speech discrimination (see table). He was prescribed aspirin. Two months later he complained of aggravation of episodic dizziness, double vision, numbness marching down the left arm and band-like headaches while using the right hand for painting walls and ceiling. His blood pressure was 110/80 mm Hg in both arms; the patient being on thiazide diuretics and potassium supplement. Neurological examination was again normal. Roentgenograms of the skull revealed calcification of the basilar artery posterior to the clivus and of the carotids overlying the sella turcica. Brain scan, electroencephalogram and arch aortogram were normal. Cerebrospinal fluid examination, including glucose and protein values, was also normal.Two weeks later, after having used the bathroom, the patient suddenly felt vertiginous with a tendency to fall either sideways, forward or backward. He complained of roaring in both ears and deafness. He denied dysarthria, dysphagia, diplopia, focal weakness, sensory loss, or loss of consciousness. General physical examination was normal. Neurological ex- amination disclosed an alert individual with normal higher cortical functions. Examination of cranial nerves revealed bilateral counterclockwise rotatory nystagmus as well as vertical nystagmus, both accentuated upon standing. He had bilateral hearing loss, right greater than left; and cold caloric stimulation of the left ear caused nystagmus to the right while the right ear stimulation produced no response. Examination of the motor and sensory systems, including plantar responses, were normal. His station was broadbased and ataxic, with a tendency to fall to the left. Tests of coordination revealed an intention tremor of the left upper extremity. Laboratory data on admission included normal results of complete blood count, electrolytes, glucose and electrocardiogram.Selective cerebral angiography showed normal carotid circulation. The arch study revealed marked stenosis of the right vertebral artery at its origin but this artery could not be selectively catheterized. Selective angiography of the left vertebral artery showed significant stenosis with m...

Objective: To find out causes of dyspepsia on upper gastrointestinal endoscopy. Setting: Endoscopyunit of Nishtar Hospital Multan. Period: May 2005 to August 2007. Material and methods: Patients suffering fromdyspepsia were referred by consultants of Nishtar Hospital Multan and doctors working in the periphery for endoscopy.Results: 502 patients were scoped for dyspepsia; 254(50.6%) were male and 248(49.4%) were female. Mean age was42.5 years and age range was 7-95 years. Most common lesion was gastroduodenitis (20% cases) followed by gastriculcer (5.4% cases). Ratio of duodenal ulcer to gastric ulcer was 1:2. 56% patients had no pathology; females were morelikely to have normal endoscopy. Conclusion: Gastroduodenitis is the most frequent organic cause of dyspepsia.Functional dyspepsia is more common among females.

To determine the etiology of dysphagia based on upper GI endoscopy in Nishtar Hospital Multan. Study design: Retrospective study. Place and Duration of study: This study was conducted at gastroenterology unit of Nishtar Hospital Multan from Feb 2013 to August 2014. Patients and methods: Three hundred and twenty three patients, ≥ 13 years old, who presented with history of dysphagia to the gastroenterology unit of Nishtar Hospital Multan. Results: Out of 323 patients, 43.7% were males and 56.3% were females. Mean age of patients was 44.37±17.395 years. Most common finding was benign stricture (28.5% cases) followed by no abnormality (21.7%), carcinoma esophagus (20.7%), achalasia (6.5%), esophageal web (4%), ulcers (3.7%), multiple pathologies (3.1%), pharyngeal cancer (2.2%), esophageal candidiasis (1.9%), reflux esophagitis (1.5%) and hiatus hernia (1.2%). Uncommon findings were incompetent LES (0.9%), extrinsic compression (0.9%), vocal cord paralysis (0.6%), barrett's esophagus (0.6%), herpes simplex esophagitis (0.6%), shatzki ring (0.3%), diverticulum (0.3%) and thick aryepiglottic folds (0.3%.). Conclusion: Esophagogastroduodenoscopy is the investigation of choice for patients of dysphagia. Most common finding in our study was benign stricture in young females, followed by carcinoma esophagus, achalasia, web, ulcer, pharyngeal cancer, reflux esophagitis, esophageal candidiasis and hiatus hernia. Incompetent LES, extrinsic compression, vocal cord paralysis, barrett esophagus, herpes simplex esophagitis, ring, diverticulum and thick aryepiglottic folds were rare causes. Measures should be taken to avoid the preventable causes by patient awareness and adequate treatment of predisposing factors.

Objectives: To determine the etiology of dysphagia based on upper GI endoscopyin Nishtar Hospital Multan. Study design: Retrospective study. Place and Duration of study:This study was conducted at gastroenterology unit of Nishtar Hospital Multan from Feb 2013 toAugust 2014. Patients and methods: Three hundred and twenty three patients, ≥ 13 years old,who presented with history of dysphagia to the gastroenterology unit of Nishtar Hospital Multan.Results: Out of 323 patients, 43.7% were males and 56.3% were females. Mean age of patientswas 44.37±17.395 years. Most common finding was benign stricture (28.5% cases) followedby no abnormality (21.7%), carcinoma esophagus (20.7%), achalasia (6.5%), esophagealweb (4%), ulcers (3.7%), multiple pathologies (3.1%), pharyngeal cancer (2.2%), esophagealcandidiasis (1.9%), reflux esophagitis (1.5%) and hiatus hernia (1.2%). Uncommon findingswere incompetent LES (0.9%), extrinsic compression (0.9%), vocal cord paralysis (0.6%),barrett’s esophagus (0.6%), herpes simplex esophagitis (0.6%), shatzki ring (0.3%), diverticulum(0.3%) and thick aryepiglottic folds (0.3%.). Conclusion: Esophagogastroduodenoscopy is theinvestigation of choice for patients of dysphagia. Most common finding in our study was benignstricture in young females, followed by carcinoma esophagus, achalasia, web, ulcer, pharyngealcancer, reflux esophagitis, esophageal candidiasis and hiatus hernia. Incompetent LES,extrinsic compression, vocal cord paralysis, barrett esophagus, herpes simplex esophagitis,ring, diverticulum and thick aryepiglottic folds were rare causes. Measures should be taken toavoid the preventable causes by patient awareness and adequate treatment of predisposingfactors.

Objectives: To determine the etiology of lower GI bleeding based oncolonoscopic findings Study design: Retrospective study. Place and Duration of study: Thisstudy was conducted at gastroenterology unit of Nishtar Hospital Multan from Feb 2013 toAugust 2014. Patients and methods: Two hundred and fifty four patients, ≥ 14 years old whopresented with history of lower GI bleeding to the gastroenterology unit of Nishtar HospitalMultan Results: Out of 254 patients, 59.05% were males and 40.95% were females. Mean ageof patients was 37.22±10.68 years. Most common findings were haemorrhoids (40.9% cases),ulcerative colitis(35.4%), no abnormality (8.2%), solitary rectal ulcer (7.5%), growth (7.1%),proctitis (3.5%), polyps(2%), rectal varix (1.2%), infective colitis (0.8%), uremic colopathy(0.8%), rectal prolapse (0.8%), multiple polyposis coli (0.8%), petechiae (0.8%), stricture (0.8%),diverticula(0.4%)and fissure (0.4%). Conclusion: Colonoscopy is the investigation of choice forpatients of lower gastrointestinal bleeding. More common colonoscopic findings in our studywere haemorrhoids, ulcerative colitis, solitary rectal ulcer, malignancy and proctitis. Polyps anddiverticula which are common in the west were uncommon in our patients. Rectal prolapse,petechiae, stricture, uremic colopathy and multiple polyposis coli were rare causes.