Acanthamoeba encephalitis.

Central nervous system infection with free-living amoebae is rare. We present a fatal case of Acanthamoeba encephalitis in a 63-year-old female from India where acanthamoebae were demonstrated and cultured from CSF. In spite of treatment with amphotericin B, fluconazole and rifampicin the patient did not survive. Amoebic infection should be suspected in a patient of encephalitis of unexplained aetiology as timely diagnosis can lead to a favourable outcome.

Impact of ranitidine on prognosis after simple closure of perforated duodenal ulcer.

AIM: This randomized controlled study was carried out to evaluate the role of H2 receptor antagonists after simple closure of perforated duodenal ulcer. METHODS: A total of 192 patients who underwent simple closure for perforated duodenal ulcer were divided into two groups (A: study group and B: control group). Group A patients were treated with H2 receptor antagonists, while the patients in group B received placebo. Only 174 patients were available for endoscopic follow up. RESULTS: At the end of 24 weeks, only 6 patients out of 90 (6.6%) in group A as compared to 18 patients out of 84 (21.4%) in group B had persistent symptoms of ulcer disease as well as endoscopically proven ulcer (p < 0.05). CONCLUSIONS: The results indicate that H2 receptor antagonists have a definite role and endoscopic follow up is mandatory to define those cases who actually need definitive surgery.

Microbiological quality & incidence of organisms of public health importance in food & water in Ludhiana.

Bacteriological analysis of 713 samples of various types of foods and related articles and potable water samples from different places in Ludhiana, Punjab was carried out. The highest counts ranging from 2.5 x 10(6)-7.5 x 10(8) organisms/g were observed in raw vegetables and fruits, followed by 3 x 10(6)-9.8 x 10(7)/ml, 8.3 x 10(4)-8.9 x 10(7)/g and 1 x 10(3)-6.7 x 10(7)/g in fruit juice, milk and its products, and salty/non milk snacks respectively. Fresh chapati, dal, rice, cooked vegetables and karhi etc., showed no microbial contamination. However, samples of these articles from road side cafes gave counts up to 1 x 10(7) organism/g. The most probable number of coliforms and Escherichia coli/100 ml of water ranged from < 1 to > 1100. Although 1332 isolates of 16 types of organisms of public health significance were obtained those of proven enteropathogenicity were enterotoxigenic Esch. coli (55), Esch. coli O157 (3), enteropathogenic Esch. coli (1), enterotoxigenic Klebsiella (23), Streptococcus faecalis (152), Bacillus cereus (133), Staphylococcus aureus (125), Aeromonas spp (47), Salmonella spp (10), Shigella spp (4) and Yersinia enterocolitica (2). Poor quality of potable water and widespread occurrence of enteropathogens in food consumed by the common man in Ludhiana was evident.

Ascitic fluid cholesterol in malignant and tubercular ascites.

Cholesterol was estimated in ascitic fluid of 44 patients (29 malignant and 15 tubercular). Mean ascitic cholesterol level was significantly higher in malignant ascites (89.52 mg/dl) as compared to tubercular ascites (35.07 mg/dl). At a cut off value of 54.5 mg/dl (mean in tubercular ascites + 2SD), the sensitivity, specificity, positive and negative predictive value and overall diagnostic accuracy for differentiating malignant from tubercular ascites was found to be 89.65%, 100%, 100%, 83.33% and 93.18% respectively. Ascitic fluid cholesterol estimation is a reliable and simple test for differentiating malignant ascites from tubercular ascites.

Role of zipper in the management of abdominal sepsis.

BACKGROUND: Continuous peritoneal lavage, staged laparotomies and radical peritoneal debridement have been used to reduce mortality from severe abdominal sepsis. Recently, open abdomen technique using a 'zipper' with or without mesh for abdominal lavage has shown promising results. AIMS: To evaluate open abdominal technique using a zipper in patients with advanced diffuse peritonitis with impending or established multiple organ failure. METHODS: Modified open abdomen technique using zipper with or without mesh was used for abdominal closure in eight patients with severe generalized peritonitis (APACHE-II score range 27-30). RESULTS: Zipper was inserted at first laparotomy in three patients, at second exploration in four and at the time of third laparotomy in one case. Two patients required strips of mesh in addition to zipper. Six of eight patients survived and were discharged after an average period of 27 days. Two deaths were due to multisystem organ failure. In four patients additional surgical procedures like closure of perforation, temporary ileostomy and resection anastomosis of small bowel was carried out through the zipper. Zipper-mesh were removed an average of 10.5 days after insertion. Three patients developed incisional hernia at 6 months follow-up. CONCLUSION: This technique merits further controlled trials to ascertain its indications and benefits.

Indolent gastric carcinoma.

A 55 year old woman presenting with epigastric pain and dyspeptic symptoms was diagnosed to have gastric carcinoma on endoscopic biopsy independently on two occasions. She was subsequently asymptomatic without any specific therapy till she developed gastric outlet obstruction and weight loss four years later. Histology of the resected specimen revealed an adenocarcinoma infiltrating the serosa without any evidence of metastasis.

Duodeno--jejunal vascular malformation.

Vascular malformations are rare but an important cause of obscure upper gastrointestinal bleeding. A patient with a large vascular malformation involving the duodenum and proximal jejunum, presenting with a severe bout of melaena, is described. The diagnosis was suspected on endoscopy and confirmed by angiography and surgery.