Alpha-1 antitrypsin deficiency panniculitis.

A lady presented with multiple, tender discharging noduloulcerative lesions on the abdomen, following laparoscopic cholecystectomy. Histopathological features were suggestive of panniculitis. Screening of the serum for alpha-1 antitrypsin levels revealed a partial deficiency.

Benign rheumatoid nodules.

Rheumatoid nodules occur usually in advanced seropositive rheumatoid arthritis, signifying poor prognosis. However rarely rheumatoid nodules can be encountered in patients with no antecedent evidence of arthritis. Herein a case of an arthritic benign rheumatoid nodules is described.

Comparative evaluation of antimicrobial activity of polyvinylpyrrolidone (PVP)-iodine versus topical antibiotics in cataract surgery.

Comparative evaluation of polyvinylpyrrolidone (PVP)-iodine versus topical broad-spectrum antibiotics for disinfecting the eye and surrounding area to prevent postoperative complications was carried out on 100 patients. PVP-iodine proved superior antiseptic for pre-operative preparation of eyes before cataract surgery. It was cheaper, caused minimal side-effects, reduced bacterial counts to a great extent and eliminated fungi completely.

Helicobacter pylori infection in patients with perforated duodenal ulcer.

AIM: Perforation is the commonest complication of duodenal ulcer. Helicobacter pylori is found in 95% patients with duodenal ulcer. However, there is paucity of reports on prevalence of H. pylori infection in patients with duodenal ulcer perforation. We, therefore compared the incidence of H. pylori infection in patients with duodenal ulcer perforation with the incidence in patients having complicated duodenal ulcers and non-ulcer dyspepsia. PATIENTS AND METHODS: The study was conducted on 45 patients (complicated duodenal ulcer 15, duodenal ulcer perforation 15, non-ulcer dyspepsia 15). Per-operative punch antral biopsies were taken in patients with duodenal ulcer perforation whereas endoscopic punch biopsies of antrum were taken in patients with non-ulcer dyspepsia. The criteria for H. pylori positivity was i) growth of H. pylori on culture, ii) combination of rapid urease test (RUT) and Giemsa staining, combination of RUT and Gram stain being positive for H. pylori. RESULTS: While 9 of 15 cases with complicated duodenal ulcer, 7 of 15 cases with non-ulcer dyspepsia were positive for H. pylori, none of the patients with duodenal ulcer perforation tested positive for H. pylori (p < 0.000). All patients with perforated duodenal ulcer had histological gastritis (H. pylori -ve). Fourteen of 15 patients (9 H. pylori +ve, 5 H. pylori -ve) with complicated duodenal ulcer and 9 of 15 patients (7 H. pylori +ve) with non-ulcer dyspepsia had histological gastritis. CONCLUSION: Patients with duodenal ulcer perforation do not have H. pylori infection. H. pylori negative patients of duodenal ulcer may have more predilection for perforation.

Carcinoid tumor presenting as acute abdomen due to hemoperitoneum.

A patient presenting with massive hemoperitoneum due to a large retroperitoneal carcinoid tumor is reported.

Massive haemoptysis controlled by bronchial artery embolisation: a case report.

Massive haemoptysis results in a high rate of mortality and morbidity. It is infrequently seen in children. Medical and surgical interventions are not very effective in controlling torrential bleeding. Therefore, newer modalities like bronchial artery embolisation are found to be promising in life threatening situations in both adults and children.

Spectrum of malabsorption syndrome in north Indian children.

AIMS: To know the spectrum of malabsorption syndrome (MAS) in infants and children and highlight agewise differences in etiology in different age groups. METHODS: 137 children presenting with diarrhea of more than 3 weeks' duration and/or growth failure and abnormality of one of more tests of malabsorption were studied. Etiology of MAS was determined using investigations specific for each of the causes. RESULTS: Sixty two (45%) children were below 2 years of age and 75 (55%) above. Common causes of MAS were: protracted diarrhea 45 (33%), celiac disease 35 (26%), parasitic infestations 13 (9%), milk protein intolerance 8 (6%), intestinal tuberculosis 7 (5%). In 18 (13%) patients, cause of MAS could not be determined. Protracted diarrhea (73%) and milk protein intolerance (13%) constituted the major etiology of MAS in children below 2 years of age, whereas celiac disease (43%), parasitic infestations (15%) and intestinal tuberculosis (9%) were the common causes in children above 2 years of age. CONCLUSION: The spectrum of MAS in Indian children in different age groups is distinctly different from that seen in developed countries.

Identification of Helicobacter pylori by endoscopic crush cytology.

BACKGROUND: Gastric crush cytology is employed in a variety of situations including diagnosis of malignant disease and the detection of Helicobacter pylori infection. OBJECTIVE: To evaluate the usefulness of gastric crush cytology in the detection of H pylori infection. METHODS: Gastric biopsy specimens from 50 patients of gastric or duodenal peptic ulceration were studied by gastric crush cytology, histopathology, bacteriologic culture and rapid urease test and results of various methods compared. RESULTS: Thirty seven patients had H pylori demonstrable in crush smears and 28 in histopathological sections. In 15 patients, the organism was detected by cytology alone and in 6 samples by histopathology alone. There was concordance of 76% between these two morphological techniques. The organism could be cultured from 22 biopsy specimens and urease test was positive in 37 specimens. CONCLUSION: Gastric crush cytology is a useful method for detection of H pylori infection.

Immunoperoxidase localization of fibronectin in small bowel mucosa.

An indirect immunoperoxidase technique was employed to demonstrate fibronectin in cryostat sections of small bowel mucosa. Prior exposure of the sections to a solution of pepsin (4 mg/ml) was not essential to localize antigenicity of fibronectin immunohistologically.

Periampullary carcinoma with special reference to their mucin characteristics--a pathologic study of 53 cases.

Histological features and mucin characteristics of 53 cases of periampullary carcinoma, a rare group of epithelial tumors is presented. The cases comprised of 17 resected specimens and 36 endoscopic biopsies. Jaundice was the commonest symptom. The mean tumor size was 2 cms diameter (1-6 cms). Forty cases were characterised as well differentiated adenocarcinoma, 5 as moderately differentiated adenocarcinoma, 5 as mucin secreting adenocarcinoma, 3 as papillary adenocarcinoma and 1 as undifferentiated carcinoma. Desmoplasia and insignificant mitosis were amongst the commonly encountered histological features. Forty four cases (83%) stained positive for mucin (PAS-AB) with a majority of them (66%) predominantly showing acidic mucin. The likely prognostic implication of this feature is discussed.

Visceral larva migrans in an adult.

Visceral larva migrans is rare in adults. An adult male in whom the diagnosis was made by suggestive clinical features and muscle biopsy and who responded to thiabendazole is described.

Niemann-Pick disease presenting as hepatic disorder.

A 2 year old female child with Niemann-Pick disease was referred as case of chronic liver disease; clinically, she had neurological involvement. Liver biopsy showed Niemann-Pick cells. Hepatic manifestations of Niemann-Pick disease as seen in nine cases reported from India are discussed.

Extraintestinal manifestations of idiopathic ulcerative colitis.

One hundred and fifty patients of idiopathic ulcerative colitis were studied for extraintestinal manifestations by clinical, radiological and biochemical means. One or more such manifestations occurred in 34.7% of patients. Sacroiliitis (14%) and peripheral arthritis (10.7%) were the commonest manifestations, followed by ocular (8%), mucocutaneous (2.7%), vascular (2%) and hepatobiliary (1.3%) manifestations. We conclude that the incidence and spectrum of extraintestinal manifestations in Indian patients with idiopathic ulcerative colitis are similar to those in western patients.

Endoscopic removal of duodenal bruneroma.

A case of a pedunculated Brunner's gland hamartoma of the duodenum is presented. It was resected endoscopically with complete resolution of symptoms on long term follow-up. The pathological features of the tumour and the therapeutic approaches are discussed with particular reference to endoscopic resection.

Relative merits of various rapid biopsy urease tests for diagnosis of Helicobacter pylori (Campylobacter pylori).

Three rapid urease tests, i.e., liquid urea broth containing phenol red as indicator, liquid urea broth containing bromothymol blue as indicator and CLO gel were compared in 109 patients of dyspepsia for the diagnosis of Campylobacter pylori (Helicobacter pylori) infection. Mean time taken for positive reaction in liquid broth with phenol was 3 minutes (range 0.6 to 5.3 minutes) with bromothymol blue was 3.5 minutes (range 0.4 to 5.5 minutes) while with CLO gel it was 101 minutes (range 11-261 minutes). There was no difference in results of liquid urea broth containing phenol red and bromothymol blue. The difference in timing of urea broth containing phenol red and bromothymol blue was statistically significant as compared to CLO gel (p less than 0.05). Rapid urease tests employing liquid urea broth are quick, simple and reliable for the diagnosis of Helicobacer pylori infection.

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.