Paraphimosis: A case report and medicolegal importance.

Paraphimosis has been described by standard text books of forensic medicine as a cause of temporary impotence but present case suggests that it can be an evidence of sexual activity / intercourse also.

Alterations in circulating thyroid hormones in Indian smokers (bidi and cigarette).

T4, T3 and TSH were estimated in 56 bidi and 50 cigarette smokers and their mean estimates were compared with the corresponding values in 25 healthy non-smokers. T4, T3 and their ratios were significantly lower in both bidi and cigarette smokers (p < 0.001). Circulating TSH in both groups of smokers was similar to that in nonsmokers. T4 and T4/T3 were lower in bidi smokers compared to those in cigarette smokers (p < 0.05 and < 0.01, respectively). Severity of smoking affected T4/T3, and TSH in bidi smokers and T4 in cigarette smokers. Normal TSH excluded any significant decrease in thyroid function in smokers. The alterations in circulating T4 and T3 might have been influenced by thyroid hormone production, protein binding as well as peripheral metabolism of T4 by adverse constituents of bidi/cigarette smoke.

Bifid pancreas: an endoscopic retrograde pancreaticographic curiosity.

Bifid pancreas, representing a major bifurcation of the main pancreatic duct, has rarely been reported. We report four such cases where this condition was picked up incidentally.

End point for sclerosis of esophageal varices.

BACKGROUND: Small esophageal varices are difficult to inject intravariceally and complete eradication of varices may not be therapeutically necessary. METHODS: A prospective study designed to compare the use of different end points of sclerotherapy ie (i) total eradication (grade 0) (ii) grade I varices or (iii) grade II white (IIw) varices, by stopping variceal injection when one of these was reached. The patients were followed endoscopically and clinically at 3-4 mo intervals. OUTCOME MEASURES: Variceal recurrence and rebleeding rates. RESULTS: Of 266 patients with portal hypertension (147 cirrhosis, 51 non-cirrhotic portal fibrosis, 68 extra-hepatic portal venous obstruction), 232 (87.2%) reached one of the three end points--six to grade 0, 96 to grade I and 130 to grade IIw. Among 212 patients followed up for a mean post-sclerotherapy period of 12.2 mo (range 3-48 mo), variceal recurrence rates, time intervals to recurrence and rebleed rates were comparable in patients with endpoints of grade I and grade II (white) varices (28.5% vs 38.9%, 10.8 mo vs 9.2 mo, and 7.7% vs 7.8%, respectively; all p = ns). Overall, 51 patients had interval bleed before reaching the end point--50 (98%) of them bled from grade III and IV varices while only one patient (2%) bled with grade IIw varices. CONCLUSION: Grade I or grade IIw varices should be acceptable as the end points for endoscopic sclerotherapy of esophageal varices.

Combination of anticholinergic agent and H2 receptor antagonist in duodenal ulcer treatment--a randomized, double blind multicenter study.

BACKGROUND: The acid suppressive abilities of H2 receptor antagonists and anticholinergics have been claimed to be additive. METHODS: A multicenter, double-blind, randomized trial comparing ranitidine (150 mg) plus propantheline bromide 15 mg at bedtime to ranitidine 300 mg alone at bedtime was conducted in 161 patients with endoscopically confirmed uncomplicated duodenal ulcer. RESULTS: After six weeks of therapy, ulcer healing rates in the two groups were comparable ie 80% in the combination group (ranitidine + propantheline) and 79.4% in the ranitidine group. Pain relief after one, two and four weeks of treatment was also comparable in the two groups. Side effects to drugs were minor and comparable in both the groups. CONCLUSION: A combination of 150 mg ranitidine and 15 mg propantheline bromide is as efficacious as 300 mg ranitidine in inducing healing of uncomplicated duodenal ulcers, with similar side-effects but at greatly reduced cost.

Endoscopic removal of ascaris from biliary tree.

Hepatobiliary ascariasis is an uncommon condition outside the Kashmir valley. We report here a patient with this disease from the eastern part of India.