Diabetic autonomic neuropathy causing gall bladder dysfunction.

OBJECTIVE: The objective of the study was to study gall bladder volume in fasting and 45 minutes post-prandial, by real time ultrasound in healthy controls and diabetic patients with and without autonomic neuropathy and to compare them. METHOD: Age, Sex and body mass index (BMI) matched 50 healthy subjects and 10 patients with insulin dependent diabetes mellitus and 40 patients with noninsulin dependent diabetes mellitus were evaluated according to National diabetes Data Group of National Institute of Health (1979) criteria: 1. Fasting (overnight) venous plasma glucose concentration of > 140 mg/dl on two separate occasions. 2. Following ingestion of 75 gms of glucose, venous plasma glucose concentration of > 200 mg/dl at second hour and at one other occasion during two hour test. Autonomic neuropathy was assessed by the presence of symptoms like dysphagia, abdominal fullness, nausea, vomiting, diarrhea +/- nocturnal, faecal incontinence or constipation, dysuria, urinary incontinence, the gustatory sweating, impotence etc. and were confirmed by standing test for orthostatic hypotension, hand grip test, Valsalva test and deep breaths test. RESULT: The study showed that: 1. Patients of diabetes mellitus had statistically significant larger fasting gall bladder volumes and these values were highly significant amongst patients with autonomic neuropathy. 2. Patients of diabetes mellitus and statistically significant larger post fatty meal gall bladder volume and these values were highly significant in patients with autonomic neuropathy. CONCLUSIONS: We therefore conclude that impaired gall bladder contraction was found amongst patients of diabetes mellitus with autonomic neuropathy. The mechanism responsible for cholecystoparesis is attributed to vagal neuropathy. Incomplete gall bladder emptying leads to sequestration of cholesterol and nidus formation. Therefore gall bladder functions should be evaluated routinely in such patients and early intervention is recommended.

Percussion of Traube's space--a useful index of splenic enlargement.

OBJECTIVE: To evaluate the sensitivity and specificity of palpation and percussion for splenic enlargement, as the accuracy of many of the clinical maneuvers we perform remains largely unstudied. METHODS: One hundred cases were selected at random from medical wards, and splenic enlargement was assessed by palpation and percussion of the Traube's space (Barkuns method), which was confirmed by the ultrasonography of the abdomen. The results of the various tests were tabulated and assessed statistically. RESULTS: 1) Performance of Traube's space percussion shows 24 true positive and 48 true negative cases, the test thus had an overall sensitivity of 67% and specificity of 75%. It was also found that the BMI of the false negative cases was significantly higher (29.43 Kg/m2). 2) Palpation as a diagnostic maneuver had a high specificity of 96.87% along with high false negative rate with overall low sensitivity of 44.44%. 3) Interpolation of findings of Traube's space percussion and palpation showed that maximum clinical utility could be achieved when both percussion and palpation were positive. CONCLUSION: Percussion of the Traube's space is a useful clinical screening test for splenomegaly, with a sensitivity of 67% and specificity of 75%, as compared to palpation (sensitivity of 44.44% and specificity of 96.87%). And maximum clinical utility is achieved when both percussion and palpation are combined.

Study of serum amylase in acute viral hepatitis.

Serum total Amylase and its heat stable fraction (HSF) were studied in 10 healthy controls, and 20 patients of Viral hepatitis. A highly significant (p < 0.001) elevation in the levels of total and HSF of Serum amylase was found in acute viral hepatitis, mainly due to the HSF which originates from hepatitis. The levels declined significantly after 10 days when the disease regressed and there was evidence of improvement in clinical and functional status of the liver. Hence an estimation of total and HSF of Serum amylase proved to have some diagnostic and prognostic importance.

Byssinosis in cotton textile workers of Kishangarh.

Byssinosis is an occupational hazard for the workers exposed to cotton dust. In this study 616 cotton textile workers were studied; out of which 149 had byssinosis; 37 (24.7%) had grade-1/2, 78 (52.7%) grade-1, 25 (16.6%) grade-2 and 9 (6.0%) of grade-3 byssinosis. Majority of the byssinotics were of age group between 36-40 years and had developed disease after 16 years of exposure. Disease was more common among smokers and severe, in whom consumption was more than 15 cigarettes/bidis per day for more than 10 years. Ventilatory function tests were markedly abnormal compared with non-byssinotic. On clinical examination and laboratory investigation (specially eosinophilia) and, radiological investigation (x-ray chest) no positive finding was detected. The high prevalence rate of the disease in this study was apparently due to poor working conditions of the workers.