Crossed Renal Ectopia Without Fusion: A Multidetector Computed Tomography Study.

Background: Congenital positional, rotational and fusion anomalies of the kidney are frequently encountered. Crossed renal ectopia is a condition in which the kidney is located on the side contralateral to its ureteral insertion into the urinary bladder. Crossed renal ectopia without fusion is a very rare anomaly sporadically reported in the literature. We have attempted to analyse such renal anomalies in a large series of patients. Materials & Methods: Contrast enhanced multidetector computed tomographic scans of 960 patients (491 males and 469 females, age range 4-90 years) were reviewed . Observations: Crossed renal ectopia without fusion was detected in three patients (0.31%; 1 in 320 cases). All three patients were males and left- to-right renal ectopia was noted in two cases and right-to-left ectopia in one case, in whom the ectopic right kidney was exhibiting multicystic dysplasia. An interesting observation was vascularisation of crossed ectopic unfused left kidneys by branches arising from the right common iliac artery. Conclusion: Crossed renal ectopia without fusion is an extremely rare anomaly and may remain asymptomatic without being detected. Multidetector computed tomography angiography is an excellent imaging modality to detect renal positional and rotational anomalies. To the best of our knowledge the present study is the first study to detect renal anomalies in a large series of cases.

Horseshoe Kidney: A Multidetector Computed Tomography Study.

Background and Objective:Horseshoe kidney is themost common renal fusion anomalywith a reported prevalence of 1 in 400 persons with a male to female ratio of 2:1. In many cases its presence may go unnoticed and undiagnosed because the patient may remain asymptomatic throughout life. The objective of our study is to report radiological and anatomical features of horseshoe kidney detected incidentally during retrospective evaluation of multidetector computed tomography scans. Materials and Methods: Contrast enhanced multidetector computed tomography scans of 682 patients, 355 males and 327 females, were reviewed retrospectively. Results: Seven cases of horseshoe kidney were detected incidentally, sixmales and one female,with an incidence of 1.02%. In all cases,malrotation of the kidneyswere observedwith the hilumfacing anteriorly or anterolaterally. The isthmus was made up of parenchymal tissue in all the cases and the fusion was midline in four cases and lateral in three cases. Horseshoe kidney in all cases was supplied by multiple renal arteries, varying from 3 to 6. In three cases symmetrical arterial supply and in the rest asymmetrical supplywas observed. Nephrolithiasis and hydronephrosis were noted in two patients. No other associated congenital anomaly was observed in all seven patients. Conclusion: Contrast enhanced multidetector computed tomography evaluation of patients with horseshoe kidney provide excellent information about its vascularity, collecting system and other associated conditions.

Crossed Fused Renal Ectopia Multidetector Computed Tomography Study.

Crossed renal ectopia is one of the rarest congenital malformations where a kidney is located on the side opposite to the side of its ureteral insertion into the urinary bladder and is generally fused with the normally located ipsilateral mate. Generally this anomaly remains as a silent clinical entity and is incidentally detected during evaluation for other conditions. We report here three such cases of crossed fused renal ectopia detected by multidetector row contrast enhanced computed tomography. Crossed fused renal ectopia of inferior type was observed in a male on the right side with the ureter of the ectopic left kidney crossing the midline. In two female patients, L-shaped or tandem kidney was noted, one on the right and another on the left side. Over all in two cases the left kidney was ectopic and in one the right kidney. No renal pathologies like urinary tract infection, nephrolithiasis or hematuria were found in our patients.

Role of CYP2E1genetic polymorphism in the development of oral leukoplakia among tobacco users in North Indian population.

AIM: The aim of the study to find out role of CYP2E1 genetic polymorphism in development of oral leukoplakia among tobacco users in North Indian population, this study was carried out at Department of Oral and Maxillofacial Pathology, King George’s Medical University, Lucknow, UP. STUDY DESIGN: Study include a total of 105 leukoplakia patients were genotyped for CYP2E1 polymorphism (93 males and 12 females; mean age ± SD: 47.5 ± 10.6) and 96 unrelated healthy controls (85 males and 11 females; mean age ± SD: 49 ± 11.1). All the patients had either reported for treatment of leukoplakia or were diagnosed with leukoplakia during routine oral examination. RESULTS: A total of 105 leukoplakia patients and 96 controls were included in the study. The mean age of leukoplakia patients and control were 47 ± 10 and 51 ± 10 years respectively. The exclusive smokers comprised 62 (59%) leukoplakia patients and 53 (53%) controls. The exclusive smokeless tobacco users were 16 (15%) in leukoplakia patients and 27 (28%) in controls groups, while 27 (26%) leukoplakia patients and 16 (17%) controls have both types (smoking as well as smoke less) of tobacco habits simultaneously. Range of life time smoking exposure in leukoplakia and controls were (5‑80 PY in both groups) but the mean smoking exposure in both groups were (leukoplakia: 28 ± 21.8 PY, control: 27: ±17 PY). But the mean smokeless tobacco dose in two groups were (leukoplakia: 150 ± 175 CY, controls: 137 ± 110 CY). CONCLUSION: All the results demonstrate an association between CYP2E1 genetic polymorphism and leukoplakia risk, premalignant lesion. It indicates that the CYP2E1 polymorphism, singly showed a protection towards the oral leukoplakia. Independent confirmation of this finding is required, and additional examination of the joint effect of CYP2E1genotype and other non‑tobacco‑related exposures is needed before more conclusive interpretation of our results can be made. This study demonstrates the importance of genetic variations in CYP2E1genes in susceptibility towards oral leukoplakia and it is conceivable that these variants will interact with environmental carcinogens and possibly some combinations of these genotypes will be at a high risk to oral leukoplakia.

Role of Phenazopyridine in Urinary Tract Infections.

Irritative voiding symptoms, urinary urgency, frequency, nocturia, painful voiding, bladder discomfort or stranguria, are to the urinary tract much as a cough is to the pulmonary system, i.e., they are a nonspecific manifestation of multiple potential underlying causes. Urinary tract infections (UTIs) are usually associated with irritative voiding symptoms, such as painful urination (dysuria), urinary urgency and frequency. Anticholinergic drugs like flavoxate, oxybutynin provide beneficial symptomatic relief. However, they have associated adverse anticholinergic effects, such as dry mouth, which hinders patient compliance. Phenazopyridine hydrochloride acts as a topical analgesic on the mucosal lining of the urinary tract and thus relieves the irritative symptoms associated with UTI. It is compatible with antibiotics and relieves pain during the interval before the antibiotic begins to control the infection. It is well-tolerated as it lacks the anticholinergic side effects of other anticholinergics.

An Unusual Presentation of Churg-Strauss Disease (Allergic Angiitis and Granulomatosis).

We present a case of a 45-year-old female with history of four days of fever and rash with swelling over both limbs diagnosed on postmortem autopsy as Churg-Strauss disease and further give a brief overview of the disease.

Predicting mortality in stroke.

Physicians are faced with the task of predicting the immediate and long term outcome in stroke patients. It is also important to efficiently and optimally utilize resources. We used APACHE III scoring system or predicting in hospital outcome in patients with stroke. We found it to be sensitive (>90%) and resonably specific (73%) in predicting short term, in-hospital mortality, in our study group.

A comparative study of Prameha Roga from the Brihatrayee.

The study of this Prameha Roga reveals the rich knowledge of the Ayurveda developed since the time immemorial. Although descriptions of this disease are scattered in different classics of Ayurveda but here importance has been given to Brihatrayee. The aim and object of this paper review the well documented concept of the Ayurveda about the Prameha Roga as the trend of diabetes is increasing day by day in the society and is very difficult to prevent and manage owing to its complexity. The Ayurvedic concept of this Roga information on the subject regarding classification, characteristics, features etc. has been also made in this paper. This article highlights the wisdom of ancient Indian literature and some historical view of the disease i.e. Prameha Roga or Diabetes Mellitus.

Role of oxygen free radicals in causing endothelial damage in acute myocardial infarction.

OBJECTIVES: This work was done in order to study the oxidant and anti-oxidant status in a disease resulting from endothelial injury. The disease selected for study was acute myocardial infarction. METHODS: Sixty patients of acute myocardial infarction were selected after being diagnosed in accordance to the guidelines laid down by the WHO. Thirty subjects were included as controls. Plasma levels of certain markers of oxidative stress and anti oxidant activity were measured in all the subjects. Malonaldehyde (MDA) and nitrite (NO2) were measured as markers of free radical mediated endothelial injury, and superoxide dismutase (SOD) enzyme as an indicator of antioxidant activity. RESULTS: It was found that the plasma levels of MDA and nitrite were significantly elevated in the patients of acute myocardial infarction compared to the control group (7.29 +/- 3.28 v/s 4.57 +/- 0.63 nmol/ml and 12.85 +/- 8.71 v/s 0.97 +/- 0.25 microM respectively), thereby indicating that oxygen free radicals cause endothelial damage in them. The superoxide dismutase levels were also found to be elevated in these patients (5.57 +/- 1.47 v/s 3.91 +/- 0.66 U/ml). CONCLUSION: These results indicate that acute myocardial infarction is a state of enhanced free radical activity, which causes endothelial damage. The elevated SOD levels may imply that the body attempts to combat this oxidative stress by raising it's level of anti-oxidants.

Spontaneous bacterial peritonitis in liver cirrhosis with ascites.

OBJECTIVE: The study was designed to elucidate the correlation of spontaneous bacterial peritonitis (SBP) with aetiology of liver cirrhosis, overall mortality, ascitic fluid and systemic microbial infections. METHODS: Sixty three patients with cirrhosis of the liver were included in this study. These patients were diagnosed on the basis of clinical evaluation, biochemical investigation, ultrasonography, ascitic fluid examination for protein, cells, pH, and bacterial culture. RESULTS: SBP developed in 22 (34.92%) patients of cirrhosis. Culture positive SBP was present in 18 (81.81%) and culture negative neutrocytic ascitis (CNNA) in 4 (18.18%). In the culture positive group, 14 (77.7%) patients had monomicrobial bacterascites (MNB), the commonest organism being coagulase positive Staphylococcus aureus eight (44.44%) followed by E. coli (22.22%). Only 4 (22.22%) had infection by more than one organism. Direct bed side inoculation of ascitic fluid into blood culture bottle was a better method for bacterial yield than the conventional method of ascitic fluid culture (81.8% vs. 18.2%). Only 22.8% patients with SBP had ascitic fluid protein less than 1 gm%, ascitic fluid pH < 7.3 and polymorphonuclear cell count > 250/cmm. CONCLUSION: Spontaneous bacterial peritonitis is common complication in Child Pugh class C cirrhosis. Alcoholic cirrhosis with SBP carries high mortality than their non-alcoholic group. The most common organisms isolated were coagulase positive Staphylococcus aureus followed by E. coli.

Fractionation, analysis and diagnostic utility of Mycobacterium tuberculosis H37Ra excretory-secretory antigen in pulmonary tuberculosis.

Excretory-secretory antigen of Mycobacterium tuberculosis H37Ra (Mtb ES antigen) isolated from culture filtrate was partially purified by 6% trichloroacetic acid precipitation. The TCA supernatant fraction (Mtb EST antigen) was examined for its diagnostic use in the detection of tuberculous IgG antibody in human sera by stick Indirect ELISA. Using Mtb EST antigen, tuberculous IgG antibody was detected in 90% of smear positive and 71% of smear negative pulmonary tuberculosis cases and 10% of healthy and disease controls. Further fractionation of Mtb EST antigen by SDS-PAGE yielded four active antigenic fractions viz., Mtb EST-3,4,6 and 10. Diagnostic evaluation of these fractions showed Mtb EST-6 antigen fraction to be useful in detection of both smear positive and smear negative pulmonary tuberculosis cases with sensitivities of 94% and 78% respectively and specificity of 88%.

Detection of tuberculous IgG antibodies using Mycobacterium tuberculosis H37Ra, excretory secretory antigen and tuberculin-purified protein derivative.

Different antigen preparations, viz. excretory-secretory antigen (ES Ag), phosphate buffer saline soluble antigen (PBS-S Ag) and sodium dodecyl sulphate soluble antigen (SDS-S Ag) of M. tuberculosis (M.tb) H37Ra strain along with tuberculin purified protein derivative (PPD) were employed in stick indirect ELISA to detect IgG antibodies in sera of sputum positive pulmonary tuberculosis cases. Sera from healthy individuals and individuals with diseases other than tuberculosis (cross-reacting diseases) were used as controls. ES antigen and PPD showed higher antibody titres in tuberculosis cases (GMT-1378 each) compared to PBS-S Ag (GMT-454) and SDS-S Ag (GMT-974). Thereafter, an extensive study was done analysing higher number of sera in each group for the detection of tuberculous IgG antibodies using ES Ag and PPD. The ES Ag showed better sensitivity (87%) and specificity (85%) compared to the sensitivity (73%) and specificity (78%) achieved with PPD. The ES Ag also showed higher IgG antibody titre (GMT-1068) than PPD (GMT-721). From the present study it can be envisaged that ES Ag has high diagnostic potential in tuberculosis.

The prevalence of hypertension in rural population around Sevagram.

To detect the prevalence of hypertension in an asymptomatic rural community from Central India, we screened 4045 subjects (2247 men and 1798 women) aged 20 and beyond. The prevalence of hypertension was 34.12 per thousand population, being higher in women (40.60 per thousand) than in men (28.92 per thousand). Level of physical activity, economic status, smoking and body mass index showed real association with hypertension.

False positive ECG and coronary heart disease.

In 1983, we carried out a cross-sectional, rural community based study and highlighted an abysmally low prevalence of probable coronary heart disease in resting electrocardiogram. A seven year follow-up (1983-1990) of 179 suspects showed no morbidity or mortality from coronary heart disease. Eighty one out of 98 suspects tested negative on a symptom limited maximal exercise test. Though seventeen suspects had an asymptomatic exercise-induced ST depression (> 1.0 mm) their haemodynamic response to exercise and effort tolerance was excellent. Of the twelve subjects who took a repeat exercise test six months later, eleven failed to show ST depression on exercise. We attribute the false positivity of exercise test and its poor reproducibility to labile electrocardiographic changes unmasked by exercise.

M-mode echocardiographic diagnosis of left ventricular hypertrophy.

To assess the utility of various primary and derived M-Mode Echocardiographic parameters for the purpose of defining left ventricular hypertrophy (LVH), 74 subjects with LVH were subjected to M-mode echocardiographic examination. It was concluded that except for cross sectional area, the other echocardiographic parameters performed too poorly to be of any clinical utility for defining LVH by echocardiography.

Evaluation of clinical variables as predicators of left ventricular function in acute myocardial infarction.

In 43 rural patients, all survivors of acute Myocardial infarction, left ventricular function was studied by 2-D echocardiography and evaluated in relation to 18 clinical predictors of left ventricular function. The mean left ventricular ejection fraction (LVEF) was 41.53 +/- 12.92% as compared to 70.02 +/- 7.02% in 506 healthy controls. LVEF was dichotomised at < 40% (n = 24) and > 40% (n = 19). Out of various clinical variables analysed following were found to be strong predictors of low LVEF. S3 gallop (p < 0.001) pulmonary rates (p < 0.001); Creatine phosphokinase > 200 I.U. (p < 0.001); Cardiomegaly on X-ray (p < 0.001); pulmonary congestion on chest X-ray (p < 0.001); and proportional pulse pressure (p < 0.001). There was a stepwise decline in the LVEF for each additional clinical variable. The over all predictive accuracy was 90%. It is concluded that readily obtainable clinical variables provide a useful bedside method of estimating LVEF after acute myocardial infarction.

Left ventricular M-mode echocardiographic measurements of Indian population.

The left ventricular dimensions of 506 normal healthy subjects (men = 317, women = 189) in the age group of 17 to 80 years were measured echocardiographically. The measurements were found to differ significantly from the western data. A separate limit for left ventricular echocardiographic parameter for the normal Indian population was established.