Intussusception due to gastrointestinal stromal tumour of the colon: diagnosis by colonoscopy.

Intussusception of the intestine is rare in adults. We report a case of a 45-year-old male who presented with long-standing pyrexia of unknown origin, abdominal pain, gastrointestinal bleeding and constitutional symptoms. Colonoscopic examination revealed a large invaginated mass suggestive of colonic intussusception due to gastrointestinal stromal tumour of the colon. His symptoms disappeared after surgical removal of the tumour.

Utility of P300 auditory event related potential in detecting cognitive dysfunction in patients with cirrhosis of the liver.

The P300 event related potential (P3ERP) latency has recently been advocated for detection of cognitive disturbances in early encephalopathy associated with chronic liver disease. The present study was undertaken to assess the magnitude of cognitive dysfunction, a marker of subclinical hepatic encephalopathy (SHE), in India, using this widely recommended test. One hundred and one patients with cirrhosis of the liver (17 females, 84 males; Age 43.3 +/- 11 years, 33 alcoholic, 49 viral induced, 19 cryptogenic) attending our tertiary care hospital were studied. P300 responses were elicited by the standard 'auditory odd ball paradigm'. A value of mean+2SD of the latency obtained in 40 age matched controls was established as a cut off to define latency prolongation in patients. The mean P3ERP latency of cirrhotics (363.6 +/- 32.1 msec) was significantly longer (p<0.05) than those of controls (347.8 +/- 24.8 msec). No difference was found in the latencies of cirrhotics with or without alcoholic aetiology of liver disease. 21 (20.8%) cirrhotics were found to have SHE i.e. latency prolongation beyond the cutoff value. A higher proportion of patients in advanced stage of liver disease had prolongation in latencies (p<0.02) compared to less severe cases. Till the time a gold standard is derived for detection of SHE, P3ERP latencies seem to be a reasonable method for detection as well as follow up of patients. Since SHE is considered as a preclinical stage of overt encephalopathy, it would be worthwhile screening cirrhotics for cognitive disturbances using P3ERP latencies and administering prompt therapeutic action.

Clinical and biochemical comparative study of different types of common bile duct stones.

BACKGROUND: The chemical composition of common bile duct (CBD) stones may have significance with regard to the origin, clinical presentation and treatment. OBJECTIVE: To study the chemical composition of CBD stones and compare different types of CBD stones. METHODS: Consecutive patients with CBD stones seen over a 1-year period were studied prospectively. Their stones were analyzed for cholesterol, bilirubin and calcium contents. RESULTS: Of 74 patients with CBD stones, 42 had associated gall bladder (GB) stones (Group 1), 14 had post-cholecystectomy CBD stones (Group 2) and 18 had CBD stones with a stoneless GB in situ (Group 3). Of the 40 patients whose CBD stones were analyzed, 34 (85%; 18/19 in Group 1, 5/6 in Group 2 and 11/15 in Group 3) had cholesterol stones; the remaining 6 patients had pigment stones. CONCLUSION: Most CBD stones in northern Indian patients are cholesterol stones. Even in patients with isolated CBD stones (with stoneless GB in situ), three-quarters are cholesterol stones.

A prospective study on the incidence of hepatitis B & C infections amongst patients with lymphoproliferative disorders.

Fifty one patients with acute lymphoblastic leukaemia (ALL) and non-Hodgkins lymphoma (NHL) undergoing chemotherapy were studied prospectively to determine the incidence, aetiology and natural course of hepatitis. Of 51 patients (31 NHL and 20 ALL), 22 developed hepatitis. Hepatitis B (IgM anti HBc positive) was the cause in 11 patients (50%), hepatitis C in 4 patients, and septicaemia and cytotoxic drugs in 3 patients each. Malignant infiltration of the liver was the cause in the remaining 1 patient. Hepatitis was predominantly (75%) anicteric. Mean duration of hepatitis was 21 days. Of 51 patients, 21 acquired hepatitis B and/or C virus infection. They had received 6.4 (+/- 3.4) units of packed red cells and 5.3 (+/- 11) units of platelet concentrate as compared to 3.4 (+/- 4.8) units of red cells and 5.3 (+/- 12.1) units of platelet concentrate received by those who did not acquire virus infection (P < 0.05 for packed red cells). Only transient stoppage of chemotherapy was necessary following development of hepatitis and most of the patients who developed hepatitis could complete their chemotherapy schedule. None of the patients who developed viral B or C infection cleared the infection. We conclude that there was a high incidence of hepatitis B and C infection amongst patients with lymphoproliferative disorders with an increased carrier rate. Transfusion was a major risk factor for such infections.

Anti tubercular treatment induced hepatotoxicity: does acetylator status matter?

Anti tubercular drug related hepatotoxicity is common. The mechanism of injury and factors predisposing to its development are not fully understood. Forty patients with anti tubercular drugs related hepatotoxicity were studied to see the clinical and biochemical profile of these patients and to find out the significance of acetylator phenotype in the development of hepatotoxicity. Mean age of patients with liver damage (37.82 +/- 10.0 years) was similar to those without liver damage (36.48 +/- 12.5 years). Pyrazinamide appeared to increase the hepatotoxicity of isoniazid and rifampicin. The percentage of rapid acetylators and slow acetylators among patients with hepatotoxicity (70% and 30% respectively) was similar to controls (66.6% rapid and 33.3% slow acetylators). Acetylator phenotype probably has no role in anti tubercular drugs induced hepatotoxicity.

Nonsurgical drainage for biliary obstruction.

Biliary obstruction is a common and potential fatal condition. Its pathological effects include depressed immunity, impaired phagocytic activity and reduced Kupffer cell function with consequent endotoxemia, septicemia and renal failure. Over the last decade however, non-surgical biliary drainage procedures performed with radiologic or endoscopic guidance emerged as alternative to surgical of therapy in many situations, particularly palliation of malignant strictures because of their lower morbidity and mortality rates. Endoscopic stent placement is preferred over percutaneous transhepatic catheter drainage in general. If endoscopic procedure is not possible or fails percutaneous transhepatic biliary drainage or combined radiological-endoscopic procedure should be employed. Surgery is currently reserved only for curative resection/palliative drainage in young and fit patients. Preoperative biliary drainage aimed at reducing post-operative morbidity and mortality is not universally accepted and needs further study. Benign strictures are increasingly being dilated non-surgically with temporary stenting, especially in patients with failed surgery, recurrent strictures, contraindication to surgery and pre-liver transplant strictures eg primary sclerosing cholangitis. A cohesive team consisting of a surgeon, a radiologist and an endoscopist is required to achieve the best possible results.

Rare poisoning with cerebra thevetia (yellow oleander). Review of 13 cases of suicidal attempt.

Clinical presentation, course and management of thirteen patients of suicidal poisoning with seeds of yellow-oleander were studied. All patients who took more than two seeds had gastro-intestinal as well as cardiovascular toxic effects. Patients responded well to symptomatic and supportive treatment when they had four or less than four seeds and reported to hospital within four hours intake. Progress was bad when patients took more than four seeds and reported after four hours of intake, cause of death in all the patients was cardiogenic shock.

Vasculitis--a complication of hypothyroidism.

A case of hypothyroidism presenting with cutaneous vasculitis is described. Apart from typical findings of hypothyroidism, the patient had hypertension (HT). With thyroxine replacement therapy patient showed an improvement in hypothyroidism, HT and cutaneous vasculitis.