Clinico-therapeutic profile of pyogenic liver abscess.

Nineteen consecutive patients of pyogenic liver abscess (13 males, 6 females, mean age 45.2 +/- 6, 5 years) were studied over a period of 5 years for the clinical profile and therapeutic efficacy of percutaneous aspiration. Majority of them presented with spiking fever (94.7%), pain over right upper quadrant of abdomen (53.8%) and often with prostration and shock (31.6%). The onset has been rather acute in patients with multiple abscesses (7 cases). Ascites (10.5%), clubbing of fingers (15.8%) and splenomegaly (10.5%) were observed in cases with long duration of illness. There has been the polymorphonuclear leucocytosis (89.5%) and mild to moderate anaemia (52.6%). Jaundice (42.1%) was usually mild degree (serum bilirubin 4.6 +/- 2.4 mg/dl). The serum transaminases and alkaline phosphatase were raised in 94.9% of cases. Ultrasonography revealed predominantly hypoechoic (54.1%) areas with frequent distal acoustic enhancement and internal echoes (21.6%). Seven patients had multiple abscesses with 25 lesions (size 5.2 +/- 4.6 cms) situated mainly over antero-inferior segment of the right lobe (45.9%) of the liver. The blood and pus cultures demonstrated the micro-organisms (positive in 63.9% and 86.6% respectively) predominantly of bowel flora including facultative gram negative rods and anaerobes. Mortality was 26.5% and pleuro-pulmonary complications were the commonest (26.4%) one. 15 cases were treated by percutaneous aspiration, proper antibiotic and metronidazole with encouraging results (only two deaths). Complete resolution of abscess took place in 14.2 +/- 1.2 weeks (range 6 weeks to 7.5 months). It is emphasized that percutaneous needle aspiration is useful both for diagnosis and treatment of pyogenic liver abscess.

Clinical profile of giardiasis and comparison of its therapeutic response to metronidazole and tinidazole.

Seventy five cases (50 males, 25 females; mean age 20.2 +/- 5.8 years), whose stools were positive for cysts and/or trophozoites of Giardia lamblia, were studied for their clinical profile and therapeutic response to metronidazole and tinidazole. Maximum frequency of cases (41.2%) was noted upto 20 years of age, and it declined with advancing age. A majority of them (41.3%) presented with non-specific symptoms while 38.6% were asymptomatic parasite carriers. Features of malabsorption were observed in 12% of cases and 8% presented with acute illness, having explosive, watery, foul smelling diarrhoea along with crampy upper abdominal discomfort. Most of them (62.5%) had blood group A. Tinidazole (97.5%) was more efficacious (P less than 0.01) than metronidazole (54%) in a single dose of 50 mg/Kg, with good tolerance. Tinidazole can be recommended for the treatment of giardiasis in individual cases as well as in families and close communities.

Clinical profile of herpes zoster ophthalmicus.

Herpes zoster ophthalmicus was seen in 22 cases out of 195 cases of herpes zoster (11.3% incidence). It was affecting mainly adults (90.9%). Oedema over the lids (81.8%) was invariably present and lead to ptosis. Mucopurulent conjunctivitis, predominantly mucoid (72.7%) was the commonest manifestation associated with vesicles over the lid margins. Sectorial (22.7%) and diffuse (9.1%) episcleritis appeared in later part of first week, while nodular episcleritis was observed in one case only on 12th day of the disease. Nummular keratitis was seen in 31.8% of cases between 8-10 days. Iritis and iridocyclitis was seen in 45.4% of cases out of which 36.3% had secondary ocular hypertension (glaucoma). Neuroparalytic keratitis and internal ophthalmoplegia were detected in one patient each. Postherpetic neuralgia occurred in 22.7% of cases and was uncommon in younger age group (below 40 years, 4.5%). Carbamazepine was effective in relieving the herpetic pain.

Male gonads in leprosy--a clinico-pathological study.

Sixty male leprosy patients (mean age 27.2 +/- 5.04 years) selected at random, were studied for gonadal involvement with the mean duration of illness 4.17 +/- 3.27 years. Only lerpomatous and borderline leprosy cases developed testicular and epididymal changes. Testicular pain and/or swelling (lepromatous 62.5%, borderline 30%) was the main presenting feature. Altered sexual function was observed in 34(56.6%) cases, and 11 patients revealed altered sexual hair pattern. Gynecomastia was seen in 9 cases. Reduced testicular size along with its soft feeling was present in 25% of cases while no testicular sensation was felt in 8 (13.3%) cases, and impaired testicular sensation in 9 (15%) of them. Spermogram revealed azoospermia in 19 (35%) and oligospermia in 16 (26.6%) cases. Histo-pathology revealed evidences of leprous pathology irrespective of testicular size, semen picture and clinical manifestations. There was marked variation in histopathological findings in testes and hence it was difficult to categorise them into vascular, interstitial and obliterative phase.

Rapidly progressive (crescentric) glomerulonephritis in erythema nodosum leprosum: case report

A autora faz a introduçäo do trabalho uma abordagem sobre o tabagismo como importante fator associado a doenças respiratórias, cardiovasculares e a alguns cânceres. Lembra também sobre as implicaçöes do tabagismo na gravidez e descreve alguns estudos sobre fumante passivo e refere algumas informaçöes epidemiológicas. Propöe-se a: 1- Estudar a prevalência de tabagismo entre estudantes da Universidade de Säo Paulo, campus de Ribeiräo Preto, em 1988. 2- Analisar a tendência desta prevalência no perído de 1980-1988. 3. Analisar a relaçäo entre escolhas das marcas e o custo das mesmas. Foi feito um levantamento em 1988, com questionário padronizado e com a mesma metodologia utilizada em 1980, 1981 e 1986. As principais conclusöes foram: 1- A prevalência do tabagismo nas diferentes unidades da USP, em dezembro de 1988 foi: FMRP, 11,9% EERP, 21,2%, FFRP, 8,7; FORP, 8,9%; e prevalência de extabagista foi respectimente: 6,8%; 9,3%; 7,5% e 6,5%. 2- As mulheres fumam tanto quanto os homens em 1988 entre os alunos inqueridos. 3- Até 1986, há tendência geral de declínio em todas as escolas; em 1988, esta tendência näo tem significado estatístico. 4- A tendência segundo o gênero alterou-se no período estudado, em 1980 e 1981 os homens fumam mais que as mulheres e em 1986 e 1988, homens e mulheres fumam igualmente. Foram levantadas e discutidas várias hipóteses no sentido de tentar explicar esta tendência geral de declínio e as mudanças ocorridas neste período quanto a prevalência nos dois gêneros

Histo-functional status of kidney in leprosy.

A study of 64 cases of leprosy (44 lepromatous and 20 nonlepromatous) revealed that the duration of the disease has a significant relationship with renal involvement (chi 2 = 16.9, P less than 0.001). Proteineuria, microscopic haematuria, granular and hyaline casts are mainly seen in lepromatous cases and specially with lepra reaction (100%) while few of the non-lepromatous (2%) cases may show these abnormalities. Impaired renal functions are mostly observed in lepromatous leprosy (62.9%) specially those with lepra reaction (100%) while 2% nonlepromatous cases have these impaired renal functions. Histo-pathological studies revealed non-specific changes in 44.4% of cases and those of chronic pyelonephritis in 15.5% of the cases. Renal amyloidosis is less common occurrence (4.4%). The specific lesion, that is 'leproma kidney', is rare and seen in one patient only. Acid fast bacilli could not be seen in any of the kidney tissue. It is therefore, concluded that the renal involvement in the form of inflammatory lesions and non-specific changes in the glomeruli and tubules are very common in lepromatous leprosy specially during the reactive phase.

Serum cations (calcium and magnesium) in leprosy.

Serum cations (calcium and magnesium) were studied in 80 leprosy patients and 40 normal healthy individuals to find out the correlation between the clinical status of leprosy with these cations levels in the serum. There was significant decrease of serum calcium in lepromatous leprosy (7.42 +/- 0.7 mg%, t = 14.12, P less than 0.001), which seems to be related with the extent of leprosy lesions and duration of illness as few patients (22.2%) with minimal lesions and shorter duration of illness had serum calcium within normal range. Serum magnesium was significantly decreased in all types of leprosy cases and lepromatous leprosy patients showed highly significant decrease in serum magnesium level (1.02 +/- 0.2 mEq/L, t = 14.54, P less than 0.001).