ABSTRACT
A young girl presented with Budd-Chiari syndrome (BCS) with narrowing of the retrohepatic segment of inferior vena cava (VC). Dorsal cavoatrial bypass (DCAB) was unsuccessful due to thrombotic occlusion of the graft. A limited autopsy revealed occlusion of the retrohepatic segment of IVC and the terminal parts of the three major hepatic veins. Caval occlusion was just above the level of the superior hepatic veins, and caused by a transverse fibrous shelf. An adult filarial worm was found amidst pericaval fibrosis. Filariasis should be included as a possible aetiological factor in chronic BCS.
Subject(s)
Adolescent , Budd-Chiari Syndrome/etiology , Fatal Outcome , Female , Filariasis/complications , HumansABSTRACT
A woman aged 28 years with situs inversus totalis presented with chronic Budd-Chiari syndrome with symptoms of 3 years' duration. The left sided inferior vena cava was occluded below the diaphragm above a patent morphologic right hepatic vein. A dorsal cavoatrial bypass was attempted but abandoned due to bleeding from extensive collaterals. The occurrence of coarctation of the inferior vena cava in situs inversus totalis lends support to the view that it is a congenital condition and occurs due to disturbance in fusion of the hepatic segment of the inferior vena cava and the hepatocardiac channel.
Subject(s)
Adult , Budd-Chiari Syndrome/complications , Female , Humans , Situs Inversus/complications , Vena Cava, Inferior/abnormalitiesABSTRACT
A female aged 46, with achalasia cardia had no relief of dysphagia after pneumatic dilatation done twice. At surgery the muscle fibres were found disrupted, with submucosal adhesions and friable mucosa. Heller's cardiomyotomy could not be done. Repair similar to Mickulicz pyloroplasty was done.
Subject(s)
/adverse effects , Esophageal Achalasia/surgery , Esophagus/surgery , Female , Humans , Middle AgedABSTRACT
Male aged 28, presented with coarctation of inferior vena cava (IVC) causing chronic Budd-Chiari syndrome (CBCS). The coarcted IVC was exposed by transthoracic, transdiaphragmatic, retroperitoneal approach. There was no evidence of inflammation or compression. Venotomy was done immediately below the coarctation after clamping the descending aorta above the diaphragm. Distal IVC was occluded with a Fogarty balloon catheter passed through the venotomy. There was no flow through hepatic veins. But a dry field was not obtained because of bleeding from the systemic collaterals draining into IVC above the venotomy. Hence the veno-tomy was sutured. Dorsal cavoatrial bypass (DCAB) was done anastomosing the graft, end to side of IVC at a lower level, after partial clamping of IVC. Cross clamping the descending aorta appears to be a useful technique for surgery of retrohepatic IVC to arrest blood flow from distal IVC and hepatic veins.
Subject(s)
Adult , Aorta, Thoracic , Blood Vessel Prosthesis , Budd-Chiari Syndrome/etiology , Constriction, Pathologic/surgery , Heart Atria/surgery , Humans , Male , Polytetrafluoroethylene , Vena Cava, Inferior/surgeryABSTRACT
Faecal chymotrypsin (FCT) levels were estimated in a group of patients with tropical chronic pancreatitis (TCP) and compared with patients with alcoholic chronic pancreatitis (ACP), 'gastrointestinal' controls and 'healthy' subjects. Exocrine pancreatic insufficiency as assessed by low faecal chymotrypsin levels (less than 5.8 mu/g) were present in 85.7 per cent of TPC and 84.6 per cent of ACP patients. Mean FCT levels as well as the distribution of FCT values were similar in TCP and ACP patients and significantly lower than the two control groups (P less than 0.001). There was also no difference with respect to mean FCT levels between subgroups of TCP patients with and without diabetes and those with and without calcification. Faecal chymotrypsin assay is a simple test for diagnosis of chronic pancreatitis in gastroenterological centres in tropical countries.
Subject(s)
Alcoholism/complications , Chronic Disease , Chymotrypsin/analysis , Diagnosis, Differential , Feces/enzymology , Humans , Pancreatitis/diagnosisSubject(s)
Budd-Chiari Syndrome/complications , Child , Humans , Tuberculosis, Hepatic/complicationsABSTRACT
192 patients of acute viral hepatitis (AVH) from three different hospitals of Madras metropolitan area during November 1985 to January 1986 were investigated for serologic markers of hepatitis A virus (anti HAVIgM) and hepatitis B virus (HBsAg, HBeAg, anti HBcIgM and anti HBs) by Enzyme linked immunosorbent assay (ELISA). While the overall pattern of AVH in Madras as revealed from the study showed Hepatitis A to be 36.4%, Hepatitis B 34.4% and Non-A Non-B 29.1%, the pattern differed significantly when areawise categorisation was done. The major AVH type in Government General Hospital was Hepatitis B (48.9%). While it was hepatitis A (46.9%) in Government Stanley Hospital and Non-A Non-B (40.0%) in Military Hospital. Using anti HBcIgM marker of Hepatitis B Virus and anti HAVIgM it was possible to make out that 13.5% of the cases, currently suffering from hepatitis A were either HBV carriers (8.3%) or cases convalescing from a previous Hepatitis B attack (5.3%). Various combinations of HBV markers positivity were observed and their diagnostic significance inferred.