Incidence of hepatocellular carcinoma among Indian patients with cirrhosis of liver: an experience from a tertiary care center in northern India.

BACKGROUND/AIM: Despite bearing the main burden of HCC, prospective studies from developing countries are lacking. This prospective observational study was designed to estimate the incidence of HCC among Indian patients with hepatic cirrhosis. METHODS: Between April 2001 and November 2004, we enrolled 301 patients with liver cirrhosis. Patients found to be free of HCC using baseline abdominal ultrasound, triple-phase computed tomography (TPCT) and serum alpha-fetoprotein (AFP) levels were followed up prospectively for detection of HCC using ultrasound and AFP every 6 months, and TPCT annually. RESULTS: Among the 194 patients (mean age [SD] 45.1 [+/-13.1] years; male:female 6.1:1.0) followed up, 154 had Child's A and 40 had Child's B disease. The causes of cirrhosis were: hepatitis B-71 (36.6%), hepatitis C-54 (27.8%), dual infection with hepatitis B and C-12 (6.2%) and others including autoimmune, alcoholic and cryptogenic cirrhosis 57 (29.4%). During a cumulative follow up period of 563.4 person-years, 9 cases of HCC were detected, with an incidence rate of 1.60 per 100 person-years. CONCLUSION: In our study, the incidence of HCC among patients with liver cirrhosis was intermediate, being lower than that in Japan but higher than that reported from Europe.

Complete perineal tear with rectal prolapse: an unusual case report.

The association of complete perineal tear and rectal prolapse is less reported in literature, although isolated complete perineal tear and the combinations of vaginal and rectal prolapse are not so unusual, where multiparity and unsupervised home deliveries are quiet common. An interesting case of long standing complete perineal tear with complete rectal prolapse is reported in a 60 years old lady along with review of literature, discussing the management and follow-up of the condition.

Study of drotaverine on first stage of labour and pregnancy outcome.

A prospective randomised study of 200 women with spontaneous onset of labour was carried out in 100 women who were given 40mg of drotaverine hydrochloride intravenously at > or = 3cm dilatation of the cervix, the other 100 were taken as control. The effects of the drug on the progress and outcome of labour were noted. The mean durations of active phase of labour in primigravida and multigravida were 148.9 minutes and 99.5 minutes in drotaverine group whereas in control group were 331.6 minutes and 227.9 minutes respectively. It was concluded that drotaverine is highly effective in reducing the duration of active phase of labour by hastening cervical dilatation, more effective when given in more dilated cervix than with less dilatation and more effective in multigravida than in primigravida. There was no interference with uterine contractility and no increase in operative delivery. It reduces the incidence of traumatic postpartum haemorrhage by reducing the incidence of cervical tear. It is a safe drug for the mother as well as for the baby.

Thoracic application of multi-detector CT.

Multi-detector CT (MDCT) is the latest advancement in the field of medical imaging. It has considerable advantage over single-detector helical CT in the form of shorter acquisition time, greater coverage, and superior image resolution. All these factors substantially increase the diagnostic accuracy of the examination by providing state-of-the-art image quality. Three-dimensional (3D) isotropic volume imaging is possible with MDCT and, it provides an excellent anatomy of the thorax thereby increasing the diagnostic yield comprehensively. With the advent of MDCT, there is paradigm shift in vascular imaging from conventional catheter angiography to MDCT angiography as this technique provides image quality that equals or surpasses that of conventional angiography. Recent advances in 3D volume rendering allows a fly through the tracheobronchial tree and the thoracic great vessels generating virtual endoscopic views in real-time. It is also helpful in imaging the musculo-skeletal system and the thoracic cage.