Hepatic abscess caused by Salmonella typhi.

A 64 years diabetic man presented with recurrent episodes of fever and abdominal pain. Ultrasonography revealed the presence of an abscess in the right lobe of the liver and a distended gall bladder with multiple calculi. Salmonella typhi was grown from the liver aspirate. Cholelithiasis may act as a predisposing factor for hepatic abscess formation in Salmonella carriers.

Precut papillotomy using needle knife fashioned from discarded standard papillotomes.

AIM: To evaluate the results of precut papillotomy using needle-knife papillotomes fashioned from discarded standard sphincterotomes. METHODS: Case records of 50 patients undergoing precut papillotomy for access to either common bile duct or pancreatic duct during endoscopic retrograde cholangiopancreatography were reviewed. Precut was performed using needle-knife papillotomes fashioned from standard pull-type sphicterotomes that were discarded because of broken cutting wires. A diagnostic procedure was planned in all 50 patients (bile duct = 39, pancreatic duct = 9, both ducts = 2) and therapeutic procedure in 36 patients (bile duct = 31, pancreatic duct = 5). RESULTS: Of the 47 patients who needed precut prior to diagnostic ERCP, 44 (93.6%) underwent successful cannulation of the duct of choice. Therapeutic procedures were planned in 36 patients; these were successful in 24 (67%; bile duct = 22, pancreatic duct = 2). The complications included cholangitis in 8 patients (16%) and pancreatitis in 2 (4%). None had bleeding or perforation. CONCLUSIONS: Precut needle-knife papillotomes fashioned from discarded standard sphincterotomes can be used effectively and can help in cost containment in endoscopic retrograde cholangiopancreatography.

Is Crohn's disease rare in India?

BACKGROUND: Crohn's disease (CD) is believed to be rare in India. OBJECTIVE: To analyze the data pertaining to patients with CD seen in a tertiary referral center. METHODS: Data on patients with chronic inflammatory bowel disease attending our Unit over a 5-year period were analyzed. The diagnosis of CD was established by the presence of characteristic segmental bowel involvement, consistent histological picture, exclusion of infectious causes, relapsing nature of the disease, response to appropriate drug therapy, and lack of evidence for another etiological factor. RESULTS: Of the 25 patients (age range 12-52, mean 31.7, years) 13 were men. Abdominal pain was present in 21 (84%) patients, diarrhea in 20 (80%), blood per rectum in 11 (44%) and fever in 4 (16%). The ileocecal region was involved in 6 (24%) patients and anal canal in 4 (16%); 19 (76%) had patchy involvement of different segments of the large bowel. Colonoscopic biopsies revealed granulomas in 12 (48%). During a mean follow up of 36.4 (range 6-54) months, 15 (60%) patients had 21 relapses. Despite initial response to 5-aminosalicylic acid in five patients, 23 needed glucocorticoid therapy at least once. CONCLUSIONS: CD may not be rare in India. Because of the high prevalence of intestinal tuberculosis there is a possibility that CD may be under-recognized in India.

A modified radiographic method for estimating segmental colonic transit time in subjects with rapid gut transit.

In this study on Indian subjects, the single X-ray method was assessed for its reliability in measuring the transit of particulate matter through the colon, and if inaccurate a suitable and simple alternative was to be devised. Radio-opaque markers were serially followed in 20 normal male volunteers. This was done by three 12 hourly radiographs and by stool collection to determine the transit time through the colon and its segments. It was compared with similar parameters calculated from the same data using one radiograph and three combinations of two radiographs each. The mean +/- SD colonic transit time determined by using three X-rays was 18.0 +/- 6.6 h which agreed well with the mean mouth-to-anus transit time of 24.2 +/- 6.8 h (mean +/- SDdiff = -6.2 +/- 2.9). When two of the three X-rays were used in various combinations, the best results were obtained with the method including radiographs at 12 and 36 h. Parameters calculated from a single radiograph done 36 h after the ingestion of makers showed lesser agreement with the results of the three radiograph method. Therefore in subjects with rapid gut transit, the simplified method for estimating the colonic and segmental transit times using a single X-ray is inaccurate. Using two radiographs enhances the accuracy.