Effect of Arka Taila and Patoladi Gana Kashaya in Dooshivishajanya Vicharchika

Toxicology, is a slow acting less potent poison, which does not kill the person immediately, but gets manifested in the form of many diseases. Skin diseases (Kustha) are one among the main symptoms of Dooshivisha. Vicharchika, is one among Kshudra kustha, which is highly prevalent, common and distressing condition. Recurrence and chronicity are the main threat faced by patients suffering from Vicharchika. Most of the features of Vicharchika show similarity with symptoms of the disease entity, eczema of modern dermatology. In India, the point prevalence of dermatological cases are 9.25%, and that of eczema is 6.75%. Arkatailam is the formulation prescribed in Yogaratnakaram, which reflects the therapeutic effect of toxic plant Arka, which is directly indicated for Vicharchika. The aims and objective of the study is to evaluate the combined effect of Arkataila and Patoladi gana kashaya in Dooshivishajanya Vicharchika. The study design was an interventional pre-post study with sample size 30. Patients with signs and symptoms of Vicharchika, having history of Dooshivisha, of age group between 20-60 satisfying the diagnostic criteria selected from the OPD of Government Ayurveda College Panchakarma, Hospital, Poojappura, Thiruvananthapuram, were included in the study. The study group was given Avipathychoorna internally on first day for Virechana. On 2nd day onwards Patoladi gana Kashaya was given internally and Arkataila externally for 14 days. Symptomatic assessments were done before treatment, on 8th day, after the treatment and after the follow up period of 7 days. Results were analyzed statistically. The results show that the effect of Arkataila and Patoladiganakashaya is very effective in Dooshivishajanya vicharchika.

A rare scenario of perforated gastrointestinal stromal tumours of ileum

Gastro-intestinal stromal tumours (GIST) are among the common mesenchymal tumours of the gastro-intestinal (GI) tract. It varies in location and presentation. GIST are reported in the stomach frequently (60-70%), followed by small intestine (20-25%). Mainly GIST manifest typically with bleeding or vague abdominal pain and discomfort. The spontaneous perforation of GIST is very rare. We report case of a middle-age male patient who presented in emergency with pain in right lower abdomen associated with features of peritonism. After clinical evaluation and preliminary radiological investigations, a working diagnosis of perforated appendix was made. Patient was undertaken for emergency surgery. A diagnostic laparoscopy followed by midline laparotomy was done. Intra-operatively, a perforated and necrotic outpouching at antimesenteric border of terminal ileum was found. Histopathological examination of the resected part of ileum revealed compatibility with GIST. It was strongly positive for cluster of differentiation 117 (CD117) and smooth muscle actin. Patient received adjuvant therapy with Imatinib. A complete surgical resection without extensive lymph node sampling is the primary treatment option. As GIST are rare, a high index of suspicion is warranted for diagnosis and appropriate treatment.