Isolated Congenital Bilateral Choanal Atresia and Nasopharyngeal Atresia- a case report.

A term neonate developed respiratory distress, paradoxical cyanosis (relieved by crying) soon after birth. Inability to insert No.5 French infant feeding tube through the nose into the pharynx led to the diagnosis of Bilateral Choanal Atresia , which was confirmed by HRCT Scan of the nose. Insertion of an oropharyngeal tube reduced the respiratory distress. Extensive investigations did not reveal any other congenital anomaly. The baby was treated with Transnasal Surgery.

Gradient of reduced glutathione in the tail of Hemidactylus leschenaultii (Sauria: Gekkonidae).

A proximo-distal gradient of reduced glutathione (GSH), a non enzymatic antioxidant was observed in the original tails of the lizard, H. leschenaultii. In the regenerating tails, a gradual increase in the level of GSH was noted with tail elongation. In the newly regenerated tails also the level of GSH remained higher in the proximal part than the corresponding distal parts.

Descending thoracic aortic aneurysm presenting as left sided hemorrhagic pleural effusion.

Aneurysm of descending thoracic aorta, in majority of cases is diagnosed either by chance in routine chest imaging for some other reasons or rarely due to it's symptomatic presentation like chest pain and other mediastinal compression symptoms. In this case report we present a case of 69 year old smoker who presented with cough, hemoptysis and left sided massive painless hemorrhagic pleural effusion. Further investigation revealed a large aneurysm of descending thoracic aorta which infiltrated the left lung. We suggest descending thoracic aneurysm be included in the differential diagnosis of this sort of clinical presentation which otherwise imperative with the clinical scenario of bronchogenic carcinoma.

Systemic lupus erythematosus presenting with recurrent pleural effusion without any systemic manifestation.

Pleural effusion can be the sole presenting manifestation in about 5 percent of cases with SLE. We are reporting a case of SLE which presented with recurrent pelural effusion without other systemic manifestation.

Bilateral intracerebral haemorrhages: an atypical presentation of Japanese encephalitis.

Japanese encephalitis is common human endemic encephalitis seen over various parts of the world. Usual presenting features include an encephalitic syndrome, symptoms of frontal lobe, basal ganglia and thalamic involvement. Characteristic radiological picture is bilateral thalamic and basal ganglia hypo density in the CT scan and hypo-intensity in T1 and hyperintensity in T2 weighted image in MRI. Very rarely occurrence of bilateral hemorrhage may be seen in these regions. This radiological change may be early indicator of the disease before serological confirmation by the available diagnostic modalities. In this communication, we have reported a case of Japanese encephalitis presented with bilateral basal ganglia hemorrhages.

Cholangiocarcinoma presenting with recurrent venous thrombosis.

A 38 years female presented with three episodes of venous thrombosis over one year--first in left femoral vein, next in splenic vein causing haematemesis and malena and lastly in inferior vena cava causing Budd-Chiari syndrome. During third episode, endoscopic cholangiopancreatography and guided biopsy established a diagnosis of cholangiocarcinoma at the mid portion of common bile duct. The disease was far advanced with cervical lymph node metastasis.

Isolated duodenal metastasis from breast carcinoma.

Small bowel neoplasms comprise 0.1% of all malignancies. Of these one-third are duodenal, mainly primary. Isolated duodenal secondaries arising on account of haematogenous spread is rare. Our case of duodenal obstruction due to an isolated duodenal metastasis as a result of haematogenous spread from breast carcinoma is unique in the literature.

Impact of lactational performance on bone mineral density in marginally-nourished Bangladeshi women.

This cross-sectional study, carried out during July 1997-June 1998, evaluated the effects of prolonged breast-feeding and lactational amenorrhoea on bone mineral density (BMD) in 400 marginally-nourished Bangladeshi women aged 20-81 years. A bone densitometer was used for measuring BMD in the distal and ultra-distal end of radius and ulna. The results showed that the women who breastfed for 60 months or less had a higher mean BMD compared to those who breastfed for 61-120 months and for over 120 months. There was a significantly higher BMD in the women who had a shorter duration of lactational amenorrhoea compared to those having a longer duration of lactational amenorrhoea. BMD was significantly and negatively correlated with total duration of lactational amenorrhoea (slope -0.024, p<0.05) after controlling for parity, physical workload, and total duration of breast-feeding. The study concluded that there was a negative correlation between longer duration of breast-feeding and BMD, but it was not found when other factors were controlled in multivariate analysis. The duration of lactational amenorrhoea, which is a proxy indicator of breast-feeding, showed a negative correlation with BMD. It is recommended that all lactating women be given diet with adequate calcium to support breast-feeding for maintaining good nutrition of their bones.

Sepsis in the newborn.

Systemic infection in the newborn is the commonest cause of neonatal mortality. Data from National Neonatal Perinatal Database 2000 suggest that Klebsiella pneumoniae and Staphylococcus aureus are the commonest causes of neonatal sepsis in India. Two forms of clinical presentations have been identified. Early onset sepsis, probably related to perinatal risk factors, usually presents with respiratory distress and pneumonia whthin 72 hours of age. Late onset sepsis, related to hospital acquired infections, usually presents with septicemia and pneumonia after 72 hours of age. Clinical features of sepsis are non-specific in neonates and a high index of suspicion is required for the timely diagnosis of sepsis. Although blood culture is the gold standard for the diagnosis of sepsis, reports are available after 48-72 hours. A practical septic screen for the diagnosis of sepsis has been described and some suggestions for antibiotic use have been included in the protocols.

Comparison of bone mineral density between premenopausal and postmenopausal women in Bangladesh.

This cross sectional study was conducted in the department of Obstetrics and Gynaecology at Bangabandhu Sheikh Mujib Medical University, Dhaka during July 1997 to June 1998. Two hundred and twenty (220) Bangladeshi premenopausal and post-menopausal women aged from 35 to 55 years were studied to compare the effect of age, parity, socioeconomic status and nutritional status on bone mineral density (BMD) of distal and ultra distal ends of radius and ulna. A bone densitometer (Single photon X-ray absorptiometry, DTX100, USA) was used to measure the BMD. BMD was calculated by taking the mean of the two sites and is expressed in g/cm2. Bone mineral density in post-menopausal women (0.48 +/- 0.1 g/cm2) was significantly lower than pre-menopausal women (0.61 +/- 0.06 g/cm2, p<0.001). Parity and number of family members were significantly greater in post-menopausal women compared to pre-menopausal women (6.5 +/- 2.9 vs. 4.2 +/- 2.3 and 8.1 +/- 2.5 vs. 6.2 +/- 2.3 respectively, p<0.001). Height was significantly lower in post-menopausal women (148.6 +/- 6.9 vs. 151.8 +/- 5.7 cm, p<0.001). After adjustment of various biological factors in multiple linear regression, body mass index (BMI) showed negative relationship with age (slope -0.0068, p<0.001) and positive relationship with weight (slope 0.0011, p<0.05). Peak BMD was observed upto the age of 40 years and thereafter declined and sharply after menopause. The study concluded that bone mineral density is greater in pre-menopausal women than post-menopausal women and remains high up to 35-40 years of age, and declines to older age. BMD positively correlates with weight of women. Premenopausal women have higher height than postmenopausal women though height does not have correlation with BMD in this study.

Fallot's tetralogy presenting with variceal bleed.

The erythrocytosis of Fallot's tetralogy may lead to spontaneous thrombosis at any site, but splenic vein thrombosis and variceal bleed is rarely a presentation of Fallot's tetralogy. A case of a 48 years old female with undiagnosed Fallot's tetralogy, presenting with variceal bleed due to splenic vein thrombosis, is reported. It is also interesting to note that the patient survived till this age without any medical or surgical treatment.

Pyrexia of unknown origin: a prospective study of 100 cases.

AIM: There are few studies on pyrexia of unknown origin (PUO) from India. The present study was planned to elucidate the causes of in PUO Eastern India and to define the changing patterns of PUO, if any. STUDY DESIGN: Prospective case series. PATIENTS: One hundred patients meeting the classic criteria of pyrexia of unknown origin. MAIN OUTCOME MEASUREMENT: The final diagnosis established at discharge or during follow up. RESULTS: Infections, especially tuberculosis was the most dominant cause (53%), followed by neoplasms (17%), and collagen vascular disorders (11%), Miscellaneous causes were responsible in 5% cases and in 14% the cause of fever remained undiagnosed. CONCLUSION: It is concluded that infections remain the most important cause of PUO in India, confirming the trends found earlier in other studies. The incidence of neoplasms was much higher compared to other studies from India.

Birth weight at Changlang, Arunachal Pradesh.

The data on birth weight of 524 (male--287, female--237) live born singleton babies of Changlang have been subjected to analysis in relation to sex, mean birth weight and low birth weight (LBW). For the purpose of comparison, the present data were sub-divided into three categories--Tangsa Tribe (T.T.), Tribes excluding Tangsa (T) and other groups (O.G.). Tribal babies of Changlang are found to be heavier than babies of other groups. It has also been observed that occurrence of LBW among tribal babies of Changlang is less than that of the babies of other groups of Changlang and it is much less than that of Bengali babies of Calcutta and Marathi babies of Pune District. It is apparent that tribal babies of Changlang are more healthier than caste babies of N.E. India.

Coronary artery lesions in Takayasu's arteritis--clinical and angiographic study.

Two hundred and twenty five patients of Takayasu's arteritis were studied over 13 years. Male:Female ratio was 1:7. Mean age of the study population was 19 +/- 4 years. Of these 225 patients, 75 patients had symptoms and/or signs of cardiac involvement and these patients were subjected to coronary angiography. Significant coronary artery occlusion (i.e. more than 50% narrowing of luminal diameter) was present in 9 patients. Incidence of coronary artery lesions in Takayasu's arteritis is 12% in this study. The proximal segments of coronary arteries were involved while the distal segments were spared. Out of 34 patients with angina pectoris, only 3 patients had significant coronary arterial narrowing.

Cytotoxicity of anthrax lethal factor microinjected into macrophage cells through Sendai virus envelopes.

Lethal toxin (LT) secreted by Bacillus anthracis consists of two proteins, protective antigen (PA) and lethal factor (LF). LT causes lysis of macrophages and derived cell lines at low concentrations. PA binds to the cell surface receptors and mediates translocation of LF into cytosol of mammalian cells. Internalization of LF into cytosol by osmotic lysis of pinocytic vesicles requires high concentration of LF for cell lysis. To examine the possible cell lysis by LF at low concentration, we introduced LF directly into cytosol of J774A.1 cells through reconstituted Sendai virus envelopes. The introduction of LF lysed J774A.1 cells in a concentration dependent manner. Internalization of PA alone through virosome had no toxic effect on J774A.1 cells. In the process of cytotoxicity LF was not cleaved by cellular proteases. Unlike many protein toxins, golgi was not involved in the expression of lethal toxin activity. These results indicate that LF is the toxic component of anthrax lethal toxin and prior proteolytic processing or trafficking through golgi is not required for its activity.

Reuse of pacemaker.

Implantation of a permanent pacemaker is an expensive proposition for the poor patients of our country. Many patients on permanent pacemaker die prematurely due to diseases or conditions not related to pacemaker function. The purpose of this study was to reuse these pacemakers after thorough cleansing and proper sterilisation in other suitable patients and compare the efficiency of the reused pacemakers with that of newly implanted ones. Between April 1979 and April 1992, 642 patients implanted with reused pacemakers were studied. The study population consisted of patients ranging in age from 15-85 years and included patients of both sexes (M:F = 4:1). The mean period of follow-up was 7.5 +/- 5.6 years. Removal and reimplantation of the pulse generators was carried out after obtaining the State Government's approval, informed consent of the donors, relatives and recipients. The functional status of the pulse generators was tested by a "pacing system analyser". The clinical indications for reuse were chronic complete heart block, symptomatic bifascicular heart block, sick sinus syndrome and chronic complete heart block with congestive heart failure, in decreasing order of frequency. In terms of morbidity and mortality, the efficacy of reused pacemakers was highly comparable with that of newly implanted ones. The infection rate in cases of reuse from dead patients was comparable to that in cases of new implantation. However, pacemakers reused in the same patient showed a high rate of infection. With the aid of newer generations of antimicrobials, infection when matched with efficacy and economy (of reuse) does not seem to be a major factor against pacemaker reuse.

Alteration in alkaline phosphatase activity of duodenal tissue following vestibulo-cerebellar modulation.

Effect of electrolytic lesion in vestibulo-cerebellar area of male Wistar rats was investigated on duodenal alkaline phosphatase (AP) activity. Histomorphological observations of brain indicated, that extensive lesion restricted to the wide area of nodule including ventral uvula, resulted in significant fall of AP activity at the mucosal brush border within 20 days. A comparative behavioural study in experimental and control groups by openfield test indicated that, sympathoexcitation resulting from vestibulo-cerebellar lesion may contribute to significant alteration of AP activity in duodenum of rats.