Childhood trichobezoar.

Two cases of trichobezoar with unusual presentation in rural female children are described. The first one in a healthy asymptomatic child with no abnormal psychological behaviour and other one in an emotionally disturbed child with history of trichotillomania. Both were treated surgically with no recurrence. A physical sign of indentibility is discussed and literature is also reviewed.

Comparative evaluation of computed tomography and cerebral angiography in the management of subarachnoid haemorrhage.

Plain and contrast enhanced computed tomography (CT) scan of brain and cerebral angiography were done in 20 subjects of subarachnoid haemorrhage (SAH), diagnosed on the basis of clinical parameters and proved by cerebrospinal fluid (CSF) examination. Plain CT scan of brain confirmed the diagnosis of SAH in all the 20 (100%) cases, but was able to demonstrate the cause of SAH in 11(55%) cases only. Contrast CT scan provided additional information in 7 more cases. CT was also able to demonstrate the site and extent of bleeding, evidence of intraventricular bleeding and hydrocephalus. Cerebral angiography done in all the cases, confirmed the diagnosis in 14 (70%) cases diagnosed on CT and was able to give additional information in 4 more cases. It also showed excellent vascular details which were not possible with CT scan. It is concluded that enhanced CT scan should be done first in all the cases of SAH for preliminary scouting and angiography should be done where CT scan gives incomplete information or where surgical management is contemplated. Both the investigations were found to be complementary to each other.

Visual evoked responses in megaloblastic anemia.

Pattern shift visual evoked responses (PSVER) were studied in thirty patients suffering from severe megaloblastic anemia (mean Hb level was 4.25 +/- 1.22 g/dL) of nutritional origin. All patients lacked clinical stigmata of visual and neurologic impairment. Mean P100 latency in thirty age and sex matched controls was 96.35 +/- 6.75 ms (range 86-108 ms) and mean amplitude was 10.37 +/- 3.88 microV (range 4.8-20.8 microV). Mean P100 latency in megaloblastic anemia was 114.77 +/- 11.68 (range 91-142) ms, P < 001 vs. control) and mean amplitude was 8.85 +/- 2.8 microV (range 5.1-16.2 microV). Seventy percent cases had prolonged latency of P 100. After correction of anemia with therapeutic doses of vitamin B12 and folic acid in three months (mean Hb level was 12.08 +/- 1.86 g/dL), the mean P100 latency was 105.13 +/- 9.30 ms (range 92-121 ms P < 0.001 vs. controls) and mean amplitude was 10.72 +/- 4.13 microV (range 5.1-21.4 microV). There was significant improvement in P100 latency after correction of anemia (P < 0.01). There was a negative correlation between P100 latency and hemoglobin levels, though it was statistically not significant.

Management of isoniazid poisoning--case report.

A young girl was admitted with generalized tonic clonic seizures and unconsciousness, four hours after ingestion of 12 gm of isoniazid (INH). In the absence of injectable preparation of pyridoxine, she was treated with oral pyridoxine and made a complete recovery.

Effect of vitamin D deficiency on electrocardiogram of rats.

Electrocardiograms (ECGs) were studied in rats fed vitamin D deficient diet for 12 weeks. The results indicated significant shortening of QT interval of ECG. Other intervals were normal when compared with age matched control rats. Heart/body weight ratio was significantly increased in vitamin D deficient group, which is an index of hypertrophy, with increased collagen fiber in the histology of the myocardium, inspite of normal serum calcium level. The results suggested a direct role of vitamin D in the regulation of cardiac functions.

Alteration in blood gases in tetanus.

Tetanus is an important cause of patient mortality. Hypoxia is an important determinant of poor prognosis in tetanus. Oxygen saturation (Sa02) determines effectiveness of muscle relaxants. We performed arterial blood gas (ABG) studies in 20 patients with tetanus and 20 controls. All patients had hypoxemia and metabolic acidosis at admission. The mortality rate in patients with admission PaO2 < 70mm Hg was higher compared to those with PaO2 > 70mm Hg (P < 0.01). Patient with pH < 7.2 had higher mortality compared to those with pH > 7.2 (p < 0.05). Severe hypoxemia and severe metabolic acidosis connoted poor prognosis.

Clinical, hematological and electrophysiologic study of megaloblastic anemias.

Thirty one cases of megaloblastic anaemia were studied clinically and electrophysiologically. Eight patients had clinical evidence of peripheral neuropathy. MNCV, distal sensory latency, la fibre conduction velocity, proximal conduction velocity and H-reflex amplitude and latency were compared with fourteen age and sex matched healthy controls. MNCV, proximal conduction velocity and H-reflex amplitude were significantly decreased in anaemic subjects while distal sensory latency was increased. No change was seen in la fibre conduction velocity and H-reflex latency. There was no correlation between severity of anaemia and the electrophysiologic abnormalities. MNCV and la fibre conduction velocity improved after correction of anemia.

Endosulphan poisoning presenting as status epilepticus.

A case of generalised seizures following ingestion of 20 cc of endosulphan (Endocel), an organochloride insecticide is presented. The patient, a young male of 25 years made a complete recovery. The mode of action of endosulphan is due to involvement of cholinergic neuronal system and the management is on the line of status epilepticus.