Duodenal diverticular haemorrhage in a patient taking NSAID.

We present a 55 years old male with severe anemia with history of pain abdomen for 2 weeks and malena of 10 days duration. He was taking NSAID (Diclofenac sodium). Upper GI endoscopy done twice did not reveal any abnormality. Upper gastrointestinal (UGI) barium series with small bowel follow through revealed a diverticulum on medial wall of second part of duodenum and there was evidence of ulcer in diverticulum. He underwent diverticulectomy. On follow up after 6 months patient was asymptomatic.

Radioprotective action of caffeine: use of Saccharomyces cerevisiae as a test system.

Mechanism of radioprotective action of caffeine by studying the gamma radiation -induced killing of yeast, S. cerevisae is reported. The results reveal that caffeine specifically protects aerobically (oxic) grown cells from gamma - radiation and sensitizes anaerobically (hypoxic) grown cells to some extent. Using radiation sensitive strains which lack recombinational pathway, it was found that protection by caffeine was solely brought about by reducing DNA damage, rather than by interfering with DNA repair process.

Detection of Chlamydia trachomatis antigen & Toxoplasma gondii (IgM) & Mycoplasma hominis (IgG) antibodies by ELISA in women with bad obstetric history.

A total of 365 non pregnant women with bad obstetrics history (BOH) were studied with a control group of 100 women who had delivered full term clinically normal infants. The presence of C. trachomatis antigen and T. gondii (IgM) and M. hominis (IgG) antibodies was assessed by ELISA test. C. trachomatis antigen was detected in 28.2 per cent of women with BOH whereas T. gondii and M. hominis specific antibodies were found in 43.83 and 27.1 per cent respectively, these were highly significant (P < 0.001) in comparison with the control group. In case, facilities for culture are not available then detection of antigen and IgM class of antibodies by ELISA can pinpoint current infection.

Obstetric hazards among elderly primigravidae.

Three hundred and seventeen cases of elderly primigravidae were studied from January 1987 to December 1990 at Lokmanya Tilak Municipal General Hospital, Bombay. The aim was to study the complications of pregnancy, complications of labour, perinatal mortality and maternal mortality in an urban, socio-economic backward class of elderly primigravidae and to compare them with younger primigravidae in the same population. The study covered all cases, either booked for hospital confinement or admitted as an emergency case without any prior antenatal care. The incidence of breech was found to be higher in elderly primiparae as compared to younger primiparae. Duration of labour as also operative intervention was found to be more in elderly primigravidae. There was no maternal mortality in this study. The most important feature in relation to infants was the high perinatal mortality in the study group.

Unconventional use of oxytocin.

Various agents are in wide clinical use for the purpose of inducing and or accelerating labour. Undoubtedly, the most widely used is oxytocin. The present study represents the experience in the use of oxytocin in unconventional obstetric cases. The study comprises 300 cases where oxytocin drip was used for the initiation of labour, acceleration of labour and to control postpartum haemorrhage in both unconventional and conventional cases. The results are analysed and compared in both the groups along with the complications. Oxytocin has proved to be so safe, that there is only one contra-indication to its use and that is a grossly contracted pelvis.

Squatting position for delivery.

The study was conducted on 200 normal pregnant women who were randomly classified into 2 groups of 100 cases each. The control group comprised mothers in supine position throughout labour and delivery (46 primigravidae and 54 multigravidae). The squatting group consisted of cases who were kept ambulatory during the 1st stage and were asked to squat on ordinary delivery cots during the 2nd stage of labour. Third stage of labour was conducted in supine position. The squatting group comprised 42 primigravidae and 58 multigravidae. There was a mean difference (shortening) of 3 hours in primigravidae and 2 hours in multigravidae in the duration of 1st stage of labour between the squatting and control groups. In the duration of 2nd stage of labour the mean differences in primigravidae and multigravidae of the squatting and control groups were 20 and 13.5 minutes respectively. In the squatting group there were 79 normal vaginal delivery, 16 forceps delivery and 5 caesarean sections whereas in the control group there were 80, 18 and 2 cases respectively. Although foetal complications were comparable in both the groups, the incidence of maternal injuries was observed in 14 cases in control group and 38 cases in squatting group. It was concluded that without proper birthing chairs which can give good perineal support, the usual supine position is preferable.

Rupture uterus: changing trends in etiology and management.

Sixty-four cases of rupture uterus which occurred during the period 1980-89 were studied and compared with 70 cases in the preceding decade (1970-79). The changing trends in etiological factors and management of this condition have been demonstrated. While spontaneous rupture continued to account for about two-thirds of the cases (70.3%), the incidence of traumatic rupture uterus has become less than half, from 17.1 to 7.8%, and that of scar rupture has increased to more than double (from 11.4 to 23.4%). As regards management, there are improved results seen with conservative repair of the uterus. It was also seen that a subtotal hysterectomy was more commonly resorted to than total hysterectomy in the later decade. There was a decrease in the overall morbidity from 42.8 to 35.9% and also in the mortality rate from 24.3 to 18.7%.

Mycoplasma hominis infections in female genital tract & use of immunofluorescence for antibody detection.

A total of 325 women with genital tract infection and 108 healthy controls were screened for the presence of mycoplasmas. Of these, 325 patients, mycoplasmas were recovered in 186. Thirty five isolates were M. hominis and 151 isolates of Ureaplasma urealyticum. The fluorescent-antibody technique (FAT) has been employed for the rapid identification of mycoplasma colonies growing on agar plates. The method was found to be rapid for detection of M. hominis growing on primary isolation plates. The antibody titre of patient's serum was also detected by FAT. Patients' sera were diluted four fold from 1:4 to 1:256 dilutions. In 7 patients fluorescence was seen with 1:16 serum dilution, in 18 with 1:64 dilution and in 3 with 1:256. The immunofluorescence test gave a sensitivity of 96.66 per cent, specificity of 95.0 per cent, with percentage of false negativity and false positivity being 3.45 and 5.0 per cent respectively.

Blood cardioplegia--a comparative clinical and laboratory study.

A prospective comparative study was undertaken to determine quality of myocardial preservation during open heart surgery by crystalloid and blood cardioplegic solutions. Total 55 consecutive patients were studied. Alternate patients received blood and crystalloid cardioplegia at random. Group I had 30 patients who received crystalloid cardioplegia, and group II, with 25 patients, received blood cardioplegia. The efficacy of two solutions was assessed by serum enzyme estimation of creatinine phosphokinase, M.B. fraction of creatinine phosphokinase and serum glutamate oxalate transferase (CPK, CPK-MB, SGOT), electron microscopic study of Left Ventricular biopsy and clinical assessment of post anoxic cardiac performance. Group II patients had lower serum enzyme levels, lesser microscopic myocardial damage, and better cardiac performance during immediate post-operative period, thus proving superiority of myocardial protection by blood cardioplegia.