Endoscopic management of large bile duct stones by mechanical lithotripsy.

OBJECTIVE: Our experience in treating large common bile duct stones using Olympus basket mechanical lithotripter (BML 2Q) and Soehendra lithotripter is reported. METHODS: Between July 1990 and December 1993, twenty two patients with common bile duct stones too large to be extracted by Dormia basket or balloon were treated with BML lithotripter or Soehendra lithotripter. RESULTS: The stone diameters ranged from 1.5 to 2.8 cm. Fourteen patients required one session of lithotripsy, four patients two sessions each, and two patients three sessions each. BML lithotripter was used in 14 patients. In the remaining eight patients the stones were fragmented with Soehendra lithotripter when the basket got impacted while attempting extraction. Mechanical lithotripsy was successful in 20 patients (91%). Indwelling stent was used in one patient; one patient underwent surgery. CONCLUSION: Mechanical lithotripsy is safe for the treatment of large common bile duct stones, with a success rate above ninety percent.

Course of severe ulcerative colitis in northern India.

Thirty patients with severe ulcerative colitis were studied prospectively. Sixty percent (18/30) of severe ulcerative colitis were in remission after mean duration of 9.2 days (range 2-20 days) of intensive intravenous therapy without major side effects of steroids. Factors predicting poor response to medical therapy on admission are: stool frequency > or = 9 per day, pulse rate > or = 120/minute, temperature > or = 38 degrees C, Albumin < or = 2 gm, mucosal tags on plain x-ray abdomen and pancolitis.

Esophageal prosthesis in palliation of malignant esophageal obstruction.

Esophageal intubation with a plastic prosthesis is a well established palliative treatment for esophageal carcinoma. The technique is safer with endoscopy than previous surgical techniques. Advantages of stent include rapid and long lasting relief of dysphagia in most patients with carcinoma esophagus. Repeated procedures are not required. Placement of prosthesis is the treatment of choice in BEF. Cost is less compared to other palliative modalities such as laser. SEMS have distinct advantages over conventional prosthesis as they may be inserted with less trauma and fewer complications. Diet needs occasionally to be limited to soft or blenderized foods to prevent occlusion. A disadvantage of uncovered SEMS is short duration of palliation due to tumor ingrowth which can be overcome with availability of covered SEMS. Starvation is the most common cause of death in patients with esophageal malignancy. Prosthesis combats deterioration and leads to rapid weight gain. Overall, single time procedure without general anaesthesia, short hospital stay and immediate improvement in dysphagia are considerable gains.

Evaluation of significance of AgNOR counts in differentiating benign from malignant lesions in the breast.

Nucleolar organizer regions (NORs) have been identified by means of an argyrophilic technique (AgNOR) in routinely processed formalin-fixed paraffin sections of breast lesions. 85 cases of different breast lesions were examined. The AgNOR counts were, normal breast 1.2 (1.0-1.5) Fibroadenoma 1.74 (1.6-2.7), purely cystic disease 1.6 (1.5-1.82) adenosis 2.1 (1.7-2.8), Epitheliosis 2.4 (1.9-3.2) gynaecomastia 3.7 (3.6-4.7), Noninvasive caccinoma 2.8 (2.6-4.4) invasive carcimomas 3.89 (2.7-9.9) i.e. mean AgNOR counts between benign and malignant lesions. Also gynaecomastia, a benign condition had a high mean AgNOR count. There was no significant difference in the mean AgNOR count of various types of invasive breast caninoma. Higher the histological grade, higher was the AgNOR count. To conclude, AgNOR technique does not enable a clear distinction between benign & malignant lesions. But, it could be used with other prognostic indices to predict the behaviour of breast malignancy.

Tuberculosis in ulcerative colitis: bird in the bush.

Records of one hundred and two patients with idiopathic ulcerative colitis were retrospectively studied to estimate the prevalence of associated tuberculosis. There were 49 males and 53 females with a mean age of 33 +/- 13 years. Seven patients (3 pulmonary and 4 intestinal) had associated tuberculosis. All patients with intestinal tuberculosis were females and had small bowel involvement. Patients with co-existing tuberculosis were on steroids at the time of presentation and responded well to anti tubercular treatment with gradual weight gain and remission of diarrhoea and fever. We conclude that in India, the prevalence of tuberculosis is high in patients with idiopathic ulcerative colitis on steroids and a high degree of suspicion is required to detect these cases.