ARDS in a case of vesicular mole with secondary hyperthyroidism.

Vesicular mole is best regarded as a benign neoplasia of the chorion with malignant potentials. In India, the prevalence is one in four hundred pregnancies.We present one such case who presented with thyrotoxicosis and pulmonary edema.

Hepatocellular failure in glycogen storage disorder type 3.

A case of a 21 years male patient with type 3 glycogen storage disorder diagnosed at necropsy, who died suddenly with hypovolemic shock following a massive upper gastrointestinal bleeding due to hepatocellular failure is reported. Salient features of GSD type 3 are briefly discussed.

Efficacy and tolerability of a combination of ofloxacin and tinidazole in the management of infectious diabetic foot ulcer.

The management of infectious diabetic foot ulcers is a major concern. Various treatment modalities are used. The efficacy and tolerability of a combination of ofloxacin and tinidazole in diabetic foot ulcer has been assessed in 60 patients in the present trial. The results are promising.

Neuroleptic malignant syndrome: an experience of four cases.

We report four cases of neuroleptic malignant syndrome occurring after administration of a typical antipsychotic haloperidol and a newer atypical antipsychotic clozapine. The management of these patients is discussed.

Acute accidental exposure to chlorine fumes--a study of 82 cases.

Eighty-two patients were hospitalized following an accidental exposure to chlorine. All patients presented with dyspnoea and cough. The other symptoms included irritation of throat (53.6%), irritation of eyes (42.3%), headache (29.2%), abdominal pain (26.8%), vomiting (24.3%) and giddiness (9.7%). All of them had bronchospasm and 5 (6%) had cyanosis at the onset. An x-ray of the chest revealed patchy infiltrates in 3 (3.85%) and hilar congestion in 2 (2.44%). Pulmonary function tests showed an obstructive pattern in 27.4%, restrictive in 3.25% and mixed in 53.2%. Pulmonary functions were normal in 16.1% of the patients. Bronchoscopy revealed tracheobronchial mucosal congestion in all cases, hemorrhagic spots in 35.7%, erosions and ulcers in 12.5%. All patients were treated with oxygen, aminophylline, hydrocortisone and antibiotics. Haematemesis (n = 1) and pulmonary oedema (n = 2) developed 12 hours after the admission. Two other patients developed pneumonia 48 hours later. All patients recovered satisfactorily. On follow-up 16 patients had no sequelae after one year. Pulmonary functions were normal in 5 patients after 3 years of follow-up.

Captopril--nifedipine interaction in hypertension.

Nifedipine, a calcium channel blocker exerts significant peripheral vasodilatory activity in hypertensive patients. It has been postulated that the antihypertensive effect of peripherally acting vasodilators is masked, by counter regulatory mechanism e.g. activation of renin-angiotensin aldosterone (RAA) axis. The present work was undertaken to study the effect of blockade of RAA axis using captopril, an angiotensin converting enzyme inhibitor on the blood pressure lowering activity of nifedipine. Pretreatment with captopril in a dose of 25 mg. bd was carried out for 4 weeks in one group of 10 patients before administering nifedipine 10 mg bd for 4 weeks. The other matched group of 10 patients received nifedipine alone in the same dose. It was observed that although captopril by itself had no appreciable effect on blood pressure in the dose used, it significantly enhanced the blood pressure lowering activity of nifedipine. It appears that counterregulatory mechanisms play an important role in determining the net antihypertensive effect of peripheral vasodilators.