Pancreatic ketoacidosis-a rare case report

Euglycemic Pancreatic Ketoacidosis is a syndrome of high anion gap acidosis in which the high anion gap is due to elevated serum ketone bodies comprising of acetone, aceto- acetate and beta hydroxyl-butyrate, due to increased peripheral adipose tissue breakdown by elevated serum lipase as a consequence of acute pancreatitis with normal blood glucose levels. There are multiple causes for ketonuria and/or ketonemia with or without acidosis like uncontrolled diabetes mellitus, usually of the insulin dependent type (diabetic ketoacidosis), lactic acidosis, prolonged starvation (starvation ketosis), ethanol ingestion (alcoholic ketoacidosis), sepsis, pregnancy and vomiting. Our patient was not a known diabetic and his blood glucose were always within normal limits, so this ketoacidosis cannot be attributed to Diabetes Mellitus. It cannot be attributed to starvation as our patient was not fasting when he got admitted and furthermore ketoacidosis is not a frequent manifestation of starvation adding to it that we transfused adequate amount of DNS and resumed oral intake during our observation period. It cannot be attributed to vomiting as our patient had only two episodes of vomiting. Our patient does not have any liver or kidney pathology and there is no history or evidence of alcohol intoxication. But, acute pancreatitis without diabetes-mellitus, causing ketoacidosis is a very rare presentation which is caused by high levels of pancreatic lipase in the circulation.

Juvenile recurrent respiratory papillomatosis: A rare masquerade of asthma

Juvenile recurrent respiratory papillomatosis (JRRP) is a rare condition. The varied presentation of this condition predisposes to misdiagnosis and potential life-threatening airway obstruction. In this paper, we have reported a case of JRRP presenting as severe respiratory distress and consequently mistreated as asthmatic attack culminating in a near fatal acute airway obstruction.

Anti-inflammatory effect of the serratiopeptidase – rationale or fashionable: A study in rat paw oedema model induced by the carrageenan.

Introduction – Many drugs, including serratiopeptidases, are marketed without proven efficacy in clinical trials. It is protein in nature and claimed to be effective orally. Methods – 24 albino wistar rats, 6 each in following groups were assigned – (1) Control group (distilled water, orally) (2) Diclofenac (6.75 mg/kg, IP) (3) serratiopeptidase (5.4 mg/kg, orally) (4) Combination of serratiopeptidase (5.4 mg/kg, orally) and diclofenac (2.25 mg/kg, IP). Inflammatory agent, carrageenan (0.1 ml of 1% w/v) was injected subcutaneously in the ether anesthetized rat hind paw, half an hour after the administration of drug. Rat paw volume up to lateral malleolar process was recorded with plethysmometer at various time periods. Results – Percentage formation and inhibition of oedema in serratiopeptidase or combination groups were not significantly different than control group. Both were significantly less for diclofenac group. Conclusion – Serratiopeptidase was not effective in this animal model of oedema/inflammation.

Late rejection after transabdominal pre-peritoneal inguinal repair: laparoscopic extraction of mesh.

We report a 29-year-old man who developed mesh rejection 3 years after laparoscopic transabdominal pre-peritoneal inguinal repair. The mesh, which was lying in a fluid cavity adherent to the urinary bladder and right iliac vessel, was removed laparoscopically.

Gingival fibromatosis and growth hormone deficiency syndrome--report of a rare case and review of literature.

Oikarinen et al in 1989 reported a syndrome associated with generalized gingival fibromatosis and growth hormone deficiency. This is a case report of a 15-year-old female patient who presented to the Government Dental College, Chennai with generalized gingival fibromatosis and growth hormone deficiency. Interestingly, the histopathology of the excised gingival overgrowth showed dense collagenous connective tissue in which were strewn calcified structures that resembled cementum. This syndrome is being reported for the second time after its first case report in 1989 by Oikarinen et al. We are herewith reporting this case for its rarity with a brief review of literature of syndromes associated with generalized gingival fibromatosis.

Blood basopenia as an indicator of ovulation.

Direct basophil counts were done on capillary blood samples in thirteen normal young women, during the different phases of their menstrual cycles. Mean basophil counts during the follicular and progestational phases were 36.6/cumm and 39.3/cumm respectively. A significant midcycle fall in counts of 36% and a premenstrual fall of 22% were observed. These changes are probably due to migration of the cells from the peripheral blood into the rupturing follicle of the ovary and into the ischemic premenstrual endometrium.