Methyl ethyl ketone peroxide ingestion: A rare cause of corrosive chemical poisoning.

Methyl ethyl ketone peroxide, commonly used in the lamination industry, is a highly inflammable substance. Ingestion of methyl ethyl ketone peroxide is associated with a high morbidity and mortality. It can cause injury to the gastrointestinal tract on ingestion, leading to gangrene or perforation. Gastric lavage is contraindicated as it is a highly corrosive substance. We report a patient with poisoning due to methyl ethyl ketone peroxide who presented with upper gastrointestinal bleeding, and developed gangrene of the bowel and died of septicaemia and multiorgan failure.

Myelopathy during treatment of autoimmune hemolytic anaemia.

A specific neurological syndrome resembling, subacute combined degeneration of spinal cord, has been observed to occur during treatment of autoimmune hemolytic anaemia (AHA). We propose that folate administration can precipitate this neurological syndrome in patients with subclinical deficiency of vitamin B12, a phenomenon more likely to occur in tropical countries. Such cases have not been previously reported.

Isolated splenic tuberculosis.

The authors report two cases of isolated splenic tuberculosis treated since 1989 in Nizam's Institute of Medical Sciences. One case presented as pyrexia of unknown origin (PUO) and another with idiopathic thrombocytopenic purpura (ITP). Both were found to have splenic tuberculosis after splenectomy. Pre operative diagnosis could not be made in these cases. Splenectomy followed by antituberculous chemotherapy cured the condition in both the cases. The authors underline the diagnostic difficulties, essentially related to the rarity of this condition inspite of the progress in modern imaging.

Snake bite presenting as acute myocardial infarction, ischaemic cerebrovascular accident, acute renal failure and disseminated intravascular coagulopathy.

An unusual presentation of a viperine snake bite presenting with ischaemic damage to the major organs like brain and heart leading to cerebrovascular accident and acute myocardial infarction along with acute renal failure and disseminated intravascular coagulopathy (DIC) is described in this report.

Clinical profile of falciparum malaria in a tertiary care hospital.

Falciparum malaria presents with protean manifestations and is associated with a variety of complications and has a high mortality. One hundred and fifty-eight consecutive cases of falciparum malaria were studied with respect to the clinical presentation, complications, and response to treatment. The mean age of patients was 38.60 +/- 15.45 years and majority of them were males i.e., males being 110 (69.62%) and females being 48 (30.37%). The commonest presenting manifestations were fever with chill and rigor (98.10%), altered sensorium (48.10%), algid malaria (18.35%), and jaundice (27.21%). The other presenting features being oliguria (6.96%) and bleeding manifestations due to disseminated intravascular coagulation (DIC) (4.43%). The frequently encountered complications were anaemia (74.68%), jaundice (40.50%), cerebral malaria (45.56%), thrombocytopenia (40.50%) and renal failure (24.68%). Most of the patients i.e., 126 (79.74%) recovered with treatment and 32 (20.25%) succumbed. Higher mortality was associated with higher parasite count, presence of complications like anaemia, jaundice, renal failure, DIC, adult respiratory distress syndrome (ARDS), and septicaemia. Most of the deaths were encountered in patients where there was delay in clinical diagnosis, in the pre-hospital phase, and consequent presentation in multiorgan failure. Early diagnosis and institution of specific therapy were rewarding in the remaining patients in this series.

Malignancy in rheumatoid arthritis--a report of two cases.

The development of malignancy in the setting of pre-existing connective tissue disease is well known. We report two cases of rheumatoid arthritis who developed malignancy--multiple myeloma in one of them and carcinoma cervix in the other. Case 1 was a 62 year old man, who developed multiple myeloma three years after the onset of rheumatoid arthritis. Case 2 was a 61 year old female with history of rheumatoid arthritis for two years and who developed carcinoma cervix.