Cerebral venous sinus thrombosis as presenting feature of Crohn's disease.

Hepatobiliary and vascular manifestations are rare form of extraintestinal manifestations in Crohn's disease. We report a 20-year-old man in whom cerebral venous sinus thrombosis was the presenting symptom and preceded the diagnosis of Crohn's disease.

Toxic megacolon in a renal allograft recipient with cytomegalovirus colitis.

We report a 35-year-old man, a renal allograft recipient, who presented with toxic megacolon. Segmental biopsies from the colon were consistent with cytomegalovirus colitis. Serum polymerase chain reaction for cytomegalovirus DNA confirmed the diagnosis. He was treated with ganciclovir but, though his abdominal condition improved initially, he worsened later and succumbed to his illness.

VIPoma of pancreas in a child.

An eleven-year-old girl had massive watery diarrhea. She was found to have pancreatic VIPoma. It responded favorably to surgical resection of the tumor. There was no tumor recurrence at 18 months of follow-up.

Tracheo-bronchial remnants: a rare cause of dysphagia.

A 14-year-old girl presented with dysphagia since the age of one year. Investigations revealed two strictures at the lower esophagus. Endoscopic mucosal biopsy from the strictures showed pseudostratified columnar epithelium suggesting that tracheobronchial remnants was the cause of the stenosis. Esophageal dilatation failed to relieve her symptoms.

Gastrointestinal problems in the elderly.

Improvements in nutrition and health care have led to increased life expectancy in our country, which occasioned this review of gastrointestinal problems in the elderly. Some gastrointestinal symptoms may be secondary to age-related physiological changes (e.g., presbyoesophagus). Certain diseases (e.g., diverticulosis) may be more common in the elderly. On the other hand, the elderly may have unusual presentations of common diseases (e.g., complicated peptic ulcer disease). Each of these types of problems has been detailed in this review. Included is a preliminary analysis of hospitalised elderly patients which illuminates serious gastrointestinal problems afflicting the elderly in India.

Fibrocalculus pancreatic diabetes in western Orissa.

Skiagram proved 35 cases of fibrocalculus pancreatic diabetes in order to analyse the clinical profile and its correlation with different descriptive epidemiological parameters were studied. Mean age was 25.17 +/- 7.85 years and male to female ratio was 6:1; 65.7% patients were poor (income < Rs 500 per month) and another 28.6% having average income (Rs 500 to Rs 1,000 per month); 74.3% came from rural areas having a family size of about > or = 7 members and sanitation was poor in all the cases. Mean body mass index was 15.93 +/- 3. Severe diabetes (ie, fasting blood sugar level > 251 mg%) and moderately severe diabetes (ie, fasting blood sugar level > 181 mg% but < 250 mg%) were noted in 51.4% and 11.4% cases respectively. Recurrent pain abdomen, infections, neuropathy, retinopathy, nephropathy and keto-acidosis were observed in 52.2%, 40.0%, 42.9%, 8.6%, 11.4% and 2.9% cases respectively. Mean soluble insulin requirement was 41.81 +/- 13.94 units. Four cases in whom pancreatic lithotomy was done, showed less insulin requirement and disappearance of pain. Parotid swelling, chronic diarrhoea and insulin resistance were not observed. Insulin requirement, epidemiological and biochemical parameters were similar to other young diabetics.

Schmidt's syndrome.

Schmidt's syndrome is a condition where there is auto-immune Addison's disease associated with primary hypothyroidism. We present one such case in view of its rarity in Indian literature.