A pancreaticographic study of malnutrition-related diabetes mellitus.

Pancreatic involvement is considered to be the hallmark of malnutrition-related diabetes mellitus (MRDM). Of the 2 subgroups of the disease, fibrocalculous pancreatic diabetes (FCPD) is characterized by pancreatic calcification. The nature of pancreatic abnormalities in MRDM have not been studied extensively in Indian patients. The present study was designed to compare pancreatic abnormalities (exocrine and endocrine) including endoscopic retrograde pancreaticography in patients with FCPD and protein deficient pancreatic diabetes (PDPD), in relation to controls. Ten patients each of FCPD and PDPD were studied with regard to clinical features, biochemical exocrine and endocrine pancreatic responses, C-peptide response, islet cell antibody, and pancreatographic changes. Five normal pancreatograms were taken as control. Clinical and biochemical features in patient with FCPD and PDPD were as follows: pain in 8 and 2 patients, respectively; the mean duration of diabetes was similar in both groups (62.28 +/- 71.92 months V. 72 +/- 50.9 months); and faecal fat excretion and insulin requirements were comparable in both groups. The main pancreatic duct was dilated in 6 of 10 patient with FCPD and only 1 of 10 with PDPD on ultrasonography. On pancreatography the duct was dilated in 9 of 10 patients with FCPD and only 1 of 10 patients with PDPD. The number of side branches was reduced in all cases with MRDM; in those with FCPD, these were stunted and dilated while in PDPD side branches are thin and spastic. We conclude that pancreatic ductal changes involving the main duct and side branches are more frequent in patients with FCPD as compared to those with PDPD.

Laparoscopy assisted hemi-colectomy for ileo-caecal tuberculosis.

Laparoscopy assisted hemicolectomy for ileo-caecal tuberculosis is being evaluated the world over. Several procedures are performed laparoscopically, including the laparoscopic hemicolectomy, for benign and malignant diseases. Abdominal tuberculosis is one of the commonest causes of intestinal obstruction in India. We have evaluated the role of laparoscopic resection of ileocaecal tuberculosis and successfully performed the procedure in five patients. The clinical profiles of patients and operative procedure are discussed in this article with a brief review of the literature.

Intrabiliary rupture of hepatic hydatid cyst--imaging features.

Intrabiliary rupture leading to biliary obstruction is a rare but serious presentation of hepatic echinococcosis. Four such cases are presented. Imaging studies including sonography, computed tomography and/or cholangiography, done in all patients led to a definite preoperative diagnosis which was later confirmed at surgery. Biliary tree dilatation was detected in three out of four patients, hydatid contents were seen in three patients and definite cysto-biliary communication was documented in two.

Biliary strictures on ERCP: a study in northern India.

Case records of 82 patients with biliary stricture diagnosed on endoscopic retrograde cholangiopancreatography (ERCP) during a 7-years period (1983-89) were analysed for its aetiology, clinical presentation, laboratory abnormalities and radiological characteristics. The aetiology was found to be benign in 59 and malignant in 23 patients. Forty seven percent of all strictures were post cholecystectomy strictures (PCS). Presence of mucosal irregularity and incomplete stricture were commoner with malignancy. Malignant biliary strictures (MBS) were commonly seen in males, occurred at older age, had short history, had higher alkaline phosphtase and serum bilirubin values when compared to patients with benign biliary strictures (BBS).

Variations in blood pressure of adolescents in relation to sex and social factors in a rural area of Haryana.

Adolescent students of a rural block were studied to find out variation in blood pressure in relation to sex, caste and socioeconomic status. Females had significantly higher mean values of blood pressure; both systolic and diastolic. There was significant variation in systolic blood pressure amongst adolescents of various socio- economic classes. Prevalence of systolic hypertension (95 percentile) was higher in adolescents of upper middle social class and diastolic hypertension in Prestige castes. It is suggested that screening for hypertension should be done at school leaving age and high risk adolescents should be advised about periodic check-up, proper diet, salt restrictions and exercise so that frank hypertension could be prevented in adulthood.

Pancreatic pseudocyst of the kidney: computed tomographic diagnosis.

An unusual location of pancreatic pseudocyst in the renal parenchyma in a patient of chronic calcific pancreatitis is reported. The role of computed tomography in its detection is also high-lighted.

Association between incidence of lipoprotein(a) positivity and coronary heart disease.

Serum samples from 167 (109 male, 58 female) hospital based staff as controls and 760 (596 male and 164 female) clinically documented patients of coronary heart disease (CHD) were subjected to 3.75% polyacrylamide gel electrophoresis for lipoprotein profile and the presence of lipoprotein(a) [LP(a)], which is reported to be an independent risk factor for CHD. Serum total cholesterol, triglyceride and ratio of the electrophoretically separated LDL/HDL lipoprotein fractions were also evaluated. The significant observations are (i) a large proportion of both male and female CHD patients showed the presence of LP(a) as compared to controls, (ii) The incidence of LP(a) positivity was found to be independent of sex and age in controls. Female patients however showed marginal increase (p < 0.05) with age. Male patients of < 40 years demonstrated three times higher incidence of LP(a) presence as compared to their female counterparts, (iii) Comparison of LP(a)+ and LP(a)- patients for serum lipid levels did not show any significant difference. It is inferred that LP(a) positivity may be independent of these lipid variables.

Normal endoscopic pancreatogram in an Indian referral hospital.

A total of 101 normal pancreatograms were analysed in a major referral hospital in India in an attempt to establish normal standards of pancreatic ductal morphology in Indian population. Ductal position, course, caliber, length and variations of anatomy were analysed. Most often (39%) ampulla was seen at the level of second lumbar vertebra, commonly (54%) within 30-39 mm from the lateral margin of right side of corresponding vertebral body. Most common ductal course (21.78%) was ascending-horizontal-horizontal type. Mean ductal diameters in the head, body and tail of the pancreas were 2.63, 1.95, 0.99 mm in individuals aged less than or equal to 40 yr and 3.31, 2.34, 1.23 mm in those greater than 40 yr, respectively. A significant (r = 0.46; P less than 0.001) increase in ductal size was seen between less than or equal to 40 yr and after 40 yr of age. Mean ductal length was 16.10 and 16.58 cm in subjects less than or equal to 40 yr of age and greater than 40 yr respectively. Duct of Santorini was visualised in 6.6 per cent subjects.

The missing eyeball--CT evaluation (a case report).

A case of blow out fracture of the medial wall and floor of the orbit with herniation of the eyeball into the ethmoid sinus diagnosed on CT scan is reported. To the best of our knowledge there is no previous report of prolapse of eyeball into the ethmoid sinus.

Radiologic approach to choledochal cysts.

Choledochal cysts, being uncommon and having a nonspecific presentation, require a high index of suspicion for their diagnosis. In this series of 11 patients, the correct diagnosis was established in all using a combination of real-time ultrasound (US) scanning (9 positive) and endoscopic retrograde cholangiopancreatography (ERCP; 10 positive). Real-time US is suitable as the initial imaging modality and ERCP is complementary.

Duodenoscopic sphincterotomy in a northern Indian hospital.

In a 36-month period, 154 duodenoscopic sphincterotomies (DS) were performed on 120 patients in a Northern Indian hospital. The major indication for DS was choledocholithiasis (95.8%), the rest being done for indications like papillary stenosis, periampullary carcinoma and the sump syndrome. Seven patients (5.8%) had significant associated medical illnesses. An adequate sphincterotomy was achieved in 91.6% of patients, with successful stone extraction in 95.3% of them. Overall clearance of the common bile duct (CBD) was thus achieved in 87.5% of the patients subjected to DS. Two patients (1.7%) died after undergoing DS, and six (5%) experienced early complications that necessitated emergency operation in two of them (1.7%). DS appears to be the treatment of choice for the management of choledocholithiasis in the postcholecystectomy patient as well as in the patient with gallbladder in situ who has cholangitis or jaundice or associated medical illness that may constitute a high risk for surgery.