Clinical and biochemical profiles of young diabetics in North-Eastern India.

OBJECTIVE: We compared the clinical and biochemical profiles of young diabetics in North Eastern India. METHODS: Seventy diabetics who were detected at less than 30 years of age were studied. Patients with ketoacidosis or ketonuria on insulin withdrawal were grouped as insulin dependent diabetes mellitus (IDDM), patients with history of chronic abdominal pain with or without exocrine pancreatic dysfunction who either on ultrasonography (USG) or endoscopic retrograde cholangiopancreaticoduodenography (ERCP) revealed pancreatic calcification and/or ductal dilatation were grouped as fibrocalculous pancreatic diabetes (FCPD), those having BMI < 19 kg/m2 with history or stigmata of childhood malnutrition and who were ketosis resistant were taken to be protein deficient diabetes mellitus (PDDM)/malnutrition modulated diabetes mellitus (MMDM) and those who neither had ketonuria nor history of chronic abdominal pain, malabsorption or stigmata of malnutrition were grouped as NIDDM of young (NIDDY). RESULTS: Amongst the young diabetics studied FCPD constituted 32.9%, IDDM 28.6%, MMDM 21.4% and NIDDY 17.11%. USG abnormalities were observed in 21 of the 23 patients of FCPD. Seven out of these showed pancreatic head calcification on X-ray while 14 showed pancreatic duct dilatation and calcification or calculi on USG. In the two remaining patients, ERCP revealed tortuousity of main pancreatic duct and calcification which were not detected on USG. Majority of FCPD and MMDM patients revealed insulin resistance on insulin tolerance test (ITT). HDL was significantly lower in NIDDY, while VLDL and triglycerides were significantly higher in FCPD and MMDM as compared to controls. Microvascular complications of diabetes were seen in all these groups, with peripheral neuropathy being more common in FCPD (43.5%) and background diabetic retinopathy in NIDDY (41%). CONCLUSIONS: We conclude that FCPD and MMDM together form majority (54.29%) of young diabetics at our center and a sizeable proportion of them may have microvascular complications, even at the time of diagnosis.

Effect of Piper longum Linn, Zingiber officianalis Linn and Ferula species on gastric ulceration and secretion in rats.

Use of Dipaniya Mahakasaya, a group consisting of 10 herbal drugs, has been suggested in Charaka Samhita to improve digestion. Out of these 10 plants, three, viz. P. longum (water decoction), Z. officianalis (water decoction) and Ferula species (colloidal solution) were studied for their antiulcer and mechanism of antiulcer effects in rats. All the drugs in the dose of 50 mg/kg, p.o., 60 min prior to experiment, showed significant protection against gastric ulcers induced by 2 hr cold restraint stress, aspirin (200 mg/kg, 4 hr) and 4 hr pylorus ligation. The antiulcerogenic effect seemed to be due to the augmentation of mucin secretion and decreased cell shedding rather than offensive acid and pepsin secretion which however, were found to be increased by them.

Evaluation of Manning's criteria in the diagnosis of irritable bowel syndrome.

Six symptoms of Manning et al are widely used in clinical practice to diagnose irritable bowel syndrome (IBS). We studied 123 patients to evaluate the diagnostic value of Manning's criteria, using a preformed bowel symptom questionnaire which included these six symptoms. This study included 65 patients with IBS, 35 patients with non-ulcer dyspepsia, 23 patients with organic diseases of colon and 45 healthy controls. Sensitivity of presence of three or more symptoms of Manning's criteria discriminating irritable bowel syndrome from all other groups was 66.1%. Manning's criteria discriminated irritable bowel syndrome from organic diseases of colon with specificity and positive predictive value of 66.9% and 82.6%. When irritable bowel syndrome was compared with non-ulcer dyspepsia and healthy controls, specificities of Manning's criteria were 91.4% and 93.3% and positive predictive values 93.4% and 93.4% respectively.

Obstructive jaundice--a diagnostic appraisal.

One hundred and eight suspected cases of obstructive jaundice (OJ) were analysed using ultrasonography, percutaneous transhepatic cholangiography (PTC) or Endoscopic retrograde cholangiopancreatography (ERCP) or both. Clinical evaluation had accuracy of 93% in identifying OJ and establishing aetiology in 62%, however, it lacked specificity. Ultrasonography was useful in differentiating obstructive jaundice from medical jaundice in 91% of cases. However, the cause and site of biliary obstruction could be identified in 55% and 46% respectively. PTC was helpful in detecting the site of obstruction in 80.4% and nature in 63% of cases. Its failures were mostly associated with the presence of metastasis in the liver. ERCP successfully attained cholangiography in 58% and pancreatogram in 70% of cases. Overall diagnostic yield of ERCP was 67% in view of additional endoscopic findings in 18 cases. The complications were occasional and could be managed effectively with medical treatment. This study suggests utility of clinical evaluation in OJ inspite of its poor specificity and comparative value of PTC and ERCP in establishing the site as well as nature of lesion.

Ultrasonographic patterns of hepatobiliary mass lesions.

The study deals with an analysis of ultrasonographic (USG) patterns in 100 consecutive patients with hepatobiliary mass lesions. Amoebic liver abscess, carcinoma (CA) gall bladder and secondaries in liver comprised nearly 70% of cases. USG appearances in liver abscess, hepatoma, secondaries in liver and CA gall bladder were variable, but were characteristic in hydatid disease and congenital polycystic disease. Two patients with cholangiocarcinoma revealed dilated biliary channels with an intraluminal mass in common bile duct.

Endoscopic sphincterotomy: preliminary experience at a university hospital.

Endoscopic sphincterotomy (ES) was attempted in 38 patients with biliary calculi. There were 21 patients (55.3%) with common bile duct (CBD) stones following cholecystectomy, 14 patients (36.8%) with intact gall bladder and 3 patients with retained CBD stones along with T tube in the early post-operative period. Endoscopic sphincterotomy was possible in all but one patient and duct clearance was attained in 34 (89.4%) patients. Spontaneous clearance of calculi occurred in 31 (81.6%) patients while 3 patients required instrumental extraction. Four patients failed to clear stones and required surgical intervention. Complications occurred in 4 (10.5%) patients--haemorrhage in two, pancreatitis and cholangitis in one each. One patient died of bleeding on the 4th day following ES while hemostasis was achieved in other after two units of blood. Other complications were managed conservatively without any mortality. Endoscopic sphincterotomy appears to be a simple, effective and safe therapeutic modality for the management of biliary calculi.

Serum adenosine deaminase in pulmonary tuberculosis, malignancy and non-tubercular respiratory diseases.

The study has been conducted to find out the serum ADA levels in 120 patients with various pulmonary diseases which included patients with tubercular pleural effusion (n = 86), lung cancer (n = 10) and patients with non-tubercular pulmonary diseases like pneumonia, etc (n = 24). Twenty healthy individuals served as control subjects. The mean (+/- SD) of ADA activity was 23.38 (4.47), 7.29 (1.08), 12.71 (1.95) and 2.23 (1.00) units/litre in tuberculosis, malignancy, non-tubercular pulmonary diseases and healthy controls respectively with significant difference between each other (P less than 0.001). Patients with tuberculosis (100%) fall in 97% sensitivity range with a lower cut off limit at 17 units/litre ADA activity, while for malignancy and non-tubercular respiratory diseases, the sensitivity was 90% and 83% respectively. Within the sensitivity limits, the serum ADA activity can be used for the differential diagnosis of pulmonary diseases.

Gastro-esophageal reflux disease (GERD): an appraisal of different tests for diagnosis.

Fifty symptomatic patients with GERD, 20 each of non ulcer dyspepsia (NUD) & duodenal ulcer (DU) and 10 healthy controls were subjected to various tests employed for diagnosis of GERD. Among these endoscopy and histology had highest sensitivities (92% & 91% respectively) followed by Bernstein's test (overall 88%; early positivity 72%) and oesophagography (70%). The specificities of various tests were: endoscopy (86%), histology (82%) and Bernstein's test (overall 80%; early positive 94%). The false positivity was mainly in DU subjects where majority (greater than 84%) had two or more of these tests offitive. Any two of the three tests (endoscopy, histology & Bernstein's test) in combination had a sensitivity of 80-91% and a specificity of 90-92%. Our observations suggest that these tests, particularly in combination, are useful in establishing the diagnosis of GERD and that subclinical oesophagitis in DU might be responsible for the false positivity of these tests.

Highly specific sites of prolactin binding in benign and malignant breast tissue.

An immunocytochemical method involving the application of polyclonal antisera to human prolactin (PRL) followed by a highly sensitive and a modified version of dinitrophenyl (DNP) hapten sandwich staining procedure using anti-DNP IgM monoclonal antibody has been used to detect PRL binding in benign and malignant breast tissue. The technique was applied to 5 microns thick sections of paraffin embedded formalin fixed tissue. Out of 107 breast biopsies 40 were carcinomas, 41 were fibroadenomas, 18 were benign cystic disease and 8 were gynaecomastia. In cases of carcinoma positive staining was observed in 82.5% cases whereas in fibroadenoma the positivity was in 57% cases only. The positive reaction in fibroadenoma was mainly due to the presence of apocrine metaplasia associated with the tumour. Also PRL was present in greater proportion in post menopausal patients as compared to premenopausal cancer patients. These findings suggest the presence of specific PRL binding sites in breast tissue. The staining was restricted to epithelial cells and background staining of the stroma was minimally seen in these cases. Positively stained breast carcinoma may represent an apocrine subset of the carcinoma.

Medical myotomy for achalasia cardia. Long term results.

Pneumatic dilatation was effective in relieving dysphagia in 16/17 subjects with achalasia cardia. It was also effective and safe in those with sigmoid oesophagus, although dilatation persisted in them. Recurrences were noted in one quarter of cases which were managed satisfactorily with subsequent dilatations. There were no complications. Pneumatic dilatation appears very useful in the management of achalasia cardia.

Time dependent effects of hormones on rate of protein synthesis in lymphoid organs of chickens.

Total protein content in blood serum and different lymphoid organs, such as bursa, spleen and thymus was investigated in chickens at two different circadian stages (0800 or 1600 hrs; early or late photophase) following administration of either saline or hormones (thyroxine or hydrocortisone or epinephrine). The results suggest that the lymphoid organs may respond differently to the exogenous administration of different hormones depending on the time of their administration.

Serum cations (calcium and magnesium) in leprosy.

Serum cations (calcium and magnesium) were studied in 80 leprosy patients and 40 normal healthy individuals to find out the correlation between the clinical status of leprosy with these cations levels in the serum. There was significant decrease of serum calcium in lepromatous leprosy (7.42 +/- 0.7 mg%, t = 14.12, P less than 0.001), which seems to be related with the extent of leprosy lesions and duration of illness as few patients (22.2%) with minimal lesions and shorter duration of illness had serum calcium within normal range. Serum magnesium was significantly decreased in all types of leprosy cases and lepromatous leprosy patients showed highly significant decrease in serum magnesium level (1.02 +/- 0.2 mEq/L, t = 14.54, P less than 0.001).