Erythropoietin-induced deep vein thrombosis in myelodysplastic syndrome.

We report a rare case of deep vein thrombosis (DVT) secondary to erythropoietin (EPO) in an 89-year-old patient with myelodysplastic syndrome (MDS). The incidence of EPO-induced thrombotic episode increases with an absolute increase of hemoglobin (Hb) beyond >12 gm/dL or rate of increase of Hb level >1 gm/dL every 2 weeks.

Aicardi syndrome: a report of five Indian cases.

Five Indian cases of Aicardi syndrome, aged 1-13 years and all with the classic triad of infantile spasm, corpus callosal agenesis and chorioretinal lacunae, were presented. The purpose of this report was to demonstrate the clinical, electroencephalographic (EEG) and radiological spectrum and the treatment outcome of this disorder among the Indians. None of the patient had any family history of similar illness. All had profound psychomotor impairment with no meaningful speech development. There were microphthalmia in 2, optic disc coloboma in 1, interhemispheric cyst in 1, periventricular heterotopia in 2 and thoracolumbar kyphoscoliosis in 2 cases. They all had early onset epilepsy and there were multiple types of seizures. Two cases (40%) had the characteristic dissociated burst-suppression pattern in EEG. Two cases whose antiepileptic medications included vigabatrin had complete control of seizure.

Dose-dependent effect of copper chloride on male reproductive function in immature rats.

BACKGROUND: Copper is essential as a trace element for metabolic processes. Exposure to copper in industries develops toxicity among the workers. Previous findings on adverse effects of copper on male reproductive function in adult albino rats led to investigate the effects of this metal on reproductive function of maturing male rats in the present experiment. METHODOLOGY: To study these effects, immature (30 to 35 days old) Wistar strain albino rats weighing about 50-60 g were treated intraperitoneally with copper chloride at doses of 1000, 2000 and 3000 microg/kg body weight/day for 26 days. RESULT: Significant fall in accessory sex organ weight and inhibition of testicular 17beta-hydroxysteroid dehydrogenase activity along with degeneration of testicular growing spermatogenic cells and reduction in serum testosterone, FSH and LH level were observed at the doses of 2000 and 3000microg/kg/day. On the other hand, at the dose of 1000 microg/kg/day significant increase in testicular steroidogenic enzyme activity and stimulation of testicular spermatogenesis along with rise in serum testosterone and LH level were observed, though no significant change was observed in serum FSH level. This suggests that copper has got a dose-dependent effect on testicular steroidogenesis and spermatogenesis and serum testosterone and LH level in maturing male rats.

Necrotizing fasciitis with chickenpox.

Necrotizing fasciitis can be observed in a wide variety of clinical settings in the pediatric age group. But necrotizing fasciitis as a complication of chickenpox is rare. Five cases of necrotizing fasciitis following chickenpox were treated in the authors' institutions. Clinical signs like fever, tachycardia, pallor, erythema, marked edema of the affected area and patchy areas of discoloration or gangrene of the skin were present and were the important clues to the seriousness of infection. Patients were treated with aggressive surgical debridement, frequent dressings, broad-spectrum antibiotics, nutritional support, and split skin grafting. Early diagnosis and aggressive surgical therapy are critical. Literature search showed necrotizing fasciitis following chickenpox has not been reported in India. We feel early suspicion and aggressive management can decrease the morbidity and mortality in this rare complication.

Protection of adrenocortical activity by dietary casein in ether anaesthetized rats.

Adrenal delta5-3beta-hydroxysteroid dehydrogenase (delta5-3beta-HSD) activity and serum corticosterone level were significantly higher in rats fed with 5% casein or 4% albumin diets after 1 hr of ether anaesthetic stress as compared to the controls, 5% casein and 20% casein (equivalent to 4% albumin) respectively. Ether anaesthesia to 20% casein fed rats caused no change in adrenal delta5-3beta-HSD activity and serum corticosterone level when compared with controls fed 20% casein diet. The results suggest that high milk protein diet may prevent acute stress effects by protecting adrenocortical activity. The present investigation opens up a new area of management of stress.

Pyriform sinus fistula.

Pyriform sinus fistulae/sinuses are rare causes of recurrent cervical abscess, especially on the left side. They can also present as acute thyroiditis. Treatment in the form of simple incision and drainage is invariably unsuccessful, and the entity may be confused with the residual tract of a second branchial arch anomaly. We report a case of pyriform sinus fistula, and believe that this is only the second case report in India. We feel that greater awareness can lead to proper and appropriate diagnosis of this anomaly.

Soave procedure for infants with Hirschsprung's disease.

OBJECTIVE: Traditionally the surgical treatment of Hirschsprung's disease (H.D.) includes preliminary colostomy in normally innervated bowel followed by one of several pull through procedures. The transanal single stage Soave procedure eliminated the need for preliminary colostomy and intraabdominal dissection. It is a recent concept in the management of this disease, and this is the first experience to be reported from India. METHODS: Four children aged 3 weeks to one year underwent transanal pull through procedure over a two month period. A rectal mucosectomy was performed starting 0.5 cm. proximal to the dentate line and extending proximally to the level of intraperitoneal rectum. The muscular sleeve was divided circumferentially to allow the full thickness mobilization of the proximal colon. Ganglion cells were confirmed by frozen section and bowel was transected. The rectal muscular cuff was divided longitudinally and the anastomosis was completed. RESULTS: Operative time including the frozen section averaged 160 minutes and average length of the bowel resected was 22 cm. There were no postoperative complications and all patients were discharged on seventh postoperative day. Median follow-up was 5 months (4-6 months) and stool output ranged from 2-4 per day. CONCLUSION: The authors conclude that a single stage transanal Soave's pull through for Hirschsprung's Disease can be performed successfully in infants. When compared to conventional pull through procedure, it has the potential advantage of lower cost, less risk of damage to pelvic structures, absence of any abdominal incision, a lower incidence of intraperitoneal bleeding and adhesion formation. The preliminary functional results suggest that the patients gain early bowel function post operatively without soiling or constipation.

Effect of casein diet on gonadotropin releasing hormone antagonist induced changes in adrenal gonadal functions in male rats.

Adult male rats received daily injections (sc) of gonadotropin releasing hormone antagonist (0.2 mg/kg(-1) x day(-1)) for 21 days when they were sacrificed on day 22, adrenal weight, adrenal A5-3beta (delta 5-3beta) hydroxysteroid dehydrogenase (Delta5-3beta-HSD) activity and serum level of corticosterone were increased significantly while testicular 17beta (17beta) hydroxysteroid dehydrogenase (17beta-HSD) activity and serum level of testosterone and spermatogenesis were decreased in the rats fed on 5% casein diet. GnRH antagonist treated rats fed on 20% casein diet, resulted significant decrease in adrenal weight, serum corticosterone and adrenal A5-3beta-HSD activity while testicular 17beta-HSD activity serum testosterone levels and the weights of sex organs were increased with respect to anti GnRH treated rats fed on 5% casein diet. But the GnRH antagonist treated rats fed on 20% casein diet showed decreased spermatogenesis quantitatively and sperm count appeared similar to anti GnRH treated rats fed on 5% casein diet. These results indicate that high casein diet protects adrenocortical activity and stimulates testosterone synthesis without effecting spermatogenic arrest in GnRH antagonist treated rats. It may be concluded that GnRH antagonist in presence of high milk protein diet may be considered to be a suitable antihormone in the development of an ideal male contraceptive.

Spontaneous biliary perforation presenting as gastric outlet obstruction.

Spontaneous biliary perforation (SBP) is a rare, surgically correctable cause of jaundice in neonates. The presenting feature is usually biliary ascites, and in rare cases, biliary peritonitis. This article reports a case of SBP, which presented with features of gastric outlet obstruction, leading to an erroneous preoperative diagnosis. Most probably this is the first report of such an unusual presentation of SBP. The child underwent exploratory laparotomy and a bilio-enteric bypass with drainage of the right subhepatic space, which led to a prompt resolution of the symptoms.

Prevention of adrenocortical hyperactivity by dietary casein in rats exposed to forced swimming stress.

Adrenal weight, adrenal hydroxysteroid dehydrogenase activity and serum corticosterone level were significantly higher in rats fed with 5% casein diet after 7 days of swimming stress (45 min/day) as compared to their controls. All the parameters were similar to their control levels in rats receiving 20% casein diet and exposed to swimming stress. The results suggest that casein can play an important role in preventing adrenocortical hyperactivity in swimming stressed rats.

Microwave technique in histopathology and its comparison with the conventional technique.

125 formalin fixed human tissues from different organs and 50 fresh animal tissues were taken. Each tissue piece was divided into two. Fresh animal tissues were fixed and processed in a domestic microwave oven and formalin fixed tissue were only processed in microwave oven. Simultaneous conventional processing was also carried out. Among the fresh tissues, 34 pieces were fixed in 10% formalin and 16 were stabilized in normal saline, with microwave irradiation. For histoprocessing graded ethanol (70% and absolute) for 150 tissues and graded isopropanol (70% and absolute) for 25 tissues were used for dehydration in microwave technique. Chloroform for 95 tissues, xylene for 15 tissues and isopropanol for 65 tissues were used as clearing agent in microwave technique. Liquid paraffin was impregnating agent in all 175 cases. The oven was operated at 50% power for 10 cases and 40% power for 165 cases. Recording of temperature could not be done. Regarding fixation with formalin 80% cases gave satisfactory result, while with normal saline, only 30% cases were satisfactory. Regarding dehydration with ethanol 80% were satisfactory and with isopropanol 60% were satisfactory. Regarding clearing--both chloroform and isopropyl alcohol gave satisfactory results in 80% cases but with, xylene tissues were fragmented and brittle.

Histopathology of skin lesions in chronic arsenic toxicity--grading of changes and study of proliferative markers.

Chronic arsenic toxicity (CAT) manifests predominantly as cutaneous lesions in the form of melanosis, keratosis and neoplastic changes. We have studied skin biopsies from 42 patients of CAT. Histological study of H/E stained sections showed--hyperkeratosis in 13, parakeratosis in 13, acanthosis in 12, papillomatosis in 24, elongation of reteridges in 21, increased basal pigmentation in 27 and dysplastic changes in 8 cases. Squamous cell carcinoma was present in 2, basisquamous in 1 and basal cell carcinoma in 1 case. Changes of skin lesions after drug DMSA and DMPS therapy compared to placebo were studied. The result was inconclusive. Proliferative activity of skin lesions in CAT were studied by AgNOR stain to assess the biological behaviour of the lesions. AgNOR score showed--normal control 1.08, benign changes (e.g. Hyperkeratosis, parakeratosis, acanthosis, papillomatosis etc.) without dysplasia--1.35, mild to moderate dysplasia--1.735, severe dysplasia--3.0 and carcinoma--3.56. Thus, AgNOR score gives some idea on the biological behaviour of CAT lesions. It is suggested that AgNOR staining should be done regularly along with H&E staining for proper assessment of the cases.

Emperor Akbar as a healer and his eminent physicians.

Akbar, however, was himself considered to be a healer to be healer by his miraculous powers. The court physician was one of the top-most officers of the court. Hakim Humam was such a physician who was one of the nine jewels (nauratnas) of Akbar. In 1581, Akbar curtailed the powers of Sadr (or Sadr-i-Jahan, the chief Justice and Administrator of the Empire) and he divided the empire in six zones with a Sadr in charge of each. Out of these six Sadrs, five were his physicians who were Hakim Abul Fath, Shaikh Fayzi, Hakim Humam, Hakim Ali, Hakim Ain-ul-Mulk. Tobacco was introduced either in 1604 or in 1605. Hakim Abul Fath opposed its circulation but Akbar permitted it. It was Abul Fath who found out a remedy for counteracting the pernicious effects of tobacco on health. His opinion was that if the smoke of tobacco passed through water the harmful effects would be minimised. So hukka was invented by him.

The Tughlaqs and medicine.

Muhammed Tughlaq established hospitals. A versatile scholar, Muhammed used to sit by the patients and watch the symptoms of extra ordinary diseases. His successor Firoz Tughlaq established a hospital where patients used to get free medical help and also food and drinks. This hospital was open to all. Though Firoz was known for his bigotry, we find no discrimination made between muslims and non-muslims in case of patients in this hospital. Firoz invented an eye-ointment in which, skin of black snake was used. It cured many kinds of eye diseases. This fact supports the Ayurvedic theory of and prescriptions for curing blindness with the ointment prepared with the flesh of cobras. Firoz himself was a good bone-setter.

A comparative study of balloon mitral valvuloplasty and closed mitral commissurotomy in patients with rheumatic mitral stenosis.

Rheumatic mitral stenosis is frequently encountered in our country. It affects younger population and is a major cause of morbidity Mitral valvotomy is the definitive therapy for this disease and can be achieved by closed mitral commissurotomy (CMC), open mitral commissurotomy (OMC) or by percutaneous transluminal mitral valvuloplasty (PTMV). Compared to CMC, PTMV is less invasive but more expensive at this moment. With the reduction of cost, PTMV may become the procedure of choice for the treatment of rheumatic mitral stenosis in future.