Management of a complicated ‘pacemaker pocket’ site infection

Pocket site infection after implantation of a pacemaker is a dreaded complication which requires removing the device and reimplanting it at a contralateral site. Difficulties arise when the patient is dependent on pacing and when there are issues with venous access at the contralateral site. We report a patient with pacemaker pocket site infection with congenital complete heart block managed with explantation of the device, semi-permanent pacing during antibiotic treatment, reimplantation of the device at the contralateral site and management of subtotal subclavian vein stenosis noted during reimplantation.

Chronic Calcific Pancreatitis in a 9-Year-Old Boy.

Chronic pancreatitis is defined as continuing inflammatory disease of pancreas, characterised by irreversible morphological changes leading to pancreatic insufficiency. Chronic pancreatic insufficiency without pancreatitis is also seen in children suffering from cystic fibrosis which is a disease with congenital enzyme deficiency. Mean age of chronic pancreatitis is about 40 years. We present a case of a 9-year-old boy who was diagnosed as a case of chronic calcific pancreatitis. He was admitted with the complaints of paraumbilical pain and vomiting and was found diabetic. Diagnosis was established by X-ray, USG and CT scan of abdomen and ERCP. He was treated surgically in the form of lateral pancreaticojejunostomy (Puestow’s procedure).

Scale up of dextran production from a mutant of Pediococcus pentosaceus (SPAm) using optimized medium in a bioreactor

The mutant of Pediococcus pentosaceus (SPAm) produced earlier by UV-mutagenesis exhibiting higher dextransucrase activity as compared to wild-type was used. The generated mutant SPAm gave 12.2 mg/ml, a 20 percent higher dextran than wild-type. Response surface methodology was carried out for further enhancement of dextran production. To enhance dextran production by the mutant SPAm, Plackett-Burman Design and a 2² full factorial Central Composite Design was employed. After response optimization, the optimum concentration of sucrose and yeast extract was 5.115 percent (w/v) and 0.635 percent (w/v), respectively. The experimental values of dextran 36.0 mg/ml at flask level and 35.0 mg/ml at bioreactor level were in good agreement with the predicted value of 40.8 mg/ml. The increase in dextran production by the mutant SPAm using the optimized medium was 3 fold higher as compared to unoptimized medium.

Unusual Foreign Body in Urinary Bladder: A Case Report.

In the urinary tract, foreign body is most commonly found in the urinary bladder. It is commonly self-inflicted but can rarely be introduced by other person. Various types of foreign bodies have been reported, which includes infusion set, aluminum rod, gold chain, pearl, fish, pencil etc. Here we report a case of a 28-year young man who gave the history of forceful introduction of a long wire of mobile charger into the bladder by another person. It could not be removed by himself and by the local doctors. Then he was referred to Enam Medical College & Hospital and subsequently was removed by suprapubic cystostomy.

Recurrent acute hepatitis in patient receiving pulsed methylprednisolone for multiple sclerosis.

We report clinically significant, recurrent acute hepatitis in a 48-year-old woman receiving pulsed treatment with methylprednisolone for multiple sclerosis. No other cause was found for the episodes and the temporal and histological correlations were consistent with immune-allergic type drug-induced hepatitis.

Hemodynamic effect of spironolactone in liver cirrhosis and propranolol-resistant portal hypertension.

OBJECTIVE: In a proportion of patients with liver cirrhosis, portal pressure does not decrease adequately with propranolol. These patients may benefit from another drug that may reduce portal pressure. We evaluated the role of spironolactone, alone or with propranolol, in such patients. METHODS: Patients with cirrhosis, with or without ascites, with esophageal varices and with hepatic venous pressure gradient exceeding 12 mmHg, which did not show a 20% reduction after an 80-mg oral dose of propranolol, were studied. They were allocated to receive spironolactone 100 mg orally once daily either alone (group 1, n=10) or with propranolol 40 mg orally twice daily (group 2, n=10), for 7 days, after which the hemodynamic study was repeated. RESULTS: Hepatic venous pressure gradient decreased in those receiving spironolactone and propranolol (p=0.007); 5 patients in group 1 and 7 in group 2 showed a reduction in hepatic venous pressure gradient by more than 20%. However, the reduction produced by spironolactone alone (20.5 [31.3]%) was not significantly different from that produced by combination therapy (30.3 [25.9]%; p=0.46). CONCLUSION: Spironolactone in combination with propranolol achieves adequate reduction (> or = 20%) in hepatic venous pressure gradient in propranolol-resistant portal hypertension in patients with liver cirrhosis. Spironolactone alone was also effective in some patients.