Efficacy of species specific anti-scorpion venom serum (AScVS) against severe, serious scorpion stings (Mesobuthus tamulus concanesis Pocock)--an experience from rural hospital in western Maharashtra.

BACKGROUND: Death caused by scorpion envenoming is a common event in the tropical and subtropical countries including many regions in India. Severe scorpion envenoming causes an autonomic storm producing multi-system organ-failure (MSOF) and death. OBJECTIVES: To determine the efficacy of Anti-scorpion venom serum (AScVS) in patients stung by scorpions (Mesobuthus tamulus concanesis Pocock--earlier called Buthus tamulus); to compare it with other modalities of therapy and to detect complications, if any, arising out of AScVS treatment. METHODS: Total 48 patients of severe, serious scorpion envenoming syndrome were studied during the period from 1992 to 2002. In 17 patients AScVS was the only mode of treatment. Others had received adjunctive therapy along with AScVS. RESULTS: 47 patients out of 48 scorpion sting victims recovered completely. Recovery period in patients given AScVS (10 hours) was faster than those who received alpha blockers (16-42 hours). No anaphylactic reaction with AScVS was observed. CONCLUSIONS: AScVS is effective and safe method of therapy in severe scorpion envenoming syndrome.

Portal hypertensive jejunopathy: a case control study.

BACKGROUND: Small bowel mucosa is a recognized potential source of bleeding in portal hypertension. However, the frequency of its involvement is not known. AIMS: To document the nature, severity and frequency of endoscopic and histologic changes in the jejunum in patients with portal hypertension. METHODS: Forty consecutive patients with portal hypertension and 43 patients with non-ulcer dyspepsia (controls) underwent push enteroscopy and jejunal, duodenal and gastric biopsies. Biopsies were randomized and examined by a blinded pathologist for inflammation and vascular dilatation, which was quantified by morphometry. RESULTS: Endoscopic jejunopathy was observed in 6 patients and none of the control subjects. All patients with jejunopathy had portal hypertensive gastropathy (PHG) and 5 had duodenopathy. Vascular dilatation was observed in 15 patients and 25 control subjects (p = ns). The degree of vascular dilatation was similar in both groups. Inflammatory changes were observed in 24 patients and 25 control subjects (p = 0.05). CONCLUSIONS: Endoscopic jejunopathy was present in 15% of patients with portal hypertension. These changes were mild in 83% of them. All patients with jejunopathy also had PHG. Histologic changes were similar in patients and control subjects.

Blastopathies--symmetrical conjoined twins.

Conjoined twins are one of the rarest blastopathies, challenging the medical profession. The incidence in India is reported to be 1:60,000 pregnancies. This report records two cases of female conjoined twins. The sharing of various organs and complex cardiac anomalies encountered were very fascinating. Omphalopagus conjoined twins had only three lower extremeties, a common gastro-intestinal tract beyond the terminal ileum, crossed ectopia, hypoplastic kidneys and bicornuate uterus. The heart showed dextrocardia, A.S.D. and V.S.D. No attempt was made for surgical separation in this case. The second case was a thoracopagus, with the heart showing V.S.D., cor triatrium dexter with a posterior venous chamber. Surgical separation was attempted, but was unsuccessful. Both cases showed a single fused liver. The need for antenatal diagnosis and successful separation with good pre- and post-operative management is stressed.

Hepatic hemangioendothelioma of infancy with congestive cardiac failure--report of a case.

A case of infantile hemangioendothelioma of the liver is reported in a 18 day-old male neonate. The neonate presented with CHF. He had hepatomegaly, but lacked the third component of the classical triad i.e. cutaneous hemangiomas. The S.A.F.P levels were raised to 920 ng/ml, though rise is rare in infantile hemangioendothelioma and led to the clinical diagnosis of hepatoblastoma. A left hepatic resection was performed, the histology showed a type I pattern of the tumor. This is known to be associated with a good prognosis. The baby is well post resection for a follow up period of six months.

Autopsy study of infant kidneys in cases of urinary tract anomalies.

The infant autopsies were scrutinised to find the incidence, etiology & significance in terms of fatality of urinary tract anomalies. On analysing 1329 infant autopsies, 24 cases (1.8%) of significant urinary tract anomalies were found. There was marked male predominance. Intrauterine obstruction of urinary tract was the main etiological factor leading to dysplastic changes in the renal tissue. Dysplasia is severe in extent and may be associated with persistent blastemal zones when the obstruction is complete & bilateral in nature.

Esophageal involvement in pemphigus vulgaris.

Twenty five patients with pemphigus vulgaris were prospectively studied for esophageal involvement by endoscopic examination. Eighteen (72%) had esophageal involvement; the majority of the lesions were bullae. Histological examination showed acantholysis of the cells and exuberant inflammation.

Retrospective treatment analysis of Salmonella infections.

Twenty four culture proved and nine postmortem histopathology proved cases of enteric fever were analysed retrospectively with special interest in use of various antisalmonella agents. Chloramphenicol resistance was noted in 91.7% and yet 70% of all patients received chloramphenicol alone or in combination with another antisalmonella agent. Time required for remission of fever with chloramphenical, cotrimoxazole and ciprofloxacin was 4.5, 4.1 and 6.9 days respectively. An interesting feature noted in post-mortem histopathology proved cases was enteric carditis which was documented on postmortem examination of the heart in three out of four patients who died of peripheral circulatory failure.

Collision tumour of stomach.

Collision tumour of the stomach is exceedingly rare, with only four previous reported instances in which adenocarcinoma of the stomach was found in association with a single carcinoid tumour. Our case with adenocarcinoma had multiple carcinoid tumours in the stomach.

Multiple uterine leiomyoma with metastasis of an occult pulmonary carcinoma (a case report).

A rare case of metastatic leiomyoma of the uterine corpus presenting with haemoptysis is presented.