Subacute hepatic failure in hepatitis A.

Hepatitis A is usually thought to be innocuous. We report a woman who developed subacute hepatic failure due to hepatitis A and died of the disease.

A study of inferior vena cava obstruction.

Inferior Vena Cava obstruction as a major cause of hepatic venous outflow block is not so common. A prospective study of 20 cases gave us an opportunity to device a management protocol for this disorder. Out of 20 cases we had studied, 12 had only inferior Vena Cava obstruction while rest of the 8 cases had both hepatic vein and IVC blockade. However, balloon cavoplasty showed remarkable results with substantial clinical and haemodynamic improvement in cases with isolated IVC obstruction. Therefore, we suggest that patients with IVC obstruction should be actively managed with Vena-cavography followed by cavoplasty. Treatment of Hepatic venous obstruction along with IVC obstruction is controversial; bypass shunt is usually required and long term follow-up studies are required to establish safety and efficacy.

Objective evaluation of psychological abnormality in irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is frequently regarded as a psychological disorder. Data on objective evaluation of psychological abnormalities among IBS patients and control subjects are scanty in our country. We therefore objectively studied patients with IBS. METHODS: 42 patients satisfying the Manning's criteria and Munich workers' for diagnosis of IBS underwent psychological evaluation using the following tests: a) Eyesenck personality questionnaire. b) State and trait anxiety inventory according to Speilberger's method. c) Hamilton depression rating scale for detection of depression. d) Whitely index of hypochondriasis and discriminant function by Pilowsky's illness behavior questionnaire. RESULTS: Neuroticism was detected in 76% of IBS patients compared to 9% in control population (p < 0.01). State and trait anxiety scores were 44.5 +/- 17.1 and 49.0 +/- 15.3 respectively in IBS patients; these were higher than those in controls (35.5 +/- 7.5 and 41.2 +/- 6.1 respectively; p < 0.01). Severe depression was observed in 26% of IBS patients and 6% of control subjects (p < 0.05). Significantly higher hypochondriasis score was observed in IBS patients as compared to controls (p < 0.001). CONCLUSION: Neuroticism, hypochondriasis and depression were significantly more prevalent in IBS patients attending a clinic, compared to control population.