Portal Hypertension with Visceral Leishmaniasis.

We conducted this study to observe evidence of portal hypertension in children with visceral leishmaniasis (VL). Eighty-eight consecutive cases (50 male) of VL were subjected to ultrasonography. Those with evidence of portal hypertension also underwent upper gastrointestinal endoscopy and liver biopsy. Eight patients had portal hypertension as evidenced by dilated caliber of portal and splenic veins. Two patients had periportal, splenic and peripancreatic collaterals and one patient had cavernous transformation of portal vein. Out of eight patients, four patients had esophageal and gastric varices. Liver biopsy was done in four patients and revealed hepatic sinusoidal dilations without any evidence of fibrosis. Portal hypertension may be an independent manifestation of VL and remain undiagnosed unless a physician maintains a high index of suspicion.

Current concept in the management of cerebral palsy.

The authors have described, in depth, the current concept along with the management of cerebral palsy in the present article.

Department of Paediatrics, Nalanda Medical College, Patna.

Cysticercosis is the most common parasitic disease of the central nervous system. The disease has worlwide distribution. The cysticerci might lodge in the brain parenchyma, spinal cord, eyes, ventricular system, subarachnoid space and muscle. These are most often seen in basal meninges. The presence of human lymphocyte antigen-related antigens on the surface of cysticerci has a direct relationship with microscopic signs of damage to cysticerci. The clinical manifestations depend upon number and topography of lesions, the individual immune response to the parasite and the sequelae of previous infestations. The diagnostic criteria of neurocysticercosis can be based on absolute criteria, major criteria, minor criteria and epidemiological criteria. Computerised tomography (CT) head is still most useful diagnostic tool for the diagnosis of neurocysticercosis but magnetic resonance imaging has some advantages over computerised tomography. The mainstay of therapy lies on medical and surgical intervention. Medical therapy consists of cysticidal drugs. Surgical therapy is indicated in intraventricular and subarachnoid neurocysticercosis. Steriods are used for anti-oedema measures. Anti-epileptics can also be tried. The measures for prevention of cysticercosis are proper disposal of human waste, treatment of water contaminated with human faeces before its use in irrigation of vegetable cultivation, proper cooking of pork and repeated treatment in taenia carriers.

Miltefosine: an oral drug for visceral leishmaniasis.

Miltefosine, a phosphocholine analogue originally developed as antimalignant drug, has been found to be highly active against leishmania in vitro and animal model. Based on these experiences this drug was tried against human visceral leishmaniasis and found to be highly effective and achieved 97% and 94% cure in phase 2 and phase 3 trial in children.