Paroxysmal nocturnal hemoglobinuria.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hemolytic disorder of acquired origin and is clinically manifested by chronic hemolysis, thromboses in various sites, and bone marrow failure. The disease is so rare that the delay in the diagnosis is not uncommon and this bears a tremendous impact on patient management. We present this case to draw attention to this uncommon cause of hemolytic anemia, which should be considered in any patient, of any age, who has signs of chronic hemolysis.

Cases of perforated duodenal ulcer treated in College of Medical Sciences, Bharatpur over a period of one year.

BACKGROUND: Eighteen patients were studied in our institution between January and December 2002. Simple closure followed by eradication of Helicobacter Pylori was used to manage the cases of perforated duodenal ulcer. METHOD: After resuscitation, laparoscopy followed by simple closure of perforation reinforced with pedicled omental patch was performed for all the patients. H- Pylori eradication using "triple regime" was done in all. Follow-up between 6 to 12 months was done, for which endoscopy and Visick's grade was used. Results: All the patients were male, maximum incidence (39%) noted in 51 to 60 age group. Mean time interval between start of symptoms and surgery was 60 hours. As a result the patients were moribund with gross purulent peritonitis and poor general condition. Chest infection was the commonest complication (44%) and two patients (11%) with very poor prognosis died during post operative period. Good to excellent results using Visick's grades were obtained in 81% surviving patients. Endoscopy did not show active ulcer in any of the patients. CONCLUSION: Patients with perforated duodenal ulcer were late in presenting to the hospital, precluding the option of definitive surgery for peptic ulcer disease. Simple closure of perforated duodenal ulcer if combined with eradication of H-Pylori is an effective method of treatment of duodenal perforation and is not associated with high recurrence of symptoms of peptic ulcer disease.