Clinical and endoscopic features of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) in India.

Hereditary hemorrhagic telangiectasis (HHT) is an autosomal dominant disease characterized by recurrent epistaxis and telangiectasia of the skin and mucous membranes. Most reports of HHT are from Europe and N. America. In this report of 7 patients from India we postulate that increased skin pigmentation in Asians and Negroids masks the cutaneous manifestations of the disease but without any discernible effect on mucosal lesions. The median hemoglobin value in these patients was 4 g/dl. Endoscopic lesions in the stomach or duodenum were detected in six patients. Most patients in our report (5/7) presented with a chronic iron deficiency anaemia. The treatment of HHT is mainly supportive although our preliminary data shows that low dose ethinyl estradiol therapy decreases transfusion requirement in these patients.

Endoscopic management of large bile duct stones by mechanical lithotripsy.

OBJECTIVE: Our experience in treating large common bile duct stones using Olympus basket mechanical lithotripter (BML 2Q) and Soehendra lithotripter is reported. METHODS: Between July 1990 and December 1993, twenty two patients with common bile duct stones too large to be extracted by Dormia basket or balloon were treated with BML lithotripter or Soehendra lithotripter. RESULTS: The stone diameters ranged from 1.5 to 2.8 cm. Fourteen patients required one session of lithotripsy, four patients two sessions each, and two patients three sessions each. BML lithotripter was used in 14 patients. In the remaining eight patients the stones were fragmented with Soehendra lithotripter when the basket got impacted while attempting extraction. Mechanical lithotripsy was successful in 20 patients (91%). Indwelling stent was used in one patient; one patient underwent surgery. CONCLUSION: Mechanical lithotripsy is safe for the treatment of large common bile duct stones, with a success rate above ninety percent.

Course of severe ulcerative colitis in northern India.

Thirty patients with severe ulcerative colitis were studied prospectively. Sixty percent (18/30) of severe ulcerative colitis were in remission after mean duration of 9.2 days (range 2-20 days) of intensive intravenous therapy without major side effects of steroids. Factors predicting poor response to medical therapy on admission are: stool frequency > or = 9 per day, pulse rate > or = 120/minute, temperature > or = 38 degrees C, Albumin < or = 2 gm, mucosal tags on plain x-ray abdomen and pancolitis.

Spectrum of gastrointestinal malignancy over a period of 10 years at a tertiary referal center of India.

We studied the frequency of different gastro intestinal malignancies (GIM) diagnosed in a given year, among patients attending gastroenterology department, and changing pattern of their occurrence over a period of 10 years (1984-1993). The records of all patients with histologically confirmed GIM were screened. Out of 83380 outdoor patients registered in the department over 10 years, there were a total of 1751 (2.1%) patients with GIM. The relative distribution of malignancy according to site was esophagus 36.0%, stomach 19.9%, liver secondaries 13.9%, colon 9.8%, periampullary 5.6%, gall pladder 4.5%, duodenum 3.0%, malignant ascites 2.6%, HCC 2.3% and pancreas 1.1%. Mean age for cancer of esophagus was 53.5 +/- 11.4 year, stomach 51.8 +/- 12.9, colon 49.1 +/- 16.7, duodenum 45.3 +/- 11.4, malignant ascites 51.8 +/- 13.1, pancreas 46.9 +/- 15.3 and HCC 52.5 +/- 12 years with an overall mean age of all GIM being 49.7 +/- 13.4 years. All malignancies were common in males except for cancer of gall bladder. The annual distribution of GIM did not confirm to a rising or declining trend with reference to the frequency of occurrence or age and sex distribution over the last decade.

Tuberculosis in ulcerative colitis: bird in the bush.

Records of one hundred and two patients with idiopathic ulcerative colitis were retrospectively studied to estimate the prevalence of associated tuberculosis. There were 49 males and 53 females with a mean age of 33 +/- 13 years. Seven patients (3 pulmonary and 4 intestinal) had associated tuberculosis. All patients with intestinal tuberculosis were females and had small bowel involvement. Patients with co-existing tuberculosis were on steroids at the time of presentation and responded well to anti tubercular treatment with gradual weight gain and remission of diarrhoea and fever. We conclude that in India, the prevalence of tuberculosis is high in patients with idiopathic ulcerative colitis on steroids and a high degree of suspicion is required to detect these cases.