Usefulness of echocardiography in detection of subclinical carditis in acute rheumatic polyarthritis and rheumatic chorea.

Detailed echocardiographic analysis was performed in 10 children with first episode of acute rheumatic fever who presented with acute rheumatic polyarthritis or rheumatic chorea and had no clinically detectable evidence of active carditis. Significant changes were observed in the form of mitral valve prolapse with regurgitation in 3, aortic valve prolapse with regurgitation in 1 and mitral valve billowing without regurgitation in 1 patient each. A significant (p < 0.001) anterior mitral chordal elongation was observed in both the groups--rheumatic polyarthritis and chorea when compared with age and sex matched control subjects. Mitral annular diameter was found to be increased (p < 0.001) in patients presenting with polyarthritis alone. These observations of clinically silent but echocardiographically detectable element of carditis forms the basis of how patients of acute rheumatic fever develop permanent valvular deformities in their latter lives without revealing any cardiac affection earlier.

Non-traumatic coma--profile and prognosis.

Two hundred consecutive patients of non-traumatic coma, were investigated to establish its aetiology. Neurologic profile of these patients included assessment of Glasgow Coma Scale (GCS) score and evaluation of brainstem reflexes. 102 patients died and only 54 patients could make good recovery. Cerebrovascular diseases (33%), CNS infections (21%), and hepatic encephalopathy (18%) were the frequent causes of non-traumatic coma, with the first two carrying relatively poor prognosis. Poor outcome was also associated with low GCS score and absence of brainstem reflexes specially absent pupillary, oculocephalic and oculovestibular responses and decerebrate posture.

Disappearing CT lesion in a nonepileptic patient.

Despite its high incidence, the exact cause of disappearing CT lesions in patients with epilepsy is not clear. We document a non-epileptic patient, whose clinical picture simulated idiopathic intracranial hypertension, but CT showed a spontaneously resolving ring enhancing lesion.

Clinico-therapeutic profile of pyogenic liver abscess.

Nineteen consecutive patients of pyogenic liver abscess (13 males, 6 females, mean age 45.2 +/- 6, 5 years) were studied over a period of 5 years for the clinical profile and therapeutic efficacy of percutaneous aspiration. Majority of them presented with spiking fever (94.7%), pain over right upper quadrant of abdomen (53.8%) and often with prostration and shock (31.6%). The onset has been rather acute in patients with multiple abscesses (7 cases). Ascites (10.5%), clubbing of fingers (15.8%) and splenomegaly (10.5%) were observed in cases with long duration of illness. There has been the polymorphonuclear leucocytosis (89.5%) and mild to moderate anaemia (52.6%). Jaundice (42.1%) was usually mild degree (serum bilirubin 4.6 +/- 2.4 mg/dl). The serum transaminases and alkaline phosphatase were raised in 94.9% of cases. Ultrasonography revealed predominantly hypoechoic (54.1%) areas with frequent distal acoustic enhancement and internal echoes (21.6%). Seven patients had multiple abscesses with 25 lesions (size 5.2 +/- 4.6 cms) situated mainly over antero-inferior segment of the right lobe (45.9%) of the liver. The blood and pus cultures demonstrated the micro-organisms (positive in 63.9% and 86.6% respectively) predominantly of bowel flora including facultative gram negative rods and anaerobes. Mortality was 26.5% and pleuro-pulmonary complications were the commonest (26.4%) one. 15 cases were treated by percutaneous aspiration, proper antibiotic and metronidazole with encouraging results (only two deaths). Complete resolution of abscess took place in 14.2 +/- 1.2 weeks (range 6 weeks to 7.5 months). It is emphasized that percutaneous needle aspiration is useful both for diagnosis and treatment of pyogenic liver abscess.

Diagnostic significance of T I < T III and TV1 > TV6 signs in ischaemic heart disease.

One hundred seventy patients with ischaemic heart disease (IHD) and 141 healthy controls were evaluated to assess the diagnostic significance of T I < T III and TV1 > TV6 as compared to widening of QRS-T angle. Number of cases with abnormal widening of QRS-T angle was significantly higher (P < .001) in frontal and horizontal planes in the IHD group. T I < T III sign has 61.2% sensitivity, 74.5% specificity and 25.5% false positivity in diagnosis of IHD. Along with abnormal QRS-T angle widening it gave a specificity of 95.5% but a false positivity of 35% and a low sensitivity index (35.3%). TV1 > TV6 sign has sensitivity, specificity and false positivity of 72.9% 84.4% and 15.6% respectively. Combining it with abnormally wide QRS-T angle did not materially improve these indices. Combining T I < T III and TV1 > TV6 signs gives a sensitivity of 49.4%, specificity of 95% and false positivity of 5% in IHD. This is a good diagnostic index and can be assessed at a quick glance without cumbersome estimation of QRS-T angle.

Clinical profile of giardiasis and comparison of its therapeutic response to metronidazole and tinidazole.

Seventy five cases (50 males, 25 females; mean age 20.2 +/- 5.8 years), whose stools were positive for cysts and/or trophozoites of Giardia lamblia, were studied for their clinical profile and therapeutic response to metronidazole and tinidazole. Maximum frequency of cases (41.2%) was noted upto 20 years of age, and it declined with advancing age. A majority of them (41.3%) presented with non-specific symptoms while 38.6% were asymptomatic parasite carriers. Features of malabsorption were observed in 12% of cases and 8% presented with acute illness, having explosive, watery, foul smelling diarrhoea along with crampy upper abdominal discomfort. Most of them (62.5%) had blood group A. Tinidazole (97.5%) was more efficacious (P less than 0.01) than metronidazole (54%) in a single dose of 50 mg/Kg, with good tolerance. Tinidazole can be recommended for the treatment of giardiasis in individual cases as well as in families and close communities.

Clinical profile of herpes zoster ophthalmicus.

Herpes zoster ophthalmicus was seen in 22 cases out of 195 cases of herpes zoster (11.3% incidence). It was affecting mainly adults (90.9%). Oedema over the lids (81.8%) was invariably present and lead to ptosis. Mucopurulent conjunctivitis, predominantly mucoid (72.7%) was the commonest manifestation associated with vesicles over the lid margins. Sectorial (22.7%) and diffuse (9.1%) episcleritis appeared in later part of first week, while nodular episcleritis was observed in one case only on 12th day of the disease. Nummular keratitis was seen in 31.8% of cases between 8-10 days. Iritis and iridocyclitis was seen in 45.4% of cases out of which 36.3% had secondary ocular hypertension (glaucoma). Neuroparalytic keratitis and internal ophthalmoplegia were detected in one patient each. Postherpetic neuralgia occurred in 22.7% of cases and was uncommon in younger age group (below 40 years, 4.5%). Carbamazepine was effective in relieving the herpetic pain.

Complete intraventricular dissociation. Electrocardiographic manifestation of a rare intracardiac complete dissociation.

Complete Intraventricular Dissociation manifesting as dual ventricular rhythm was observed on surface electrocardiography in two middle-aged males with acute myocardial infarction. The first patient had a dominant accelerated (AV) junctional rhythm, and there was a sudden emergence of an additional independent slow and regular idioventricular escape rhythm. These ventricular complexes were bizarre and markedly widened, waveform with prolonged undulating electric potentials. In the second case, the emergence of a dominant idioventricular rhythm was coexistent with an additional independent escape rhythm with monophasic wider agonal ventricular complexes. Terminal tracings recorded later were essentially the same, except that an ill sustained ventricular fibrillation had replaced the ectopic agonal beats, and there was an enhanced automaticity in the dominant ventricular part. The sites of ectopic ventricular rhythms were thought to be in the ischaemic damaged ventricular myocardium, with a surrounding zone of conduction block.

Male gonads in leprosy--a clinico-pathological study.

Sixty male leprosy patients (mean age 27.2 +/- 5.04 years) selected at random, were studied for gonadal involvement with the mean duration of illness 4.17 +/- 3.27 years. Only lerpomatous and borderline leprosy cases developed testicular and epididymal changes. Testicular pain and/or swelling (lepromatous 62.5%, borderline 30%) was the main presenting feature. Altered sexual function was observed in 34(56.6%) cases, and 11 patients revealed altered sexual hair pattern. Gynecomastia was seen in 9 cases. Reduced testicular size along with its soft feeling was present in 25% of cases while no testicular sensation was felt in 8 (13.3%) cases, and impaired testicular sensation in 9 (15%) of them. Spermogram revealed azoospermia in 19 (35%) and oligospermia in 16 (26.6%) cases. Histo-pathology revealed evidences of leprous pathology irrespective of testicular size, semen picture and clinical manifestations. There was marked variation in histopathological findings in testes and hence it was difficult to categorise them into vascular, interstitial and obliterative phase.