Embedded esophageal foreign body. A diagnostic challenge

Esophageal foreign body [EFB] ingestion is of ubiquitous occurrence in pediatric population. Diagnosis and precise localization of non-radio opaque FB poses considerable challenge. Delayed presentation, poor history, and inconclusive esophagoscopic findings often lead to diagnostic delay. Multidetector computed tomography [MDCT] could be a great option in these situations. We present a case of EFB in a child who presented with failure to thrive, had negative fibreoptic endoscopy, ultimately diagnosed conclusively on MDCT examination

Subcutaneous insulin pulse therapy.

Subcutaneous Insulin Pulse Therapy (SIPT) consists of administration of small doses of regular insulin hourly or two hourly in the subcutaneous tissue of anterior abdominal wall through a scalp vein needle. Fifteen Non-Insulin Dependent Diabetes Mellitus (NIDDM) subjects, 8 males and 7 females with mean ages 58 +/- 8.7 years and mean duration of diabetes 11.7 +/- 9.1 years and mean BMI 25.2 +/- 5.64 were admitted for elective surgery. Glycemic control was attempted preoperatively with multiple pre-meal doses of Actrapid MC with a single injection of Monotard MC at bed time. The mean fasting plasma glucose in the 15 subjects with this insulin regimen was 321.28 +/- 69.32 mgm% and the insulin requirement per day was 106.87 +/- 35.77 units. The subjects were put on SIPT for 48 to 72 hours. During SIPT the mean fasting plasma glucose dropped to 123.2 +/- 74.11 mgm% and this marked decline in fasting plasma glucose value was statistically significant (P < .05). The insulin requirement during SIPT was 96.42 +/- 31.36 units, similar to the previous regimen (NS). The subjects were switched back to conventional insulin therapy after SIPT during which period the mean fasting plasma glucose was 125.82 +/- 34.50 mgm% and this value was again significantly lower than the pre SIPT fasting plasma glucose value (P < .05). Insulin requirement during conventional insulin therapy after SIPT was reduced to 71 +/- 21.89 units/day. This dose was significantly lower than the insulin dose administered during SIPT (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Parathyroid adenoma associated with multiple tendon rupture; a case report

A rare and unusual case is described of multiple lower limb fractures and complete closed tendon ruptures, following trivial trauma, in a 50 years old woman who had been complaining of low back pain and generalised weakness for two years. She had generalised osteoporosis and bilateral nephrolithiasis. Investigations revealed hyperparathyroidism as the underlying cause. The diagnosis of the cause was difficult. It was elucidated by blood biochemical and hormonal assays. The parathyrod adenoma was detected only by ultrasonography of the neck. The pathological manifestations rapidly improved after surgical reconstruction of the skeletal and tendinous lesions, and after excision of the hyperactive parathyroid adenoma, together with appropriate medical and supportive treatment

Heat stroke in long distance runners.

Four cases of young cadets who developed severe heat stroke while on a cross country run in Doon Valley are reported. Physical exertion alone caused the episode in a homeothermic environment. One patient continued to have left facial nerve palsy.