Periampullary carcinoid: An uncommon tumor at an unusual site.

Gastrointestinal carcinoid tumors represent a group of well-differentiated tumors originating from various neuroendocrine cells located in the gastrointestinal mucosa and submucosa. Consequently, there is diversity in their clinical presentation, incidence at specific anatomic sites, biological behavior, hormone production, morphologic characteristics, and immunophenotype. Periampullary carcinoids are extremely rare and less then 100 patients have been reported in the world literature, that too mostly as case reports. We are reporting two cases of periampullary carcinoids, one of which presented with rare manifestation as gastrointestinal bleed and both are doing well after successful pancreatoduodenectomy.

Asteracantha longifolia (L.) Nees, Acanthaceae: chemistry, traditional, medicinal uses and its pharmacological activities - a review / Asteracantha longifolia (L.) Nees, Acanthaceae: química, usos tradicionais e medicinais e suas atividades farmacológicas - uma revisão

Asteracantha longifolia (L.) Nees, Acanthaceae, is a source of the ayurvedic drug, 'Kokilaaksha' and the Unani drug, Talimakhana. The seeds are acrid, bitter, aphrodisiac, tonic, sedative, used for diseases of the blood. The plant is known to possess antitumor, hypoglycemic, aphrodisiac, antibacterial, free radical scavenging and lipid peroxidation, hepatoprotective and haematopoietic activity. It contains lupeol, stigmasterol, butelin, fatty acids, and alkaloids. The present review article is focused on phytochemical, pharmacological and other important aspects of Talimakhana.

Asteracantha longifolia (L.) Nees, Acanthaceae, é a fonte do medicamento ayurvédico "Kokilaaksha", e da droga Unani, Talimakhana. As sementes têm de sabor acre e amargas, são afrodisíacas, tônicas, calmantes, e usadas para doenças do sangue. A planta é conhecida por possuir propriedades antitumorais, hipoglicêmica, afrodisíaca, anti-bacteriana, na eliminação de radicais livres e peroxidação lipídica, atividade hepatoprotetora e hematopoiéticas. Ele contém lupeol, estigmasterol, butelina, ácidos graxos e alcaloides. Este trabalho apresenta estudos químicos, farmacológicos e outros aspectos importantes da Talimakhana.

Epidemiological and clinical profile of irritable bowel syndrome in India: report of the Indian Society of Gastroenterology Task Force.

AIMS: To study the profile of irritable bowel syndrome (IBS), and the frequency of such symptoms among the general population, in India. METHODS: In this prospective, multi-center study, data were obtained from 2785 patients with chronic lower gastrointestinal symptoms (complainants) with no alarm feature and negative investigations for organic causes visiting physicians at 30 centers, and from 4500 community subjects (non-complainants), using separate questionnaires. RESULTS: Most complainants were middle-aged (mean age 39.4 years) and male (1891; 68%). The common symptoms were: abdominal pain or discomfort (1958; 70%), abdominal fullness (1951; 70%); subjective feeling of constipation (1404 of 2656; 53%), or diarrhea (1252 of 2656, 47%), incomplete evacuation (2134; 77%), mucus with stools (1506; 54%), straining at stools (1271; 46%), epigastric pain (1364; 49%) and milk intolerance (906; 32%). Median stool frequency was similar in patients who felt they had constipation or those who felt they had diarrhea. Information to subtype symptoms using standard criteria was available in 1301 patients; of these, 507 (39%) had constipation-predominant IBS ( 3 <or= stools/week), 50 (4%) had diarrhea-predominant IBS (>3 stools/day) and 744 (57%) had indeterminate symptoms. Among non-complainants, most subjects reported daily defecation frequency of one (2520 [56%]) or two (1535 [34%]). Among non-complainants, 567 (12.6%) reported abdominal pain, 503 (11%) irregular bowel, 1030 (23%) incomplete evacuation, 167 (4%) mucus and 846 (18%) straining at stools; a combination of abdominal pain or discomfort relieved by defecation, and incomplete evacuation was present in 189/4500 (4.2%) community subjects. CONCLUSIONS: Most patients with IBS in India are middle-aged men, and have a sense of incomplete evacuation and mucus with stools. Abdominal pain or discomfort is frequent but not universal. Importantly, stool frequency was similar irrespective of whether the patients felt having constipation or diarrhea. Most (90%) non-complainant subjects had 1 or 2 stools per day; symptoms complex suggestive of IBS was present in 4.2% of community subjects.

Diagnostic value of serum CA242, CA 19-9, CA 15-3 and CA 125 in patients with carcinoma of the gallbladder.

BACKGROUND: Tumor markers have an increasing significance in the diagnosis and evaluation of tumor, but their role in gallbladder cancer has not been established. The present study was undertaken to determine the utility of serological markers in carcinoma of the gallbladder (CaGB). METHODS: This study was carried out in 55 cases and 8 healthy controls presenting to a single surgical unit of the University Hospital, Varanasi, India. CA242, CA19-9, CA15-3 and CA125 were assayed preoperatively in serum of patients with carcinoma of the gallbladder (39), cholelithiasis (16) and healthy controls (8) using ELISA technique. RESULTS: Mean concentration of all tumor markers was significantly raised in carcinoma of the gallbladder when compared with cholelithiasis. CA 242 was 12.10 vs 42.19 u/ ml, CA19-9 was 211.27 vs 86.06 uml, CA 15-3 was 71.42 vs 1.93u/ml and CA125 was 253.61 vs 65.5 u/ml <0.05). Sensitivity and specificity were calculated at various cut off points. Significant changes in CAl9-9 and CA242 occurred with advanced stage (p <0.05) and grade of tumor (p<0.00 1). When two tumor markers were combined, like CA242 and CA125, sensitivity and specificity improved to 87.5% and 85.7% respectively. Diagnostic accuracy is highest with a combination of CA 19-9 and CA 125 (80.65%). However, combination of tumor markers did not improve any further sensitivity or specificity of markers. CONCLUSION: Assay of CA242, CA15-3, CA19-9 and CA 125 are fairly good markers for discriminating patients of carcinoma of the gallbladder from cholelithiasis. CA242 and CA125 when used together achieved best sensitivity and specificity. Serum markers seem to be less sensitive when used individually in carcinoma of the gallbladder but may prove useful in combination.

Internet--implications for the future of phytopharmacological research.

Modern information technologies and world wide communications through the Internet play a significant role in medicinal plant research across the globe. The phenomenal growth in Internet usage is largely due to the success of World Wide Web. Various useful websites and databases on phytopharmacology are already in the "Net" and many more are being added constantly. The future of phytopharmacological research is handling the existing information in proper way. In this review of the Internet, compilation of important websites is expected to stimulate, instruct and update academicians and researchers involved in phytopharmacological research.

Sonographic and colour doppler morphology in carcinoma gallbladder.

Conventional radiography has limitations in accurate diagnosis of gallbladder cancer (GBC). Ultrasonography (USG) allows correct diagnosis in 70-80% advanced and 23% early GBC. Present study was initiated to identify morphology and flow characteristics in GBC using conventional USG and Colour Doppler USG (CD-USG). In 100 patients, USG assessed morphology of mass lesion/wall thickening together with associated features. Of these, 60 cases were studied using CD-USG for intralesional/perilesional vascularity, peak systolic flow velocity (V max), resistive index (RI) and pulsatility index (PI). USG identified GB with mass lesion in 44% cases (Group-I) and only mass in GB fossa in 56% cases (Group-II). Findings identified calculi (73%), liver infiltration (74%), intrahepatic ductal dilatation (IHDD) (52%), lymphadenopathy (19%) and ascites (5%). CD-USG revealed vascularity, mainly pulsatile flow, in 78.3% cases (in 91.3% Group-I cases). Mean Vmax was 0.3037 m/sec (0.109 - 0.646 m/sec.), mean RI was 0.6621 (0.526 - 1.000) and PI was 1.282 (0.772 -2.140), Mean Vmax and PI were higher in Group-I compared to Group-II. Presence of calculus in 73% cases suggests a high association between calculus and malignancy. As flow signals were seen in 78% of all cases and 91.3% Group-I cases undergoing CD-USG, USG and CD-USG together can improve pickup rate of GBC.

Clinical and biochemical profiles of young diabetics in North-Eastern India.

OBJECTIVE: We compared the clinical and biochemical profiles of young diabetics in North Eastern India. METHODS: Seventy diabetics who were detected at less than 30 years of age were studied. Patients with ketoacidosis or ketonuria on insulin withdrawal were grouped as insulin dependent diabetes mellitus (IDDM), patients with history of chronic abdominal pain with or without exocrine pancreatic dysfunction who either on ultrasonography (USG) or endoscopic retrograde cholangiopancreaticoduodenography (ERCP) revealed pancreatic calcification and/or ductal dilatation were grouped as fibrocalculous pancreatic diabetes (FCPD), those having BMI < 19 kg/m2 with history or stigmata of childhood malnutrition and who were ketosis resistant were taken to be protein deficient diabetes mellitus (PDDM)/malnutrition modulated diabetes mellitus (MMDM) and those who neither had ketonuria nor history of chronic abdominal pain, malabsorption or stigmata of malnutrition were grouped as NIDDM of young (NIDDY). RESULTS: Amongst the young diabetics studied FCPD constituted 32.9%, IDDM 28.6%, MMDM 21.4% and NIDDY 17.11%. USG abnormalities were observed in 21 of the 23 patients of FCPD. Seven out of these showed pancreatic head calcification on X-ray while 14 showed pancreatic duct dilatation and calcification or calculi on USG. In the two remaining patients, ERCP revealed tortuousity of main pancreatic duct and calcification which were not detected on USG. Majority of FCPD and MMDM patients revealed insulin resistance on insulin tolerance test (ITT). HDL was significantly lower in NIDDY, while VLDL and triglycerides were significantly higher in FCPD and MMDM as compared to controls. Microvascular complications of diabetes were seen in all these groups, with peripheral neuropathy being more common in FCPD (43.5%) and background diabetic retinopathy in NIDDY (41%). CONCLUSIONS: We conclude that FCPD and MMDM together form majority (54.29%) of young diabetics at our center and a sizeable proportion of them may have microvascular complications, even at the time of diagnosis.

Correlation of Helicobacter pylori and gastric carcinoma.

BACKGROUND: Difference of opinion about the prevalence of H. pylori association with gastric cancer exists in the literature. AIMS: To study the correlation of Helicobacter pylori (H. pylori) to gastric carcinoma. METHODS: 50 proved cases of gastric cancer were studied by rapid urease test, culture, histopathology and ELISA test for H. pylori IgG. RESULTS: 68% of cases of gastric cancer were found to be positive for H. pylori infection as compared to 74% of healthy controls. CONCLUSIONS: The prevalence rate of H. pylori infection in our patients of gastric cancer was lower than in the control population though statistically not significant, suggesting that H. pylori may not be responsible for gastric carcinogenesis in this population.

14C-urea breath test for assessment of gastric Helicobacter pylori colonization and eradication.

BACKGROUND AND OBJECTIVE: Urea breath test (UBT) is a reliable noninvasive technique for detecting gastric Helicobacter pylori colonization. 14C isotope-based test requires simple equipment and is inexpensive. We studied the utility of 14C-UBT in diagnosis of gastric H. pylori infection. METHODS: Presence of H. pylori was studied using antral histology and culture in patients with rapid urease test (RUT)-positive peptic ulcer. 14C-UBT was performed using a 185-kBq dose. Radioactivity in 15-min breath samples was measured using a beta-scintillation counter and result expressed as % dose recovered/mmol CO2. H. pylori was considered positive when any two tests were positive. All tests were repeated one month after completion of H. pylori eradication therapy. RESULTS: Among 41 patients (duodenal ulcer 36, gastric ulcer 5), H. pylori was detected by histology in 23 (56%) and by culture in 27 (66%). Overall, H. pylori was detected in 28 (68%) patients. Follow-up assessment was possible in 28 patients: 26 cleared the infection (all three tests negative). Mean 14C recovery values at 15 minutes associated with H. pylori-positive status were significantly higher (12.3 [SD 6.8] x 10(-3); n=30; p<0.001) than those associated with H. pylori-negative status (2.1 [0.9] x 10(-3); n=26). Using receiver-operating-characteristic analysis of 15-minute 14C recovery values, a cut-off of 6.5x10(-3) gave the best separation of H. pylori-positive and -negative cases. 14C-UBT had 93% sensitivity, 96% specificity and 95% accuracy. CONCLUSION: 14C-UBT appears to be a reliable noninvasive test for diagnosis of H. pylori infection.

Hepatic duct stones masquerading as Klatskin tumour.

We report woman who presented with painless progressive jaundice following cholecystectomy. Radiological investigations indicated proximal bile duct obstruction suggestive of hilar malignancy. Exploratory laparatomy revealed bilateral hepatic duct stone causing obstruction.

Needle aspiration in large amoebic liver abscess.

The role of percutaneous needle aspiration for therapy of uncomplicated, large amoebic liver abscess (ALA) is not defined. Twenty nine patients of ALA with a cavity larger than 5 cm were randomised to two groups: (i) metronidazole 800 mg tid for 10 days combined with needle aspiration (group A, n = 15) and (ii) metronidazole therapy alone (group B, n = 14). Clinical parameters, viz, fever, pain and abdominal tenderness were recorded daily and graded 0 to 3 (in order of increasing severity). A statistically significant benefit was demonstrated in group A for clinical parameters evaluated. Group A patients took less time to become afebrile from the grade 2 level as compared to group B (3.8 +/- 1.7 days and 5.6 +/- 2.2 days respectively; p < 0.05). Reduction in pain intensity and abdominal tenderness from grade 2 to 1 also occurred earlier in group A (0.7 +/- 0.7 days vs 2.9 +/- 0.9 days for pain, P < 0.001 and 1.7 +/- 0.8 days vs 2.9 +/- 1.2 days for abdominal tenderness, p < 0.001). The mean duration of hospitalization was significantly shorter in group A as compared to group B (5.8 +/- 0.8 days vs 7.4 +/- 1.5 days, p < 0.001). Improvement in haematological and biochemical variables was similar in both groups. We conclude that percutaneous therapeutic needle aspiration of uncomplicated, large ALA hastens clinical recovery.

Splenic hemangiomatosis with osseous involvement.

A rare case of splenic hemangiomatosis with bone involvement in the upper extremity is presented. The findings on ultrasonography and CT scan abdomen were suggestive of splenic hemangiomatosis. X-ray of left forearm showed findings characteristic of osseous hemangiomatosis, which was subsequently confirmed on histology.

Obstructive jaundice--a diagnostic appraisal.

One hundred and eight suspected cases of obstructive jaundice (OJ) were analysed using ultrasonography, percutaneous transhepatic cholangiography (PTC) or Endoscopic retrograde cholangiopancreatography (ERCP) or both. Clinical evaluation had accuracy of 93% in identifying OJ and establishing aetiology in 62%, however, it lacked specificity. Ultrasonography was useful in differentiating obstructive jaundice from medical jaundice in 91% of cases. However, the cause and site of biliary obstruction could be identified in 55% and 46% respectively. PTC was helpful in detecting the site of obstruction in 80.4% and nature in 63% of cases. Its failures were mostly associated with the presence of metastasis in the liver. ERCP successfully attained cholangiography in 58% and pancreatogram in 70% of cases. Overall diagnostic yield of ERCP was 67% in view of additional endoscopic findings in 18 cases. The complications were occasional and could be managed effectively with medical treatment. This study suggests utility of clinical evaluation in OJ inspite of its poor specificity and comparative value of PTC and ERCP in establishing the site as well as nature of lesion.

Endoscopic sphincterotomy: preliminary experience at a university hospital.

Endoscopic sphincterotomy (ES) was attempted in 38 patients with biliary calculi. There were 21 patients (55.3%) with common bile duct (CBD) stones following cholecystectomy, 14 patients (36.8%) with intact gall bladder and 3 patients with retained CBD stones along with T tube in the early post-operative period. Endoscopic sphincterotomy was possible in all but one patient and duct clearance was attained in 34 (89.4%) patients. Spontaneous clearance of calculi occurred in 31 (81.6%) patients while 3 patients required instrumental extraction. Four patients failed to clear stones and required surgical intervention. Complications occurred in 4 (10.5%) patients--haemorrhage in two, pancreatitis and cholangitis in one each. One patient died of bleeding on the 4th day following ES while hemostasis was achieved in other after two units of blood. Other complications were managed conservatively without any mortality. Endoscopic sphincterotomy appears to be a simple, effective and safe therapeutic modality for the management of biliary calculi.