Acute pancreatitis in acute viral hepatitis.

INTRODUCTION: The association of acute viral hepatitis and acute pancreatitis is well described. This study was conducted to find out the frequency of pancreatic involvement in acute viral hepatitis in the Nepalese population. METHODS: Consecutive patients of acute viral hepatitis presenting with severe abdominal pain between January 2005 and April 2010 were studied. Patients with history of significant alcohol consumption and gall stones were excluded. Acute viral hepatitis was diagnosed by clinical examination, liver function test, ultrasound examination and confirmed by viral serology. Pancreatitis was diagnosed by clinical presentation, biochemistry, ultrasound examination and CT scan. RESULTS: Severe abdominal pain was present in 38 of 382 serologically-confirmed acute viral hepatitis patients. Twenty five patients were diagnosed to have acute pancreatitis. The pancreatitis was mild in 14 and severe in 11 patients. The etiology of pancreatitis was hepatitis E virus in 18 and hepatitis A virus in 7 patients. Two patients died of complications secondary to shock. The remaining patients recovered from both pancreatitis and hepatitis on conservative treatment. CONCLUSIONS: Acute pancreatitis occurred in 6.5% of patients with acute viral hepatitis. Cholelithiasis and gastric ulcers are the other causes of severe abdominal pain. The majority of the patients recover with conservative management.

Cervical rib causing thrombosis of subclavian artery.

We describe here an unusual case of thrombosis of left subclavian artery in a patient with cervical rib. The patient presented with features of ischaemia of left upper limb. X-ray chest revealed bilateral cervical ribs, longer on the left side. Color Doppler studies showed echogenic thrombus within the left subclavian artery. Angiography revealed complete occlusion of left subclavian artery. Embolectomy was done. She was planned for excision of rib.

Ultrasonographic evaluation of carotid intima-media thickness in hypertensive and normotensive individuals.

This was a case control study designed to evaluate carotid intima-medial thickness (IMT) by high-resolution ultrasound in hypertensive and normotensive individuals. High-resolution carotid ultrasound was done in 203 hypertensive patients (cases) and 101 normotensive individuals (control). Scanning of bilateral common carotid artery (CCA) was performed in anteroposterior projections. To obtain a better image sound wave was adjusted perpendicularly to the arterial surface of the posterior wall of the vessel, yielding two parallel echogenic lines which correspond to lumen-intima and media-adventitia interfaces. Intima-medial thickness was measured in the far wall 1-1.5 cm proximal to the bulb bilaterally. The age of the study population ranged from 35 to 65 years. Mean IMT was significantly high in hypertensive patients compared to the control group, p<0.001 (in cases, IMT in right side was 0.968 mm and that of left side was 0.969 mm and in control group IMT of right side was 0.551 mm and that of left side was 0.555 mm). A significant difference in IMT of bilateral common carotid arteries was found between the smoker and non-smoker hypertensive patients (p<0.02). IMT was found to increase progressively with age. In conclusion, the study revealed a strong correlation between IMT of common carotid artery and hypertension. Hence, IMT measurement of CCA by high-resolution ultrasound in hypertensive patients is a helpful tool to assess the atherosclerosis and to identify individual at risk of cardiovascular and cerebrovascular complications.