A comparative study of salivary buffering capacity, flow rate, resting pH, and salivary Immunoglobulin A in children with rampant caries and caries-resistant children.

PURPOSE: This study was conducted to identify various factors in the development of rampant type of dental caries in South Kerala children, other than high sucrose intake and poor oral hygiene. This was done by comparing the salivary buffering capacity(BC), flow-rate(FR), resting pH and salivary immunoglobulin-A(s-IgA) levels in children who are caries resistant(CR) and who have rampant dental caries. MATERIALS AND METHODS: Two study groups, a rampant caries group(RC) with more than five active caries lesions in the early stages and a CR with no caries lesions were selected based on a specific criteria. Unstimulated whole mixed saliva was collected directly from the floor of the mouth for a period of 10 min and the FR was calculated. Resting pH of saliva was measured using color coded pH paper. BC was measured by calculating the amount of citric acid of pH2.5, required to lower the initial pH of saliva down to 3. s-IgA levels were also estimated by immunoturbidometric method after forming a precipitate of s-IgA with specific anti-IgA antibodies. RESULT: The salivary BC, FRs, pH and s-IgA levels were significantly lower in the RC group when compared to the CR group. CONCLUSION: This study showed that salivary BC, flow-rate, resting pH and levels of s-IgA in saliva are risk factors in the development of RC in children.

Endoluminal formalin application for haemorrhagic radiation proctitis.

BACKGROUND: Radiation proctitis is a common complication following radiation therapy for pelvic malignancies. This is associated with significant morbidity which adversely affects the quality of life. Local application of formalin has been used effectively in the treatment of radiation proctitis. METHODOLOGY: Thirty patients with haemorrhagic radiation proctitis who underwent endoluminal application of 4% formalin between January 1998 to October 2002 were followed up prospectively to assess the efficacy of the treatment. RESULTS: The follow up ranged from 5 to 36 months (mean 18.1 months). Nineteen (63.3%) patients had complete response to formalin application while 7 (23.3%) patients had partial response. There were 4 (13.3%) failures. No procedure related complication was observed. CONCLUSION: Local application of formalin is a simple, safe, inexpensive and fairly effective outpatient treatment modality for chronic radiation proctitis.

Cavernous haemangioma of the rectum: an uncommon cause of rectal bleeding.

Cavernous haemangioma of the rectum is an uncommon cause of rectal bleeding. Initial diagnosis is often elusive because of lack of awareness. For accurate diagnosis, investigations such as endoscopy, plain X-ray of the abdomen, barium enema and selective angiography of the inferior mesenteric artery are required. Complete surgical excision of the haemangioma and colo-anal sleeve anastomosis is the most favoured operative procedure to eradicate the disease. We report a case of cavernous haemangioma of the rectum and discuss its salient clinical features, investigations and management.

Choledochal cysts in adults.

The clinical features and management of 14 adults with choledochal cysts who presented to our hospital are discussed. There were 10 Todani type I, and four type IV cysts. The cysts were fusiform in all but three cases. The pancreatobiliary junction was abnormal in only two patients. Ten patients had cystolithiasis. Six patients had undergone previous biliary surgery, three of whom presented with biliary strictures. We recommend that choledochal cyst be considered as a differential diagnosis in all patients with dilated bile ducts, especially when symptoms persist after biliary surgery. In two patients who had undergone endoscopic sphincterotomy and stone clearance, and in whom the diagnosis was still in doubt after cholangiography, hepatic iminodiacetic acid (HIDA) scan confirmed the diagnosis of choledochal cyst by showing persistent biliary stagnation despite free flow of bile across the sphincter of Oddi. Complete resection of the cyst was achieved in all cases with one postoperative death. A modification of the standard surgical technique is described which makes mobilisation of the cyst easier. The need to demonstrate the pancreatobiliary ductal confluence as an aid to complete excision of the cyst is emphasised.

Randomized controlled trial of lateral internal sphincterotomy with haemorrhoidectomy.

A prospective trial was conducted to compare haemorrhoidectomy alone (control, group 1) with haemorrhoidectomy plus lateral internal sphincterotomy (group 2) for prolapsed piles. Some 33 patients (18 men, 15 women) of mean(s.e.m.) age 40(2.3) years were randomized, 16 to group 1 and 17 to group 2. There were no significant differences in postoperative pain scores. Mean resting and maximum anal squeeze pressures, studied 6 weeks and 3 months after operation, were generally lower in group 2, but were not significantly different. Two patients in group 2 were distressed by incontinence to liquid faeces which persisted in one after 1 year. There were no other complications in either group after a mean(s.e.m.) follow-up of 11(0.4) months. The addition of lateral internal sphincterotomy to routine haemorrhoidectomy is unnecessary and carries the added risk of incontinence.

Traumatic eventration of diaphragm complicated by mesenteroaxial volvulus of the stomach.

Diaphragmatic disruption is an uncommon consequence of blunt trauma and is often overlooked unless there is a high index of clinical suspicion. A case of eventration of left dome of diaphragm following trauma with mesenteroaxial volvulus of the stomach is presented. Anatomical considerations on levels of diaphragm on chest x-ray has been elaborated.

Do long-standing nodular goitres result in malignancies?

The records of 506 patients with histologically proven nodular goitre treated by thyroidectomy between January 1966 and July 1988 were reviewed. There were 21 patients with thyroid carcinoma in nodular goitre giving a proportion of 4.1%. There was an almost equal ratio of papillary to follicular carcinomas in the patients with malignancy occurring in a multinodular goitre (11 papillary to 9 follicular). One had an anaplastic lesion. These patients had swelling for a longer period, 9.11 years, as compared with an average of 5.48 years for those with only nodular goitre (P = < 0.01) using the Student's t-test. The male to female ratio in those with multinodular goitre alone was 1:10.8 while in those with carcinoma in multinodular goitre was 1:3.2. Comparing these two groups, the odds ratio of malignancy among males was 2.82 (95% confidence limits of the odds ratio being 1.4-5.5). This indicates that males with multinodular goitre had a significantly higher chance of developing a malignancy, Chi-squared value 5.74 (P < 0.05).

Wuchereria bancrofti induced pancreatitis.

A case of pancreatitis of filarial origin is reported for the first time. The patient presented with chronic pancreatic pain. Laparotomy revealed an inflammed pancreas and fine needle aspiration cytology confirmed pancreatitis. Imprint of a peripancreatic lymphnode revealed a microfilaria. He was successfully treated with Diethyl Carbamazine.