Surgical outcome in relation to duct size at the porta hepatis and the use of cholagogues in patients with biliary atresia.

BACKGROUND: Small ductules communicating with the bile ducts have been described at the porta hepatis in extrahepatic biliary atresia (EHBA) and these form the basis for hepatic portoenterostomy. The use of cholagogues like dehydrocholic acid (DHC) and ursodeoxycholic acid (UDCA) to enhance bile flow postoperatively has been reported. AIMS: This communication describes our experience with the use of cholagogues following surgery in EHBA and attempts to correlate the outcomes with the diameter of the ductules. MATERIAL AND METHODS: Fifty five EHBA patients treated by the Kasai procedure form the basis of this study; 35 patients treated during 1979-1986 and administered DHC (3-5 mg/kg) postoperatively and 20 patients treated during 1999-2002 and administered UDCA (15 mg/kg) postoperatively. The diameter of ductules was measured using an optical micrometer on 5 microm serial sections; the ducts were classified as type I (no demonstrable ducts, n = 14), type II (< 50 microm, n=22) and type III (> 50 microm, n = 19). The clinical outcome was categorized as 1 (jaundice free survival at 5 years follow-up, n = 7), 2 (initial good response but deteriorated after one year, n = 27) and 3 (expired within one year following surgery, n = 21). The response to surgery was monitored using biochemical liver function tests (LFT), hepatobiliary scintigraphy (HIDA scan) and occurrence of cholangitis. RESULTS: Age did not affect the size of ducts in both DHC and UDCA groups but patients in the DHC group were older than those treated with UDCA (mean age DHC: 105.22 +/- 33.53 days, UDCA: 74.68 +/- 23.73 days; p = 0.009). There was no statistically significant difference between duct size and postoperative LFT in both groups (DHC p = 0.1, UDCA p = 0.5). Bile excretion on HIDA scan was significantly better with larger ducts (DHC p = 0.003, UDCA p = 0.025); overall UDCA showed significantly better bile excretion (p = 0.003) but this was not reflected in the surgical outcome. There was no significant difference in the surgical outcome of those treated with DHC or UDCA but a significantly higher incidence of cholangitis was seen with smaller ducts in the UDCA group (p = 0.02). CONCLUSIONS: There was no correlation between duct diameter and postoperative LFT but type III ducts were associated with better bile flow on HIDA scan. Cholangitis was seen more often with type I and II ducts in both DHC and UDCA groups. UDCA administration seemed to be beneficial in patients with type III ducts in increasing bile flow and reducing cholangitis.

Profile of trauma related mortality at Manipal.

BACKGROUND: The main objective of the present study is to analyse the pattern of death related to trauma/injuries at Manipal in Udupi district, Karnataka state, India. MATERIAL AND METHODS: Retrospective data (January 2001 to December 2003) were collected from autopsy reports maintained in the department of forensic medicine, and the inquest reports from the police. Out of the total (n=470) autopsies, 344 victims had traumatic fatality. The demographic data, type of trauma, duration of survival, body areas involved was recorded. RESULTS: 470 autopsies were performed during the period of study. Of these 344 (73%) were traumatic fatalities. Males were preponderant (71%). More than half of the victims were between 1-40 years. The youth age of 21-30 years were affected maximum due to all type of trauma except for falls and assault in this area of the country (India). The leading type of trauma was Road Traffic Accident (RTA) (52%) followed by burn (24%). Females were predominant with 74% in trauma due to burns. In majority of cases where the death was reported in the hospital, among them more than 50% of victims were survived in hospital for more than 24 hours. The victims those expired within 3 hours were in majority from RTA and those who survived for more than 24 hours were in majority from burns. Majority (258) of the victims had head injuries followed by thoracic injuries (169), and abdomen (125). Twenty four percent of the victims died on the spot or before reaching hospital. CONCLUSION: In this area of the country the trauma due to RTA is a leading cause of death among the traumatic death followed by burns.

Some comments on diabetes and herbal therapy.

Diabetes mellitus is a chronic disease recognized as a malady of aged people and the young. As the contemporary civilization is advanced more people in civilized world are suffering from diabetes mellitus due to irrational dietary habits. Though the disease was known since long effective treatment was scarce. There is no effective treatment for its radical cure but the preventive measures can be resorted to. However, ayurvedic system has been successful in controlling the disease by medicines and sound advice on dietetics.

Studies on the method - ethnobotany of calotropis gigantea and C.procera.

The paper reviews the economic and traditional medicinal uses of the plants, Calotropis gigantean and C. procera from the published literature from various of India. The ethno-medicinal uses of the former species in Orissa are also incorporated. Their distribution in India, Botany, Physical and Chemical properties of the plant parts are provided. Uses of the traditional medicines and their authentication as evidence by the available clinical trials are discussed. Besides, uses and standardization of doses against various ailments are suggested.

Effect of age on thermal inactivation of glucose-6-phosphate dehydrogenase in liver and kidney of the male garden lizard.

A comparison between middle-aged and old lizards revealed no significant age change in glucose-6-phosphate dehydrogenase activity of liver and kidney. Thermal inactivation at 51 +/- 1 degree C induced a significantly higher degree of decline in enzyme activity of tissues of old than that of middle-aged lizards. The increase in thermolability of enzyme in liver and kidney of ageing lizards suggests an accumulation of altered enzyme molecules.

Reduced pyridine nucleotide oxidases of Eugena gracilis var. bacillaris.

Cell-free extracts of a streptomycin-bleached strain of Euglena gracilis var. bacillaris have been examined for enzyme systems primarily responsible for the oxidation of reduced pyridine nucelotides. NADH lipoyl dehydrogenase, NADH and NADPH oxidase, NADH and NADPH diaphorase, and NADH and NADPH cytochrome c reductase have been demonstrated. The NADPH-linked enzymes had lower activity rates and were less sensitive to N-ethyl maleimide and p-hydroxymercuribenzoate than their NADH-linked counterparts. NADH cytochrome c reductase was the most sensitive to antimycin A. Michaelis-Menten constants (Km) determined were as follows: NADH diaphorase, 350 muM; NADPH oxidase 150 muM ; NADH lipoyl dehydrogenase, 0.35 muM. Enzyme activities after storage at -5 C indicate that the diaphorases are less labile than the other tested enzymes, and the differential activities of the NADH and NADPH linked enzymes suggest that functionally they may have different roles.