Study of Gonadal Hormones in Males With Liver Cirrhosis and Its Correlation With Child-Turcotte-Pugh and Model for End-Stage Liver Disease Scores.

BACKGROUND AND AIMS: Liver cirrhosis influences gonadal hormone metabolism by multiple mechanisms and causes gonadal dysfunction. This study aimed to study sex hormones in males with cirrhosis and determine their correlation with prognostic scores. METHODS:  An observational study was conducted between October 2019 and August 2021 in India. Sixty males with liver cirrhosis and 60 healthy age-matched controls were enrolled. Serum-free testosterone (T), estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (Prl) were checked. Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD-Na) scores were calculated. RESULTS: Mean age of patients was 46.9±8.38 years. Forty-three were alcoholics. A total of 29 (48.33%) patients had low levels of free T. Cirrhotic males had lower testosterone and higher estradiol levels and lower T:E2 ratio compared to controls. Levels of luteinizing hormone, follicle-stimulating hormone, and prolactin were comparable. Lower testosterone was significantly associated with advancing age, alcoholism, duration of cirrhosis, loss of libido, and ascites. The higher the CTP scores, the lower the free testosterone levels and the higher the E2 levels. There was no significant association between low free testosterone levels and MELD-Na score. CONCLUSIONS: Age, alcohol, duration of disease, and low albumin levels are risk factors for hypogonadism in cirrhosis. There was a significant positive correlation between low free testosterone levels and poor CTP scores.

Clinical and endoscopic study of dyspepsia in overweight and obese patients.

Objectives: Globally, the prevalence of obesity is increasing at an alarming rate. Obese patients often suffer from chronic dyspeptic symptoms. The aim of the study was to know the gross and histologic upper gastrointestinal mucosal changes and the prevalence of Helicobacter Pylori (H. Pylori) infection in overweight and obese dyspeptic patients. Materials and Methods: A cross-sectional, observational study was done on 100 patients with dyspepsia and a body mass index (BMI) of ≥25 kg/m2. The study was done between August 2019 and September 2021 at a tertiary care hospital in Maharashtra, India. Statistical Analysis: Chi-square test, Mann-Whitney test, and Fischer exact tests were applied to study the association between categorical variables. A P value of < 0.05 was considered statistically significant with a confidence level of 95%. Results: There were 59 males and 41 females. The mean age of the study subjects was 41.95 ± 12.32 years and the age range was 19-67 years. The maximum number of patients (36%) were in the age group of 50-59 years. Hypertension (45%) and type 2 diabetes mellitus (T2DM) (30%) were the common comorbidities present. Heartburn and regurgitation were the most common symptoms, present in 37% and 35% of the subjects, respectively. Inflammatory lesions oesophagitis (28%) and gastritis (43%) were the common findings in upper gastrointestinal endoscopy (UGIE). The stomach was the most common site with lesions. On histopathological examination, erosive gastritis (33%) and oesophagitis (28%) were confirmed. A total of 86% of obese subjects had at least one grossly abnormal finding. The prevalence of H. Pylori was 32%. Obese subjects had significantly more abnormal findings on UGIE compared to overweight subjects (P < 0.05). Obese patients suffering from type 2 diabetes mellitus had significantly abnormal findings on UGIE compared to non-diabetic obese patients (P < 0.05). Obese patients with higher body mass index (BMI) and the presence of H. Pylori infection were more likely to have abnormal UGIE findings. Conclusions: Inflammatory and erosive lesions of the stomach and oesophagus are more common in obese dyspeptic patients. UGIE should be the investigation of choice and should be performed in overweight and obese patients with dyspepsia to predict and prevent Gastrointestinal (GI) disorders and their related complications.

Antero-posterior Duplicate Exstrophy with a Wet Bladder Plate: A Diagnostic Dilemma.

Variants of exstrophy are rare anomalies seen in the spectrum of bladder exstrophy-epispadias complex. We present a rare case of duplicate exstrophy with a wet bladder plate. This is a deviation from the classical description of antero-posterior duplicate exstrophy that is associated with a dry bladder plate.

Thoracoscopic excision of foregut duplication cyst: A case report and review of literature.

Thoracoscopy has major advantages over thoracotomy. We report a successful management of foregut duplication cyst thoracoscopically in a child with review of literature.

Synchronous Ipsilateral Wilms' Tumor and Neuroblastoma in an Infant.

Wilms' tumor (WT) and neuroblastoma (NB), the two most common extra-cranial solid malignant tumors, are seldom seen together in the same patient. A 10-month girl presented with a right retroperitoneal mass. A preoperative diagnosis of Wilms' tumor (WT) was made. She was given preoperative chemotherapy followed by surgery. At surgery a renal mass (WT) and a suprarenal mass (neuroblastoma - NB) were removed. She finally succumbed to metastatic NB in the postoperative period.

Sacrococcygeal Teratoma with Yolk Sac Component in a Neonate.

Sacrococcygeal teratoma (SCT) is the most common congenital tumor in neonates. SCT may be benign (mature and immature) or malignant. Malignancy is rare in SCT diagnosed before 2 months of age. Here, we describe a neonate having a mature teratoma with a focus of malignant yolk sac tumor within and the difficulties faced in its management.

Extra-Renal Wilms' Tumor: A Rare Diagnosis.

The diagnosis of extra-renal Wilms' tumor is often missed at initial clinical presentation leading to a delay in initiating appropriate therapy. A 5-year-old girl presented with a 3-week history of a painless lump in the pelvis. Radiological investigations suggested an ovarian neoplasm. Tumor markers for ovarian malignancy were in normal range. Trucut biopsy also suggested the possibility of an ovarian neoplasm. The tumor was excised and final histopathology revealed it a Wilms' tumor.