Vesicular and bullous eruptions in tropical (filarial) eosinophilia

A case of tropical (filarial) eosinophilia (TE) presented with vesicular and bullous eruptions. The patient had skin and mucosal blistering. Histopathological changes were that of bullous pemphigoid. The patient had very high eosinophilia with abnormal vacuoles in the cytoplasm. ELISA test was positive for filarial antibodies. There were no pulmonary signs or symptoms. X-ray chest was normal. The patient responded well to diethylcarbamazine.     

Study of thiobarbituric reactive substances and total reduced glutathione as indices of oxidative stress in chronic smokers with and without chronic obstructive pulmonary disease

BACKGROUND: The imbalance between oxidants and antioxidants is thought to play an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). METHODS: Biomarkers of lipid oxidation such as thiobarbituric reactive substances (TBARs), total reduced glutathione (GSH) were estimated in chronic smokers with and without COPD, and non-smokers. RESULTS: The following subjects (all males) were studied: (i) chronic smokers (32.5 +/- 8.6 pack years) with stable COPD (n = 20; mean age 47.2 +/- 7.8 years); (ii) chronic smokers (6.3 +/- 1.9 pack years) without COPD (n = 20; mean age 35.3 +/- 4.5 years); and (iii) non-smokers (n = 20; mean age 37.5 +/- 5.5 years). The mean TBARs levels (nmol of malondialdehyde per ml of plasma) were higher among smokers with COPD (5.72 +/- 1.02) when compared with smokers without COPD (4.85 +/- 0.97) and non-smokers (2.58 +/- 0.56) (p < 0.001). The mean GSH levels (micromol/mg of protein) were significantly higher in non-smokers (0.163 +/- 0.113) compared to smokers with COPD (0.083 +/- 0.05) and those without COPD (0.050 +/- 0.051) (p < 0.001). There was no statistically significant difference in the plasma GSH levels among smokers with and without COPD (p > 0.05). CONCLUSIONS: Our observations demonstrate increased lipid peroxidation because of oxidative stress due to smoking.     

Early results of combined valve replacement and coronary revascularisation

Fortyfive patients underwent combined valve replacement and coronary revascularisation from June 1987 to May 1993. Twentytwo patients underwent MVR and CABG, 21 patients A V Rand CABG and 2 had both aortic and mitral valve replacement in addition to CABG. Cold potassium blood cardioplegla was used for intraoperative myocardial protection in all the patients. Among those who underwent A V R and CABG, 3 patients died and 3 others died from among those who underwent MVR and CABG. Both patients who underwent double valve replacement and CABG did well. Rheumatic mitral lesions were the common indication for MVR in patients with combined mitral lesions and coronary artery diseases. This is in contrast to western patients, where ischaemic and degenerative lesions are more common.     

Safe corridors for K-wiring in phalangeal fractures

Background:Unstable phalangeal fractures are commonly treated with K-wire fixation. Operative fixation must be used judiciously and with the expectation that the ultimate outcome should be better than the outcome after nonoperative management. It is necessary to achieve a stable fracture fixation and early mobilization. In order to achieve this goal, one should closely understand the safe portals/corridors in hand for K-wire entry for fractures of the phalanges. Safe corridors were defined and tested using a pilot cadaveric and a clinical case study by assessing the outcome.Results:47 (95%) patients had excellent TAM and the mean postoperative DASH score was 58.05. All patients achieved excellent and good scores proving the importance of the safe corridor concept.Conclusion:K-wiring through the safe corridor has proved to yield the best clinical results because of least tethering of soft tissues as evidenced by performing “on-table active finger movement test” at the time of surgery. We strongly recommend K-wiring through safe portals in all phalangeal fractures.     

Reoperation for residual defects following intracardiac repair for tetralogy of Fallot

Reoperation was carried out in two patients who had previously undergone correction for tetralogy of Fallot and presented with severe pulmonary hypertension. One patient who had undergone intracardiac repair five years earlier had a residual ventricular septal defect (VSD), right ventricular outflow (RVOT) obstruction, patent ductus arteriosus and severe pulmonary hypertension. The second patient, who had undergone intracardiac repair four years earlier, also had a residual VSD and RVOT obstruction. Both underwent VSD closure, RVOT resection and pulmonary valve replacement and did well postoperatively. We recommend aggressive surgical treatment in such patients even in the presence of pulmonary hypertension.