CIRCADIAN RHYTHMS IN PATIENTS WITH ABDOMINAL PAIN SYNDROMES

:Circadian rhythms for Cortisol, 6-sulphatoxy melatonin and core body temperature were compared in control subjects and patients with functional abdominal pain. There were 20 patients with biliary pain after cholecystectomy, ten with biliary pain without cholecystectomy and 14 with irritable bowel syndrome. Rhythms were determined by urine collections at intervals of 4 h for 48 h and by overnight monitoring of core body temperature using the Vitalog system. Data were fitted to a sine curve to yield the time of maximal urinary excretion/lowest temperature and the amplitude of each rhythm. Urinary excretion of free Cortisol was similar in patients and control subjects. For urinary 6-sulphatoxy melatonin, the timing (phase) of rhythms was similar in patients and controls but those with pain had a lower urinary excretion of 6-sulphatoxy melatonin (p<0.05) and a rhythm of lower amplitude (p<0.02). The amplitude of the temperature rhythm was also lower in patients with biliary pain with and without prior cholecystectomy (p<0.05). Functional abdominal pain is associated with 6-sulphatoxy melatonin and temperature rhythms of low amplitude, presumably because of suppression of circadian oscillators.     

Biliary Ascariasis in the Indian Subcontinent: A Study of 42 Cases

Background/Aim:

History of ascariasis is known to stretch back many centuries. One quarter of the world''s population is known to be infected by ascariasis. It is endemic in various parts of the Indian subcontinent and the gangetic plain of West Bengal is one of them. We aimed to study the various types of clinical presentations, complications and different diagnostic tools and to assess various options for the management of biliary ascariasis.

Materials and Methods:

Forty-two cases of hepatobiliary ascariasis were studied over a period of 3 years. All the patients were adults aged between 20 and 50 years and all but two were admitted with acute upper abdominal pain.

Results:

In this study, biliary ascariasis was found to be more common in females, 73.8% (31 patients). The most common presentation was upper abdominal pain in 95.2% of the patients (40 patients). Complications observed were obstructive jaundice in 28.56% (12 patients), cholangitis in 16.7% (seven patients), acute pancreatitis in 2.4% (one patient) and hepatic abscess in 2.4% (one patient). History of worm emesis was present in 38.1% (16 patients). History of previous cholecystectomy was present in 16.7% (seven patients) and endoscopic sphincterotomy in 4.8% (two patients). Ultrasound was the diagnostic tool of choice with 100% results. Conservative management was successful in 83.3% (35 patients). During follow-up, worm reinvasion of the biliary system occurred in 7.1% (three patients).

Conclusion:

In endemic countries, ascariasis should be suspected in patients with biliary disease, especially if a cholecystectomy or sphincterotomy has been performed in the past. Most of the patients respond to conservative management.     

ABDOMINAL PAIN AFTER MIGRATION OF A BILIARY ENDOPROSTHESIS

The use of endoprostheses in cases of obstruction of the biliary tract is common practice. We describe a case in which repetitive displacement of endoprostheses caused severe complications.     

NON-HODGKIN'S LYMPHOMA AS A CAUSE OF HYPOADRENALISM

Abstract Non-Hodgkin's lymphoma which presents as adrenocortical insufficiency is rare, however, it should be a well-recognised entity because, in addition to specific chemotherapy or radiotherapy, it needs hormonal replacement. We report a patient with diffuse histiocytic lymphoma, who had remission for seven years and relapsed with Addisonian crisis.     

ALGODYSTROPHY: A COMMON UNRECOGNIZED CAUSE OF CHRONIC KNEE PAIN

Thirty-three patients with undiagnosed chronic knee pain hadfeatures of autonomic disturbance. Thermography is a usefulimaging technique for demonstrating this abnormality. The patientslacked the thermographic symmetry observed in 16 normal controlsbut this returned with resolution of the pain. Recognized radiologicaland scintigraphic features of algodystrophy were found. Thelong duration of symptoms, high proportion of young femalesand the severity of the associated disability were notable.It is suggested that algodystrophy is a more frequent causeof chronic knee pain than previously recognized. Autonomic abnormalitiesmay be less intense in disease at this site, particularly inyoung females and may be overlooked. This characteristic ofalgodystrophy of the knee may contribute to chronicity and subsequentdisability. KEY WORDS: Algodystrophy, Sudeck’s atrophy, Reflex sympathetic dystrophy, Knee, Autonomic nervous system     

急性胰腺炎104例腹痛临床特点分析

目的探讨急性胰腺炎腹痛的特点。方法回顾性分析武汉大学人民医院2007年1月至2009年12月住院诊治的急性胰腺炎104例临床资料,分别统计人口统计学资料、临床表现及治疗与转归。结果全部104例患者均以腹痛为主诉,多数患者具有典型的腹痛症状,但也不乏腹痛特点不典型者。诱因为进食零食、水果者占5.8%(6/104);疼痛位于脐周及下腹部等不典型部位者12.5%(13/104);腹痛性质为隐痛及胀痛者29.8%(31/104);有恶心、呕吐、发热、畏寒等伴随症状者65.4%(68/104);早期加用生长抑素疼痛缓解时间明显缩短者82.7%(86/104)。结论腹痛是急性胰腺炎患者的主要症状。目前确诊的急性胰腺炎患者中,虽具有典型急性胰腺炎腹痛特点的患者居多,但也不乏腹痛特点不典型的患者。只有提高对急性胰腺炎腹痛及相关表现的认知,更加全面细致的病史询问,结合对病情的动态观察及辅助检查结果,才能更好的早期、准确诊断急性胰腺炎,避免误诊。     

INFANTILE MYOFIBROMATOSIS: A CAUSE OF SEVERE BONE PAIN IN A NEONATE

A 3-week-old, female infant, developed severe bilateral shoulderpain in association with large, symmetrical, lytic lesions inthe proximal humeri. The radiological appearance was suggestiveof infantile myofibromatosis and bone biopsy confirmed the diagnosis.She subsequently made a complete recovery. This uncommon conditionis infrequently confined to bone and except in the presenceof obvious pathological fracture, severe pain has not previouslybeen reported. KEY WORDS: Infantile myofibromatosis, Neonate, Shoulder pain, Lytic lesions     

DEFECTIVE THYROGLOBULIN EXPORT AS A CAUSE OF CONGENITAL GOITRE

The thyroids of two brothers aged 13 and 15 with congenital goitre, butanolinsoluble iodine in blood and which had pronounced decrease of immunoreactive thyroglobulin content in the thyroid were studied. Two types of thyroglobulin were identified. The first amounted to only about 200-300 mug/g wet tissue and was fully immunoreactive with anti normal human thyroglobulin antiserum (iTG-G). It was purified by affinity chromatography. The other was mainly associated with intracytoplasmic membranes, amounted to about 8 mg/g wet tissue and was only partially immunoreactive (piTG-G). Both had abnormal amino acid compositions but only iTG-G showed a decreased carbohydrate content. Surprisingly, piTG-G showed a normal iodination level (0-5%) and a normal iodoamino acid composition. Immunochemical studies performed on slices or cell-free fractions incubated in the presence of labelled amino acids and/or monosaccharides showed that: (1) thyroglobulin peptide chains were being synthesized and almost normally discharged into the cisternae of the rough endoplasmic reticulum; (2) incorporation of sugars into iTG-G was decreased; (3) sialyl- and galactosyltransferase activities were normal and the enzymes normally located, and (4) albumin which is present in the thyroid as the iodinated protein was probably not synthesized by the goitrous tissues. Two major abnormalities were detected by light and electron microscopy: absence or pronounced scarcity of colloid in the follicular lumina and overdistended endoplasmic reticulum cisternae. These observations are compatible with a defect in TG transport from the cell into the lumen as the cause of the goitre. Whether defective thyroglobulin export is basically related to abnormality of the protein structure or to another cause is discussed.