Norovirus Genogroup II Gastroenteritis in Hospitalized Children in South India

The distribution of norovirus (NoV) genogroup II in children < 5 years of age admitted to a south Indian hospital with diarrhea was investigated. Viral RNA extracted from 282 stool samples were screened for NoV GII and positive amplicons sequenced. Twenty-eight (9.9%) had NoV GII infection with a median age of 6 months, with more severe episodes of diarrhea among infected (median Vesikari score 13, interquartile range [IQR] 10–15) than children without infection (median score 10, IQR 8–13, P = 0.002). The study documents NoV GII infections as an important cause of gastroenteritis and the genetic diversity of circulating strains.     

Sperm acrosin levels in semen: comparison between ACCU-SPERM and Kennedy's methods

Summary. The purpose of this experiment was to evaluate the accuracy, specificity, and sensitivity of a new acrosin activity assay, ACCU-SPERM, and to correlate these results with the original Kennedy method. Thirty-nine specimens (26 patients and 13 donors) of 54 (72%) were found to be in the normal range (>25 μIU acrosin/10⁶ sperm) by the Kennedy method; the other 15 specimens were in either the indeterminate or subfertile range (< 14 μIU). However, according to the ACCU-SPERM method, (normal: 6.6–27 AAI; infertile: < 3.6), 90% of specimens (49 of 54) whose acrosin activity was measured were in the subfertile or infertile range. Similarly, only 28% (4 of 14) of donors in the ACCU-SPERM method were in the normal range in contrast to the 93% (13 of 14) in Kennedy. After calculating the ACCU-SPERM normal range in our laboratory using the linear regression curve between the acrosin values generated by the Kennedy and ACCU-SPERM methods, we again compared results of the two methods. The new normal range of > 1.82 AAI in ACCU-SPERM corresponded to > 25 μIU in the Kennedy method; similarly a value of < 1.35 AAI in ACCU-SPERM corresponded to < 14 μIU in the Kennedy technique. Analysis of the results generated by the two methods revealed a poor correlation with a positive concordance of 51% and a negative concordance of 50% in both assays. These results strongly suggest that the ACCU-SPERM method for measurement of acrosin activity is not a reliable assay.     

Open port placement of the first laparoscopic port: a safe technique.

BACKGROUND: Blind insertion of the Veress needle and of the first trocar is a significant cause of complications in laparoscopic surgery. Despite this risk, the closed technique is still more popular than the open one. Our aim is to report the results of our experience with the routine use of the modified open technique in laparoscopic surgery and to describe the technical details of the creation of pnuemoperitoneum by the open technique that we used. METHODS: A prospective study was conducted in the department of surgery at Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi. A modified method of open laparoscopy was performed on 755 consecutive patients requiring laparoscopy or laparoscopic surgery over a 5-year period from August 1998 to February 2003 in 1 surgical unit. RESULTS: The mean time taken was 4 minutes (range, 2 to 10). No intraoperative complications occurred during trocar insertion. Forty-nine (6.49%) patients had minor umbilical sepsis, 22 (2.91%) had periumbilical hematoma, but none had umbilical hernia during 3 months of follow-up after surgery. CONCLUSION: Based on our own experience, we recommend open laparoscopy as a safe and easy approach for routine laparoscopic interventions.     

Nasopharyngeal angiofibroma with cavernous sinus involvement — An unusual presentation

Juvenile nasopharyngeal angiofibrama (JNA) is a benign vascular tumour which is locally aggressive and occasionally extends intracranially. It occurs mainly in adolescent males. We report an interesting case of a targe JNA with intracranial extention encroaching on the cavernous sinus which we treated surgically by the conventional lateral rhinotomy and transpalatal approach.     

The morphology of coronary arterial dissection occurring subsequent to angioplasty and its influence on acute complications

We reviewed the records of 402 patients undergoing percutaneous transluminal coronary angioplasty to identify factors predicting an ischemic event with arterial disruption during an otherwise uncomplicated angioplasty. Major dissection of the coronary arteries without immediate occlusion was found in 25 patients, who exhibited 28 dissected lesions. Dissections were classified into 2 types: those producing a continuous extraluminal and parallel filling tract, and those with a continuous parallel filling tract extending into and compromising the lumen. Ischemic complications (defined as myocardial infarction, the need for repeat angioplasty, or coronary arterial bypass surgery) occurred in 6 patients (24%) within 24 hours of the completion of the procedure. The remaining 19 patients had an uncomplicated hospital course. Acute ischemic complications following dissection correlated with the percentage of luminal compromise 50 +/- 0% in those with complications as opposed to 17 +/- 21% in those without: P less than 0.001) and the development of dissection producing a filling tract which compromised at least half the lumen (100% in those with complications versus 9.1% in those without: P less than 0.001). There was a trend towards an increase in ischemic complications in patients with proximal and eccentric lesions. We conclude that patients who develop dissections which produce significant luminal compromise after an otherwise uncomplicated angioplasty are at a high risk of developing an acute ischemic complication within 24 hours of the procedure.     

Aortic Valve Rheumatoid Nodules Producing Clinical Aortic Regurgitation and A Review of the Literature

The majority of cardiac involvement in rheumatoid arthritis (RA) is an incidental finding at postmortem, as less than 3% of patients with RA have clinical cardiac signs or symptoms. Most cardiac involvement in RA involves the pericardium and has been known since Charcot first described an RA patient with pericarditis in 1881. Cardiac involvement takes two different forms: non-specific inflammatory changes and specific granuloma formation. Specific rheumatoid nodules in the heart are an infrequent complication of RA. This is the first case report of a surgically excised heart valve with rheumatoid nodules. A 74-year-old RA patient with a high seropositive rheumatoid factor presented with severe aortic regurgitation and underwent a valve replacement. The native aortic valve showed significant stenosis with multiple, classic rheumatoid nodules. Cardiovas Pathol 1999;8: 333–338     

Rotationplasty as a limb salvage procedure for malignant bone tumours

Summary. Sixteen patients with malignant bone tumours, 15 osteosarcoma and one Ewing’s sarcoma, were treated by rotationplasty at Tata Memorial Hospital between 1989 and 1994. The functional results are better than after amputation.

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Résumé. Les auteurs rapportent 16 cas de tumeur osseuse maligne traités par plastie de rotation à l’H?pital Tata Memorial entre 1989 et 1994. Il s’agit de 15 ostéosarcomes et d’une sarcome d’Ewing. Avec une bonne rééducation prothétique les résultats donnent une meilleure qualité de vie que ceux apportés par une amputation.

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Accepted: 10 July 1997