Balloon tamponade in the management of bleeding oesophageal varices

Sixty-three patients with acute variceal haemorrhage were treated with the Sengstaken-Blakemore tube (SBT). Bleeding was initially controlled with the gastric balloon in 37 patients (60%) and with both gastric and oesophageal balloons in another 17 (27%), giving overall primary success in 54 patients (87%). Sixteen (26%) patients re-bled within 24 hours of deflation of the tube. Repeat balloon tamponade helped in controlling bleeding in 9 of these. Thus, a total of 47 (75%) patients stopped bleeding with SBT. There was no mortality. The only major complication was pulmonary infection (15%), which improved with antibiotics. Use of the SBT was found to be simple, quick, low cost and attended with few complications. Its use is recommended in patients with acute variceal bleeding, especially in developing countries with limited resources.     

Tear glucose levels in normal people and in diabetic patients.

Fifty normal people and 50 diabetic patients were studied by means of an enzymatic method for the glucose content in the blood, tears, and urine before and after the peroral glucose load. In normal subjects the fasting glucose levels in the tears averaged 3.6 mg/100 ml (0.2 mmol/l) and in the diabetic patients it averaged 16.6 mg/100 ml (0.92 mmol/l). As in blood and urine, tear glucose levels are significantly higher in diabetic patients than normal persons both at fasting and after the peroral glucose load test. The fasting tear glucose level did not appear to be a satisfactory index for classifying a person as a diabetic or normal. It was found that after the peroral glucose load test a tear glucose level at 11 mg/100 ml (0.61 mmol/l) resulted in only 4.6% of the diabetics being missed, while 5.8% of the normal persons were misclassified as diabetics.     

Successful treatment of pure red cell aplasia associated with systemic lupus erythematosus with oral danazol and steroid

We describe a middle-aged Chinese systemic lupus erythematosus (SLE) patient developing steroid refractory and transfusion dependent red cell aplasia. Oral danazol 200 mg twice per day was started together with low-dose prednisolone therapy. There was no further recurrence of anemia 1 month after this combined therapy.     

Deep vein thrombosis: a rare complication of thalidomide therapy in recurrent erythema nodosum leprosum

A case of deep-vein thrombosis is reported in a female patient with multibacillary leprosy who received pulses of dexamethasone and cyclophosphamide for recurrent ENL that had not responded to prednisone and thalidomide.     

Multispiral computed tomographic angiography of renal arteries of live potential renal donors: a review of 118 cases

OBJECTIVES: Review of the angiographic data of 118 live kidney donors was performed to assess the renal vessel anatomy; compare the findings with the perioperative findings using multislice spiral (MS) computed tomographic angiography (CTA) with the use of 50 mL of intravenous contrast; determine the sensitivity of this technique in the workup of live potential renal donors; and finally to discuss and compare the results of the present study with the reported results using single-slice spiral (SS) CTA, magnetic resonance angiography (MRA), and conventional angiography (CA). METHODS: Retrospective analysis of the angiographic data of 118 of prospective live kidney donors was performed. All donors underwent renal angiography on MSCTA scanning using 50 mL of intravenous contrast with 1.25-mm slice thickness followed by maximum intensity projection and virtual rendering techniques postprocessing algorithms. Analysis was made on imaging and intraoperatively for the number of renal arteries as well as their bifurcation pattern, location, vessel caliber, length, and venous anatomy, and these were then compared with each other. RESULTS: MSCTA showed clear delineation of the main renal arteries in all the donors with detailed vessel morphology. The study also revealed a 100% sensitivity in the detection of accessory renal vessels, which had an overall incidence of 26.67%, with the most common distribution in the perihilar region. CONCLUSIONS: The present study showed a 100% sensitivity and specificity in the visualization and detection of main and accessory renal vessels with the use of only 50 mL of intravenous contrast with similar results seen with CA which has so far been considered the "gold standard." The results on MSCTA were also better than those with the use of SSCTA and MRA in the workup of liver renal donors, with the above technique also proving to be more cost effective. The overall incidence of supernumerary vessels was the same as reported in the literature; however, a higher incidence of single aberrant vessels was seen on the right side, contrary to what has been suggested so far and was attributable to improved detection of accessory vessels less then 2 mm in diameter.     

Systemic neutrophil priming by lipid mediators in post-shock mesenteric lymph exists across species

BACKGROUND: Post-hemorrhagic shock mesenteric lymph (PHSML) has been linked with neutrophil (PMN) priming, endothelial cell (EC) activation, and acute lung injury (ALI) in rodent models. We have previously identified the lipid fraction of PHSML as containing the causative agent(s). Due to the lesson learned from the rodent gut bacterial translocation experience, we sought to confirm this phenomenon using a large animal model; hypothesizing that lymph collected from the porcine gut following ischemia/reperfusion (I/R) would cause PMN priming. METHODS: Mesenteric lymph was collected from adult pigs before, during, and for 2 hours after non-lethal hemorrhagic shock (mean arterial pressure = 30 mm Hg x 45 minutes). Whole lymph and the extracted lipid fractions of the lymph were then added to isolated human and porcine PMNs and superoxide production was measured by cytochrome C reduction. RESULTS: Hemorrhagic shock profoundly affected mesenteric lymph flow from baseline (pre-shock) flow rates of 75.63 +/- 8.86 mL/hr to 49.38 +/- 5.76 mL/hr during shock and increasing to 253.38 +/- 27.62 mL/hr after 2 hours of resuscitation. Human PMNs exposed to both whole lymph (PHSML) and its extracted lipids (PHSML Lipid) collected 2 hours after shock exhibited more than a two-fold increase in superoxide release upon activation compared with pre-shock samples: PHSML- 6.27 +/- 0.83 versus 2.56 +/- 0.60 nmolO2(-)/ 3.75 cells/mL/min, respectively (p = 0.007), PHSML Lipid- 4.93 +/- 0.34 versus 2.49 +/- 0.11 nmolO2(-)/ 3.75 cells/mL/min (p < 0.001). Similarly, porcine PMNs exhibited close to a two-fold activation when exposed to the lymph and lipid fraction: PHSML- 4.51 +/- 0.42 versus 1.06 +/- 0.28 nmolO2(-)/ 3.75 cells/mL/min (p = 0.008), PHSML Lipid-4.80 +/- 0.81 versus 1.55 +/- 0.23 nmolO2(-)/ 3.75 cells/mL/min (p = 0.002). CONCLUSION: Mesenteric lymphatics serve as the conduit for inflammatory mediators elaborated by the post-ischemic gut in both small and large animal models. Further, the causal agent(s) exist in the lipid fraction of the lymph and are active on both human and animal PMNs.     

Isolated gastric varices: prevalence,clinical relevance and natural history

BACKGROUND: Isolated ectopic gastric varices (IGV2) are present either in the body or antrum of the stomach or upper duodenum. The prevalence, natural history and clinical significance of these varices has not been adequately described. MATERIALS AND METHODS: Consecutive patients with portal hypertension, prospectively studied and diagnosed to have IGV2, were assessed for their time of appearance - primary (at first presentation) or secondary (after obliteration of oesophageal varices), association with other varices, portal hypertensive gastropathy and any overt bleeding. RESULTS: Fifty-three of the 1128 (4.7%) patients had IGV2. The IGV2 were commonly seen in the antrum (53%), duodenum (32%), or at both sites (11%) and rarely in body and fundus (4%). IGV2 were predominantly (84.9%) secondary in origin, developing after oesophageal variceal obliteration. The median time for emergence of secondary IGV2 was 8.2 months for patients with cirrhosis, 12.8 months for non-cirrhotic portal fibrosis and 10.8 months for extra-hepatic portal vein obstruction. Eight (15%) patients had primary IGV2, 6 of them had underlying portal vein obstruction. Portal gastropathy (p < 0.05) and UGI bleeding were more common in the secondary than in primary IGV2. Bleeding due to IGV2 was seen only in 3 (5.7%) patients during a mean follow-up of 36.3 +/- 12.1 months, and could be successfully managed with endoscopic ligation or obliteration. CONCLUSIONS: Isolated ectopic gastric varices are not uncommon and generally develop following obliteration of main variceal columns. They rarely bleed and often can be managed with endoscopic interventions.