Spontaneous gastroduodenal disruption in neonate

A 2-day-old female presented with massive abdominal distention and respiratory distress. An erect abdominal X-ray film revealed a pneumoperitoneum of saddlebag configuration. The patient was resuscitated and a peritoneal drain was put through the right flank. Air and bile drained, and the respiratory distress was relieved. After the patient had stabilised haemodynamically, an exploratory laparotomy revealed a total gastroduodenal disruption. A gastrojejunostomy was done; the pyloric and duodenal ends were closed in two layers. The postoperative course was uneventful. We report this case for its unusual and rare presentation. Accepted: 1 March 2001     

Neoadjuvant chemotherapy with ifosfamide and cisplatin combination in advanced head and neck cancer: a retrospective analysis of 519 patients: a single institution experience

Advanced head and neck cancer is a major therapeutic problem in India. Ifosfamide has shown significant activity as a single agent in head and neck squamous carcinoma. In this study, we present our experience with two cycles of ifosfamide and cisplatin in the neoadjuvant setting given to a total of 519 patients. The complete response rate was 20% and the overall response rate was 80%. The treatment was well tolerated, there was no need for dose reduction, and there were no life-threatening side effects. We feel that this high response rate is sufficient to warrant more studies using ifosfamide-based combinations in a neoadjuvant setting for squamous carcinoma of the head and neck.     

Niemann Pick disease--a case report

Niemann Pick disease is a rare disorder occuring in paediatric age group. The clinical features, hematological characteristics and autopsy findings in an one year old male diagnosed to have Niemann Pick disease are presented.     

Epidemiology of cholera--a five year study

A total of 286 strains of Vibro Cholerae were isolated and tested over a period of five years. The strains were identified by standard methods and confirmed by slide agglutination tests with polyvalent, Ogawa and Inaba antisera. The non-agglutinating strains were tested with O-139 antisera. The maximum number of cases were found in the age group of 0-10 years. The number of females affected was more than the males. V. cholerae O-139 was isolated in the year 1998 and then again in 2000. V. cholerae serotype Inaba was found only in the year 1999. All of the other isolates belonged to the serotype Ogawa. The periodic shift between O1 and O-139 serogoups is reminiscent of the shifts from the Ogawa to the Inaba serotypes periodically witnessed among V. cholerae, possibly mediated by the immune pressure in the population.     

Talking to patients about St. John's wort

St. John's wort, an unregulated herbal supplement widely used as a self-treatment for depression, can cause side effects and drug interactions. Physicians should ask their patients about use of over-the-counter products such as St. John's wort and discuss their use in a frank but nonjudgmental manner.     

Cerebellar volume decline in normal aging, alcoholism, and Korsakoff's syndrome: relation to ataxia

The authors used magnetic resonance imaging to measure gray and white matter volumes in cerebellar hemispheres and 4 vermian regions in 61 normal control (NC) men aged 23-72 years, 25 men with uncomplicated alcoholism (ALC), and 8 men and 1 woman with alcoholic Korsakoff s syndrome (KS). NC and ALC took quantitative gait and balance tests. Gray but not white matter volume declined with normal age in both hemispheres and anterior-superior vermis. ALC had gray but not white matter cerebellar hemisphere volume deficits, whereas KS had deficits in both tissue types. ALC and KS had gray and white matter volume deficits in anterior superior but not posterior inferior vermis. ALC had a 1 SD ataxia deficit, significantly and selectively correlated with white matter volume in anterior superior vermis. Regional distribution but not severity of cerebellar volume deficits is similar in alcoholic individuals whether or not complicated by KS and relates to ataxia.     

Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India

The article presents the effect of home-based neonatal care and management of sepsis on neonatal mortality in the Gadchiroli district of India. The study responds to the growing need for the reduction of neonatal mortality rate in developing countries. Sample population involved 39 intervention and 47 control villages in the Gadchiroli district. Baseline data for 2 years (1993-95) were collected from these districts. Neonatal care was introduced in the intervention villages in 1995-98, wherein village health workers trained in neonatal care made home visits and managed sepsis and other neonatal problems. Other workers recorded all births and deaths in the intervention and the control area (1993-98) to estimate mortality rates. Findings showed that the net percentage reduction in the third year of intervention for the neonatal mortality rate was 25.5 (62.2%); for the infant mortality rate, 38.8 (45.7%); and for the perinatal mortality rate, 47.8 (71.0%). Case fatality in neonatal sepsis declined from 16.6% before treatment to 2.8% after treatment by village workers (p 0.01). The article concludes that home-based neonatal care, including management of sepsis could reduce neonatal mortality substantially in developing countries.     

Quantitative estimation and recommendations for supplementation of protein lost through scaling in exfoliative dermatitis

BACKGROUND: Exfoliative dermatitis (ED) can result in protein loss due to scaling causing a negative nitrogen balance. Freedberg and Baden (J Invest Dermatol 1962; 38: 277-284) estimated the amount of scale lost in ED by collecting it in an occlusive suit. Subsequently, the nitrogen content was determined by the Kjeldahl method. The exact amount of protein supplementation in ED, dependent on scale loss, is not well established. As occlusion and hyperthermia caused by the suit can inhibit scaling, the objectives of the present study were to design an alternative method to measure the amount of scale lost, to estimate the protein content of the scale, and to propose suitable recommendations for protein supplementation. METHODS: In 40 patients with ED, the total protein content lost through scaling per day (P) was determined by the following equation: P = TxIxYxX/25x10(4) g, where T is the total body surface area in square meters, I is the percentage area involved in scaling, estimated using computer-aided design (CAD graph), Y is the amount of scale lost per unit area (0.0025 m2) in milligrams, and X is the quantity of protein present in 1 g of scale in milligrams estimated by a spectrophotometer. RESULTS: It was observed that patients with ED secondary to drug reactions, eczema, and psoriasis lost 7.2, 9.6, and 22.6 g of scale with a protein content of 4.2, 5.6, and 12.8 g respectively. The difference in the amount of protein lost in ED secondary to drug reactions and eczema was not statistically significant; however, the protein lost in psoriasis was significant (p < 0.01 to p < 0.05). CONCLUSIONS: ED may increase the daily protein loss by approximately 25-30% in psoriasis and 10-15% in other causes. Standard treatment for ED and protein supplementation based on our recommendations can minimize the adverse effects of a negative nitrogen balance.     

Laser-assisted corneal transplantation surgery

Corneal transplant surgeries have a broad range of indications with outcomes largely dependent on surgeon experience. Traditional manual techniques have certain limitations pertaining to the preparation of donor tissue and the recipient bed that might affect the predictability of visual outcomes. Use of lasers for keratoplasty procedures not only improves the repeatability and consistency of the technique, but also enables the surgeon to control the thickness and shape of the transplant tissue tailored to the specific condition. Despite the advantages, cost-effectiveness and technical know-how remain the major challenges. We discuss the various techniques of laser-assisted keratoplasties with respect to their methods, precision, and efficacy in various corneal indications.