Postcholecystectomy syndrome in northern India--study on the diagnostic and therapeutic role of ERCP

One hundred and twenty two patients with postcholecystectomy syndrome were studied by endoscopic retrograde cholangiopancreatography (ERCP). The procedure was successful in 105 patients (85.3%) and it accurately detected abnormality of the pancreatico-biliary system in 71 patients (67.6%). ERCP results were abnormal in 82.6% of patients with biliary symptoms, with or without jaundice, compared with 34.7% of patients with non-biliary symptoms (P less than 0.001). Though ERCP showed abnormality in all patients with biliary symptoms and jaundice, as many as 70.4% of patients without jaundice had abnormal ERCP. The commonest abnormality was retained/recurrent stones (37/105 patients). Patients with biliary strictures presented significantly more often with jaundice compared with patients with biliary stones (74.3% vs 22.3%). In 19 of the 37 patients with retained biliary stones endoscopic sphincterotomy was performed and it was successful in 16 patients (84.2%). Our data indicates that ERCP detects the anatomical level as well as the nature of lesion accurately, and is essential and safe in the diagnosis and management of patients with postcholecystectomy syndrome.     

A troubled youth: Relations with somatization, depression and anxiety in adulthood

BACKGROUND: Childhood experiences profoundly affect later functioning asan adult. Family practitioners are well-placed to discover thelinks between childhood troubles and later somatization, depressionor anxiety. OBJECTIVES: We aimed to study the interrelation of somatization, depressiveand anxiety disorders in frequently attending patients in generalpractice; to investigate whether these problems are relatedto a childhood history of illness experiences, deprivation,life events and abuse; and to determine the independent contributionsof these childhood factors to the prediction of adult somatization,depressive and anxiety disorders. METHODS: One hundred and six adult general practice patients with highconsultation frequency were studied. Somatization was operationalizedas a more comprehensive version of DSM-III-R somatization disorder(5 complaints; SSI 5/5). For depression (ever depressive and/ordysthymic) and anxiety (panic, phobias and/or generalized anxiety)DSM-III-R criteria were used. Using a structured questionnairewe assessed illness experiences, deprivation of parental care,abuse (sexual/physical) and other life events before age 19. RESULTS: The overlap between somatization, depression and anxiety waslargely accounted for by 16 patients with a triple problem:somatization and depression and anxiety. Somatization was specificallyrelated to deprivation, depression to other life events. Abuse(prevalence 16%) independently predicted psychiatric problemsin general. Youth experiences before age 12 were most important. CONCLUSIONS: The high prevalence of triple problems suggests a need to reconsiderconcepts like somatic anxiety and anxious depression. The specificityof the relation between deprivation and somatization and ofthe relation between other life events and depression indicatesthat distinct causal mechanisms (in youth) contribute to theseproblems. Keywords. Parental deprivation, child abuse, somatoform disorders, depressive disorders, anxiety disorders.     

Rolipram inhibits PAF-induced airway microvascular leakage in guinea-pig: a comparison with milrinone and theophylline

The effects of 3 phosphodiesterase (PDE) inhibitors, rolipram (PDE IV), milrinone (PDE III) and theophylline (non-selective) on PAF (50 ng kg-1; iv)-induced airway vascular leakage have been evaluated in guinea-pigs. Rolipram (3-300 micrograms kg-1; iv) reduced the increase in permeability induced by PAF at all airway levels whereas milrinone (10-1000 micrograms kg-1; iv) and theophylline (30 mg kg-1; iv) were without effects. The anti-leakage activity of rolipram may be of therapeutic value in asthma.     

Peroxidase-containing microgranules in human neutrophils: physical, morphological, cytochemical, and secretory properties

A microgranule fraction, isolated from human neutrophils by using a novel high-resolution Percoll density gradient system contained granules with the lowest density and diameter when compared with 12 other isopycnic granule fractions. Ultrastructurally, from 34% to 50% of the microgranules showed homogeneous diaminobenzidine (DAB) staining under conditions for localizing peroxidase reactivity. The presence of myeloperoxidase (MPO) was further confirmed by biochemical and spectral analysis and immunodiffusion methods. Periodate-thiocarbohydrazide- silver proteinate (PA-TCH-SP) intensely stained vicinal glycols in the matrix of greater than 97% microgranules in contrast to the weak or absent staining seen in larger primary granules. Directly sampled segmented neutrophils contained small DAB- and PA-TCH-SP-positive granules, which often appeared in clusters. These DAB-positive microgranules selectively remained within the cells after stimulation of exocytosis with the calcium ionophore A23187. The enriched DAB- positive microgranule fraction recovered from A23187-treated cells also contained lysozyme and beta-glucuronidase but lacked vitamin B12 binding protein activity. A similar small, DAB- and PA-TCH-SP-positive granule type was also identified in normal promyelocytes and was the predominant or only granule type observed in leukemic or preleukemic myeloid cells from four patients. This study demonstrates a unique subpopulation of MPO-containing microgranules in normal and leukemic human myeloid cells that are distinguished from (other) primary granules by their extremely low density, small size, content of complex carbohydrates, and resistance to secretion.     

Complete pelviureteric junction obstruction following a diuretic renal scan

A 13-day-old neonate with a single functioning, hydronephrotic kidney developed complete pelviureteric junction (PUJ) obstruction and anuria following a diuretic radionuclide renal scan. Urgent pyeloplasty resulted in a favourable outcome. Possible dynamics of the obstruction are discussed. Monitoring urine output after diuretic renal scans, especially in infants with a single functioning kidney and PUJ obstruction, is of paramount importance.