APPRAISAL OF SURGICAL AND ENDOSCOPIC MANAGEMENT OF CHOLEDOCHOLITHIASIS

One hundred and ten patients with common bile duct (CBD) stones were treated in the Department of Surgical Gastroenterology at SGPGIMS, Lucknow, India between January 1989 and December 1992. The primary modality of treatment was surgery in 62 patients (group I) and endoscopic sphincterotomy (ES) in 48 (group II). The two groups were well matched with respect to clinical features and presence of medical risk factors. Surgical clearance of CBD stones was achieved in 58 patients (93.5%; group Ia). Four patients (7%) had retained stones following surgery (group Ib). In group II, the CBD was cleared by endoscopic means in 20 out of 48 patients (42%) and was categorized into group IIa. In the remaining patients ES was followed by CBD exploration (group IIb). Significantly higher morbidity was seen in patients needing CBD surgery following attempted endoscopic clearance, because of ES-related complications, such as bleeding, cholangitis, septicaemia and numerous others. Use of ES to treat CBD stones on a routine basis was therefore not found to be any better than one-time surgical exploration.     

Pleomorphic adenoma of the nasal septum

Despite the common occurrence of pleomorphic adenoma of major salivary glands, intranasal pleomorphic adenoma are rare. We present a ease of pleomorphic adenoma of the nasal septum along with a brief review of literature. The histological nature of this lesion in comparison to other salivary gland tumours and the importance of an accurate diagnosis has been stressed.     

Verrucous carcinoma of larynx

A 55 years male presented with hoarsness of voice (4 months), cough (1 month), difficulty in breathing (15 days). Patient underwent an emergency tracneostomy and further workup proved it to be a case of verrucous carcinoma of larynx. Patient was treated surgically with satisfactory result.     

Increasing prevalence of high degree resistance amongst Salmonella to different antibiotics.

National Salmonella & Escherichia Centre situated at Central Research Institute, Kasauli receives Salmonella strains from all over the country. Eight hundred and fourteen Salmonella strains belonging to 14 serotypes received during 1986 were studied for antibiotic resistance and Minimum Inhibitory concentration (MIC) with regard to ampicillin (A), chloramphenicol (C), furazolidone (Fz) and gentamicin (G). Resistance to ampicillin was found to be highest (80%) and furazolidone the least (0.1%). Similarly a large number of strains (31%) had very high MIC values greater than 640 mcg per ml for chloramphenicol, whereas only 3.4% strains were found to have MIC values greater than 640 mcg per ml for gentamicin. The present findings have been discussed in the light of similar data published from this Centre earlier and from other sources in India.     

5-HT1B Receptor Polymorphism and Clinical Response to Sumatriptan

The 5-HT₁ receptor agonist, sumatriptan, is highly effective in the treatment of migraine. Some patients, however, do not respond or experience recurrence of the headache. In addition, some patients report chest symptoms after sumatriptan. We investigated whether these different responses could be attributed to genetic diversity of the 5-HT_1B receptor, which most likely mediates the therapeutic action and the coronary side effects of sumatriptan. Allele frequencies of two polymorphisms in the 5-HT_1B receptor gene ( G861C and T-261G ) were investigated in migraine patients with consistently good response to sumatriptan (n=14), with no response (n=12), with recurrence of the headache (n=12), with chest symptoms (n=13), and in patients without chest symptoms (n=27). Allele frequencies (G:0.74; C:0.26 at nt 861 and T:0.39; G:0.61 at nt -261) did not differ between patient groups, indicating that genetic diversity of the 5-HT_1B receptor does not seem to be involved in the different clinical responses to sumatriptan.     

Movement of carbofuran (nematicide) in soil columns

Adsorption and movement of carbofuran (a systemic nematicide) were studied using two Indian soils (clay loam and silt loam) of alluvial origin. Equilibrium adsorption coefficient (K) values measured using a batch-slurry technique follows the order clay loam greater than silt loam soil. The distribution coefficients (Kd) for both the soils in batch adsorption as well as in columns were also calculated. Carbofuran movement in soil columns during water infiltration in both air-dried and water-saturated columns was estimated. The order was as anticipated from K and Kd values. A larger amount of water was needed for leaching the carbofuran to 152 cm in clay loam soil than in silt loam soil. Carbofuran appears to increase in drier soils and in finer textured soils.     

5-HT(1)-like receptor agonists and the pathophysiology of migraine

Recently, AG-25086 and GR-43175 have been reported to be highly effective in aborting acute migraine attacks. These compounds seem selectively to stimulate a sub-population of 5-HT(1)-like receptors to inhibit noradrenaline release from certain sympathetic neurovascular terminals, to contract dog saphenous vein and dog, monkey and human basilar arteries, and to decrease the arteriovenous anastomotic component of carotid blood flow in the cat. GR-43175 neither has any antinociceptive effect nor crosses the blood-brain barrier. Pramod Saxena and Michel Ferrari review the clinical effectiveness of these 5-HT(1)-like receptor agonists and their selective pharmacology, both of which strongly suggest that excessive dilatation in the extracerebral cranial (scalp and/or dural) vasculature is an integral part of the pathophysiology of migraine.