Pyriform sinus fistula

Pyriform sinus fistulae/sinuses are rare causes of recurrent cervical abscess, especially on the left side. They can also present as acute thyroiditis. Treatment in the form of simple incision and drainage is invariably unsuccessful, and the entity may be confused with the residual tract of a second branchial arch anomaly. We report a case of pyriform sinus fistula, and believe that this is only the second case report in India. We feel that greater awareness can lead to proper and appropriate diagnosis of this anomaly.     

Biliary‐enteric bypass in unresectable malignant hilar biliary obstruction: Kwong Wah Hospital experience

Objective : To evaluate the efficacy of biliary‐enteric bypass in the palliation of malignant hilar biliary obstruction. Materials and Methods : Records of 19 patients from 1995 to 1998 were reviewed. There were 13 patients with cholangiocarcinoma and 6 patients with carcinoma of the gallbladder. Single biliary‐enteric bypass had been performed in 13 of the patients; the rest had more than one biliary‐enteric anastomosis. Results : The 30‐day mortality was 21% (4/19 patients). Bile leakage occurred in 2 patients, leading, in both, to fatality. Excluding the 30‐day mortality, the median survival of patients with carcinoma of the gallbladder and cholangiocarcinoma was 116 days (43–200) and 202 days (47–1207), respectively. The mean hospital stay was 31 days (13–59) and all patients were discharged with their symptoms relieved and a drop in bilirubin of at least two‐thirds their pre‐operative level. The late complication rate was 26.7% (4/15 patients). Conclusion : Biliary‐enteric bypass is effective in the palliation of symptoms of patients suffering from unresectable hilar biliary obstruction, although it carries considerable mortality and morbidity. Stenting, rather than surgery, should be considered for patients with unresectable gallbladder cancer.      

Purification and stabilization of 99mTc-d,l-HMPAO: role of organic extractants

99mTc-d,l-HMPAO, an important SPECT agent for imaging cerebral perfusion, suffers from the disadvantage of an inherent instability and its shelf life has been reported to be 30 min. The latter is a harsh constraint and not compatible with Centralized Radiopharmacy procedures. During the attempts to improve upon the stability of 99mTc-d,l-HMPAO, preservation of product as an organic extract into suitable solvents like diethylether, ethylacetate, methylethylketone, chloroform was tried out. Chloroform extraction (yield: >90%) resulted in a product having stability not less than 5 hours. Gentle drying of the chloroform extract and reconstitution in normal saline resulted in quantitative recovery of 99mTc-d,l-HMPAO with acceptable radiochemical purity (>90%). This finding is thus of much significance, especially in the context of centralized large hospital radiopharmacy setting, by rendering convenience and flexibility in scheduling patients.     

Tuberculous meningitis in children

Between May 1988 and November 1992 the data from 52 patients with tuberculous meningitis (TBM) were noted down for their symptoms and signs, BCG vaccines, PPD tests; clinical, laboratory, radiologic and microbiologic findings. These data were discussed by means of literature knowledge. Cranial computed tomography (CT) demonstrated hydrocephalus (HC) in 98% of the patients. There was a statistically significant difference among the clinical stages on admission in respect to prognosis (P < 0.05). In addition, there was also a significant relationship between prognosis and HC (P < 0.05). However, we did not find any significant relationship between parenchymal involvement, basilar meningitis and prognosis (P > 0.05).     

Trimethoprim-sulphamethoxazole in urinary tract infection due to Streptococcus faecalis

In-vitro sensitivities were performed on 140 specimens of urine which grew Streptococcus faecalis of more than 100 000 organisms/ml between March 1970 and February 1971. Although the combination of trimethoprim and sulphamethoxazole definitely appeared to be more effective than sulphonamide alone and as effective as ampicillin, its use for more than two weeks in 14 cases of uncomplicated urinary tract infection due to Streptococcus faecalis led to development of resistance. As in these cases organisms were resistant to sulphonamide to start with, it is suggested that the combination should be used in prolonged treatment only where the organisms are sensitive to both the individual antibiotics. Ampicillin is still the drug of choice in urinary tract infection due to Streptococcus faecalis. The alternative appears to be rotational therapy with other potent antibiotics.