Effect of shunt surgery on spleen size, portal pressure and oesophageal varices in patients with non-cirrhotic portal hypertension

Shunt surgery is considered to be the treatment of choice in patients with non-cirrhotic portal hypertension. There is little data on the effect of side-to-side lieno-renal (SSLR) shunt on oesophageal variceal size, splenic size and splenic pulp pressure (SPP) in patients with non-cirrhotic portal hypertension. We evaluated pre- and postoperatively endoscopic grading of varices, splenic size and SPP for predicting shunt patency in 86 patients with non-cirrhotic portal hypertension: 56 with extrahepatic portal venous obstruction (EHPVO) and 30 with non-cirrhotic portal fibrosis (NCPF). The EHPVO patients with patent shunts (n= 47) showed significant reduction in SPP (pre-operative 43.56±7.9 vs postoperative 29.96±7.7 cm of saline), splenic size (6.5±2.8 vs 4.00±2.6 cm below costal margin) and varices grades (2.96±0.5 vs 0.92±0.8). Patients with blocked shunt (n= 9) did not show significant reduction in SPP and varices grades. However, there was reduction in spleen size (8.6±3.0 vs 6.3±4.3). In the NCPF group, 28 had patent shunts and showed significant reduction in SPP (46.3±13.5 vs 33.8±7.6 cm of saline), splenic size (9.1±3.3 vs 6.8±4.6 cm below costal margin) and varices grades (2.8±0.7 vs 1.05±0.96). As only two patients with NCPF had blocked shunts, no statistical comparison between patients with patent and patients with blocked shunts could be done. In conclusion, following SSLR, there is a significant reduction in SPP and varices grades in patients with patent shunts. Endoscopic grading of varices can be used to predict shunt patency. However, spleen size is not a good criteria for predicting shunt patency.     

Lupus erythematosus associated with erythema multiforme: report of two cases and review of the literature

Rowell's syndrome (RS) is a rare presentation of lupus erythematosus (LE) with erythema multiforme‐like lesions associated with antinuclear, anti‐La (SS‐B)/anti‐Ro (SS‐A) antibodies and rheumatoid factor (RF) positivity. This syndrome is suggested to be a different variant of cutaneous lupus erythematosus by some authors in literature. Here we present a 64‐year‐old woman with LE and a 51‐year‐old woman with LE and Sjögren syndrome (SS) who had erythema multiforme‐like eruptions and discuss the coexistence of lupus erythematosus and erythema multiforme.     

Controlled FiO2 Therapy to Neonates by Oxygenhood in the Absence of Oxygen Analyzer

Background

A study was conducted to evaluate a system of standardizing the oxygen concentration inside the oxygen hood and to develop guidelines for controlled FiO₂ administration by changing size of the hood, lid position on the hood and the oxygen flow rate, without an oxygen analyzer. The effect of low flow rates on carbon dioxide (CO₂) retention was also studied.

Method

A dummy patient and thirty neonates, requiring oxygen to be delivered through head box, constituted the material for the study group. Oxygen content in the head box was measured using a standard oxygen analyzer while the size of head box, flow rate and lid position were changed independently and in combination. The head boxes were tested on a dummy patient. These results were analyzed, and applied to thirty neonates requiring oxygen therapy using a head box.

Result

Volume of headbox had an inverse relation with the oxygen concentration inside the headbox and smaller sized headbox achieved more predictable oxygen concentration at all flow rates. Maximum difference in oxygen concentration by varying the lid position was seen in the large headbox. Keeping the variables constant, oxygen concentration was significantly lower in babies as compared to dummy. No significant CO₂ retention was found at a flow rate of four litres per minute (lpm) in small and three lpm in a medium and large head box respectively, while lower flow rates were associated with CO₂ retention.

Conclusion

It is possible to predict the oxygen concentration inside the head box without the use of oxygen analyzer. Larger head box and higher lid position, results in lower oxygen concentration, at a given oxygen flow rate. Oxygen concentration achieved in babies is lesser than the concentration achieved in a dummy. Flow rates of less than four lpm in small and three lpm in medium and large sized head boxes are associated with CO₂ retention. These results are not applicable to infants weighing less than 2 kg.Key Words: Neonates, Oxygen therapy, Oxygen hood, Oxygen concentration, Oxygen analyzer     

Fetal erythropoiesis in steel mutant mice. III. Defect in differentiation from BFU-E to CFU-E during early development

Erythroid progenitor cells in +/+ and Sl/Sld fetal livers manifested as burst-forming units-erythroid (BFU-E) and colony-forming units- erythroid (CFU-E) were assayed in vitro during early development. The proportion of BFU-E was higher as mutant than in normal fetal livers. On the other hand, the proportion of CFU-E was less in the mutant than in the normal. These results suggest that the defect in Sl/Sld fetal hepatic erythropoiesis is expressed at the steps of differentiation that effect the transition from BFU-E to CFU-E.     

Management guidelines for uninvestigated and functional dyspepsia in the Asia-Pacific region: First Asian Pacific working party on functional dyspepsia

Dyspepsia is most optimally defined as pain or discomfort centred in the upper abdomen. The symptom complex may be caused by peptic ulcer disease, gastro-oesophageal reflux, or gastric cancer but is most often due to functional (or non-ulcer) dyspepsia. While upper endoscopy is the method of choice to determine the underlying cause of dyspepsia, it is expensive. A more pragmatic approach is needed in the Asia-Pacific region where health services are limited. A detailed treatment algorithm is given for managing patients presenting with new-onset dyspepsia and documented functional dyspepsia after endoscopy, and evidence to support this approach is reviewed. Prompt endoscopy is recommended for patients with alarm features. In patients without alarm features, treatment for 2–4 weeks with an empirical anti-secretory or prokinetic agent, followed by investigation using non-invasive Helicobacter pylori testing and treatment for patients who do not respond or relapse, is recommended. Trials of management strategies are now needed to establish the efficacy and cost-effectiveness of the approaches recommended.     

Mucoid presentation of acute enterocolitis in children: a hospital-based case-control study

A hospital-based case-control study was carried out to clarify the characteristics of mucoid presentation of acute enterocolitis in children. One hundred sixty-eight cases of acute mucoid enterocolitis (study population) were compared with 200 cases of watery diarrhoea and 118 cases of blood dysentery (control groups) on the basis of clinical characteristics and findings on stool examination. Study and control groups were comparable with respect to age, body weight and nutritional status. There was no significant difference in clinical characteristics (duration of diarrhoea, stool frequency, presence of vomiting, fever and dehydration) between patients suffering from mucoid enterocolitis and blood dysentery. However, watery diarrhoea patients had significantly high frequencies of vomiting (p = 0.00001) and dehydration (p