Peritoneal Tuberculosis: Laparoscopic Patterns and Its Diagnostic Accuracy

We report laparoscopic findings in 38 proven cases of peritoneal tuberculosis. The laparoscopic appearances can be classified into three types: thickened peritoneum with miliary yellowish white tubercles with or without adhesions (n = 25), only thickened peritoneum with or without adhesions (n = 8), and fibroadhesive pattern (n = 5). Biopsies were avoided from fibroadhesive lesions due to risk of complications. Visual diagnosis was accurate in 95% of patients. In comparison, in 27 (82%) of 33 patients, the examination enabled a histologic diagnosis to he made on the basis of typical granulomas. The combined use of guinea pig inoculation and culture isolated Mycobacterium tuberculosis in six (37.5%) of 16 patients. Mycobacteria were scarcely (3%) seen on histological sections. We conclude that, although target biopsy is an effective method of obtaining an early diagnosis of peritoneal tuberculosis, chemotherapy may be started on the basis of visual laparoscopic appearances alone.     

Anterior dural ectasia mimicking a lytic lesion in the posterior vertebral body in ankylosing spondylitis

Anterior dural ectasia is an extremely rare finding in ankylosing spondylitis (AS). The authors describe a unique case of AS in which the patient presented with cauda equina syndrome as well as an unusual imaging finding of erosion of the posterior aspect of the L-1 (predominantly) and L-2 vertebral bodies due to anterior dural ectasia. Symptomatic patients with long-standing AS should be monitored for the presence of dural ectasia, which can be anterior in location, as is demonstrated in the present case.     

Prevalence of protease and elastase production by clinical isolates of Pseudomonas Aeruginosa in relation to aeruginocine typing patterns

Sixty six consecutive P. aeruginosa isolates from heterogeneous clinical specimens were subjected to aeruginocine (pyocine) typing and assayed for in vitro protease and elastase production by a simple and reproducible qualitative test.The 45.4% of the clinical isolates were found to be both protease and elastase (P + E +) producers; 40.9% were only protease producers (P + E –) and 13.6% were non producers (P– E t-). Aeruginocine code 7777 strains were found to be predominant among P + E + and P+ E– types, as 48.2% and 51.7% isolates belonged to the types, respectively, suggesting thereby the virulence of this aeruginocine type in P. aeruginosa infections and the possible association of protease and elastase production with aeruginocine production.     

Insulin Receptor Characteristics of Erythrocytes from Human Newborns

Erythrocytes from human newborns were observed to have specific insulin receptors. The characteristics of these receptors were similar to those of the normal adult subjects. An observed slight increase in R_o and a decrease in _e of insulin receptors in erythrocytes may be speculated to facilitate the transfer of insulin from the fetal erythrocytes to other rapidly growing fetal tissues at a rate faster than that present in the circulation of the adult subjects.     

Aeruginocine typing of Pseudomonas aeruginosa

Aeruginocine typing using eight indicator strains of Wahba on Bacto tryptone-glucose yeast extract Agar (Difco) with an incubation temperature of 32°C was found to be a reproducible and easy method which could be readily adopted by a diagnostic clinical laboratory. The results of aeruginocine typing of 1500 strains of Ps. aeruginosa suggest that hospitals differ in the range and patterns of aeruginocine types of strains isolated in them. In addition to representatives of nine of the 10 pyocine types of Wahba, a large number of strains isolated in India were found to fall into other groups not described in Wahba's system. Hence, 20 new inhibition patterns (aeruginocine types) are proposed.     

Measuring the Performance of Critical Access Hospitals in Missouri Using Data Envelopment Analysis

Purpose: Rural hospitals are critical for access to health care, and for their contributions to local economies. However, many rural hospitals, especially critical access hospitals (CAHs) need to strive for more efficiency for continued viability. Routinely evaluating their performance, and providing feedback to management and policy makers, is therefore important. Method: Three measures of relative efficiency are estimated for CAHs in Missouri using an Input‐oriented Data Envelopment Analysis with a variable returns to scale assumption and compared with the efficiency of other rural hospitals in Missouri using Banker's F‐test. Using 30‐day readmission rate as a measure of quality, CAHs are evaluated against efficiency‐quality dimensions. Findings: CAHs in Missouri had a slight decline in average technical efficiency, but they had a slight gain in average cost efficiency in 2009 compared to 2006. More than half of the CAHs were neither economically nor technically efficient in both years. The relative efficiency of other rural hospitals was statistically higher than that of CAHs in Missouri. Conclusions: This study validates the finding of relative inefficiency of CAHs compared to other hospitals paid under the Prospective Payment System at a state level (Missouri). However, with considerable variation in socioeconomic as well as health care access indicators across states, a relative efficiency frontier may not be the only relevant indicator of value for the evaluation of the performance of CAHs. Access to health care and the impact on the local economy provided by these CAHs to the community are also critical indicators for more comprehensive performance evaluation.     

Adult onset moyamoya disease: institutional experience

Moyamoya disease is a progressive steno-occlusive disease of bilateral carotid forks with the formation of fine collateral vascular network and is an angiographic diagnosis. We analyzed case records of 11 patients with "adult-onset moyamoya disease." Six patients presented with intracranial hemorrhage (intracerebral and/or intraventricular) and 5 with focal ischemia. Angiography revealed bilateral Internal carotid artery involvement in 8 patients and unilateral involvement in 3. Posterior cerebral artery involvement was seen in 3 patients. Saccular aneurysm involving posterior circulation was seen in only 1 patient. Although rare, adult-onset moyamoya disease should be considered as one of the causes for intracerebral and intraventricular hemorrhage in adults.     

Mechanism of malabsorption in giardiasis: a study of bacterial flora and bile salt deconjugation in upper jejunum.

Sixty-three unselected cases of giardiasis, with no evidence of other systemic disease, were screened for evidence of steatorrhoea. No patient had any evidence of protein-energy malnutrition. Seventeen (27%) of the cases had steatorrhoea; three (17-8%) of the 17 patients having steatorrhoea also had D-xylose malabsorption. Vitamin B12 absorption was normal in all. Bacterial culture and qualitative analysis of bile salt in jejunal fluid was carried out in all the 17 cases having steatorrhoea as well as 13 cases with normal absorptive parameters (eight cases of irritable bowel syndrome and five cases of giardia infection) who served as controls. All the patients showing bacterial overgrowth had free bile acids in their duodenal aspirate. Free bile acids could also be detected in jejunal aspirates of five of the seven patients having no bacterial overgrowth. Two control cases of giardia infection with normal small bowel function and sterile duodenal aspirate showed evidence of bile salt deconjugation. The significance of these findings is discussed in relation to the pathogenesis of steatorrhoea in patients with giardiasis. The possible role of giardia in bile salt deconjugation is suggested.     

Evaluation of Enzyme-Linked Immunosorbent Assay using Mycobacterial Saline-Extracted Antigen for the Serodiagnosis of Abdominal Tuberculosis

The efficacy of enzyme-linked immunosorbent assay (ELISA) was evaluated in the sera of 215 individuals as a diagnostic aid in abdominal tuberculosis. The subjects had abdominal tuberculosis (group 1), intestinal disorders other than tuberculosis (group 2), cirrhosis of the liver (group 3), and peritoneal malignancy (group 4). Sera from patients of pulmonary tuberculosis and healthy volunteers (group 5) were also analyzed for enzyme activity and served as positive and negative controls. In patients with abdominal tuberculosis, the absorbance (OD) values were significantly higher than for the other groups and healthy volunteers (p less than 0.001). OD values were similar in abdominal and pulmonary tuberculosis (p greater than 0.05). Level above 0.7 (OD) in serum suggests tuberculosis with a sensitivity of 81%, specificity of 88%, and a diagnostic accuracy of 84%. These results suggest that ELISA may be used for the diagnosis of abdominal tuberculosis and in differentiating it from other nontuberculous abdominal diseases.