Hepatic-pericardio-phrenic collateral (natural shunt) in a patient with Budd-Chiari syndrome

Hepatic venous outflow tract obstruction, Budd-Chiari syndrome (BCS), leads to portal hypertension and to the development of collaterals that bypass the obstruction. Described here is a BCS patient with an unusually large transdiaphragmatic collateral between the left hepatic and left innominate veins, which decompressed the oesophageal varices. This has not been reported earlier in the literature.     

Keratitis, ichthyosis, deafness (KID) syndrome-the first report from India

A patient with the keratitis, ichthyosis and deafness (KID) syndrome is described. The patient had recurrent skin infections which led to complete scalp hair loss. The nails were dystrophic. Physical development was normal; however, his intelligence was subnormal. The erythro-keratodermatous plaques over the face, trunk and extremities were characteristic and the skin in general was dry and hyperkeratotic. Palms and soles showed marked thickening with a stippled appearance.     

Pattern of upper gastrointestinal haemorrhage in northern India—An endoscopic study of 316 patients

Three hundred and sixteen patients with acute upper gastrointestinal haemorrhage were studied prospectively and consecutively. The most frequent cause was variceal bleeding due to portal hypertension (36%), followed by peptic ulceration (24%) and gastric erosions (19%). Variceal haemorrhage tended to be severe and had a high individual mortality rate. Associated acute mucosal lesions with portal hypertension were strikingly less frequent when compared with the experience from the West. Seven per cent of patients died of bleeding alone and an equal number of an associated systemic disorder or complication. Splenomegaly was present in all patients with a variceal haemorrhage due to non-cirrhotic portal hypertension. However, in patients with portal hypertension due to cirrhosis splenomegaly was present in 63%. Endoscopy altered the clinical diagnosis in 13.2% of patients. Based on previous experience oesophago-gastro-duodenal endoscopy has been a useful tool in the management of acute upper gastrointestinal haemorrhage.     

Social environment and health behaviour: a case study of Japanese overseas students

The health related problems and issues of overseas studentsstudying in Australia were addressed within the social perspectiveof health and health behaviours. It was argued that a clinical‘one-to-one’ approach to treating somantic illnesswithin the biomedical model and modifying health behavioursthrough traditional health education approaches, failed to bringabout comprehensive changes in health outcomes. Instead, a modelwhich addresses the social perspective of health behaviour andsocial environmental strategies was proposed as a more effectivemeans by which to bring about changes. A case study of 28 Japanesestudents studying English-as-a-Second-Language (ESL) at an Australianrural tertiary education institution is presented to illustratethe effects which the physical and socio-cultural environmentshave upon the health behaviours of a culturally sensitive andisolated population. Factors which were found to influence thehealth status and health habits of Japanese students were thoserelated to community structure and its competencies, socialinteraction, diet, traditional Japanese healing practices andconceptualization of illness within Japanese culture. Thesefactors inadvertently interacted with the Australian physicaland socio-cultural environment resulting in health problems.It was proposed that primary health care policy-based strategies,focusing on the Japanese and Australian socio-environmentalas well as socio-physiological aspects of health, leading toreorientation, would be more successful in inducing change.     

Percutaneous liver biopsy: A safe outpatient procedure

Percutaneous liver biopsy with Menghini or Trucut needle as an outpatient procedure was performed on 159 patients over a 3.5-year period. No major complications were observed. Liver biopsy is recommended as an outpatient procedure, which would reduce the patient load on limited hospital beds and economize on the hospital resources.     

Synthetic and conformational studies on dehydrophenylalanine containing model peptides

Four model dipeptides containing a Z-dehydrophenylalanine residue (Δ^ZPhe) at the C-terminal, Boc-X-Δ^Z Phe-NHMe (X = Ala (1), Gly (2), Pro (3), and Val (4)), have been synthesised and their solution conformations investigated by 270 MHz ¹H n.m.r. and i.r. spectroscopy. N.m.r. studies on these peptides clearly show the presence of intramolecularly hydrogen bonded structures in CHCl₃ solutions while such structures appear to be absent in the corresponding saturated peptides. This conclusion is also supported by i.r. studies. Studies of the nuclear Overhauser effect provided evidence for the occurrence of a significant population of β-turn structures in solvents like CDCl₃ and (CD₃)₂SO. The observed NOES are consistent with a major contribution from Type II β-turn structure in CDCl₃, while in (CD₃)₂SO solutions there is evidence of a partially extended structure also.     

SOTALOL IN HYPERTHYROIDISM

Ten hyperthyroid patients were studied before and after 2 weeks' β-adrenoceptor blockade with sotalol. The following variables were measured: resting pulse rate, blood pressure, weight, thyroid hormone levels, plasma lipids, alkaline phosphatase, plasma glucose and insulin responses to oral glucose, bromsulph-thalein retention and the 24-h urinary excretion of calcium, hydroxyproline, creatine and creatinine. Sotalol produced a significant fall in pulse and blood pressure. Weight loss continued during treatment. No metabolic changes of any consequence were found. It is concluded that sotalol should not be used as the sole treatment of a patient with hyperthyroidism.     

Effect of wine phenolics on cytokine-induced C-reactive protein expression

Summary.  Background:  Elevation of C-reactive protein (CRP) levels in blood was recognized as one of the cardiac disease risk factors. Consumption of wine is shown to reduce the risk from heart disease and improve longevity. Objectives:  In the present study, we evaluated the effect of various wine polyphenolic compounds and several active synthetic derivatives of resveratrol on the inflammatory cytokines (IL-1ß + IL-6)-induced CRP expression in Hep3B cells. Results:  Among the wine phenolics tested, quercetin and resveratrol, in a dose-dependent manner, suppressed cytokine-induced CRP expression. Two of the synthetic derivatives of resveratrol, R3 and 7b, elicited a fiftyfold higher suppressive effect compared with resveratrol. The inhibitory effects of resveratrol and its derivatives on CRP expression were at the level of mRNA production. Investigation of signaling pathways showed that the cytokines induced the phosphorylation of p38 and p44/42 MAP kinases. Inhibitors of p38 and p44/42 mitogen-activated protein kinase (MAPK) activation inhibited CRP expression, implicating the involvement of both pathways in cytokine-induced CRP expression. These data revealed a previously unrecognized role of the p44/42 MAPK signaling pathway in CRP expression. Wine polyphenolics or the synthetic compounds of resveratrol did not affect cytokine-activated phosphorylation of these MAPKs. Conclusions:  Wine phenolics inhibit CRP expression; however, to do so, they do not utilize the MAPK pathways.