Sperm disomy in idiopathic severely oligoasthenoteratozoospermic males

This work aimed to determine the incidence of sperm disomy in infertile men with idiopathic severe oligoasthenoteratozoospermia (OAT). Fifty male subjects were included in this study: 30 infertile men with idiopathic severe OAT and 20 healthy fertile men as controls. Semen analysis, hormonal assay (follicle-stimulating hormone, luteinising hormone and testosterone), scrotal ultrasound examination and fluorescent in situ hybridisation of their semen samples were performed to determine the disomy levels of chromosomes X and Y. There was a significant higher frequency for XX disomy and XY disomy in spermatozoa from severe OAT patients than that in controls. There was nonsignificant difference in the percentage of YY disomy between OAT cases and controls. XX, YY and XY disomy showed nonsignificant correlation with the age. Sperm concentration and sperm motility demonstrated significant negative correlation with XX and XY disomy. Sperm abnormal forms had significant negative correlation with XX and XY disomy. Nonsignificant correlation was demonstrated between YY disomy and semen parameters. XX disomy showed significant positive correlation with XY disomy and nonsignificant correlation with YY disomy. YY disomy showed nonsignificant correlation with XY disomy. It is concluded that sperm disomy in severe OAT is increased, which should be taken into account when undergoing micromanipulation.

Delayed fixation of displaced type II and III pediatric femoral neck fractures

BACKGROUND

Time from injury to fixation of femoral neck fractures has been postulated as a vital determinant for rate of complications; however, no prospective study is available in the English literature. Delay, unfortunately, is inevitable in developing countries. The aim of the present study is to retrospectively review the outcome after delayed fixation of displaced type II and III femoral neck fractures in children.

MATERIALS AND METHODS

Using a standard assessment chart, we retrospectively reviewed medical records of all pediatric patients having femoral neck fractures presenting to our institution from June 1999 to May 2006. Inclusion criteria were children between 5 and 15 years of age sustaining displaced Delbet type II and III femoral neck fractures having a complete follow-up of at least 2 years. Patients with known metabolic disease, poliomyelitis or cerebral palsy, were excluded from the study. After application of inclusion and exclusion criteria, 22 patients having 22 fractures (13 type II and 9 type III) were studied. Surgery could be performed after a mean delay of 11.22 days (ranging from 2 to 21 days). Closed reduction was achieved in 14 cases and 8 cases required open reduction through anterolateral approach.

RESULT

Osteonecrosis was noted in eight patients (36.37%) who included two of nine patients (22.22%) operated in the first week, three of eight patients (37.51%) operated in the second week, and three of five patients (60%) operated in the third week of injury. Nonunion was seen in four (18.18%) cases, and two of them were associated with failure of implants. One was treated by valgus osteotomy and the other by Meyer's procedure. Fractures united in both children but the latter developed avascular necrosis. Functional results, as assessed using Ratliff's criteria, were good in 14 (63.63%), fair in 2 (9%), and poor in 6 (27.27%) patients.

CONCLUSION

Delay in fixation, type of fracture, and ability to achieve and maintain reduction are factors primarily responsible for the outcome. We also found that delay after the first week further adversely affects the outcome.

Free fibular strut graft in neglected femoral neck fractures in adult

BACKGROUND

Neglected femoral neck fracture in adults still poses a formidable challenge. Existing treatment options varies from osteotomy (with or without graft) to osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and nonvascularized fibula). The aim of this study was to assess outcome of nonvascularized fibular strut graft and cancellous screw fixation in neglected femoral neck fractures in the younger age group.

MATERIALS AND METHODS

Medical records of 32 patients of neglected femoral neck fracture, in the age group of 22-45 years (mean 37.8 years), operated between May 1994 to December 2001, were retrospectively reviewed. After the application of inclusion and exclusion criteria, 28 patients having three years minimum follow-up (mean 4.6 years) were included. Delay between injury and operation varied from four weeks to 42 weeks (mean 16.4 weeks). Closed reduction was achieved in 17 patients; open reduction through Watson-Jones anterolateral approach was performed in the remaining 15 patients in whom closed reduction failed. The fracture was transfixed with three parallel guide wires. Appropriate sized cannulated lag screw (7 mm) was then inserted in two of the wires. Selection of the third guide wire for fibula depended on the space available in both anteroposterior and lateral view.

RESULTS

Satisfactory bony union was obtained in 25 patients, of whom in four cases, the union occurred in 10-20 degrees (mean 15 degrees ) of varus. Nonunion occurred in three patients (9.37%), and aseptic necrosis occurred in another six patients (18.75%). Of the 25 patients where union was achieved, five patients showed excellent results; 14 good and six had poor functional result, as evaluated using modified Anglen criteria.

CONCLUSION

Nonvascularized fibular strut graft along with cancellous screws provides a dependable and technically less-demanding alternative procedure for neglected femoral neck fractures in young adults. Fibula being cortical provides mechanical strength besides stimulating the union and getting incorporated as biological graft.

Gastrointestinal stromal tumors (GISTs): clinical presentation, diagnosis, surgical treatment and its outcome

This study included 13 selected patients treated by surgical excision for lesions that proved postoperatively to be gastrointestinal stromal tumors (GISTs) by histopathological and immunohistochemistry studies. The demographic, clinical and operative reports data were collected. Eight cases were gastric GISTs, four cases were small bowel GISTs (jejunum 1 & ileum, 3) and GIST of the sigmoid colon was in one patient. Eight cases presented at the emergency department due to hematemesis (3), gastrointestinal obstruction (3), bowel perforation (1) and severe bleeding per rectum (1). Three cases presented with a feeling of abdominal fullness and ill-defined palpable abdominal mass. Two cases were discovered incidentally during GIT endoscopy for dyspepsia. Diagnosis of GISTs was presumed on clinical basis and operative findings from gross morphological features. Complete resection (R0) was achieved for 12 tumors (92.3%). The immunohistochemistry profile was positive for C-kit for all cases. One operative death was due to massive pulmonary embolism. Postoperative complications occurred in three (23%) as upper GIT bleeding (1), biliary gastritis (1) and wound infection (1), and one (7.69%) of ileum tumor recurrence.

Early experience with the bioabsorbable anal fistula plug

PURPOSE

Management of anal fistula represents a balance between curing the condition and maintaining anal continence. Recent reports of the results of the porcine anal fistula plug have demonstrated excellent fistula healing rates without reporting significant complications.

METHODS

The outcome of patients who underwent treatment for anal fistula with the Surgisis anal plug was retrospectively reviewed.

RESULTS

Twenty patients were treated; three underwent concomitant anal advancement flap at the time of plug placement. Seventeen patients had a trans-sphincteric fistula, and three had an anoperineal fistula. Ten patients had previously undergone failed surgical therapy to cure their fistula, including anal advancement flap in four, muscle interposition flap in two, fistulotomy in two, and cutting seton placement in two. Mean follow-up was 7.4 months. Only 4 of 17 (24%) patients treated with the plug alone had closure of their fistula. Acute postoperative sepsis was seen in 5 of 17 (29%) patients treated with the plug alone. Four developed perianal abscesses that required incision and drainage, and one intersphincteric abscess was treated with antibiotics. Two of the patients who underwent concomitant anal advancement flaps and plug placement healed successfully.

CONCLUSIONS

Contrary to other published series, the use of the Surgisis anal plug was associated with a low rate of fistula healing and a high incidence of perianal sepsis. The addition of a transanal advancement flap to the procedure may improve success rates.

Posterolateral rotatory instability of elbow: an uncommon entity

Posterolateral rotatory instability of elbow is an exceedingly uncommon entity, which results from injury to the lateral ligamentous complex. Failure of adequate healing of lateral collateral ligaments may necessitate its surgical repair or reconstruction. We describe here a boy 12 years of age who was initially treated as soft tissue injury and later presented with instability of the same elbow. He later required repair of lateral ulnar collateral ligament.

The use of metformin as first line treatment in polycystic ovary syndrome

This study evaluated the use of metformin as first line treatment for patients with polycystic ovary syndrome. A retrospective review of patients' files diagnosed with PCOS over 16 months in Department of obstetrics and gynaecology of a Regional hospital. The outcome was the response to metformin treatment regardless of the main complaint. Treatment response was measured by change in LH/FSH ratio, fasting insulin, testosterone, day 21 progesterone and/or pregnancy. A day 21 progesterone greater than 25.5 nmol/l and/or pregnancy were the parameter of ovulation. Thirty-four patients were diagnosed with PCOS. Twenty-five complained of infertility (14 primary and 11 secondary), six patients had oligomenorrhoea or amenorrhoea and three presented with hirsutism. Seventeen patients received metformin as first line treatment. Eight received it with other treatment (5 clomiphene citrate and 3 ant androgens). Nine patients did not receive metformin. This study justifies the use of metformin as an appropriate first line treatment for PCOS.

Denver peritoneovenous shunt in the management of refractory ascites due to chronic liver diseases: impact of patients selection on its outcome

Forty four patients with refractory ascites due to chronic liver diseases that fulfilling the inclusion criteria of selection were divided into 2 groups. The first group (GI, n=24) was subdivided into 2 subgroups according to degree of liver condition; GIa (n=11) with Child-Pugh class B and GIb (n=13) with early class C. The patients were subjected to P-V shunt (Denver group). Similarly, patients in the second group (GII, n=20) were divided into 2 subgroups GIIa (n=10) & GIIb (n=10) respectively and treated by the repeated tapping and albumin infusion (control group). Postoperative results revealed a significant increase in urine out put (P<0.001), decrease in abdominal girth (P<0.01) and body weight (p<0.01) with more patients fitness and satisfaction than in controls. Postoperative complications were more in GIb. Ascites recurrence occurred in 3 (23%) patients in GIb due to severe infection (2 cases) and irreversible shunt obstruction (1 case) and without recurrence in GIa. So, Denver P-V shunt offers a good palliation in such patients, but its use is more justified in selected cases.

Repeated intracorporeal self-injection: effect on peak systolic velocity and cavernosal artery diameter

This work is aimed at evaluating the effect of repeated intracavernosal injection (ICI) self-injection on the peak systolic velocity (PSV) and the diameter of cavernosal arteries. Sixty erectile dysfunction (ED) patients who were positive responders for ICI therapy were studied. Pharmacopenile duplex ultrasonography (PPDU) was carried out before starting ICI and after 10 doses of home therapy in an open-label uncontrolled study. There was significant increase in the cavernosal artery diameter and their PSV before and after injection. Cavernosal arteries diameter before injection in both right and left sides was 0.64+/-0.13 and 0.63+/-0.12 mm at the start and became 0.81+/-0.22 and 0.79+/-0.22 mm respectively at the end with significant differences (P<0.001). Cavernosal arteries diameter after injection in both right and left sides was 1.10+/-0.18 and 1.09+/-0.19 mm at the start and became 1.34+/-0.39 and 1.27+/-0.33 mm respectively at the end with significant differences (P<0.001). PSV at the start was 33.77+/-13.26 and 32.33+/-8.09 cm/s on both right and left sides and became 44.4+/-1.19 and 46.1+/-5.86 cm/s respectively at the end with significant differences (P<0.001). It is concluded that repeated ICI improves arterial erectile response with associated increase in PSV and cavernosal artery diameters.

Interest of non-invasive and semi-invasive testings in asymptomatic children with pre-excitation syndrome

AIMS

To determine the feasibility and the results of exercise testing (ET) and electrophysiological study (EPS) in outpatient asymptomatic children with a Wolff-Parkinson-White (WPW) syndrome.

METHODS AND RESULTS

Exercise testing and transesophageal EPS were performed in 55 outpatient asymptomatic children aged 6 to 19 years old (14 +/- 3) with WPW. Wolff-Parkinson-White persisted during maximal exercise. Isoproterenol was not required in five children younger than 10 years old, because they developed a catecholaminergic sinus tachycardia. Maximal rate conducted through accessory pathway (AP) was higher in children younger than 16 years old than in teenagers (P < 0.05). Atrioventricular re-entrant tachycardia (AVRT) was induced in six children; atrial fibrillation (AF) in 12 children. The induction of tachycardias and the dangerous forms (18%) were not influenced by age. After 5 +/- 1 years, one child, 12 year old with inducible rapid AF, had a sudden cardiac arrest; two children became symptomatic after ablation.

CONCLUSIONS

Transesophageal EPS was required to determine the prognosis of asymptomatic WPW in children. The maximal rate conducted in AP was higher in children younger than 16 years old than in teenagers; other data did not differ. AVRT was rare; 71% of children had no inducible arrhythmia and were authorized to resume physical activities.

[Significance of permanent atrial fibrillation in idiopathic dilated cardiomyopathy]

The significance of atrial fibrillation (AF) in idiopathic dilated cardiomyopathy (IDCM) remains discussed. The purpose of the study was to evaluate the clinical significance of permanent atrial fibrillation in patients with IDCM.

METHODS

Systematic noninvasive and invasive studies including Holter monitoring, measurement of left ventricular ejection fraction (LVEF), electrophysiological study and coronary angiography were performed in 323 patients with IDCM; all patients had a left ventricular ejection fraction (LVEF)<40%. The studies were indicated for spontaneous ventricular tachycardia (VT) in 69 patients, syncope in 103 patients and nonsustained VT on Holter monitoring in 151 asymptomatic patients. Sixty-five patients were in permanent AF (group I). Remaining patients were in sinus rhythm at the time of evaluation (group II). Programmed ventricular stimulation using up to 3 extrastimuli in control state and if necessary after isoproterenol was systematic. Patients were followed 3+/-2 years.

RESULTS

Mean age was significantly older in group I (61+/-8 years) than in group II (52+/-12) (P<0.01). Syncope (31 vs 36%), spontaneous sustained VT (18 vs 23%); mean LVEF (28+/-9% vs 29+/-9%), VT induction (25 vs 35%) were similar in both groups. During the follow-up, there were no statistical differences between groups I and II concerning each event: sudden death occurred in 13 patients, 1.5% of group I patients and 5% of group II patients (NS); a death related to heart failure occurred 22 patients, 5% of group I patients and 7% of group II patients (NS); heart transplantation was performed in 13 patients, 8% of group I patients and 3% of group II patients (NS).

CONCLUSIONS

An older age is the only significant clinical factor associated with the presence of a permanent atrial fibrillation in idiopathic dilated cardiomyopathy. The presence of permanent AF does not increase the induction of a sustained ventricular tachycardia and does not affect the general prognosis of IDCM.

Calciphylaxis: emerging concept in vascular patients

Calciphylaxis is a small vessel vasculopathy with medial calcification associated with intimal proliferation, fibrosis and thrombosis. This study discusses the clinical features and treatment of calciphylaxis and assesses the prognosis of patients with calciphylaxis. All patients admitted to vascular or renal wards from January 2003 to December 2004 at Royal Perth Hospital, with diagnosis of calciphylaxis confirmed histologically were included in the study. Five patients were included in the study; four male and one female. Three patients had end stage renal failure on haemodialysis and two had normal renal function. All three patients with end-stage renal failure had secondary hyperparathyroidism associated with elevated parathormone and corrected ionised calcium. The two patients with normal renal function had normal calcium, phosphate, and parathormone levels. The diagnosis of calciphylaxis was confirmed in all patients. The wounds of four patients healed and one patient died 8 months after the diagnosis of calciphylaxis had been made. Calciphylaxis is a condition mostly present in patients with end-stage renal failure and can occur in patients with normal renal function. It usually carries a poor prognosis, but in this small series the outcome of patients was good with satisfactory healing of wounds.

Supraventricular tachyarrhythmia as a cause of sudden cardiac arrest

INTRODUCTION

Supraventricular tachyarrhythmias (SVTA) are an accepted cause of cardiac arrest in patients with Wolff-Parkinson-White syndrome (WPW) and hypertrophic cardiomyopathy but their participation in other conditions is less well understood. The purpose of the study was to examine the role of SVTA in sudden cardiac arrest (SCA) by comprehensive evaluation of patients successfully resuscitated from SCA.

METHODS

A total of 169 survivors of SCA in the absence of acute myocardial infarction underwent systematic evaluation that included echocardiography, Holter monitoring, coronary angiography and electrophysiological study (EPS) with additional testing in selected cases using provocative drug testing with isoproterenol, ajmaline or ergonovine.

RESULTS

SVTA was found as the only possible cause or as the cause facilitating SCA in 29 patients: (1) 3 had a WPW syndrome related to accessory pathway with short refractory period; (2) for 12 patients, SVTA was the cause of cardiovascular collapse; heart disease (HD) was present in 11 cases, but disappeared in two of four with dilated cardiomyopathy after the restoration of sinus rhythm; (3) in 14 patients, SVTA degenerated either in a VF or ventricular tachycardia (VT); HD was present in 12 cases, but disappeared in one; two had no HD and recurrent similar arrhythmia was documented by cardiac defibrillator in one of them. SVTA induced coronary ischemia was the main cause of SCA.

CONCLUSION

Rapid SVTA was a cause of SCA, either by cardiovascular collapse or by the degeneration in VT or VF. The complication generally occurred in patients with advanced HD or with rapid SVTA-induced cardiomyopathy and rarely in patients without HD. The incidence of SVTA as the only cause or the facilitating cause of SCAs is probably underestimated, because it is difficult to prove.

New approach in surgical management of complicated umbilical hernia in the cirrhotic patient with ascites

A total of 23 consecutive patients operated upon on emergency basis for the treatment of complicated umbilical hernias associated with liver cirrhosis and ascites. The hernia was complicated by strangulation in 11 and ascitic fluid leak in twelve of the patients. Patients were assigned randomly in two groups. In the first group (GI, n = 12) peritoneal drainage at the conclusion of their surgery was done but no drainage was applied in the second group (GII, n=12). All patients were operated upon and when closed system peritoneal drainage was done, it was brought to outside of the abdomen through a separate stab. No negative pressure was applied. The main outcome measures were postoperative wound healing, control of ascites, complications, and hernia recurrence rate at follow up. The male/female ratio, Child's class, ascites severity, and mode of hernia complication were almost matched in both groups. Postoperative wound dehiscence occurred in four patients in G II (23.5%) but in none of GI. Control of ascites was achieved in all patients of GI. The overall mean hospital stay was significantly lower in-patient of GI than those of the G II (P < 0.0 1). Recurrences of the hernia occurred in one patient only of the G I and in three of the G II on a mean follow- up of 19+/-3 months. So, postoperative closed peritoneal drainage in the management of complicated umbilical hernias associated with liver cirrhosis and ascites safe and effective in assuring postoperative wound healing, control of ascites and the prevention of hernia recurrence. It is specifically indicated in cases with bowel resection anastomosis and in patients with low preoperative serum albumin and history of rapid ascites re-accumulation under medical therapy.

Conservative versus radical surgery for treatment of uncomplicated hepatic hydatid cysts

This work evaluated both radical and conservative surgical approaches in the management of hepatic hydatid cyst. A total of 32 cases with uncomplicated hepatic hydatid cysts were divided into 2 groups according to the type of surgery. Patients in the first group (n=18) were subjected to conservative surgery in the form of endocystectomy, omentoplasty with or without drainage. Cases in the second group (n=14) underwent radical surgery that included closed pericystectomy, open pericystectomy, wedge hepatic resection or segmentectomy. The results showed that the use of rib cage retractor could avoid the need for thoracotomy incision with its morbidity to manage cysts at the dome of the liver. The mean operating time in GI (140.15 +/- 38.30 min) was significantly shorter than in GII (190.4 +/- 50.2 min), with P< 0.05. The need of blood transfusion in GI (16.7%) was lesser than in GII (35.7%), but the difference was statistically not significant. The postoperative pain, evaluated by the number of IM analgesic injection was significantly lower in GI (7.2 +/- 3.3) than in GII (9.9 +/- 3.9) with P < 0.05. Wound complications were more observed in GII. There was only one reported recurrence in GI in a case with multiorgan cysts that did not receive perioperative anthelmintic chemotherapy. So, conservative surgical management of uncomplicated hepatic hydatid cysts with perioperative anthelmintic chemotherapy supposed to be a simple, safe and effective approach. Its efficacy is comparable to radical surgical procedures with much less morbidity.

Management of type C intercondylar fractures of lower end humerus in adults: A clinical study

Thirty-six patients of type C intercondylar fractures of lower end of humerus who visited JN Medical College, Aligarh between January, 2001 and January, 2003 were included in the study. All patients were treated surgically by open reduction and internal fixation with 4mm cancellous screws, reconstruction plates, one-third tubular plates. Early physiotherapy was started and the results graded using Krishnamoorthy criteria.

Findings from a buruli ulcer mouse model study

SUMMARY INTRODUCTION

Buruli ulcer disease is endemic in many developing countries in Africa. It is caused by Mycobacterium ulcerans, a toxin-producing bacterium with predilection for the skin and its deeper tissues. The exact mode of transmission is unclear and the pathogenesis is also not well understood, necessitating further elucidation through animal studies.

OBJECTIVE

The study assessed the infectivity of a Ghanaian Mycobacterium ulcerans isolate and the dose-response pattern in BALB/c mice.

METHOD

Ten standardized bacterial suspensions of different concentrations were prepared from the M. ulcerans isolate and inoculated into the foot-pads of the mice. Thereafter they were observed for clinical signs of Buruli ulcer, upon which they were serially euthanised and evaluated for pathological and microbiological changes.

RESULTS

Irrespective of the inoculum dose, all the experimentally infected mice developed similar clinical lesions, from erythema to foot ulceration (3.1 to 6.7 weeks after inoculation). However, the higher the inoculum dose the earlier the onset of the lesions. After the development of foot ulceration, mice that had received between 1 to 4 doses developed gangrene (5.7 to 7.2 weeks after inoculation) and died within a week, while those that had received 5 to 10 doses lost their limbs spontaneously (5.6 to 6.1 weeks after inoculation), followed by sudden clinical recovery. Eight weeks after the spontaneous amputation the amputees relapsed with concomitant metastasis, anasarca and death. Acid-fast bacilli (AFBs) were detected in inoculated and non-inoculated limbs, tails, visceral organs, faecal pellets and caecal contents of the mice. The AFBs detected in the caecal samples were innumerable and unusually long. Though AFBs were consistently detected in lymph nodes they were never detected in blood samples.

CONCLUSION

The findings suggest that the progression and final outcome of an M. ulcerans infection maybe dose related. The unequivocal absence of AFBs in the blood, but their consistent presence in lymph nodes located in the lower limbs right up to the neck, suggests that the microbes are disseminated through the lymphatic system rather than through the blood.

von Willebrand Disease Associated with Superficial Temporal Artery Pseudoaneurysm

We report on two patients with von Willebrand disease (vWD) that presented with superficial temporal artery pseudoaneurysms following minor blunt trauma. We discuss the possible pathophysiological link between vWD and blood vessel abnormalities. The cases highlight the importance of considering the diagnosis of vWD in patients presenting with pseudoaneurysm.

A Review of the Current Treatment of Renal Artery Stenosis

PURPOSE

Atherosclerotic renal artery stenosis (ARAS) is associated with morbidity and mortality consequent to progressive ischemic renal failure and the cardiovascular consequences of hypertension. There is considerable uncertainty concerning the optimal management of patients with this condition. This review considers the aetiological factors and the physiologic consequences of ARAS and compares the results of clinical studies of medical and endovascular therapies on blood pressure control and preservation of renal function.

RESULTS

Although, in patients with fibromuscular disease the results of percutaneous transluminal angioplasty (PTA) are clearly superior to medical therapy and surgery, in asymptomatic patients with ARAS the antihypertensive benefits and preservation of renal function of endovascular, surgical and medical therapies appear similar. In selected symptomatic patients interventions may, however, be life-saving. Surgery is generally reserved for arterial occlusions with preserved renal parenchyma and function.

CONCLUSIONS

The results of larger, multicentre, randomised, controlled trials are required to clearly clarify the role of interventional therapy in asymptomatic patients.

Glycaemic and insulin responses of six traditional Sudanese carbohydrate-rich meals in subjects with Type 2 diabetes mellitus

AIMS

The objective of this study was to investigate the influence of six Sudanese traditional carbohydrate-rich meals on glucose and insulin responses and to formulate appropriate dietary guidelines based on glycaemic excursions of traditional foods.

METHODS

On six occasions with 1-week intervals, 10 Type 2 diabetic subjects consumed six Sudanese traditional carbohydrate-rich meals. The following meals were tested and also analysed for their composition: wheat gorasa (pancakes), sorghum kisra (flat bread) and sorghum acida (porridge), millet kisra and millet acida and maize acida. Blood samples were collected before and after meal ingestion at 0, 30, 60, 120 and 240 min and analysed for plasma glucose and plasma insulin and incremental areas under the curves (AUC) were calculated.

RESULTS

A significant variation in AUC for glucose and insulin responses were found between meals, the over all differences in incremental AUCs between the six meals were significant for both plasma glucose (P = 0.0092) and insulin (P = 0.0001). The 2-h glucose values were 10.5 +/- 2.7 for sorghum flatbread, 9.5 +/- 3.1 for sorghum porridge, 10.3 +/- 3.4 for millet flatbread, 10.6 +/- 3.6 for millet porridge, 11.4 +/- 2.7 for maize porridge and 8.7 +/- 2.4 for the wheat pancakes. The comparison between the AUCs of the meals showed that millet acida (porridge) followed by wheat gorasa (pancakes) displayed significantly lower post-prandial glucose and insulin responses, whereas maize acida induced a higher post-prandial glucose and insulin response.

CONCLUSIONS

The comparison of glycaemic and insulin responses to six traditional Sudanese meals show differences of clinical importance, and could form a basis for dietary advice to diabetic subjects in Sudan and countries sharing similar food traditions.

Importance of screening household members of acute brucellosis cases in endemic areas

Isolated reports of brucellosis among family members have been documented. The aim of this study is to determine if active serological screening of the households' members of acute brucellosis cases will detect additional unrecognized cases. From May 2000 to October 2001, patients with acute brucellosis were enrolled and their household members were serologically screened for brucellosis using the Standard Agglutination Test (SAT). Fifty-five index cases with acute brucellosis and 404 household members were enrolled. The majority of index cases (48%) were young adults, and 79% were illiterate. Ownership of animals and ingestion of unpasteurized raw milk were reported by 45 and 75% of the index cases respectively. Of the 55 families screened, 23 (42%) had two family members or more with serological evidence of brucellosis and 32 (58%) had only the index case. Households of > or = 5 members and a history of raw-milk ingestion by family members were risk factors associated with the seropositives (P < 0.05). Of the 404 household members screened, 53 (13%) were seropositive; of these 39 (74%) were symptomatic, and 9 (35%) had brucella bacteraemia. Symptomatic seropositives tended to have bacteraemia and higher brucella antibody titres compared to asymptomatic seropositives (P < or = 0.05). Screening family members of an index case of acute brucellosis will detect additional cases.

Primary splenic flexure volvulus--a case report with review of literature

Splenic flexure is a rare site for volvulus. Very few cases have been reported in the literature. Cases mostly present with recurrent attacks of obstruction with distension of the abdomen. A case of a young female who had primary splenic plexure volvulus due to absence of ligamental attachment has been presented here. Resection of the volvulus segment with end to end anastomosis is the curative surgical treatment.