Spontaneous hyphema in an infant with Christmas disease

A 4-month-old boy presented with an apparently spontaneous uniocular hyphema as the initial manifestation of Christmas disease (hemophilia B). Although it is uncommon for patients with hemophilia to experience major bleeds in infancy, and the ocular involvement is usually limited to periocular hemorrhages, we recommend that a coagulation profile be obtained in all patients with intraocular hemorrhage to rule out this disease.

Inosithin neutralization test to measure lupus anticoagulants

The inosithin neutralization test was performed in 14 patients in whom lupus anticoagulant was detected. To test its specificity, it was also performed in 10 patients with severe hemophilia and in three patients with Factor VIII inhibitors. Prolonged kaolin clotting time was corrected by adding varying amounts of inosithin (Asolectin, 0.19 to 100 micrograms), a soybean-derived phospholipid, in all patients with lupus anticoagulant but not in patients with hemophilia or in two patients with Factor VIII inhibitors. In one patient, both Factor VIII inhibitors and lupus anticoagulant were present. The concentration of lupus anticoagulant in a patient was expressed as the amount of inosithin (measured in micrograms) required to normalize the prolonged kaolin clotting time. This amount correlated significantly with the occurrence of thrombosis and/or recurrent abortion. The inosithin neutralization test is useful to measure lupus anticoagulant.

Partial cholecystectomy--safe and effective

Patients undergoing surgical treatment for calculous disease were considered to have had a partial cholecystectomy performed when a part of the gall bladder wall was retained for technical reasons. Forty patients underwent partial cholecystectomy: for chronic cholecystitis (20), acute cholecystitis (4), Mirizzi's syndrome (14), portal hypertension or partially accessible gall bladder (one patient each). Four patients (10%) developed infective complications and two patients had retained common bile duct stones. In a mean follow up period of 13 months (range 1-36 mths), only 3 patients have ongoing mild dyspeptic symptoms while the rest have remained asymptomatic. Partial cholecystectomy has been found to be a safe and effective procedure in difficult cholecystectomy situations, since it combines the merits of cholecystectomy and cholecystostomy.

Cholecystectomy and drainage: ultrasonographic and radioisotopic evaluation

Eighty patients undergoing cholecystectomy were either assigned deliberately (n = 30) or randomized (n = 50) to drainage (n = 38) or nondrainage (n = 42). Subhepatic collections were seen on ultrasonography (US) after 48 to 72 hours in 12 of 35 patients with drainage and 24 of 42 patients without drainage (p < 0.05). Only two patients with subhepatic collections were symptomatic, and none required treatment. Postoperative infective complications were seen in 13 of 38 patients with drainage and with a collection, and none of the 18 patients without drainage and without a collection had postoperative infective complications (p < 0.05). Cholecystectomy was then performed in 100 patients without using a drain. BULIDA radioisotope scans revealed a bile leak in only 4 of 34 patients studied. Subhepatic collections were seen on US after 48 to 72 hours in 42 patients. The collection resolved in 22 patients and was smaller in 6 on repeat US. None of the patients with collection was symptomatic, and none required treatment. Postoperative infective complications were seen in 7 of 42 patients with a collection and 5 of 58 patients without a collection (not significant). We conclude that (1) cholecystectomy with drainage is associated with more infective complications than when a drain is not used; (2) cholecystectomy without drainage is safe; and (3) asymptomatic nonbilious subhepatic collections are common after cholecystectomy without drainage but do not require treatment, resolving spontaneously.

Peritoneal mesothelioma simulating pseudomyxoma peritonei on CT and sonography

We present an unusual case of peritoneal mesothelioma with ultrasound (US) and computed tomographic (CT) features of scalloping of liver margins and ascitic septations mimicking pseudomyxoma peritonei. A brief review of the literature is also presented.

Alpha-fetoprotein production by rhabdomyosarcoma of the urinary bladder

Alpha-fetoprotein has emerged as a useful diagnostic tool for hepatic tumour and tumours of germ cell origin. However, isolated case reports of association of this tumour marker with tumours of the lung and non-germ cell tumours of the ovary are reported. We present a case of a Rhabdomyosarcoma, a generally non-secretory tumour that showed raised levels of AFP in serum and reacted positively for the same in a PAP technique for AFP. Cross striations were visible in many cells on II & E stained sections.

Isolated right ventricular infarction

The literature on isolated right ventricular infarction is reviewed and local experience is reported. Chronic lung disease is an important risk factor. Chest pain and breathlessness are common. Syncope and sudden collapse can also occur. Rhythm disorders include sinus bradycardia, atrial fibrillation and ventricular tachycardia or fibrillation. Atrioventricular block is rare. Hypotension and a right-sided fourth heart sound are common. Cautious use of slow-release nitroglycerin is not hazardous in the absence of hypotension. High doses of steroids and anticoagulants can be helpful. The prognosis is usually good, although sudden collapse can occur due to ventricular fibrillation, rupture of the right ventricular free wall or massive pulmonary embolism.

Paget's disease of the breast: a study of 43 cases

Paget's Disease of the breast is caused by spread of duct carcinoma cells along the mammary ducts to the epidermis of the nipple and areola. This is a study of 43 cases of Paget's Disease of the breast. Though only few patients presented with a lump; a carcinoma, either DCIS or IDC or both were found in all cases. The presence of an underlying breast carcinoma in Paget's Disease of the breast suggests that radical mastectomy is the treatment of choice in this condition.

Postpartum myocardial infarction treated by balloon coronary angioplasty

Acute myocardial infarction in pregnancy is a rare event that carries substantial morbidity and mortality. New technologies have been developed in cardiology to open obstructed vessels during the acute evolution of coronary thrombosis. We present a case of acute postpartum myocardial infarction in a woman with class F/R diabetes. She underwent successful balloon angioplasty but developed chest pain suspicious of angina pectoris 6 weeks after the procedure. A thallium scan demonstrated fixed defects in the inferoposterior and posterolateral segments and minimal apical redistribution. This represents the second case of angioplasty performed in pregnancy and the first for an acute myocardial infarction.

Autoimmunity and glomerulonephritis

Autoimmunity is now unequivocally regarded as the predominant pathogenic process underlying most forms of primary and secondary glomerulonephritis in humans. Most of the investigations so far have been focused upon humoral mechanisms. Consequently, the role of cell-mediated immunity in nephritis is still incompletely understood. Nonetheless, as a result of contemporary studies, a number of previously unidentified auto-antibodies in association with glomerulonephritis have been discovered. However, apart from anti-NC1 antibodies in the classical Goodpasture syndrome, the exact role of these auto-antibodies in the pathogenesis of glomerulonephritis yet remains undefined. This fact, however, does not undermine the relevance of exploring these auto-antibodies. They have been of immense help in sub-classifying glomerulonephritis previously thought homogeneous (Figure 3). Besides, analysis of auto-antibodies has assisted tremendously in the early diagnosis of rapidly progressive glomerulonephritis. This, in turn, has aided in early commencement of therapy thus contributing to regression in morbidity and mortality resulting from these disorders. Moreover, investigation of these auto-antibodies is of enormous value for future studies aimed at understanding the pathogenic mechanisms involved in glomerulonephritis.

Frequency locking in phase-conjugate ring oscillators

Frequency locking in a photorefractive phase-conjugate ring oscillator was studied by injecting a seed beam into the resonator. For a seed beam coherent with the pump, frequency locking of the oscillator was observed at large seed powers. At lower seed levels, the beat signal displayed multiple harmonics in its frequency behavior. No evidence of locking was found for a seed incoherent with respect to the pump.

[Autoantibodies as serological markers in the diagnosis of glomerulonephritis]

Autoimmunity is now regarded as the unequivocally predominant pathogenic process underlying most forms of primary and secondary glomerulonephritis in humans, and a number of autoantibodies occurring in conjunction with glomerulonephritis have been discovered. However, apart from the anti-NC1 antibodies occurring in classic Goodpasture's syndrome, the exact pathogenic role of these autoantibodies in human glomerulonephritis remains to be established, though this in no way diminishes the importance of their study. They have been of enormous value in subclassifying glomerulonephritis, previously thought to be a homogeneous entity. Autoantibody analysis has become a vital aid in the early diagnosis of rapidly progressive glomerulonephritis, which in turn has enabled treatment to be started early, thus contributing to a decline in the morbidity and mortality resulting from these disorders. Moreover, investigation of these autoantibodies will be of immense value in future studies focused on the pathogenic mechanisms involved in glomerulonephritis.

Evaluation of four coagulation tests to detect plasma lupus anticoagulants

Lupus anticoagulant was detected in 205 newly diagnosed, untreated patients with systemic lupus erythematosus by the following tests: kaolin clotting time, activated partial thromboplastin time, plasma prothrombin time, and, in the last 99 patients, by dilute Russell's viper venom time. In 10 patients, lupus anticoagulant was detected by kaolin clotting time prolongation, corrected by inosithin but not by normal plasma; 12 and 6 of them had prolonged activated partial thromboplastin time and partial plasma prothrombin time, respectively. Only 10 patients had a history of recurrent abortions and/or thrombosis, nine of whom had lupus anticoagulant as shown by the kaolin clotting time test. Of the 99 patients studied by all four tests, 9 showed lupus anticoagulant by both kaolin clotting time and dilute Russell's viper venom time; 7 had a history of abortion and/or thrombosis. The dilute Russell's viper venom time test is easy to perform and not affected by inhibitors to factor VIII or IX. It is recommended as a primary screening test for lupus anticoagulant detection in a hospital clinical laboratory.

A clinico-haematologic profile of paroxysmal nocturnal haemoglobinuria

Clinico-haematological parameters in sixteen patients of paroxysmal nocturnal haemoglobinuria (PNH) are presented. Their modes of presentation included recurrent episodes of cola-coloured urine (6/16), refractory anaemia (9/16) and predominant thrombotic manifestations (1/16). Laboratory investigations revealed the presence of anaemia (16/16), reticulocytosis (14/16), thrombocytopenia (11/16), leucopenia (5/16) and cellular bone marrow (14/16). Two patients had hypoplastic bone marrow initially but subsequently developed PNH. The patients were treated with haematinics, prednisolone (16/16) and oxymethalone (2). Prednisone was effective in suppressing haemolytic episodes. Oxymethalone given to the 2 patients with hypoplastic bone marrow resulted in amelioration of anaemia in one but no effect in the other patient.

Intraductal hepatocellular carcinoma with normal liver--case report

Hepatocellular carcinoma commonly invades the portal vein but is rarely seen in the bile duct. When seen, a minor intraductal component usually accompanies a prominent hepatic involvement. We report a case of hepatocellular carcinoma that entirely involved the common bile duct, the hepatic involvement was undiscernible at operation or ultrasonography. The patient had obstructive jaundice both at first presentation and at recurrence. The liver was normal at both explorations. The elevated AFP levels returned to normal after second resection. The diagnosis was confirmed by electron microscopy.

Macrophage migration as an index of immune status

Peritoneal macrophages from mice and guinea pigs pretreated with Freund's complete adjuvant (FCA) or any other immunostimulant when packed in a glass capillary and placed in a migration chamber migrated to a larger area than macrophages from normal untreated animals. The extent of migration could be correlated with the dose of FCA and the period of treatment. Under optimum conditions the ratio between the areas of migration of macrophages from FCA-treated animals and of macrophages from untreated animals was above 3.0. A close correlation was observed between macrophage migration and delayed type hypersensitivity (DTH) response in animals sensitized with ovalbumin or sheep red blood cells. The macrophages of immunostimulant-treated animals had relatively higher phagocytic activity. The macrophage migration index (MMI) appears to be a close correlate of macrophage activation and possibly also of the status of cell mediated immune response.