Surgical survey of peptic ulcer in South India

Between 1944 and 1960, 1138 consecutive patients operated on in the Christian Medical College Hospital, Vellore, for peptic ulcer were documented. Deaths within 1 month of operation gave an overall mortality of 3.3 per cent. Six hundred and seventy-eight patients with duodenal or gastric ulcer were operated on by one of three standard procedures, and were followed up for 5 to 15 years after operation. Relief of symptoms was obtained in 80 per cent of patients. Vagotomy and gastrojejunostomy was found to be the best standard operation.

Controlled clinical trial of clofazimine in untreated lepromatous leprosy

A comparison of clofazimine and dapsone in the management of untreated lepromatous leprosy showed no significant differences between the two drugs in terms of morphological and bacterial indices. The incidence of erythema nodosum leprosum was similar in the two groups. Since dapsone is cheaper than clofazimine it remains the drug of choice for the routine management of untreated lepromatous leprosy.

The relationship of pulmonary venous wedge to pulmonary arterial pressures

A comparison of pressure levels and pressure-time relationships in pulmonary artery pressure (PAP) and pulmonary venous wedge pressure (PVWP) tracings was made from cardiac catheterization records of 60 patients, aged 1 day to 16 years. In 50 patients with normal or low PAP's there was close correlation between systolic, diastolic, and mean pressures in the two sites. In all 10 patients with pulmonary hypertension the PVWP's were elevated but were significantly different from corresponding PAP's. The wave contours showed qualitative similarities in most cases, but the duration of the rise in systolic pressure was longer, and the Q-pressure intervals were delayed in the PVWP tracings. Satisfactory PVWP's were obtained in 42 of 67 (63%) consecutive patients approached from the leg. Lack of correlation of pressures from the two sites in the presence of pulmonary hypertension may be attributed, in part, to decreased compliance of the pulmonary arterial system. It is concluded that the PVWP is useful in catheter evaluation of heart disease: when the PVWP is normal it usually reflects accurately the PAP; an elevated PVWP suggests an elevated PAP but cannot be used reliably as an indication of the actual arterial pressure.

Liver in leprosy: histological and biochemical findings

The histological findings and their correlation with biochemical functions of the liver in 240 leprosy patients are presented. In 21% with tuberculoid leprosy and in 62% with lepromatous leprosy leprous granulomata were found in the liver. A significant prevalence of granulomatous lesions in the liver among patients with tuberculoid and borderline-tuberculoid leprosy of less than one year's duration suggests that bacillaemia occurs early in all forms of leprosy.There was a direct correlation between bacterial index and the presence of acid-fast bacilli in the liver. Of 50 patients with negative skin smears seven had acid-fast bacilli at liver biopsy. From none of these liver homogenates were acid-fast bacilli grown on culture in Löwenstein-Jensen medium.The alterations in liver functions were more consistently seen when acid-fast bacilli were associated with the presence of leprous granulomatous lesions. The acid-fast bacilli were found to persist even after one to five years of specific antileprosy therapy and after the bacilli in the skin had cleared up. This may explain the relatively frequent recrudescence or relapse of the bacillated types of leprosy when specific antileprosy therapy is stopped soon after bacterial negativity is attained on skin smears.

Spontaneous closure of physiologically advantageous ventricular septal defects

The clinical and pathological features of two cases in which physiologically advantageous ventricular septal defects closed spontaneously are presented. The first patient, with tricuspid atresia, Type I(c), developed symptoms and signs of increasing systemic hypoxemia, decreasing pulmonary blood flow, and a systolic murmur of decreasing intensity. His ventricular septal defect, previously demonstrated angiocardiographically, could not be found at autopsy; it is presumed to have closed by fusion of its muscular rims with subsequent covering by endocardial proliferation. The second patient, with a double-outlet right ventricle, demonstrated progressive left ventricular enlargement and congestive failure despite increasing pulmonary vascular resistance. Postmortem examination showed that this defect was sealed by adherence of the septal leaflet of the tricuspid valve to the edges of the defect. Appreciation of the true nature of the changing anatomical situation would have resulted in more rational effective therapeutic approaches.

The cases presented and review of pertinent literature contribute to more complete understanding of circumstances surrounding the spontaneous closure of ventricular septal defects.

An epidemiological study of hemiplegia due to stroke in South India

The findings of a preliminary epidemiological survey of Vellore, South India, and adjoining rural areas are presented. The prevalence of "completed strokes" and hemiplegias due to any cause is 56.9 per 100,000. The high incidence of hemiplegia in the young has been pointed out. The need for concerted efforts for a proper evaluation of the incidence of cerebrovascular disease in India seems imperative.

Noradrenaline and tyramine action on isolated atrial muscle of endotoxin-treated guinea-pigs

1. Isolated left-atrial strips of guinea-pigs were driven electrically at a constant rate and log-concentration curves were determined for the positive inotropic effect of noradrenaline and tyramine.2. The atrial tissue from endotoxin-treated animals had a reduced sensitivity to noradrenaline and tyramine.3. After endotoxin, the sensitizing effect of cocaine on the response to noradrenaline was normal but accumulation of (3)H-noradrenaline in nerve terminals was markedly reduced.4. Atrial tissue of endotoxin-treated guinea-pigs responded normally to stretch.