Characterization of SiO2-Na2O-Fe2O3-CaO-P2O5-B2O3 glass ceramics

Bioactivity and magnetic properties were investigated in glass and glass ceramics based on the SiO2-Na2O-Fe2O3-CaO-P2O5-B2O3 system to find their suitability as thermoseed for hyperthermia treatment of cancer. The effect of change in compositions on bioactivity was examined in simulated body fluids. The glass ceramic samples exhibit Na3CaSi3O8 and Na3-XFeXPO4 phases. After dipping the glass ceramic samples in simulated body fluids silica hydrogel first forms, followed by an amorphous calcium phosphate layer. Magnetic and microwave resonance experiments further demonstrate the potential of these glass ceramics for possible use in hyperthermia.

Effect of rotavirus infection on small gut pathophysiology in a mouse model

AIM

To study the effect of rotavirus infection on amino acid uptake in the small intestine in an experimental mouse model.

METHODS

Infant mice (7-8 days of age) were orally infected with the EB serotype 3 strain of rotavirus and animals (both infected and control) were killed on days 0, 1, 3, 5, 7 and 10 post inoculation (PI) after recording their bodyweights. Gamma-glutamyltranspeptidase (GGT), leucine amino peptidase (LAP), glutathione (GSH) and leucine amino acid uptake in the jejunum and ileum were assessed.

RESULTS

Infected animals showed significant reduction in their bodyweights and intestinal lengths on the third day PI compared with controls. Leucine amino peptidase, GGT, GSH and leucine uptake were significantly reduced in the ileum on the third and fifth day PI compared with controls while uptake in the jejunum was only reduced on third day PI. The LAP, GGTP, GSH and leucine uptake attained normal levels on the seventh day when diarrhoea stopped. Histology showed damage to the villi in the jejunum and prominent cytoplasmic vacuolation in the ileum of infected animals on the third and fifth day PI.

CONCLUSION

Rotavirus affects amino acid uptake in the small intestine at the time of peak infection.

Mandibulo-acral dysplasia: Indian patient with severe bony changes

We report an Indian patient with mandibulo-acral dysplasia. This patient had absence of spinous processes of 4th and 5th cervical vertebrae and very severe bony changes but no loss of teeth.

Inhibition of copper-zinc superoxide dismutase induces cell growth, hypertrophic phenotype, and apoptosis in neonatal rat cardiac myocytes in vitro

Oxidative stress has been implicated in the pathophysiology of myocardial failure. We tested the hypothesis that inhibition of endogenous antioxidant enzymes can regulate the phenotype of cardiac myocytes. Neonatal rat ventricular myocytes in vitro were exposed to diethyldithiocarbamic acid (DDC), an inhibitor of cytosolic (Cu, Zn) and extracellular superoxide dismutase (SOD). DDC inhibited SOD activity and increased intracellular superoxide in a concentration-dependent manner. A low concentration (1 micromol/L) of DDC stimulated myocyte growth, as demonstrated by increases in protein synthesis, cellular protein, prepro-atrial natriuretic peptide, and c-fos mRNAs and decreased sarcoplasmic reticulum Ca(2+)ATPase mRNA. These actions were all inhibited by the superoxide scavenger Tiron (4,5-dihydroxy-1,3-benzene disulfonic acid). Higher concentrations of DDC (100 micromol/L) stimulated myocyte apoptosis, as evidenced by DNA laddering, characteristic nuclear morphology, in situ terminal deoxynucleotidyl transferase-mediated nick end-labeling (TUNEL), and increased bax mRNA expression. DDC-stimulated apoptosis was inhibited by the SOD/catalase mimetic EUK-8. The growth and apoptotic effects of DDC were mimicked by superoxide generation with xanthine plus xanthine oxidase. Thus, increased intracellular superoxide resulting from inhibition of SOD causes activation of a growth program and apoptosis in cardiac myocytes. These findings support a role for oxidative stress in the pathogenesis of myocardial remodeling and failure.

Analysis of the role of glutamine 190 in the catalytic mechanism of murine leukemia virus reverse transcriptase

To determine the catalytic role of Gln(190), a member of the highly conserved LPQG motif in Moloney murine leukemia virus reverse transcriptase, we carried out site-directed mutagenesis of this residue to generate Q190N and Q190A. Both mutant proteins exhibited a significant loss in their polymerase and pyrophosphorolysis activities with a more pronounced effect noted with the Gln --> Asn substitution. The catalytic efficiencies of the mutants exhibited a 40-70-fold reduction with poly(rC) and poly(dC) templates in the presence of Mg(2+) and a 10-20-fold reduction with poly(rA) template in the presence of Mn(2+). Interestingly, the K(m) for NTP exhibited only a moderate 3-10-fold increase irrespective of the template-primer and the metal ion. Photoaffinity labeling of both the mutant and the WT enzymes exhibited an identical affinity for RNA.DNA and DNA.DNA template-primers. However, unlike the WT enzyme, the mutant enzymes exhibited a significantly reduced ability to catalyze the nucleotidyltransferase reaction on the covalently immobilized template-primer. An examination of the rate constants for the first and the second nucleotide for the mutant enzymes indicated dissimilar rates, indicating that Gln(190) may be involved in a rate-limiting, conformational change step both before and after the phosphodiester bond formation. Furthermore, the processivity of DNA synthesis by the mutant enzymes was decreased severely, which may result from the lower catalytic efficiency as well as translocation defect.

A monoclonal antibody-based test system for detection of Entamoeba histolytica-specific coproantigen

BACKGROUND

Diagnosis of amebiasis based on stool microscopy or demonstration of anti-amebic antibodies has limitations. A diagnostic system based on demonstration of the parasite product in clinical specimens holds promise.

METHODS

Murine monoclonal antibodies were developed against an Entamoeba histolytica-specific coproantigen. A monoclonal antibody (MoAb) 3D10 was employed in a double-antibody sandwich microELISA system for the detection of amebic coproantigen in fecal specimens. The system was evaluated in three groups of subjects: 63 patients with intestinal amebae, 27 with non-amebic parasitosis, and 57 apparently healthy controls.

RESULTS

The MoAb 3D10 belonged to IgG1 isotype and recognized three antigens, with mol. wt. 36, 25 and 17 kDa in the crude extract of E. histolytica (HM1-IMSS), and an amebic coproantigen with MW 36 kDa in the stool supernatant from patients with intestinal amebae. The coproantigen was detected in the stool eluates of 56 (89%) patients with intestinal amebae and in none of the stool eluates from other subjects, thereby giving this system a sensitivity of 89% and specificity of 100% for the detection of intestinal amebae.

CONCLUSIONS

This monoclonal antibody recognizes as intact epitope on the E. histolytica-specific coproantigen. The validity of the MoAb-based microELISA system needs to be established.

Effect of the levonorgestrel-releasing intrauterine system on uterine myomas in a renal transplant patient

The levonorgestrel-releasing intrauterine system (LNG-IUS) has been used in the treatment of both idiopathic menorrhagia and adenomyosis. An electronic search of the on-line medical literature revealed no reports of its use for menorrhagia secondary to uterine myomas. Presented here is the successful treatment of uterine myomas with menorrhagia in a woman with a renal transplant. There was a significant reduction in menorrhagia, dysmenorrhea, and uterine and myoma size with the use of the LNG-IUS. We believe that this system provides an alternative to conventional hysterectomy and gonadotrophin-releasing hormonal analog medical treatment for uterine myomas, with a possibly inhibitory effect on myoma growth.

Extended survival of carcinoma head of pancreas following palliative treatment

A 48 year old woman presented with obstructive jaundice 10 years back. Upper gastrointestinal endoscopy revealed a growth infiltrating the ampulla of Vater, which was confirmed to be adenocarcinoma on cytology. At laparotomy, a large nodular growth was seen in the head of pancreas. Surgical resection could not be done because of encasement of superior mesenteric vessels, hence a cholecystojejunostomy was performed. The patient remained asymptomatic for 9 years, when she developed cholangitis. Duodenoscopy at this stage revealed an ulcerated growth at the ampulla and biopsy from the growth confirmed a well differentiated adenocarcinoma. A straight flap 10 F stent was placed in the common bile duct. Thereafter the patient has remained asymptomatic for more than a year.

Pregnancy and its outcome in patients with noncirrhotic portal hypertension

There is paucity of data in the literature on the occurrence of pregnancy and its outcome in patients with noncirrhotic portal hypertension. The present study was undertaken to assess the fertility pattern, fetal loss, and consequences of variceal bleeding during pregnancy in these patients. Fifty-five women of child-bearing age with a diagnosis of noncirrhotic portal hypertension (including 32 with noncirrhotic portal fibrosis and 23 with extrahepatic portal venous obstruction) and 44 age-matched controls were studied. A detailed history of obstetric events and bleeding episodes was recorded in all patients. Any complication of portal hypertension was managed accordingly. Patients were classified into three groups for analysis: group 1-obstetric events after the diagnosis of portal hypertension in patients; group II-obstetric events before the diagnosis of portal hypertension in patients; and group III-obstetric events in controls. A total of 116 pregnancies took place in 44 patients. Of these, 36 occurred after and 80 before the diagnosis of portal hypertension was made. In the 44 controls, 118 pregnancies took place. The mean fertility rates of groups I, II and III were 0.20+/-0.24, 0.18+/-0.21, and 0.22+/-0.12 pregnancies per year, respectively, which were not statistically different (P>0.05). The numbers of fetal losses in groups I, II and III were 3/36 (8.3%), 6/80 (7.5%), and 12/118 (10.17%) pregnancies, respectively. Menstrual irregularities were found in 7/55 (12.72%) patients and 6/44 (13.6%) controls (P>0.05). Five episodes of variceal bleeding occurred in 36 pregnancies after the diagnosis of portal hypertension (13.88%). All five were successfully managed with endoscopic sclerotherapy. In conclusion, noncirrhotic portal hypertensive patients have normal fertility and outcome of pregnancy. Variceal bleeding episodes are not common and endoscopic sclerotherapy is safe and effective in pregnancy.

Does an acidic medium enhance the efficacy of vaginal misoprostol for pre-abortion cervical priming?

Absorption pharmacokinetics reveal a relationship between plasma concentrations of misoprostol and its therapeutic effect. To achieve a constant plasma profile and optimal efficacy, it is important to develop a medium that ensures complete dissolution of vaginal misoprostol tablets. Vaginal misoprostol is said to liquefy better in an acidic medium; thus, the aim of this study was to determine whether a 200 microg misoprostol tablet dissolved in acetic acid would be more efficacious than 200 microg misoprostol dissolved in water for pre-abortion cervical priming. A total of 120 healthy nulliparous women requesting legal termination of pregnancy between 6-12 weeks gestation were allocated randomly to either of the study groups. Vacuum aspiration was performed 3-4 h after insertion of the misoprostol tablet. Using Hegar's dilator, the degree of cervical dilatation before operation was measured. Of 60 women, 14 (23%) achieved a cervical dilatation of >/=8 mm when the misoprostol dose was dissolved in acetic acid; 12 (20%) achieved a similar cervical dilatation when the dose was dissolved in water. The mean cervical dilatation for the acid and water media used was 6.3 mm and 6.2 mm respectively; these differences were not statistically significant, neither were pre-operative and intra-operative blood losses statistically different between the two groups. Twenty-four (40%) and four (7%) respectively of women in whom a water medium was used experienced vaginal bleeding and abdominal pain; 20 (33%) and 0 women respectively among those in whom an acetic acid medium was used experienced vaginal bleeding and abdominal pain. These differences in side effects were not statistically significant. Our study shows that the use of acetic acid to dissolve vaginal misoprostol does not improve the efficacy in achieving successful cervical dilatation for pre-abortion cervical priming.

Helicobacter pylori eradication: comparison of three treatment regimens in India

Conventional bismuth-based triple therapy has multiple problems, such as inadequate drug compliance, side effects, and drug resistance. Combination of omeprazole and clarithromycin with or without combination with antibiotics like amoxycillin has been shown to be effective in eradication of Helicobacter pylori. Reports from India are few on the efficacy of clarithromycin-based drug combinations. Therefore, we evaluated efficacy of omeprazole and clarithromycin with or without amoxycillin for treating H. pylori infection. Sixty-four consecutive patients with upper gastrointestinal symptoms and having H. pylori infection were included. In every patient, complete upper gastrointestinal endoscopy was done. H. pylori infection was diagnosed by identification of organism on antral biopsies and positive rapid urease test. Patients were treated with omeprazole 40 mg/day + clarithromycin 250 mg twice daily (group I, n = 22), or omeprazole 40 mg/day + clarithromycin 250 mg twice daily + amoxycillin 500 mg three times daily (group II, n = 20), or bismuth subcitrate 120 mg four times daily + amoxycillin 500 mg three times daily + metronidazole 400 mg three times daily (group III, n = 22) for 2 weeks. H. pylori status was reevaluated 1 month after completion of treatment. One patient in each group stopped drugs due to side effects. Eradication rate was not significantly different in group I (15/22, 68%), group II (14/20, 70%), and group III (13/22, 59%). Of those completing therapy, side effects were observed in three patients in group III (nausea, skin rash, metallic taste), whereas none of the patients in group I and group II had any side effects. Addition of amoxycillin did not appear to improve efficacy of dual omeprazole and clarithromycin therapy and appeared to be no different than bismuth, metronidazole, and amoxycillin triple therapy. Overall, none of regimens was particularly good.

Helicobacter pylori: evidence for spouse-to-spouse transmission

BACKGROUND

Spouse-to-spouse transmission of Helicobacter pylori infection still remains controversial.

METHODS

We studied the prevalence of H. pylori infection among spouses of H. pylori-positive or -negative individuals and looked for intraspousal transmission. Twenty-five couples were studied. Initially, one individual per couple was selected as the index subject. Spouses of these H. pylori-positive or -negative index individuals underwent screening for H. pylori by serology, the rapid urease test and histology. Those couples in whom only one spouse was positive were followed up and H. pylori status was re-evaluated using the above tests after approximately 1 year in the H. pylori-negative spouse.

RESULTS

Of 25 randomly selected index subjects, 18 were H. pylori positive and seven were negative. There was no significant difference in age, sex, socioeconomic status, presence of dyspeptic symptoms, duration of marriage and number of children in these index subjects. Spouses of H. pylori-infected index subjects had a significantly higher prevalence of H. pylori infection than the spouses of H. pylori-negative index subjects (83.3 vs 28.5%; P < 0.01). Age, sex, socioeconomic status, dyspeptic symptoms, duration of marriage and number of children were not different in H. pylori-positive or -negative spouses of H. pylori-positive index subjects. There were five such couples in whom only one spouse was H. pylori positive initially. At follow up, three of these H. pylori-negative spouses became positive. These findings suggest person-to-person transmission or common source exposure within couples.

Species differences in cis-elements of the proalpha1(I) procollagen promoter and their binding proteins

Previous studies suggest that there may be species differences in the utilization of cis-elements of the type I collagen genes. The present study was designed to examine this possibility by focusing on two regions of the proalpha1(I) collagen promoter. One is the GC-rich A1 region (-194/168) that modulates transcriptional activity of the mouse promoter. The other contains a glucocorticoid response element (GRE) implicated in negative glucocorticoid regulation of the rat promoter. Unlike mouse A1 probes, probes representing the analogous human (-195/-168) and rat (-193/-179) regions failed to bind nuclear proteins in gel shift assays. Binding assays with mouse A1 probes containing base substitutions indicated that this behavior could be ascribed to five bases in the human, and two in the rat sequences. In addition, the pattern of expression of c-Krox, a protein that alters transcriptional activity via the mouse A1 element, differed in mouse and human tissues. Computer analysis revealed differences in the arrangement of GRE half-sites in human and rat proalpha1(I) collagen promoters. In a region of the human promoter (-700/673) analogous to the rat (-672/-633), there are three half-sites, each separated by two nucleotides, that cooperate in binding of glucocorticoid receptor. There also is a proximal half-site at position -335 of the human promoter that binds glucocorticoid receptor, but it is not present in the rat promoter. This study has defined several species-specific differences in the sequences and nuclear protein binding activity of regions involved in transcriptional activity of the proalpha1(I) collagen promoter. The results suggest that the A1 regions of the human and rat promoters examined here are unlikely to function as regulatory cis-elements, and they provide a framework for investigating the role of GREs in transcriptional regulation. They also suggest that species differences in cis-elements and transcription factors should be taken into consideration when using heterologous systems to study collagen gene regulation.

Comparison of phacotrabeculectomy with 5-fluorouracil, mitomycin-C, and without antifibrotic agents

BACKGROUND AND OBJECTIVE

To evaluate the potential benefits, complications, and prognostic risk factors for failure of phacotrabeculectomy performed with or without 5-fluorouracil (5-FU) and mitomycin-C (MMC).

PATIENTS AND METHODS

Retrospective chart review of 78 patients who underwent phacotrabeculectomy during a 2-year period. Patients were divided into 3 groups, those who received 5-FU (N = 28). MMC (N = 29), or no antifibrotic agent (N = 21).

RESULTS

All 3 groups had statistically significant lower intraocular pressures (IOP) on fewer antiglaucomatous medications at 6-month, 12-month, and last follow-up compared to preoperative levels (P < .05). Intraocular pressures were lower in the group that received MMC compared to the 5-FU group, but not in the group that did not receive antimetabolites, at all time intervals measured (P < .05). Black race was a strong predictor of failure of trabeculectomy (P = 009). No differences in final visual acuity or complications were found between groups.

CONCLUSIONS

Phacotrabeculectomy is effective regardless of antimetabolite use. Race is a strong predictor of failure.

[14C]-urea breath test to confirm eradication of Helicobacter pylori

BACKGROUND

Treatment for Helicobacter pylori reduces ulcer recurrence. Eradication rates of the organism vary with different drug regimens from 30% to 90%. There is a need to identify patients who have failed treatment. [14C]-Urea breath test (UBT) is non-invasive, sensitive, safe and highly reliable test for diagnosis of H. pylori infection. As there is a paucity of reports on the utility of [14C]-UBT in confirming H. pylori eradication, this study was undertaken.

METHODS

Thirty-eight patients (age 34 +/- 17 years, range 16-84 years, 27 men) with upper gastrointestinal symptoms underwent upper gastrointestinal endoscopy. Baseline H. pylori infection was diagnosed by identification of the organism on antral biopsies and positive rapid urease test (RUT). After 1 month of completion of treatment, repeat RUT and histological examination of antral endoscopic biopsies were performed. Eradication of H. pylori was defined as absence of the organism on histology, and negative RUT. The [14C]-UBT was performed using 185 kBq [14C]-urea dissolved in 300 mL water. Breath samples were collected once before ingestion of [14C]-urea, and subsequently at 5 and 15 min. Results were expressed as 14CO2/mmol CO2 exhaled as per cent of administered urea.

RESULTS

Endoscopy revealed antral gastritis (n = 14), duodenal ulcer (n = 8), duodenitis (n = 2), oesophagitis (n = 1), antral gastritis and duodenal ulcer (n = 3), antral gastritis and duodenitis (n = 7) and normal upper gastrointestinal endoscopy (n = 3). All the 20 patients who were negative for H. pylori on RUT and histology, tested negative for H. pylori on [14C]-UBT. However, of 18 patients shown to have H. pylori infection on RUT and histology, 16 were positive for H. pylori on [14C]-UBT. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of [14C]-UBT were 100, 89, 91, 100 and 95% respectively.

CONCLUSIONS

The [14C]-UBT is a reliable indicator of H. pylori eradication after treatment. It can obviate the need for antral biopsies to confirm eradication of H. pylori after completion of treatment.

Watermelon stomach: a rare cause of upper gastrointestinal bleeding

Watermelon stomach is a rare cause of upper gastrointestinal bleeding. We report a middle-aged woman who had been having recurrent bleeding from watermelon stomach. She was treated surgically by gastrectomy and Billroth II anastomosis.

Clinical and laboratory study of kala-azar in children in Nepal

Reports are scanty regarding kala-azar in children in Nepal. In this communication we document 20 children diagnosed to have kala-azar who were admitted and treated at B. P. Koirala Institute of Health Sciences, Dharan, Nepal. The children were between 2 and 14 years old. The duration of illness varied between 12 days and 24 months with a majority (65 per cent) of children being ill for less than 6 months. Hepatomegaly and splenomegaly were seen in 95 and 90 per cent of cases respectively. Splenomegaly was not found in two (10 per cent) children. Anaemia, leucopenia, and thrombocytopenia were seen in 95, 60, and 75 per cent of children respectively. Amastigotes of Leishmania donovani (LD bodies) were demonstrated in Giemsa-stained smears of bone marrow aspirates in 16 (80 per cent) children. All the children responded to treatment with sodium stibogluconate. No mortality was observed. This study emphasizes the importance of kala-azar in children in endemic areas of eastern Nepal.

Endoscopic management of bleeding ectopic varices with histoacryl

Bleeding from antral and duodenal varices is an uncommon feature in patients with portal hypertension. We report a patient with cirrhosis and portal vein thrombosis, who had a massive bleed from antral and duodenal varices. Bleeding was controlled with endoscopic injection of varices using histoacryl. Endoscopic treatment and the relatively uncommon occurrence of antral and duodenal varices are highlighted.

Impact of ranitidine on prognosis after simple closure of perforated duodenal ulcer

AIM

This randomized controlled study was carried out to evaluate the role of H2 receptor antagonists after simple closure of perforated duodenal ulcer.

METHODS

A total of 192 patients who underwent simple closure for perforated duodenal ulcer were divided into two groups (A: study group and B: control group). Group A patients were treated with H2 receptor antagonists, while the patients in group B received placebo. Only 174 patients were available for endoscopic follow up.

RESULTS

At the end of 24 weeks, only 6 patients out of 90 (6.6%) in group A as compared to 18 patients out of 84 (21.4%) in group B had persistent symptoms of ulcer disease as well as endoscopically proven ulcer (p < 0.05).

CONCLUSIONS

The results indicate that H2 receptor antagonists have a definite role and endoscopic follow up is mandatory to define those cases who actually need definitive surgery.

Liver span and weight in health and disease

BACKGROUND

The liver mass, made up of independent functional units called acini, correlates with liver functions. Hepatic morphological changes causing alteration in its size and volume occur in various hepatic disorders.

METHODS

Antemortem clinical liver span and postmortem liver weight was studied in 23 critically ill patients. Out of these, 8 had fulminant hepatic failure, 7 had chronic liver disease with encephalopathy and 8 had other serious illnesses (chronic renal failure 3; ischaemic heart disease 3; cerebrovascular accidents 2). We also studied postmortem liver span and liver weight in 173 healthy individuals dying of accident/terrorist attacks.

RESULTS

Antemortem liver span in 23 critically ill patients was 9.9 +/- 4.7 cm (mean +/- S.D.) and postmortem liver weight was 1536.9 +/- 704.7 g (mean +/- S.D.). Antemortem liver span correlated well with the postmortem liver weight (r = 0.9635). Postmortem liver span in 173 healthy individuals was 16.3 +/- 2.7 cm (mean +/- S.D.) and liver weight was 1301.5 +/- 358.8 g (mean +/- S.D.). There was very good correlation between the postmortem liver span and liver weight (r = 0.516), height (r = 0.410) and body weight (r = 0.340) in these individuals.

CONCLUSION

Liver span fortells the liver weight, hence, the functional liver mass in diseased and healthy individuals.

Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures

BACKGROUND

Intralesional corticosteroid injection has been shown to be effective in refractory esophageal strictures of various etiologies. The present study was conducted to determine the efficacy of intralesional triamcinolone in augmenting results of endoscopic dilation in corrosive esophageal strictures.

METHODS

Seventeen patients with corrosive esophageal strictures were treated with endoscopic dilation together with injection of triamcinolone acetonide into the stricture. Fourteen patients were already undergoing dilation; 3 patients were newly recruited. The interval between dilations and frequency of dilation were calculated before and after corticosteroid injections, and periodic dilation index was calculated as number of dilations/number of months.

RESULTS

The mean age of the 17 patients (8 men and 9 women) was 30+/-9.21 (range 13 to 52). Thirteen had strictures due to acid ingestion, four to alkali ingestion. There were 18 strictures in total, involving the upper (n = 2), middle (n = 10), and lower (n = 6) thirds of esophagus. Fourteen patients already on a dilation program had undergone 27.92+/-28.63 (range 6 to 92) dilations over a period of 22.92+/-30.73 months (range 2 to 96) before corticosteroid injections. Nine patients received a single injection of triamcinolone, whereas four each had two and three sessions. The dilation requirement after injections in these 14 patients was reduced to 3.57+/-2.90 (range 0 to 10) dilations over a period of 10.5+/-5.58 (range 4 to 21) months. The median total periodic dilation index irrespective of corticosteroid therapy was 0.33 (range 0.55 to 1.8). In 12 of the 14 patients, periodic dilation index before injections (range 0.91 to 3.0, median 1.67) was higher than the median total periodic dilation index and in all the 14 patients periodic dilation index after corticosteroid therapy (range 0 to 0.83, median 0.32) was less than the median of total periodic dilation index (p < 0.01). In addition three patients received intralesional corticosteroid injections at the time of first dilation. These three patients could be effectively dilated with 5, 3, and 3 dilations.

CONCLUSIONS

Intralesional triamcinolone injections augment the effects of endoscopic dilation in patients with corrosive esophageal strictures.

Previous cesarean section and abortion as risk factors for developing placenta previa

OBJECTIVE

To determine the risk of subsequent occurrence of placenta previa in women with a history of previous cesarean sections and/or spontaneous and induced abortions.

METHODS

A retrospective analysis of all single gestation deliveries at National University Hospital of Singapore from 1993-1997 was done. Women with placenta previa were identified by clinical or ultrasonographic diagnosis.

RESULTS

Of the 16,169 singleton deliveries, 164 women (1.0%) had placenta previa. Women with placenta previa had a significantly higher incidence of previous cesarean sections (p < 0.001). Among the 164 women with placenta previa, women with 1, 2, and 3 previous cesarean sections had 2.2 (95% CI 1.4, 3.4), 4.1 (95% CI 1.9, 8.8) and 22.4 (95% CI 6.4, 78.3) times increased risk of developing placenta previa respectively. Similarly, women with 2 or more previous abortions had a 2.1 (95% CI 1.2, 3.5) times increased risk of subsequently developing placenta previa.

CONCLUSION

There is a strong association between previous cesarean section and risk of subsequent development of placenta previa. This risk increased with the number of previous cesarean sections. Increasing frequency of abortions was also found to predispose a woman to placenta previa.

Helicobacter pylori in gastric cancer in India

BACKGROUND/AIMS

Helicobacter pylori infection has been implicated in pathogenesis of gastric cancer. Since there is paucity of reports from developing countries on association of H. pylori with gastric cancer, we performed case control study to find out the relationship between H. pylori and gastric cancer and also compared characteristics of gastric cancer and H. pylori positivity in younger and older patients.

PATIENTS AND METHODS

Gastrectomy (n = 37) or endoscopic biopsy (n = 43) samples from area adjoining the cancer were collected from 80 patients of gastric cancer. Tissue specimens were stained with hematoxylin-eosin and Giemsa stains and histological type of cancer was determined according to Lauren, as intestinal or diffuse type. The presence of H. pylori was assessed by Giemsa staining. Eighty age and sex matched patients with non-ulcer dyspepsia (NUD) served as controls.

RESULTS

Of 80 patients, 48 had intestinal type, 28 diffuse type and 4 had mixed type of gastric cancer. Tumour was located in antrum in 37, in body in 31, and at other sites in 12 cases. H. pyolri infection was present in 29 of patients compared to 36 patients with non-ulcer dyspepsia (p > 0.05, odd ratio 0.69, confidence interval 0.37-1.32). The positivity for H. pylori was higher in intestinal type than in diffuse type (p < 0.05) of gastric cancer but similar in patients with growth in antrum and body (p = NS) of stomach. There was no significant difference in tumor type, tumor site, frequency of intestinal metaplasia and H. pylori positivity (39% vs 35%, P > 0.05, odd ratio 1.19, confidence interval 0.44-3.23) in younger (< 45 yrs) and older (> 45 yrs) patients.

CONCLUSIONS

Approximately one-third of patients with gastric cancer show presence of H. pylori infection on histological examination. No difference in H. pylori positivity were observed in young and old patients of gastric cancer.

Balloon dilatation in achalasia cardia

Treatment of achalasia cardia by pneumatic dilatation is an established method. However, data on results of pneumatic dilatation in Indian patients with achalasia cardia are scarce. We report our experience with treatment of achalasia cardia by pneumatic dilatation in 38 patients. The diagnosis of achalasia cardia was based on clinical examination, barium swallow and upper gastrointestinal (GI) endoscopy. Twenty nine (76.3%) patients improved with first dilatation, 8 (21%) patients had to undergo second dilatation and 1 (2.6%) required a third. Most of the patients remained asymptomatic during a follow-up of 6 months to 6 years. Immediate and late complications occurred in 5 (13%) and 2 (5.2%) patients, respectively. Thus, pneumatic dilatation is a simple, safe and effective method for treating Indian patients with achalasia cardia.