Rifampicin-induced upper gastrointestinal bleeding

Gastrointestinal disturbances like anorexia, nausea, vomiting, abdominal discomfort and diarrhoea are known adverse effects of rifampicin. We report an upper gastrointestinal bleeding due to haemorrhagic gastric erosions after ingestion of rifampicin for pulmonary tuberculosis. The cause and effect relationship between development of haemorrhagic gastric erosions and rifampicin administration was confirmed by rechallenge with rifampicin. To our knowledge no such adverse effect of rifampicin has been reported previously.

Candidiasis complicating sclerotherapy-induced esophageal ulcer presenting as recurrent hematemesis

A ten year old child with extrahepatic portal venous obstruction had recurrent upper gastrointestinal bleeding after endoscopic variceal sclerotherapy. Sclerotherapy-induced esophageal ulcer complicated by candidiasis was found to be the source of bleeding. This as yet unrecognised complication of sclerotherapy requires prompt diagnosis and early antifungal therapy.

Serum growth hormone, insulin and blood sugar responses to oral glucose in protein energy malnutrition

Blood sugar (BS), serum immunoreactive insulin (IRI) and growth hormone (GH) were measured in 5 normal children and 15 with varying grades of protein energy malnutrition (PEM) during a standard oral glucose tolerance test (OGTT). Impaired glucose tolerance was noted in grade III and IV PEM but not in grade II. Serum insulin responses were low but appropriate to blood glucose in grade II and grade III PEM and were lower (p less than 0.001) in Grade IV PEM subjects. Higher basal GH was observed in most cases of grade III and IV PEM (p less than 0.001) and the elevated GH was not suppressed following the oral glucose load. Further, a paradoxical rise in GH during OGTT was seen in 3 of the 5 subjects with grade-IV PEM.

Cryptosporidium causing chronic diarrhea

The authors report a case of a child with chronic diarrhea due to Cryptosporidium. The child had also hemolytic uraemic syndrome. Cryptosporidium oocysts were identified by the modified Ziehl-Neelsen technique.

Jejunal interposition hepaticoduodenostomy for choledochal cyst

Four cases of choledochal cyst with interesting modes of presentation were managed by excision of the cyst and biliary drainage by a new physiological and antireflux technique of jejunal loop interposition hepaticoduodenostomy. The advantages of this new technique over earlier practiced procedures are discussed.