Natural history of precancerous and early cancerous lesions of the uterine cervix

A prospective study of cervical dysplasia cases and control cases matched for age and parity was undertaken in search of factors related to cervical carcinogenesis. Cytologic examination of 66,736 women revealed negative findings in 28.5%, inflammation in 70.3%, dysplasia in 1.4% and carcinoma in 0.1% of the cases. Data on epidemiologic features, cytomorphologic characteristics and serologic findings of antibodies to herpes simplex virus (HSV) were collected for proven cancer patients, dysplasia cases and control subjects. Cancer patients revealed significantly elevated antibodies to HSV as compared to the controls. The analysis revealed a higher proportion of dysplasia cases with an age at consummation of marriage of less than or equal to 15 years as compared to controls, with a relative risk of 1.5 (P less than .05). Similarly, a higher proportion of women with dysplasia had HSV-II-specific antibodies as compared to control women. The relative risk was found to be 1.3, which was not statistically significant (P greater than .05). The Mantel-Haenszel summary relative risk between antibodies to HSV and the two groups (dysplasia cases and controls), adjusted for the age at consummation of marriage, worked out to be 1.38, which was also statistically not significant (P greater than .05). The overall progression rate of dysplasia to malignancy was found to be 11.7% at the end of 54 months (during a total follow-up period of 84 months). Progression to cancer was highest in severe dysplasia cases and less in mild dysplasia cases. The progression rates were also significantly higher in the group of women who revealed antibodies to HSV II. Similar differences in the progression rates were observed with regard to the age at consummation of marriage.

Acute isoniazid toxicity--report of 2 cases and review of literature

Accidental or intentional isoniazid (INH) overdose is not uncommon. Two patients suffering from pulmonary tuberculosis ingested INH (9 g and 12 g respectively) intentionally following acute personal stress. One patient presented with oliguria and coma whereas seizures were the dominant feature in the second case. Serum levels of INH were high in both cases. Satisfactory clinical recovery followed after the administration of intravenous pyridoxine. Literature on the subject was reviewed and the manifestations and recommendations for the management of acute INH toxicity are highlighted.

Drug utilization studies in internal medicine

An appraisal of the prescribing trends in the outpatients and inpatients, was done in the Department of Internal Medicine of Nehru Hospital attached to the Postgraduate Institute of Medical Education & Research, Chandigarh. Prescriptions of 162 outpatients and 78 inpatients were audited under heads of total number of drugs prescribed, proprietary/nonproprietary drug prescribing; choice of drug, its dosage, dosage form, interdosage interval and duration of prescription. Good standards of scientific therapeutics were found in general. Some lacunae are discussed.

Double-blind, randomized, cross-over clinical trial of metoprolol and propranolol in mild to moderate essential hypertension

Thirty-two patients with mild to moderate essential hypertension completed this double-blind cross-over clinical trial of propranolol and metoprolol. Metoprolol was found to be as effective and safe as propranolol in lowering the systolic and diastolic blood pressure in both supine and standing positions. The mean fall in blood pressure was greater in the group which received metoprolol as the first treatment, as compared to the group which received propranolol as the first treatment. The side-effects produced by both drugs were mild and did not require discontinuation of therapy except for 2 patients who were on metoprolol. One patient who was controlled diabetic developed severe weakness and the other patient developed bronchospasm. Metoprolol did not produce any central nervous system related side-effects.

Comparative bioequivalence study of furosemide in patients with edema of renal origin

A double-blind cross-over randomized clinical study with two different brands of furosemide was carried out in seven patients with edema of renal origin. The study indicated that the two brands were biologically equivalent.

Intrarenal gas abscess

Intrarenal abscess owing to gas-forming gram-negative bacteria is rare. Female patients and diabetics, or those with urinary calculi or obstructive uropathic conditions commonly are affected. We report on a nondiabetic man who was infected with Pseudomonas aeruginosa. Initial medical management and subsequent partial nephrectomy offered cure.

Extramedullary haemopoiesis in the small bowel

A patient with myelofibrosis developed repeated gastrointestinal haemorrhage from the small intestine, which was found to be infiltrated with extramedullary haemopoiesis. Nineteen months later he presented with subacute intestinal obstruction; radiology and laparotomy documented progressive infiltration of the small bowel. Histological examination of the resected terminal ileum showed patchy mucosal ulceration, with underlying submucosal and serosal extramedullary haemopoiesis.

Low-dose captopril alone and in combination with hydrochlorothiazide in the treatment of mild to moderate essential hypertension

In this open, titrated dose clinical trial, captopril, when used in small doses (up to 150 mg daily) for 8 weeks (n = 5) and 4 months (n = 13) in patients suffering from mild to moderate essential hypertension, produced a fall in blood pressure both systolic and diastolic. The end point viz. supine diastolic blood pressure of 90 mmHg or less was reached in 6 out of 18 patients with captopril alone and in another 4 patients after the addition of hydrochlorothiazide (25 mg to 50 mg daily). In 4 more patients, a good response was observed but the end point was not reached. The response was fair in 1 and poor in 3 remaining patients. The side effects produced were only mild in nature and did not require any change in dosage schedule. No significant changes were produced in serum electrolytes, creatinine and blood counts.

Comparative effect of propranolol and labetalol on isometric exercise and cold stress induced increase in arterial blood pressure

The effect of propranolol and labetalol on cold stress and isometric exercise induced rise of blood pressure was studied in 7 patients with essential hypertension and 14 normal volunteers in a controlled, double blind, randomized, cross-over trial design. The subjects received either propranolol (40 mg) or labetalol (100 mg) orally after breakfast. In patients of mild to moderate essential hypertension, labetalol reduced significantly both systolic as well as diastolic rise of blood pressure induced by both types of exercises. Propranolol only reduced the rise of systolic blood pressure significantly. In normotensive subjects, labetalol reduced significantly the rise in systolic as well as diastolic blood pressure induced by cold stress, but not by the isometric exercise, while propranolol only reduced significantly the rise in systolic blood pressure induced by both the tests. The rise in heart rate was more with isometric exercise than with cold stress both in hypertensive patients and control subjects. The heart rate rise was significantly reduced by propranolol in all the experiments except for the rise induced by cold stress in hypertensive patients. The changes in heart rate produced by labetalol were not significant.

Experimental haematogenous pyelonephritis in mice with uropathogenic, enteropathogenic and enterotoxigenic Escherichia coli

Acute haematogenous pyelonephritis was produced with known uropathogenic (075), enteropathogenic (0111) and enterotoxigenic (H10407) Escherichia coli in mice. The enterotoxigenic E. coli showed the highest bacterial counts in kidney and urine and was found to have the same potential for causing pyelonephritis as a known pyelonephritogenic strain both in untreated and corticosteroid treated mice. Enteropathogenic E. coli was found to be less pyelonephritogenic in untreated mice, but under the effect of corticosteroids it showed similar pyelonephritogenic potential.

Twenty-four hour intragastric acidity during treatment with oral omeprazole

In a series of 59 experiments on nine duodenal ulcer patients, 24-hour intragastric acidity was measured before, during and after treatment with daily oral omeprazole. Omeprazole, 10, 20, ro 30 mg/day for 1 week, caused a 37%, 90%, and 97% decrease respectively of 24-hour intragastric acidity. No further decrease of acidity was observed when the dose of omeprazole was doubled to 60 mg/day, or after a second week of treatment with 30 mg/day. One week after stopping treatment with omeprazole (14 doses), there was still a significant 26% decrease of 24-hour intragastric acidity, with full recovery 7 weeks later. Fasting plasma gastrin concentration was significantly elevated during treatment with all doses of omeprazole. The optimal dose of omeprazole is 30 mg/day for a maximal decrease of 24-hour intragastric acidity in duodenal ulcer patients.

Double-blind cross-over clinical trial of acebutolol and propranolol in mild to moderate essential hypertension

Twenty patients with mild to moderate essential hypertension completed this double-blind cross-over randomized clinical trial of propranolol and acebutolol. Acebutolol was found to be as effective and safe as propranolol in lowering the systolic and diastolic blood pressure both in supine as well as in standing positions. However, the difference between the two drugs was not statistically significant. No significant change was produced in serum electrolytes, uric acid, fasting blood sugar with either drug. The accepted dose ratio of 1:2.5 propranolol and acebutolol, respectively, was found to be true only in 50% of the patients. Therefore, for optimal effect, the dose of acebutolol should be individualized depending upon the response.

Double blind cross-over clinical trial of acebutolol and propranolol in angina pectoris

Twenty-four patients with classical angina of effort completed this double-blind cross-over clinical trial of acebutolol and propranolol. Both acebutolol (100-400 mg) and propranolol (40-160 mg) three times a day produced a significant reduction in the incidence of anginal attacks, consumption of nitroglycerine tablets and increased exercise tolerance. Both drugs produced mild and tolerable side effects which did not require any reduction of doses of the drugs being used. No change in laboratory parameters assessing the function of the liver, the kidneys and the hemopoietic system was found. The commonly accepted dose ratio of 1:2.5 propranolol and acebutolol, respectively, was found to be true in less than 50% of the patients. Therefore, for optimal effect, the dose of acebutolol should be individualized depending upon the response.

Spectrum of renovascular hypertension in the young in north India: a hospital based study on occurrence and clinical features

Occurrence of renovascular hypertension and its etiology is described in this work as seen in north India. Out of 2395 young hypertensives admitted for evaluation during the years 1978-1983, 91 patients (3.8%) were found to be having renovascular hypertension. In all patients suspected diagnosis of RVH was confirmed by the angiography of aorta and main vessels. Idiopathic aortoarteritis, diagnosed in 54 patients (59.4%) was the commonest cause of renovascular hypertension. In this group renal arterial involvement was found to be bilateral in 26 patients. Twenty-eight patients had isolated renal artery stenosis of unknown etiology. Six had fibromuscular dysplasia, 2 had polyarteritis and one had renal artery aneurysm. Twenty-three patients underwent surgery which included autotransplantation, arterial by-pass and nephrectomy with improved blood pressure control in 15. It is concluded that aortoarteritis seems to be the major cause of renovascular hypertension in the young in this part of the world.

A double-blind crossover clinical trial of labetalol and propranolol in patients of essential hypertension

The efficacy and safety of labetalol was compared in a double-blind crossover design with propranolol in 27 patients suffering from essential hypertension with a supine diastolic blood pressure of more than 100 mm Hg. Twelve patients completed the trial. Both the drugs significantly reduced the blood pressure as compared to pretreatment values and the end-point, i.e. a supine diastolic blood pressure of 90 mm Hg or less, was achieved at the end of each treatment. However, the control of blood pressure appeared to be better sustained with labetalol. The side-effects, though minor in nature, were relatively more often observed with propranolol.

Fixed ratio combination of propranolol and bendrofluazide in the treatment of hypertension

The combination of beta adrenoceptor blocker, i.e. propranolol (80 mg) and a diuretic, i.e. bendrofluazide (2.5 mg) in a single capsule (Inderetic) produced an effective control of blood pressure in 12 out of 13 patients with mild and moderately severe hypertension in this single-blind study. Treatment for 12 weeks did not produce any changes in biochemical parameters and no change in ECG, except that a significant decrease in heart rate was observed. No serious side-effects were observed.

Septilin and geriforte in allergic and vasomotor rhinitis

Our study comprised 50 patients of allergic and vasomotor rhinitis. Seventeen patients gave history of stress and strain hence they were given Geriforte in addition to Septilin. The results of therapy were judged on following criteria: i) Symptomatic improvement. ii) Appearance of nasal mucosa before and after the therapy. Thirty-nine patients (78%) were cured 100% as they had total relief from symptoms along with change of nasal mucosa from bluish to pink. Eight patients (16%) had about 75% improvement and 3 patients (6%) had only 50% improvement. These patients were advised to continue the therapy for a longer time (6-8 weeks). Of these, 4 patients showed further improvement. In our opinion, Septilin has proved very useful in cases of allergic and vasomotor rhinitis. The patients who have history of stress and strain may also need Geriforte in addition to Septilin.

Disseminated infection associated with corticosteroid therapy after transduodenal sphincteroplasty

Treatment with oral prednisolone appears to have precipitated an episode of ascending cholangitis in an asymptomatic 55-year-old patient. He had undergone a Pólya partial gastrectomy, a cholecystectomy and a sphincteroplasty 19, 6 and 2 years earlier, respectively. The cholangitis was complicated by septicaemia with six different enteric organisms including aerobes and anaerobes. He developed liver and lung abscesses, and an indolent Pseudomonas aeruginosa septic arthritis of both hip joints. The patient eventually made a complete recovery, but required surgical replacement of both hips.

Intragastric bacterial activity and nitrosation before, during, and after treatment with omeprazole

Ten healthy volunteers were studied before, during, and after treatment with omeprazole 30 mg daily for two weeks. On the 14th night mean nocturnal (2100-0700) intragastric acidity was significantly decreased by 75% (p less than 0.001). At 0700, 22 hours after the last dose of omeprazole, there were significant increases in the bacterial count and the nitrite and N-nitrosamine concentrations in the gastric juice (p less than 0.001). Three days later these changes had resolved. Short term treatment of healthy volunteers with omeprazole is associated with a short lived increase in the gastric bacterial flora, with endogenous production of N-nitroso compounds.

A comparative randomized double-blind clinical trial of bumetanide and furosemide in congestive cardiac failure and other edema states

The efficacy and safety of oral bumetanide, a pharmacologically new diuretic was compared with that of furosemide in 30 patients suffering from congestive cardiac failure and other edema states. In addition intravenous bumetanide was studied in 14 patients of congestive cardiac failure and nephrotic syndrome to determine the onset, peak and duration of action. In the controlled double-blind oral study bumetanide was equipotent with furosemide at one fortieth the molar dosage and did not differ from furosemide with regards to its pattern of water and electrolyte excretion. On continuous oral administration for seven days it produced sustained diuresis with minimal biochemical alterations. No hyperglycemia or hematological abnormalities were noted. Intravenous bumetanide had onset of action between 10 and 15 minutes with a peak at 50 minutes and a total duration of action of about 240 minutes. Bumetanide was well tolerated by patients and is on a weight basis the most potent diuretic available today.

Optimal dose of oral omeprazole for maximal 24 hour decrease of intragastric acidity

In a series of 59 experiments in nine duodenal ulcer patients, 24 hour intragastric acidity was measured before, during, and after treatment with daily oral omeprazole. Omeprazole 10, 20, and 30 mg/day for one week caused a 37, 90, and 97% decrease of 24 hour intragastric acidity, respectively. No further decrease of acidity was observed when the dose of omeprazole was doubled to 60 mg/day, or after a second week of treatment with 30 mg/day. One week after stopping treatment with omeprazole (14 doses) there was a significant 26% decrease of 24 hour intragastric acidity, with full recovery seven weeks later. Fasting plasma gastrin concentration was significantly raised during treatment with all doses of omeprazole. Omeprazole 30 mg/day is the optimal dose for a maximal decrease of 24 hour intragastric acidity in duodenal ulcer patients.

Carcinoid tumour secreting dopa

A middle aged woman referred for an abdominal mass was found to have large amounts of dopa (3-4-dihydroxyphenylalanine) metabolites in her urine. At operation a tumour affecting almost the entire left lobe of the liver was removed. Histologically the tumour was a metastatic carcinoid. After operation the excretion of dopa metabolites fell substantially, confirming that the tumour was the source. Apparently, owing to an enzyme defect the tumour had been unable to decarboxylate dopa. These findings are further evidence of a neural origin for the endocrine system of the gut.

Dyspnea and dysphagia in a child due to an antrochoanal polyp

A 3-year-old girl with complaints of dyspnea and dysphagia due to a huge antrochoanal polyp is presented. On examination of the left nostril a huge polyp occupying whole of the nostril was seen with mucoid discharge. It was so huge that it was reaching the laryngopharynx and causing dyspnea and dysphagia (11 cm in length and 3 cm in diameter). The tracheostomy was avoided by performing an emergency polypectomy.

Leucocyte migration inhibition test in human Plasmodium vivax malaria

Specific antigen-induced T-lymphocyte response in human P. vivax malaria has been studied by a leucocyte migration inhibition test. The test was performed in four groups: (1) American/European controls; (2) Indians with acute P. vivax malaria; (3) immune Indians with no clinical attacks of malaria for 5 years; and (4) Indians with chronic infection. Group 3 showed significantly high inhibition as compared to group 1 (P less than 0.001) and group 2 (P less than 0.01). There was however no significant difference between the 'immune' and 'chronic' groups. Indirect haemagglutinating antibodies were also monitored in the test sera and there was an inverse correlation (r = -0.613; P less than 0.01) between IHA antibodies in serum and percentage leucocyte migration inhibition.

Renal lesions in leprosy amongst north Indian patients

Sixty consecutive patients with leprosy were investigated for renal involvement. Clinically overt renal disease was present in 4 patients; 3 presented with a nephrotic state and one patient with progressive renal failure. Urinalysis showed daily protein loss ranging from 0.4 to 8.9 g in 8 patients and microscopic haematuria in 4 cases. Elevated levels of blood urea and creatinine were seen only in one patient with diffuse proliferative glomerulonephritis. Of the 36 patients in whom distal tubular functions were evaluated, concentration and/or acidification defects were detected in 9 patients (25%). Renal histology revealed no abnormality in any of these patients. Serum C3 levels were decreased in 5 patients with lepromatous leprosy and 3 patients with borderline leprosy. Histological evidence of renal involvement was detected in 9 patients (15%). Amyloid deposits were seen in 3 (5%) patients of whom 2 had lepromatous leprosy and one had tuberculoid leprosy with chronic trophic ulcers. Mesangial proliferative lesions were seen in 5 (8.3%) and diffuse proliferative lesions (with crescents in more than 70% of glomeruli) in one patient. All of them had lepromatous leprosy. Three of the 5 patients with mesangial proliferative glomerulonephritis had erythema nodosum leprosum at the time of biopsy. Immunofluorescence studies revealed granular deposits of IgA, IgM and C3 in one patient with mesangial proliferation and IgA/IgM with or without C3 in 3 more patients in whom renal histology was normal. Glomerulonephritis associated with leprosy appears to be immune mediated but confirmation requires identification of lepra antigen in the glomerular immune complex deposits.