Retroperitoneal laparoscopic nephrectomy: initial case report

Pre-transplant nephrectomy was done in a 25-year-old man for calculous pyelonephritis using a retroperitoneal laparoscopic approach with a newly devised ligature applicator-dissector- kidney retractor.

Diagnostic significance of T I < T III and TV1 > TV6 signs in ischaemic heart disease

One hundred seventy patients with ischaemic heart disease (IHD) and 141 healthy controls were evaluated to assess the diagnostic significance of T I < T III and TV1 > TV6 as compared to widening of QRS-T angle. Number of cases with abnormal widening of QRS-T angle was significantly higher (P < .001) in frontal and horizontal planes in the IHD group. T I < T III sign has 61.2% sensitivity, 74.5% specificity and 25.5% false positivity in diagnosis of IHD. Along with abnormal QRS-T angle widening it gave a specificity of 95.5% but a false positivity of 35% and a low sensitivity index (35.3%). TV1 > TV6 sign has sensitivity, specificity and false positivity of 72.9% 84.4% and 15.6% respectively. Combining it with abnormally wide QRS-T angle did not materially improve these indices. Combining T I < T III and TV1 > TV6 signs gives a sensitivity of 49.4%, specificity of 95% and false positivity of 5% in IHD. This is a good diagnostic index and can be assessed at a quick glance without cumbersome estimation of QRS-T angle.

Benign non-traumatic inflammatory stricture of the common bile duct

A case of isolated benign non-traumatic inflammatory stricture of the mid portion of the common bile duct presenting with recurrent jaundice and cholangitis is reported. The histological features suggested that this was not due to sclerosing cholangitis.

Physical and sexual growth pattern of affluent Indian children from 5 to 18 years of age

The present study was conducted to study growth parameters on 12,899 boys and 9,951 girls of affluent class from 8 States of the country. In pooled data, the 50th centile height approached 30-40th centile till 6 1/2 years in boys and up to 10 years in girls, and ultimately the height growth curves for both fell between the 10-20th centile of NCHS standards. Similarly, for weight, they approached 10-20th centile of NCHS at the age of 17 yr. Comparison with other European countries showed that Indian affluents are shorter and lighter; however, they are similar to their counterparts of Asian origin. The secular trend for height in Delhi showed increase of 2.1 cm for boys, and 2.7 cm for girls per decade at 17 yr and 14 yr, respectively. In Varanasi, the corresponding trend was 1.5 and 2.1 cm at 16 yr for boys and girls, respectively. The mean ages for genital development stages G 2-5 were 11.9, 13.3, 14.6 and 15.9 yr; respectively. In girls, the breast development Stages B 2-5 had mean ages of 10.9, 12.8, 13.9 and 14.8 yr, respectively. The mean age for menarche was 12.6 yr. In 14 yr old boys, the mean height may vary between 150.3, 155.8, 161.2 and 165.2 cm and mean weight between 38.0, 42.5, 46.8 and 52.9 kg for genital stages G 2-5, respectively. Similarly, girls of 12.5 yr (close to menarcheal age of 12.6 yr) had mean height 145.3, 150.3, 152.1 and 153.8 cm and mean weight 34.7, 41.2, 45.4 and 54.4 kg for breast stages B 2-5, respectively. It is recommended that for growth assessment during adolescence these charts in relation to sexual development and age be used for comparison.

Multiple venous thromboses and membranous obstruction of inferior vena cava in association with hereditary protein C deficiency: a case report

A forty year old male presented with multiple dilated venous channels over the whole body involving both inferior and superior vena caval territories, along with features of chronic liver disease and portal hypertension. On investigation, he was found to have membranous obstruction of the inferior vena cava (MOIVC) as well as obstruction of both brachiocephalic and right subclavian veins and 'hereditary protein C deficiency'. He was managed successfully by percutaneous transluminal balloon angioplasty for the inferior vena cava (IVC) obstruction and was doing well on follow-up.

Inhalation toxicity of methylisocyanate: assessment of germ cell mutagenicity and reproductive effects in rats

Adult male Wistar rats were exposed to methylisocyanate (MIC, 3.2 mg/l, single inhalation exposure for 8 min under static condition) or ethyl methanesulphonate (EMS, 150 mg/kg, single ip dose) for the assessment of germ cell mutagenicity and reproductive effects. Sequential matings of treated males with normal females on days 1-7, 8-14 and 15-21 post-exposure did not indicate any induction of dominant lethal mutation (increased frequency of preimplantation losses and early fetal deaths) by MIC but it was significantly induced by EMS as compared to respective controls. Males, necropsied after 21 days of exposure, showed no effect of MIC on epididymal sperm density and morphology. EMS also had no effect on sperm density but it significantly induced morphological abnormalities in sperm as compared to untreated controls. There was an acute and transitional reduction in reproductive performance (10-21%) of MIC-exposed males during days 1-14 post-exposure followed by recovery to the normal level during days 15-21 post-exposure. The progeny of MIC-exposed males was also normal in terms of litter size, litter weight, neonatal survival and body weight gain in litters up to 10 days post-partem. It is concluded with the evidence at hand that the observed failure of MIC to cause germ cell mutagenicity is related to its poor biodistribution to the target site(s) and a transient reduction in the reproductive performance of MIC-exposed males is a result of general stress and disconsolate copulation.

Growth and behavior development in rural infants in relation to malnutrition and environment

A group of 224 children from a rural cohort of 625 children registered from 1981 to 1983 in 10 villages of KV Block, Varanasi was assessed for morbidity, physical growth, and behavior development (Gesell's developmental schedule). By first birthday children of normal nutrition grade were reduced to one fourth and numbers in Grade II and III malnutrition doubled. This deterioration in nutritional status was probably due to high morbidity, i.e., gastrointestinal, respiratory infections, etc. The skull circumference was 43 cm at the age of one year, being lower by 3 cm than the average size. Children having Grades II and III malnutrition showed poor development in all the areas of behavior, i.e., motor, adaptive, language and personal social. Besides malnutrition, environmental factors like mother's involvement in teaching, encouraging the child, talking to him or being within the visual range; the parental education, their caste and the child's birth order contributed significantly to the development of the child during infancy.

Growth, behavior, development and intelligence in rural children between 1-3 years of life

In a rural cohort of 625 children registered from 1981 to 1983 in 10 villages of K.V. Block, Varanasi, 196 children were assessed for physical growth, development, intelligence and concept development between 1 and 3 years of age. Home environment was also assessed using Caldwell Home inventory. These rural children remained below 3rd centile of NCHS standard for weight, height, skull and mid-arm circumferences throughout the study. Malnourished children scored poorly in all the areas of development, i.e., motor, adaptive, language and personal social, 9% in Grade I and 16.6% children in Grade II + III had IQ less than 79 (inferior). Concept for color shape and size was poorly developed in malnourished children. Maternal involvement and stimulation was strongly associated with better behavior development and intelligence. Multiple regression analysis showed that the effect of home environment on development and intelligence was of a higher magnitude as compared to status and family variables and nutritional status during 1-3 years of age.

Percutaneous catheter drainage of amoebic liver abscess

Fifteen patients with amoebic liver abscesses underwent percutaneous catheter drainage under ultrasonographic guidance. Thirteen patients had solitary abscesses (right lobe 12, left lobe 1), two had associated subdiaphragmatic collections, while two patients had multiple abscesses. The indications for the drainage included lack of response to medical therapy: imminent rupture in five cases; ruptured liver abscesses in three; enlarging abscesses after hospitalization in three; persistent symptoms in two; and large left lobe abscesses in two. The volume of the abscesses before drainage was 102-1008 ml (mean 432 ml). Pigtail catheters (8 F) were used in nine of the patients and 12 F sump catheters in six. When multiple abscesses and associated subdiaphragmatic collection were present, each was drained separately. The catheters were removed (mean 7 days, range 3-20 days) when patients became apyrexial, catheter drainage was less than 10 ml in 24 h and cavitogram showed a negligible cavity (mean residual volume 5.5 ml, range 3-15 ml). Complications included minor blood loss through the catheter for 12 h in one patient and reappearance of the abscess in another requiring further drainage. Our experience suggests that catheter drainage of amoebic liver abscesses in selected cases is safe and effective, and results in prompt and early resolution of the abscess cavity with restoration of normal parenchyma.

In vitro anti-oxidant property of protein-A of Staphylococcus aureus

Protein-A (PA) is a cell-surface glycoprotein of S. aureus Cowan I with immunomodulatory and anti-tumor activities, and ability to ameliorate cyclophosphamide and carbontetrachloride (CCl4) induced toxicity in rodents. The likely mechanism of this effect appears to be the anti-oxidant property of PA, evidenced in the present study by inhibition of CCl4 and Fe2-ascorbate induced lipid peroxidation in rat liver homogenates and inhibition of deaminative-oxidative degradation of L-glutamate into 2-thiobarbituric acid reactive products in a constituted chemical system. The anti-oxidant property of PA seem to arise from its molecular characteristics and the ability to interact with a superoxide derived free-radical species without any affinity for superoxide anion, hydroxyl radical and singlet oxygen species.

Inhalation toxicity of furfural vapours: an assessment of biochemical response in rat lungs

The pulmonary biochemical response, particularly the effects on mixed-function oxidases, was investigated in rats exposed to 40 ppm furfural for 1 h daily, 5 days per week, for periods of 7, 15 and 30 days. This concentration is ca. 22% of the acute LC50 dose. Exposure to furfural increased the activities of acid and alkaline phosphatases and glutamic-pyruvic transaminase, inhibited the activities of arginase and succinic dehydrogenases and elevated the concentration of lactic acid in the lungs. In the group of mixed-function oxidases, the activities of aminopyrene-N-demethylase and aniline hydroxylase (phase I, cytochrome P-450b specific) significantly increased and the activity of Benzo[a]pyrene hydroxylase (phase I, cytochrome P-450c specific) decreased. The activity of glutathione-S-transferase (phase II component) also was increased concurrently with a decrease in the concentration of glutathione. The magnitude of biochemical alterations in most cases was related directly to the duration of exposure. Our observations indicate that furfural caused pulmonary irritation, parenchymal injury and the regenerative proliferation of type II pneumocytes. Selective (cellular and/or cytochrome P-450 isozyme specific) enhancement of pulmonary mixed-function oxidases by furfural appears to stimulate its own pulmonary biotransformation, and the excretion of oxidative metabolites was facilitated by their enzymatic conjugation with glutathione.

Impact of anaemia prophylaxis in pregnancy on maternal haemoglobin, serum ferritin & birth weight

A total of 418 pregnant women at 16-24 wk of gestation, from six subcentres of a rural block of Varanasi district were selected. Pregnant women (137 of 215) from 3 subcentres received the supplementation of 60 mg elemental iron as ferrous sulphate combined with 500 micrograms folic acid, daily for 100 days (study group) and 123 (of 203) pregnant women from the other 3 subcentres without supplementation (control group) could be evaluated for their pregnancy outcome. The haemoglobin and serum ferritin levels increased significantly in the study group. In the latter, the mean birth weight was 2.88 +/- 0.41 kg with low birth weight incidence of 20.4 per cent as compared to the control figures of 2.59 +/- 0.34 kg and 37.9 per cent respectively. The incidence of low birth weight was further reduced to 12.1 per cent if the supplementation could be started by 16-19 wk of gestation.

Pathobiochemical response of tracheobronchial lymph nodes following intratracheal instillation of polyvinylchloride dust in rats

PVC dust, following a single intratracheal instillation (25 mg/rat), was substantially cleared through the lymphatic circulation and progressively accumulated in the tracheobronchial lymph nodes (TBLN) in a time-dependent manner for up to 1 year. The tissue response in TBLN during 60-270 days post-instillation of PVC dust was characterized by progressive increase in total organ fresh weight, dry weight, DNA, RNA and protein contents, concurrent with the proliferation of macrophages and hyperplasia of reticular cells. Active phagocytosis and enhanced hydrolytic activity in TBLN was evident around 270 days post-instillation by the appearance of PVC-laden macrophages near and within the dust foci, and increased activity of acid phosphatase, DNAse, RNAse and beta-glucuronidase. PVC dust caused degeneration of macrophages, and consequent release of hydrolytic enzymes resulted in limited cytotoxicity without inducing reticulination and fibrosis in the TBLN. The histology and clinical biochemistry of liver, kidney, spleen and serum were not altered and there were no detectable PVC particles in these tissues at up to 365 days. It is therefore concluded that lymphatic clearance of intratracheally instilled PVC dust results in its accumulation and mild foreign body reaction in TBLN which is non-fibrogenic at up to 365 days post-instillation.

Learning disability in rural primary school children

In rural primary school children observed for two years, 12.97 per cent of those having IQ greater than or equal to 90 were found to have poor achievement in arithmetic test and teacher's assessment. These learning disabled children had impaired perceptual maturity and conceptual grasp as observed on MISIC (Indian modification of WISC), Bender Gestalt test and Piaget's test. On WISC Bannatyne categories learning disabled children scored highest in verbal conceptualization (similarities, vocabulary, comprehension), followed by spatial (picture completion, object assembly, block design) and sequencing (arithmetic, digit span, coding) abilities. These children on Bender Gestalt test made more errors particularly distortions (distortion of parts, incorrect number of dots, shape of design lost etc). They also showed delayed development on Piagetian tasks class inclusion, conservation (for length, substance, liquid and number) ordinal relation and one to one correspondence. These observations indicate impaired perceptual maturity, conception and information processing deficit.

Extra corporeal shock wave lithotripsy of bile duct stones: absence of short term complications with the use of very high number of shock waves

Extracorporeal shock wave lithotripsy (ESWL), generated by the Siemens lithotripter (Lithostar), was used in six patients (two males, four females, aged 28 to 70 years) with large bile duct stones (diameter 16 mm to 30 mm; single in five, multiple in one) in whom routine endoscopic measures had failed. Disintegration of stones was achieved in four patients. The mean number of shocks delivered per patient, at energy levels generated by 19 kv, was 18,267 (range 4200-39,000) over 1 to 8 sessions, with a maximum of 6000 shocks per session. Exacerbation of cholangitis occurred in one patient after stone disintegration. Cutaneous petechiae were noted in four patients. Our report describes the use of a very high number of shock waves in the treatment of bile duct stones, with no appreciable short term complications noted in this small experience. Our initial experience of treating large bile duct stones with ESWL appears encouraging and safe.

Physical growth characteristics in rural adolescent girls of Varanasi

Four hundred and twenty one rural girls of Varanasi in the age group 8.5-14 years were followed up for assessment of their physical growth characteristics. The observed gain in height was 15.93 cm; in weight 9.80 kg and in sitting height 7.92 cm during the age interval of 10-14 years. In the same period the biacromial and the bicristal diameters showed a gain of 5.26 and 4.20 cm, respectively. The maximum increase in these parameters was observed after 13 years of age indicating the onset of the growth spurt. The chest and the mid-arm circumference increased by 14.70 and 3.02 cm, respectively during this period. There was no rapid increase in these parameters upto 14 years of age. The head circumference showed only a modest increase of 2.22 cm. It is concluded that the rural girls have a delayed and slower gain in physical growth characteristics than urban well-to-do girls.

Anaemia and mental functions in rural primary school children

Mental functions of 388 (6-8 years of age) rural primary school children matched for social and educational status were assessed in relation to anaemia and nutritional status. Malin's intelligence scale for Indian children and an arithmetic test were administered to assess intelligence, attention and concentration. No significant differences were found between the IQ scores of anaemic and non-anaemic groups, except for the subtest digit span. In contrast, there was an effect of nutritional status on IQ scores. Observations on the arithmetic test showed that anaemia is associated with lower levels of attention and concentration.

Influence of malnutrition on intellectual development

The relationship between malnutrition and intellectual performance was studied in 1336 rural primary school children (6-8 yr). Observations showed that the relative risk of having an IQ less than or equal to 89 in severe, moderate and mild malnutrition was 3.5, 2.7 and 1.4 times for boys and in girls it was 2.4, 1.7 and 1.4 times respectively. Mean full scale, verbal and performance IQ as well as the scores for various subtests decreased with the severity of malnutrition. However, though the decrease in IQ scores was significant, below average performance of malnourished children was observed only for performance IQ (87.6 +/- 9.13), and subtests information (87.9 +/- 10.5), digit span (79.6 +/- 11.9), picture completion (88.6 +/- 13.9), object assembly (81.1 +/- 18.1), and coding (80.5 +/- 14.4). Further, the stunted children had lower IQ scores as compared to those who were wasted. Multiple regression analysis showed that besides nutrition, socio-economic status had significant influence on verbal IQ; economic sufficiency on picture completion and block design, psychosocial and family environment on vocabulary and digit span subtests. However, the values of correlations obtained were too low to be used for prediction of scores. The overall observations demonstrate that even moderate degree of malnutrition influences the IQ scores and its effect is of a higher magnitude on immediate memory, visual perception, and visual motor integration as compared to verbal reasoning and comprehension.

Soft neurological signs and EEG pattern in rural malnourished children

The present study was carried out in 208, 8-10 yr old male, rural, primary school children of Kashi Vidyapith Block, Varanasi. These children were examined for anthropometry, soft neurological signs and electroencephalographic pattern. It was found that the presence of soft neurological signs was related to the severity of malnutrition. The relationship between nutritional status and motor tasks showed that the performance in successive finger tapping, toe tapping, heel toe tapping, hand patting and alternating hand pronation supination in both hands while finger tapping with the right, was significantly affected. The EEG pattern in 16 children with soft neurological signs showed abnormalities in the form of slow and sharp waves, particularly in the frontal lobe, but also in the parietal and temporal lobes. The motor deficits were more marked on the contralateral side of the EEG abnormality.