Zollinger Ellison syndrome

ZES is an uncommon disease with clinical manifestations akin to patients with peptic ulcer. Marked gastric acid hypersecretion can be checked but cause of death in the patients is usually metastasis. An early diagnosis and hence a possible surgical cure is very important and one must have high index of suspicion for diagnosis. As many as 50% of patients may have non diagnostic serum gastrin levels and hence need provocative tests to establish the diagnosis. Hypersecretion of acid should be controlled by antisecreting drugs followed by tumor localization with contrast CT, selective angiography and portal venous sampling for gastrin levels in doubtful cases. In MEN-I and metastatic patient, major surgery should be avoided. All pancreatic and extra pancreatic tumors should be resected if there is no metastasis.

Metabolic labeling of Entamoeba histolytica antigens: characterization of a 28-kDa major intracellular antigen

The in vivo incorporation of radiolabeled amino acids into antigens of Entamoeba histolytica, HM-1:IMSS, is reported. Immunoprecipitation with sera from patients with invasive amebiasis revealed a 28-kDa antigen present in whole cell lysates of E. histolytica. This antigen was of cytoplasmic origin, as indicated by cell fractionation and Triton X-114 detergent-phase separation. Immunoprecipitation, using sera from patients with invasive amebiasis and symptomless cyst passers, revealed the 28-kDa antigen as the major antigen recognized by the sera tested. Immunoprecipitation analysis using radiolabeled-released proteins instead of whole cell lysates showed a number of bands, including the 28-kDa antigen. The data suggest that the 28-kDa antigen is of cytoplasmic origin or is released from the cytoplasmic compartment.

Paroxysmal nocturnal hemoglobinuria with hepatic vein thrombosis presenting as hepatic encephalopathy

We present a patient with paroxysmal nocturnal hemoglobinuria with diffuse hepatic central vein thrombosis who presented with encephalopathy and recovered from the hepatic manifestations with antihepatic coma measures alone.

Etiology of liver abscess with special reference to anaerobic bacteria

Specimens of pus from 78 patients with liver abscesses were cultured using anaerobic culture techniques in an attempt to ascertain the etiologic role of anaerobes. Bacteria were isolated from 28 of the 78 specimens, 9 with anaerobes and or microaerophilic streptococci. Two pus specimens yielded mixed growth. Fourteen liver abscess pus specimens were subjected to direct gas liquid chromatography for detection of volatile and nonvolatile fatty acids (VFA/NVFA). Two of the 3 specimens positive for multiple VFA were bacteriologically sterile--an indirect evidence of the presence of anaerobic bacteria at the site of infection bringing the number of patients with anaerobic infection to 11 (14.1%).

Needle aspiration of amoebic liver abscess

OBJECTIVE

To determine the value of needle aspiration in uncomplicated amoebic liver abscess.

DESIGN

Randomised case-control study with a minimum follow up of one year, comparing patients treated with drugs alone with those treated with additional needle aspiration.

SETTING

Referral based gastroenterology clinic.

PATIENTS

39 Consecutive patients with amoebic liver abscess in the right lobe, of whom 37 completed the study.

INTERVENTION

Metronidazole 2.4 g/day was given to all patients for 10 days. Needle aspiration of the abscess was performed in 19 patients on the day of admission to hospital.

MAIN OUTCOME MEASURES

Abdominal pain, fever, anorexia, and hepatomegaly were measured. Erythrocyte sedimentation rate, serum aspartate, and alanine aminotransferase activities, and alkaline phosphatase activity were also measured.

RESULTS

Clinical improvement was similar in both groups of patients. Improvement in haematological and biochemical variables and rates of healing of cavities were also similar.

CONCLUSIONS

Chemotherapy with potent tissue amoebicidal drugs such as metronidazole is optimally effective in treating amoebic liver abscess, and in uncomplicated cases routine aspiration is not required.

Serum alpha-feto protein in amoebic liver abscess

Serum alpha-feto protein (AFP) levels were determined using a sensitive and specific ELISA technique in healthy persons (40), patients with amoebic liver abscess (ALA, 70) and hepatocellular carcinoma (HCC, 20). The AFP levels in normal persons ranged between 0 to 20 ng/ml. Most of ALA patients had AFP levels in the normal range; only a small proportion (14.3%) showed elevated levels (range 20-75 ng/ml). Sera from HCC patients had significantly high AFP values in the range of 25 to 340 ng/ml as compared to normal controls and ALA patients. An analysis of serial samples from 10 ALA patients in convalescent phase showed no difference in AFP level during acute and convalescent phase of infection.

Poor response to long-term albendazole therapy of hydatid liver cysts

Seven patients with uncomplicated hepatic hydatid cysts (Echinococcus granulosus) were treated with albendazole 10 mg/kg/day for 2-6 months (mean 4 months). Serial sonographic evaluation showed reduction in cyst size in only 1 patient (the anteroposterior diameter decreased from 16.5 cm to 4.9 cm). Therapy in this patient was discontinued after 4 months due to development of jaundice. Albendazole appears to have a limited role in the treatment of hydatid disease of the liver.