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.

The effect of various anaesthetics on the spatial tuning of two major wave peaks in the transient pattern electroretinogram of the cat: evidence for pattern and luminance components

The main PERG component of the transient contrast reversal pattern electroretinogram (PERG) in cats was a negative wave (3.5 microV average, SD 1.7 microV) peaking at about 130 msec (N130) with a spatial resolution above 5.5 c/deg, close to behavioural estimates. The early positivity (P35) was more variable, smaller and had lower spatial resolution. Different anaesthetic protocols affected both the waveform and the amplitude by spatial frequency functions. Responses of urethane anaesthetised cats were like those reported previously for decerebrate cats or cats paralysed and ventilated with N2O/O2/CO2 (75%/24%/1%). P35 was evoked only by coarse stimuli and N130 amplitude decreased linearly as spatial frequency increased. When the luminance response amplitude, predicted from the optical transfer function of the eye, was subtracted, spatial tuning appeared. An anaesthetic mixture of ketamine hydrochloride and xylazine depressed both P35 and N130 at low spatial frequencies while enhancing them at high frequencies. In paralysed animals ventilated with N2O/O2 (67%/33%) P35 was larger and recordable to 1.6 c/deg. Peak times were reduced and the inter-peak time halved. Other anaesthetics depressed the ERGs. These effects suggest that cats are a good model for studying N130 in isolation or its interaction with P35 and that both PERG peaks include luminance and pattern components.

Urethane as a sole general anaesthetic in cats used for electroretinogram studies

Cats are very sensitive to induction of anaesthesia by urethane. To anaesthetize cats with urethane, 1.0-1.3 g/kg, of freshly prepared urethane is administered intravenously at a rate of 1.92 g/h, while anaesthesia is maintained with 0.5% halothane in a 66%/33% nitrous oxide/carbogen gas mixture. Cats can then be maintained for up to 3 days by intravenous infusion at a rate of 4 ml/h of a 100 ml solution containing 50 IU heparin, 2.4 mg atropine, 4.7 g anhydrous D-glucose, and 240 mg urethane/kg. Using this anaesthetic, excellent electroretinograms can be recorded with no interfering eye movements.

Endoscopic sclerotherapy for portal hypertension due to extrahepatic obstruction: long-term follow-up

Between 1982 and 1987, 43 patients with variceal bleeding due to extrahepatic portal obstruction were treated by repeated endoscopic injection sclerotherapy using 1% polidocanol intravariceally. This decreased rebleeding, as evidenced by a decrease in bleeding risk factor (BRF), mean transfusion requirement, and mean number of transfusions per patient per month of follow-up. Differences between pre- and postsclerotherapy parameters were significant (p less than 0.001). The varices were eradicated in 86% of patients. The mean sclerotherapy sessions required were 7.68 +/- 2.39 (SD). Complications were infrequent. Forty-three patients were followed from 5 to 68 months: cumulative survival was 97.7% and varices recurred in 16%. Sclerotherapy avoided a second operation in 21 postsurgical patients. Sclerotherapy for managing variceal bleeding due to extrahepatic portal obstruction is a reasonable alternative to surgery.

Effect of incorporation of isabgol husk in a low fibre diet on faecal excretion and serum levels of lipids in adolescent girls

The effect of consumption of isabgol husk for 3 weeks on faecal excretion and serum levels of lipids was investigated in 11 adolescent girls. The consumption of isabgol husk lowered serum lipids and increased faecal fat.

Gastrointestinal tract infection in immunocompromised hosts

The recent regognition of AIDS has stimulated the development of newer cytotoxic therapies and hematological support system which have prolonged the life of these immunocompromised subjects. Moreover, greater number of patients are being recognised who are susceptible to various opportunistic infections involving the GI tract. In view of the poor anti-inflammatory response and minimal signs and symptoms of infection, the diagnosis of these organisms is often difficult. Hence a proper knowledge of the predisposing conditions and meticulous attention to minor symptoms and thorough physical examination alone can lead to an early diagnosis of infection. The common infectious agents include cryptosporiodium, herps virus cytomegalovirus and Giardia. Since, a satisfactory treatment is not available for many of these pathogens, attention should be paid to preventive measures while injudicious use of broadspectrum antibiotics must be checked to prevent superinfections.

Massive lower gastrointestinal bleeding as a presenting feature of Behcet's disease

This reports a 27 yr old female Patient with seronegative polyarthritis who presented with lower GI bleeding and subsequently developed evidence of cutaneous vasculitis (palpable purpura) and orogenital ulcers. The cause of the GI bleeding was multiple ulcerations in the terminal ileum, cecum ascending colon and transverse colon. Continued and massive bleeding necessitated surgical resection of the involved segment of gut which on histopathological examination confirmed the presence of vasculities. This patient was thus diagnosed as having Behcet's disease. Although major GI bleeding is a rare manifestation of Behcet's disease with vasculitis of the gut, one must consider this possibility if the patient has multi-system involvement with evidence of vasculitis involving the skin in the form of palpable purpura.

Acanthosis nigricans associated with adenocarcinoma of the gallbladder

We present a case of malignant acanthosis nigricans in association with primary adenocarcinoma of the gallbladder. The extreme rarity of the association is noted and discussed in light of the relevant literature and the suggested pathogenic mechanisms of malignant acanthosis nigricans.

Xenon arc photocoagulation for treatment of subluxation of lens

In the treatment of congenital or acquired subluxation of the lens a conservative approach to reposition the pupil in front of the aphakic area by the use of the xenon arc photocoagulator is emphasised. The management of two cases of subluxation is discussed in detail and the results evaluated. The ease of repositioning the pupil by means of iris photocoagulation and the absence of surgical complications are indications for the use of this non-invasive procedure in the treatment of subluxated lenses.