The spectrum of chronic autoimmune hepatitis.

Autoimmune hepatitis (AIH) is characterised by the presence of periportal hepatitis coupled with the presence of autoantibodies in the serum. We report our experience with 10 cases (females--8, males--2) who presented to the rheumatology clinic with either articular or extra-articular manifestations. Three patients (1 SLE, 1 Sjogren's and 1 RA), satisfied the criteria for an underlying rheumatic disease (secondary AIH) while, others had primary AIH.

The impact of infection control on intensive care unit microbial isolates.

In todays world, good infection control practices in high pressure intensive care units is of vital importance. Endogenous infections from the patients own microbial flora now cause the majority of nosocomial infections as the exogenous infections are curtailed to a large extent with aggressive surveillance and prevention of infection. We analysed absolute numbers of microbial isolates as an indirect reflection of infection rate in the intensive care unit (ICU) for 6 months in 1992, 1994 and 1996.

An unusual systemic presentation of gout.

An elderly female presented with a systemic febrile illness and acute polyarthritis as the first manifestation of gout. She improved dramatically with anti-inflammatory therapy.

Clinical trial of benidipine in mild to moderate hypertension.

Thirty four patients with mild to moderate hypertension, were put on benidipine 4 mg/day after two weeks of placebo therapy. Twenty five patients completed the trial successfully for 4 mg benidipine. The blood pressure of 20 patients was controlled with benidipine 4 mg/day (effective rate 80%).

Hyperimmunoglobulinaemia E syndrome: pulmonary imaging features.

Hyperimmunoglobulinaemia E (hyper-IgE) syndrome (Job's syndrome) is a rare disease that presents with recurrent cutaneous and sinopulmonary infections, and which begins in infancy and is associated with extreme hyper-IgE. The pulmonary imaging features typically consist of recurrent alveolar lung infections, pneumatocoeles and, occasionally, pneumothorax. Various other causes of pneumatocoeles in children can be excluded on the basis of clinical history and other data.

Gamma-knife radiosurgery for trigeminal neuralgia.

Gamma knife was installed at the PD Hinduja National Hospital and Medical Research Centre, Mumbai, India, in January 1997. In the first year of gamma-knife radiosurgery to January 1998, we treated 110 patients, of whom six had medically refractory trigeminal neuralgia. Seven treatments were administered to this group of six patients (one had bilateral neuralgia).

Pneumocephalus secondary to colonic perforation by ventriculoperitoneal shunt catheter.

We present a case of colonic perforation as a complication arising from ventriculoperitoneal shunt catheter. A 58-year-old woman with a ventriculoperitoneal shunt catheter inserted for obstructive hydrocephalus was admitted to hospital with signs and symptoms of meningitis. CT showed an air-fluid level within both lateral ventricles, raising the possibility of colonic perforation since no other aetiology for the pneumocephalus could be found.

Cerebrospinal fluid otorhinorrhea in patients with defects through the lamina cribrosa of the internal auditory canal.

We describe three patients with bilateral cerebrospinal fluid (CSF) otorhinorrhea with unilateral progressive hearing loss in whom CT showed the defect to be located in the lamina cribrosa of the internal auditory canal. CT cisternography showed the CSF fistula in two of the three patients who had Mondini malformation, whereas the CSF fistula was obvious on the plain high-resolution temporal bone CT study in the third patient, who had a posttraumatic (nonsurgical) fracture of the lamina cribrosa. Fast spin-echo T2-weighted coronal MR cisternography also showed the site of leakage in the third patient.

Magnetic resonance angiography.

The field of MRA has progressed to a stage at which several clinical applications are of obvious value, including the diagnosis of cerebral aneurysms, venous disorders and disease of the carotid bifurcation. Additionally spin echo images are useful in studying the parenchyma and this together with MRA works to be an excellent diagnostic package in the presurgical workup of patients with cerebral vascular abnormalities. With further technical improvements, it seems likely that important applications of MRA will also be found in the diagnosis of peripheral artery disease, stenosis of the renal artery and ischemic heart disease.

Free radical generation and the role of allopurinol as a cardioprotective agent during coronary artery bypass grafting surgery.

Objectives: To determine the time course of free radical generation and the role of allopurinol as a cardioprotective agent during coronary artery bypass surgery.

Design: Patients were chosen on a strict 'first come, first chosen' basis, irrespective of their age and sex.

Setting: Tertiary referral-based hospital and medical research centre.

Evidence for free-radical mediated injury during coronary artery bypass surgery.

Prolonged global ischemia followed by reperfusion during coronary artery bypass graft (CABG) surgery leads to a burst of oxygen free-radical generation and subsequent myocardial impairment. Blood samples were collected at different time periods from the right atrium of patients (n = 55) who underwent CABG surgery. Free-radical activity was measured by assays for thiobarbituric acid reactive species (TBARS), mainly malondialdehyde (MDA), at zero minute (before aortic cross-clamp), one minute and 10 minutes after declamping i.

Allergic fungal sinusitis: incidence and clinical and pathological features of seven cases.

Allergic fungal sinusitis, like allergic bronchopulmonary fungal disease, is a noninvasive inflammatory process. It manifests as recurrent nasal polyposis. Histologically the characteristic feature is the presence of thick mucin with dense collections of degenerating eosinophils and Charcot-Leyden crystals (allergic mucin).

Dyslipidemia in patients with chronic renal failure and in renal transplant patients.

Indian studies on lipid profile abnormalities in chronic renal failure (CRF) have varied from no abnormalities at all to significant abnormality (hypertriglyceridemia and reduced HDL) as described in the Western literature. Moreover, there is no Indian study on the effect of renal transplantation on the abnormal lipid profile of CRF. The aim of our study was to determine the lipid profile of CRF patients on conservative treatment, end stage renal disease (ESRD) patients on maintenance hemodialysis (HD) treatment and renal transplant patients.

Brown tumor of the hard palate in secondary hyperparathyroidism.

Jaw bones are rarely involved in secondary hyperparathyroidism. We report a case of 13 year old girl who presented with progressive chronic renal failure and secondary hyperparathyroidism. Five months after beginning of hemodialysis, a large brown tumor developed on the hard palate, extending to the maxilla causing difficulty in swallowing and breathing.