Showing papers in "Journal of Association of Physicians of India in 1989"

Clinical trials with gugulipid. A new hypolipidaemic agent.

Abstract: Multicentric clinical trials of the efficacy of gugulipid conducted at Bombay, Bangalore, Delhi, Jaipur, Lucknow, Nagpur and Varanasi have been reported. Two hundred and five patients completed 12 week open trial with gugulipid in a dose of 500 mg tds after 8 week diet and placebo therapy. One patient showed gastrointestinal symptoms which did not necessitate withdrawal of the drug. A significant lowering of serum cholesterol (av. 23.6%) and serum triglycerides (av. 22.6%) was observed in 70-80% patients Double-blind, crossover study was completed in 125 patients with gugulipid therapy and in 108 patients with clofibrate therapy. Two patients had flu-like syndrome with clofibrate and opted out from the study. With gugulipid the average fall in serum cholesterol and triglycerides was 11 and 16.8% respectively and with clofibrate 10 and 21.6% respectively. The lipid lowering effect of both drugs became evident 3-4 week after starting the drug and had no relationship with age, sex, and concomitant drug intake. Hypercholesterolaemic patients responded better to gugulipid therapy than hypertriglyceridaemic patients who responded better to clofibrate therapy. In mixed hyperlipidaemic patients response to both drugs was comparable. HDL-cholesterol was increased in 60% cases who responded to gugulipid therapy. Clofibrate had no effect on HDL-cholesterol. A significant decrease in LDL-cholesterol was observed in the responder group to both drugs.

Spot diagnosis of aluminium phosphide ingestion: an application of a simple test.

Abstract: Silver nitrate impregnated paper test was performed with the gastric fluid and in breath in 50 patients of aluminium phosphide poisoning The test was 100% positive with gastric fluid but was positive in 50% patients in breath The test is simple, reliable and sensitive method to detect phosphine (PH3) for bed side diagnosis of aluminium phosphide (AIP) ingestion

Deglycyrrhizinated liquorice in aphthous ulcers.

Abstract: Twenty patients with aphthous ulcers were advised deglycyrrhizinated liquorice (DGL) mouth wash and were followed for two weeks. Fifteen patients experienced 50-75% improvement within one day followed by complete healing of the ulcers by third day.

Cardiovascular manifestations of aluminium phosphide intoxication.

Abstract: Aluminium phosphide (ALP) a major suicidal agent in the developing countries is freely available as grain fumigant. It is highly toxic to lungs, heart and blood vessels causing pulmonary oedema, shock and arrhythmias. There is massive focal myocardial damage resulting in raised cardiac enzymes. Clinical manifestations were nausea and vomiting (32), dyspnoea and palpitations (25 each), cyanosis (12), hypotension (12) and shock (15). Cardiac arrhythmias were present in 28 cases and hypermagnesaemia in 13 patients. Mean serum magnesium level (1.95 +/- 0.2O, mEq/L) was significantly raised compared to mean magnesium level in control subjects (1.62 +/- 0.23 mEq/L). Hypermagnesaemia occurs due to myocardial and liver damage. Out of 32 cases studied, 22 died 18 within 24 hours of ALP ingestion. Thirty two cases of ALP were studied.

Falciparum malaria--present day problems. An experience with 425 cases.

Abstract: Clinical details and present day problems encountered in 425 cases of falciparum malaria (PF) are reported. 10.11% had taken chloroquine prior to reporting to us. Parasitic count done in 23.05% cases lacked correlation with severity of disease. Pattern of fever varied markedly but 5.4% were afebrile throughout and presented only with bodyache and malaise. Apyrexial spell was noted in 5.64%. 28.70% had typical facial looks of anaemia and sallow complexion. Cerebral symptoms were noted in 3.05%. Other symptoms were severe headache 33.4%, pain abdomen 3.29%, gastroenteritis 5.64%, jaundice 2.58% and bronchitis in 7.50%. We encountered subconjunctival haemorrhages with purpura and/or urticaria in four cases, symptoms suggestive of shock lung in 3, pulmonary oedema in 2, severe anaemia (HB less than 4 g%) in seven pregnant ladies, extrapyramidal symptoms in follow up period in 5 and congenital malaria in 2 cases. 83.25% were cured with chloroquine and oxytetracycline. 8.47% (who deteriorated despite the above treatment) were treated with quinine for 6 days. 5.17% (with severe disease) were also given quinine as first line drug. 2.82% (unresponsive to chloroquine and oxytetracycline but with mild disease) were treated with pyrimethamine-sulphamezathine combination for 5 days. One case who did not respond to quinine was treated with quinidine. Recrudescence was seen in 3.67% of patients treated with chloroquine and oxytetracycline. There was no case with renal failure, haemolysis due to G6PD deficiency and black water fever. There was only one death (0.23%) in our series. Self-medication, haphazard therapy and the slogan "Fever may be malaria-take chloroquine" can lead to problems in falciparum malaria.

Male sexual dysfunction after stroke.

Abstract: Male sexual functions namely libido and potency were evaluated in fourteen right handed stroke patients. Half of the studied patients had reduced libido while reduced potency was found in 86% patients. Right hemispheric stroke patients had significantly higher reduction in libido as compared to left hemispheric stroke patients. Libido may have some specific cortical or limbic representation in right cerebral hemisphere.

Adult respiratory distress syndrome following aluminium phosphide ingestion. Report of 4 cases.

Abstract: Four cases of adult respiratory distress syndrome (ARDS) following aluminium phosphide ingestion (ALP) are being reported. The dose of the intoxicant varied from 2 tablets (6.0 gm) to 3 tablets (9.0 gm). All patients had shock at admission and developed ARDS within 6 hours. The exhalation of Phosphine, (PH3) detected by positive silver nitrate paper test, was the possible noxious triggering factor in our cases. The cases are being reported because of their rare occurrence.

Jaundice in Plasmodium falciparum

Abstract: Thirty-two patients of smear positive Plasmodium falciparum malaria having jaundice were analysed retrospectively. Majority of the cases were in the age group of 31-40 years. Serum bilirubin levels ranged from 2 mg to 40 mg%. Fourteen (42.6%) had serum bilirubin above 10 mg%. Conjugated bilirubinaemia was found in twenty one patients (65.5%), unconjugated in 4 (12.5%) while 7 patients (21.8%) had a mixed pattern. Serum transaminases were high in 21.8% patients. Twenty five patients (78%) had associated azotaemia, 11(34.3%) had intravascular haemolysis and 3(9.3%) had possible cerebral malaria. Hepatosplenomegaly was seen in all the 32 patients. Mortality was 21% but none died of hepatic encephalopathy. Histologically the most consistent finding in liver biopsies was reticulo-endothelial cell hyperplasia. Pigmentation in kupffer cells, fatty change, sinusoidal and portal infiltration and cholestasis were the other features seen.

Lipid profile in smokers.

Abstract: In this study we observed that all the lipids except HDL cholesterol were higher in heavy smokers and those making for longer duration. HDL cholesterol was lower in smokers than nonsmokers. The changes in lipid profile were similar in cigarette and bidi smokers.

Pneumatic dilatation in achalasia.

Abstract: Pneumatic dilatation of achalasia cardia was performed on 22 patients using Rider-Moeller bag under fluoroscopic control-during a three year period. The diagnosis was established at barium study and endoscopy. A total of 28 dilatations were performed on 22 patients. Sixteen patients required a single dilatation, five required another sitting while one patient had to be dilated thrice. Surgery was not required in any patient. There was a single complication in the form of an intramural leak which could be successfully managed conservatively. Our short term follow up results reiterate the consensus that pneumatic dilatation should be the initial form of management in these cases.

Role of metronidazole in improving response and specific drug sensitivity in advanced pulmonary tuberculosis.

Abstract: One hundred and thirty-seven patients of advanced pulmonary tuberculosis were randomly allocated to receive metronidazole 400mg tid (76) or placebo (61) for 2 months in a single blind study. All received streptomycin 0.75 g,INH 30 mg and rifampicin 450 mg daily as standard antitubercle treatment. There were no significant pretreatment differences, among both groups. Compared to placebo group there was superior clinical improvement in metronidazole treated group at 4 and 8 weeks (81% vs 53%-P less than 0.05; 87% vs 72%-P less than 0.05 respectively), greater sputum reduction at 4 weeks (49% vs 9%-P less than 0.001) greater radiologic improvement at 4 weeks (60% vs 43%-P less than 0.01) and a better antituberculous drug sensitivity. Metronidazole seems to have beneficial adjuvant role in the drug treatment of tuberculosis. This may improve response in advanced cases.

Posterior fossa abscesses. A review of 33 cases.

Abstract: Thirty three cases of posterior fossa abscesses seen over a period of 20 years are reviewed. 84.8% of these were secondary to otogenic disease. Two abscesses were due to tuberculosis and one due to actinomycotic infection. The overall mortality was 12.1%. Total excision of the abscess with appropriate antibiotic therapy was associated with an operative mortality of 3.4%.

Role of dexamethasone in the outcome from acute stroke.

Abstract: Forty patients of acute stroke of less than 48 hours duration above the age of 40 years were studied. All patients were evaluated as per the evaluation scoring system at the time of admission within 24 hours and 7 days after admission to hospital. 25 patients were given dexamethasone and 15 patients who were not given dexamethasone were matched for age, sex, underlying diseases and clinical condition as per the evaluation scoring. The mean evaluation score in study group showed significant improvement at 7 days (p less than 0.05) as compared to control group. There was no significant difference in mortality between the study and control group, being 36% and 33% respectively. Functional status also remained identical in the two groups at the time of discharge. There was also no significant difference in the outcome of patients of intracerebral haemorrhage vs. cerebral infarction whether treated with dexamethasone or not.

Coronary artery disease pattern in the young.

Abstract: Ninety-two patients aged 40 years or less with documented coronary artery disease were studied with special emphasis on risk factors, coronary angiographic patterns and left ventricular function. Tobacco consumption was the most common risk factor (54%) followed by family history of coronary artery disease (40%). Hyperlipidaemia was not a frequent risk factor. Significant single vessel disease was present in 29% of patients. The incidence of double vessel and triple vessel disease was much higher. The left anterior descending artery was the most commonly involved vessel followed by right and circumflex coronary arteries. Left ventricular function as determined by ejection fraction was abnormal in 51% of patients; left ventricular end diastolic pressure was abnormal in 28% of patients. Sixty-eight percent of patients with no risk factors had either zero vessel or single vessel disease indicating a positive relationship between occurrence of risk factors and significant coronary artery disease in the young.

Clinicopathological study of acute renal failure following viperine snake bite.

Abstract: Fifty patients of acute renal failure following Viperine snake bite were studied. Oliguria (100%), local swelling (48%) and bleeding tendencies (42%) were the predominant clinical features encountered. Of the 25 patients in whom detailed coagulation studies were done, 24 patients had disseminated intravascular coagulation (DIC) and 1 had primary fibrinolysis. DIC was commoner with Russell's viper bite (62%) in comparison to Echis carinatus bites (40%). Renal histology obtained in 29 cases revealed tubular necrosis (35%), cortical necrosis (24%) tubular degeneration (17%) and glomerular changes (17%). Ballooning of glomerular capillaries (59%), splitting of glomerular basement membrane (40.7%), swelling of endothelial cells (29.6%), and focal proliferation of mesangial cells (17%) were the significant glomerular changes encountered. 20 (40%) patients succumbed, DIC (50%), irreversible shock (30%) and septicaemia (20%) being the immediate causes of death. Development of oliguria within 24 hours of snake bite and cortical necrosis were associated with higher mortality.

Fibrocalculous pancreatic diabetes in the elderly.

Abstract: Fibrocalculous pancreatic diabetes (FCPD) is a form of diabetes seen in tropical countries. It is secondary to chronic, calcific, non-alcoholic pancreatitis. FCPD is usually a disease of youth. This paper reports on two elderly onset cases of FCPD. Macrovascular complications are usually rare in FCPD patients. These two patients had evidence of macrovascular diseases probably due to the older age group of the patients.

Yellow oleander (cerbera thevetia) poisoning with jaundice and renal failure

Abstract: Jaundice and renal failure in yellow oleander poisoning have not been reported previously. Similarly no post-mortem report has shown renal tabular necrosis and glomerular pathology, liver and brain changes in this poisoning. Four cases of yellow oleander poisoning with jaundice and renal failure and the postmortem findings in another three cases are reported.

Geriatric tuberculosis in Himachal Pradesh--a clinico-radiological profile.

Abstract: Clinico-radiological profile of 100 geriatric pulmonary tuberculosis cases hailing from hilly areas of Himachal Pradesh was studied. The clinical presentation was altered due to associated smoking as well as chronic obstructive pulmonary disease. Breathlessness was the main presenting feature. Sixty-five cases had exudative lesions radiologically. Both conventional and short course regimens were equally effective. Drug toxicity was not a major problem. Delayed action taken and poor compliance were main handicaps in such cases. Need for individualized care for geriatric patients is stressed.

Fatal pancytopenia in falciparum malaria.

Abstract: Various pernicious syndromes in Plasmodium falciparum infection are being reported with increasing frequency from tropical countries. A rare case of fatal pancytopenia associated with falciparum malaria is described. The patient developed fulminant aspiration bronchopneumonia which was unresponsive to antibiotic therapy and contributed to the development of adult respiratory distress syndrome. He also had severe uncontrolled gastrointestinal bleeding and possibly an intracerebral haemorrhage. Anaemia and thrombocytopenia are well known in malaria but severe leucopenia is very rare and pancytopenia has not been reported.

Tropical myositis. A clinical immunological and histopathological study.

Abstract: Thirty cases of tropical myositis, (22 suppurative, 8 non-suppurative) aged 11 to 65 years were seen in a period of one year. There were 22 males and 8 females. There was a total of 78 muscular lesions in 22 suppurative cases and 19 muscular lesions in 8 non-suppurative cases. The most common presentation was localised myalgia (100%), fever (96.7%) generalized myalgia (56.7%), arthralgia (40%), pain in abdomen (33.3%) and breathlessness (30%). Extramuscular complications were present in 50% cases. Twenty four muscle biopsies were taken. Sixteen showed changes of suppurative myositis i.e. non-specific acute inflammatory reaction, muscle necrosis with myocytolysis, vacuolation of cytoplasm and loss of striations. Cell mediated immunity was found to be suppressed in patients of non-suppurative myositis in comparison with the suppurative group. IgG, IgA and IgM were significantly raised in patients in comparison to controls (p less than 0.05). The intact humoral immunity indicates good response to acute phase reaction and increased levels of IgG, IgA and IgM (specially IgG) can be taken as good prognostic parameter.

Kala-azar mortality in hospitalized cases in north Bihar, India.

Abstract: The mortality in kala-azar was studied in 261 cases admitted in SKMCH during the years 1983-1987. 23 deaths (8.81%) were observed; 9 (39.1%) died due to complications of the disease, while 14 (60.9%) died of toxicity of Sodium Stibogluconate or Pentamidine.

Clinical, haemodynamic and echocardiographic study in chronic cor pulmonale.

Abstract: Thirty patients of chronic cor pulmonale were studied clinically and by chest skiagram, electrocardiography, echocardiography, pulmonary function tests, arterial blood gas analysis and, wherever possible by right heart catheterization. Pulmonary arterial pressures (PAP) correlated significantly only with cardiomegaly on skiagram and with arterial oxygen tension (PaO2). There was no significant correlation between mean PA pressures and prominent pulmonary conus on RVH by ECG, FEV1, PaCO2 or right ventricular outflow tract dimensions by echocardiography. Left ventricular function, as assessed by pulmonary capillary wedge pressure on cardiac catheterization, by LV ejection fraction and fractional shortening on echocardiography was normal in all cases except two (6.67%). There was significant increase in left ventricular posterior wall thickness in the patients studied.

Juvenile diabetes manifesting as epilepsia partialis continua.

Abstract: Epilepsia partialis continua was the chief initial complaint in a young diabetic who was found to have hyperosmolar non ketotic hyperglycaemia. Such a presentation in a juvenile diabetic is rare. Literature relevant to this interesting neurologic disturbance has been briefly reviewed.

Study of intestinal transit time in patient with anxiety and depression

Abstract: Intestinal transit time (ITT) was measured in 10 normal healthy individuals (Group-I) and 15 cases each of predominant anxiety (Group-IIA) and depression (Group IIB). Dietary habits were similar in all subjects. The ITT was significantly faster in group IIA (24.4 +/- 4.2 hrs. P less than 0.001) and significantly slower in Group IIB (47.5 +/- 3.9 hrs. P less than 0.001) as compared to that of Group I (36.5 +/- 0.97 hrs); but there was no correlation between the ITT and the levels of anxiety and depression. Also, physical complaints related to various systems, in the test group, could not be substantiated on physical examination and investigations. Psychological factors play an important role in GIT motility disorders and therapeutic interventions directed at psychological problem appear to be an important part of management.

Bronchogenic carcinoma. A study of 109 cases.

Abstract: The clinical profile of 109 cases of bronchogenic carcinoma has been studied. Definite histopathological typing of malignancy was possible in 61 patients, squamous cell carcinoma being the commonest tumour in 27 followed by small cell carcinoma in 16, adenocarcinoma in 11 and large cell carcinoma in 7. Another 23 patients showed changes suggestive of malignancy on histological/cytological examination. Definitive diagnosis was obtained in half of the patients by bronchial biopsy, in 16% by bronchial aspiration fluid cytology, in 13% by pleural biopsy, in 11% by lymph node biopsy and in others by pleural fluid cytology, lung biopsy and skin biopsy. Commonest radiological involvement among different cell types was hilar involvement in small cell carcinoma in 62%, evidence of bronchial obstruction (collapse/consolidation) in squamous cell carcinoma in 56%, peripheral mass in adenocarcinoma in 54% and cavitation in a mass in squamous cell carcinoma in 15% cases.

Medical emergencies associated with disorders of calcium homeostasis.

Abstract: Medical emergencies due to severe hypercalcaemia and hypocalcaemia are relatively rare in clinical practice. 89 cases of hypercalcaemia were seen during 1975-1987 and 16 presented as medical emergencies; renal colic (7) acute renal failure (3), spontaneous fractures (3), acute pancreatitis (1), cardiac arrhythmia (1) and acute hypercalcaemic crisis resulting in death (1). 81 cases of severe hypocalcaemia were seen during the same period. 22 presented initially as epileptic seizures with one ending fatally due to status epilepticus. The other emergencies were severe laryngeal stridor and inability to speak (7), papilloedema (3) and acute behavioural disorder (4). A few illustrative cases have been briefly described.

Cranial nerve palsies in benign intracranial hypertension.

Abstract: Benign intracranial hypertension may occasionally be associated with various cranial nerve palsies. A case with multiple cranial nerve involvement is presented.