A patient with hypercoagulable state due to tuberculosis.

A 55-year-old male patient presented with status epilepticus following prolonged fever. Investigations revealed miliary opacities in lungs that were diagnosed as tubercular after thoracoscopic lung biopsy. Wide derangement of coagulation parameters was found, indicating a pro-coagulent state. There was evidence of widespread thrombosis.

Portopulmonary hypertension in a case of non-cirrhotic portal fibrosis.

Portopulmonary hypertension (PPHT) is the unusual association of portal hypertension (HT) with pulmonary HT. We report a case of noncirrhotic portal fibrosis (NCPF) leading to PPHT which is exceedingly rare with only very few cases reported in the literature. This is an autopsy report of a 30 years old man, a known case of portal HT who died suddenly due to a syncopal attack. Autopsy revealed massive pulmonary thromobembolism with pulmonary HT. Liver showed changes of NCPF. The rarity of NCPF causing PPHT prompted this case report.

Pulmonary hyalinizing granuloma with ureteric fibrosis: A case report and review of relevant literature.

A 52-year-old, asymptomatic patient presented with bilateral lung nodules on chest radiograph. She was diagnosed to have "pulmonary hyalinizing granuloma" on an open lung biopsy. We review the clinical features of this rare disease.

A preliminary investigation into maximal expiratory pressures in some village children.

A clinical mercury sphygmomanometer was used to measure Maximal Expiratory Pressure (MEP) in 29 boys (mean age 8 +/- 1.4 yr) and 21 girls (mean age 7.6 +/- 1.5 yr) of a village in interior Maharashtra. The values of 70.6 +/- 13.4 mmHg SD for the boys and 61.9 +/- 18.9 mmHg for the girls were quite comparable to the respiratory pressures reported elsewhere in literature, even though the subjects were apparently poorly nourished. There was no statistical difference between the MEPs of boys and girls. The MEP was positively and significantly (P<0.01) correlated to height (r=0.51) and weight (r=0.05) in the boys. The MEP denoting respiratory muscle strength also correlated positively with handgrip power used to represent non-respiratory muscle strength (r=0.34) (P>0.05). The simple, reproducible method of measuring MEP as described may be useful for measuring this important physiological parameter at the bedside in children whose respiratory muscle function needs to be evaluated.

Cytomegalovirus nasal polyp after renal transplant.

Infection is a major problem after transplantation. Cytomegalovirus (CMV) is the most common viral infection affecting transplant patients. We describe a case of CMV infection with rare clinical manifestation in the form of nasal polyp. Patient presented 6 weeks following renal transplantation with history of fever and stuffy nose. On evaluation he was found to have nasal polyp which was excised. Histopathology revealed characteristic CMV inclusion bodies. Patient responded to ganciclovir therapy and is presently doing well eighteen months after transplantation.

Treatment of AA amyloidosis in rheumatoid arthritis.

Four patients of rheumatoid arthritis (RA) with biopsy confirmed AA amyloidosis were treated with chlorambucil. All had established but uncontrolled RA with a persistently raised ESR. Moderate (> 1 gm, < 3.5 gm/d) to nephrotic range (> 3.5 gm/d) proteinuria and a relatively well preserved renal function was noted in three patients. One patient had deranged renal function and required dialysis. On chlorambucil, there was complete recovery, partial improvement and no improvement in one patient each. The fourth patient required haemodialysis, did not tolerate chlorambucil and succumbed to the illness. Therapy with chlorambucil can benefit some patients of RA with AA amyloidosis. Leucopenia is the most important dose limiting side effect.

Spontaneous resolution of diffuse alveolar septal amyloidosis.

Amyloidosis is a generic term for a heterogeneous group of disorders associated with deposition of protein in an abnormal fibrillar form. Amyloidosis can be hereditary or acquired, localised or systemic and potentially lethal or merely an incidental finding. We report a case of a male who was totally asymptomatic and was incidentally detected to have lung amyloidosis. He was not given any treatment but kept under observation., His chest radiograph (CXR) and high resolution computed tomograph (HRCT) of the chest cleared spontaneously after one year and the patient continues to remain asymptomatic even after two years.

Prevalence of missed opportunities for measles immunization in rural areas of Gujarat.

To assess the prevalence of missed opportunities for measles immunization, reason for their occurrence and potential aspect of avoiding them on measles immunization coverage a cross sectional study in 40 clusters of 4 villages, Ardi, Valasan, Chikhodra and Bamroli having a population of twenty four thousand was carried out. A total of 300 children between the age group 9-24 months were included in the study. Immunization status of each child was recorded either from immunization card or maternal recall. Coverage for measles vaccine was 78.66%. Prevalence of missed opportunity was 15.33%. It was found that significant increase in measles coverage can be achieved upto 94% if all missed opportunities for measles vaccine are avoided.

Attire and appearance of pediatrician: parents'/guardians' opinion.

Professional appearance of a pediatrician is an important element affecting the perception of competence of the doctor among patients and their parents/guardians, thus influencing their compliance. As there is no study on this issue addressing the Indian scene, we requested responses to a questionnaire containing 15 questions from the parents/guardians of the children. The purpose of the study was to assess their opinion regarding attire and appearance of pediatricians. Five each of the questions were related to common aspects of appearance and attire of the pediatrician in general and that of the male and the female pediatrician in particular. A total of 210 parents/guardians responded to see the question listed in the questionnaire. Assertive responses to each question were analysed for any association with the following categories--Urban, Rural, Males, Females, Urban Males, Rural Males, Urban Females, Rural Females, age below 40 years and age 40 years or more. Majority of the total assertive respondents preferred a formal/traditional attire and appearance for the pediatrician. Although most of the above categories concurred with this general opinion, some categories showed statistically significant, but practically unimportant, differences in the extent of agreement. The respondents generally favoured a white coat and nameplate on the pediatrician, shoes and a necktie for the male pediatrician and saree for the female pediatrician. They did not approve clothes with bizarre designs, use of perfumes by the pediatrician, long hair, T-shirts and jeans pant for the male pediatrician, chudidar, lipstick and other make-ups, costly jewelery and short hair for the female pediatrician.

Evaluation of the knee pathology by ultrasonography.

Fourteen patients undergoing total knee replacement for the arthritic conditions of the knee were evaluated by ultrasonography (USG) prior to surgery. USG findings (synovium, fluid, femoral cartilage, cyst and loose bodies) were compared with surgical findings. USG and surgical findings matched for synovial pathology in 57%, for presence fluid in 71% and for cartilage damage in 45%. Loose bodies and cyst present in one patient was not picked up by USG. Baker's cyst was detected in one patient.

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. Median duration of hepatic involvement was 6 months and the varied presentations were noted. Articular disease ranged from arthralgias, palindromic arthritis to persistent non-erosive/non-deforming arthritis (Jaccoud's arthritis). Autoimmune thrombocytopenia was seen in 2 and autoimmune hypo and hyperthyroidism were seen in 3 patients each. Anti-nuclear antibody was positive in 9/10 (6 with speckled pattern and 3 with homogenous pattern) and anti-mitochondrial antibodies were positive in three. Hepatitis C virus (HCV) markers were positive in 1, who probably had viral hepatitis with dominant autoimmune features. All have been started on steroids (5 patients--1 mg/kg dose, 1 patient--0.5 mg/kg dose and 3 patients--0.25 mg/kg dose). The HCV positive patient was on a low dose steroid (0.25 mg/kg) and interferron treatment was contemplated before she was lost to follow up. Four patients are also on azathioprine in the dose of 2 mg/kg/day. Of the 6 patients who are under regular follow up, the liver parameters have normalised in 5 and one showed hypoalbuminaemia with normal enzyme levels at the last follow up.

Adenocarcinoma of cervical esophagus arising in aberrant gastric mucosa.

Ectopic gastric epithelium is common in the cervical esophagus. However, complications arising from such tissue are rare. We report an adenocarcinoma arising in ectopic gastric mucosa of the cardiac type in the cervical esophagus of a 60-year-old man.

A clinicopathologic profile of adrenocortical tumors.

OBJECTIVE: To study the clinical, biochemical, hormonal, radiological and histopathological profile of adrenocortical tumors in children; to assess the clinicopathological correlations and note the future outcome. DESIGN: Retrospective and prospective study. SETTING: Hospital based; Endocrine Service of our institution and other institution based services. SUBJECTS: 14 children (Females = 11, Males = 3) with adrenocortical tumor, aged 8 months to 13 years (mean age 5.1 +/- 3.42 years), seen over a period of 9 years. RESULTS: Females predominated (F:M = 3.7:1). Majority (64%) had a mixed picture with cushingoid features and virilization, whereas 36% presented only for virilization. Elevated serum cortisol levels with loss of diurnal variation was noted only in those with mixed clinical presentation. Adrenal androgen elevation was noted in majority of cases as virilization was common to all. CT confirmed the diagnosis of tumor, 7 on either side. Thirteen cases were operated. Histopathologic diagnosis was carcinoma in 7 and adenoma in 6 cases. Three of the seven with carcinoma died within 3 months to 2 years but two of these with small tumours (weight 60-65 g and diameter < 6 cm) were well at 2 and 5 years, while as one of the six with a large adenoma had recurrence and metastasis after three years. CONCLUSION: Female preponderance was marked (4 times), 43% of tumors had occurred by 3 years of age and 64% by 6 years. Neither the hormonal parameters nor the histopathology correlated well with the biological behavior and outcome. Prolonged and vigilant follow up is essential.

Lung function values in healthy children (10-15 years).

The present study was designed to establish norms for pulmonary functions in urban healthy children of Delhi under the age group of 10-15 years. Pulmonary functions were assessed using an electronic lung function spirometer in 222 boys and 188 girls belonging to middle income group families of East Delhi. The pulmonary functions were separated by age and sex. All pulmonary functions showed an increase with advancing age. FEV1 and FVC were more in boys as compared to girls. Values of PEFR, FRC and TLC were similar in both sexes till the age of 13 years after which boys attained higher values. Prediction equations were obtained using height, age and weight as independent variables. Forward selection method was used to choose the best equation for each pulmonary function. Maximum variance in the lung functions was explained with the height. It is felt that norms established in the present study will act as reference standards for various lung functions in well nourished urban Delhi children under the age group of 10-15 years.