Pericardial effusion following esophageal variceal sclerotherapy.

We report a 37-year-old man with portal cavernoma who developed pericardial effusion two weeks following sclerotherapy for esophageal varices. It responded to conservative management.

Prediction of novel and analogous folds using fragment assembly and fold recognition.

A number of new and newly improved methods for predicting protein structure developed by the Jones-University College London group were used to make predictions for the CASP6 experiment. Structures were predicted with a combination of fold recognition methods (mGenTHREADER, nFOLD, and THREADER) and a substantially enhanced version of FRAGFOLD, our fragment assembly method. Attempts at automatic domain parsing were made using DomPred and DomSSEA, which are based on a secondary structure parsing algorithm and additionally for DomPred, a simple local sequence alignment scoring function. Disorder prediction was carried out using a new SVM-based version of DISOPRED. Attempts were also made at domain docking and "microdomain" folding in order to build complete chain models for some targets.

Prediction and functional analysis of native disorder in proteins from the three kingdoms of life.

An automatic method for recognizing natively disordered regions from amino acid sequence is described and benchmarked against predictors that were assessed at the latest critical assessment of techniques for protein structure prediction (CASP) experiment. The method attains a Wilcoxon score of 90.0, which represents a statistically significant improvement on the methods evaluated on the same targets at CASP. The classifier, DISOPRED2, was used to estimate the frequency of native disorder in several representative genomes from the three kingdoms of life. Putative, long (>30 residue) disordered segments are found to occur in 2.0% of archaean, 4.2% of eubacterial and 33.0% of eukaryotic proteins. The function of proteins with long predicted regions of disorder was investigated using the gene ontology annotations supplied with the Saccharomyces genome database. The analysis of the yeast proteome suggests that proteins containing disorder are often located in the cell nucleus and are involved in the regulation of transcription and cell signalling. The results also indicate that native disorder is associated with the molecular functions of kinase activity and nucleic acid binding.

Omeprazole as adjuvant therapy to endoscopic combination injection sclerotherapy for treating bleeding peptic ulcer.

BACKGROUND: Therapeutic endoscopy has provided a new means of treating bleeding peptic ulcers. Additional medical therapy may enhance the therapeutic benefit. Hemostasis is highly pH dependent and is severely impaired at low pH. Proton pump inhibitors, by achieving a significantly higher inhibition of gastric acidity, may improve the therapeutic outcomes after endoscopic treatment of ulcers. PATIENT AND METHODS: We enrolled 166 patients with hemorrhage from duodenal, gastric, or stomal ulcers and signs of recent hemorrhage, as confirmed by endoscopy. Twenty-six patients had ulcers with an arterial spurt, 41 patients had active ooze, 37 had a visible vessel, and 62 patients had an adherent clot. All patients received endoscopic injection sclerotherapy using 1:10,000 adrenaline and 1% polidocanol and were randomly assigned to receive omeprazole (40 mg orally) every 12 hours for 5 days or an identical-looking placebo. The outcome measures used were recurrent bleeding, surgery, blood transfusion, and hospital stay. RESULTS: Six (7%) of 82 patients in the omeprazole group had recurrent bleeding, as compared with 18 (21%) in the placebo group (P = 0.02). Two patients in the omeprazole group and 7 patients in the placebo group needed surgery to control their bleeding (P = 0.17). One patient in the omeprazole group and 2 patients in the placebo group died (P = 0.98). Twenty-nine patients (35%) in the omeprazole group and 61 patients (73%) in the placebo group received blood transfusions (P <0.001). The average hospital stay was 4.6 +/- 1.1 days in the omeprazole group and 6.0 +/- 0.7 days in the placebo group (P <0.001). CONCLUSION: The addition of oral omeprazole to combination injection sclerotherapy decreases the rate of recurrent bleeding, reduces the need for surgery and transfusion, and shortens the hospital stay for patients with stigmata of recent hemorrhage.

Gastrointestinal tract tuberculosis: a study of 102 cases including 55 hemicolectomies.

Tuberculosis continues to be a major health problem in India. Our experience of 102 cases of gastrointestinal tract tuberculosis is presented. Eighty-one of these patients experienced obstructive symptoms, 62 had radiographic evidence of intestinal obstruction, and four had bowel perforation. Lymphadenopathy was present in 16 patients and pulmonary tuberculosis in 28. The commonest sites of bowel involvement were ileo-caecal, ileum and ascending colon. Duodenal lesions were seen in three cases and in another three there was isolated appendicular involvement. Right hemicolectomy was necessary in 55 of the 74 patients who had surgical exploration. Histopathological reports were available in 88 subjects. The various radiographic manifestations of tuberculosis of the bowel are discussed. Radiologically and sometimes even on histopathology, differentiation of ileo-caecal tuberculosis from Crohn's ileo-colitis may prove impossible.

Extrahepatic portal hypertension: a review of 70 cases.

Among 70 children with extrahepatic portal hypertension, more than 350 episodes of bleeding occurred. Of the 32 children who were not operated upon, six (19%) died of bleeding. Twelve children in the nonoperated group are thriving and well, although six of them have rebled 1-2 times. The operated group of 38 children had a total of 43 procedures. Central splenorenal and cavomesenteric anastomosis prevented further bleeding in 10 of 12 cases in which follow-up is available. Operative mortality was 24%, the majority of which were in emergency procedures.

Hydatid cyst causing spinal compression.

This report deals with two cases of spinal cord compression, one secondary to hydatid disease of C4 vertebra and the other due to a posterior mediastinal hydatid with an intraspinal component. After a brief review of the pertinent literature and pathogenesis of the disease, the distinguishing radiological features have been brought out.

Observations on the value and limitations of infusion pyelography in anuric patients.

Infusion pyelography was performed in 103 anuric patients with no attendant mortality. It was useful in 83 cases in distinguishing obstructive uropathy from renal parenchymal disease. However, in the remaining 20 cases when either renal parenchymal disease co-existed with obstructive uropathy or obstructive uropathy existed alone under certain circumstances, opacification of the collecting system did not occur. The clinicopathological setting of some of the latter group of cases is illustrated by examples.

Infusion pyelography in anuric patients.

The spectrum for the use of retrograde pyelography in renal failure has been narrowed further by extending the facility of infusion urography to anuric patients. The latter study has helped greatly in sifting apart pre-renal and renal anuria patients from those with obstructive uropathy. In obstructive anuria infusion urography has proved comprehensive in influencing judgment about the exact site and nature of obstruction, in affixing laterality towards the better functioning renal unit and in deciding a suitable definitive operation or planned staged procedures.

Peripheral vascular deficit in leprosy.

There is considerable controversy regarding the frequency and significance of vascular lesions in leprosy. Thirty-five patients of leprosy under 40 years of age, without any local and systemic arterial disease, with normal looking hands and feet, were subjected to brachial arteriography. One patient also had posterior tibial arteriography. Diagnosis of leprosy was confirmed by bacteriologic and histopathologic technics. Biopsy material was studied from the area of radiographic abnormality, similar material was obtained from nine matched control subjects at autopsy. Skin thermometry and reflex vasodilatation were studied in eight cases. Various fractions of serum lipids and cholesterol were estimated in all patients and found to be within normal range. Arteriographic abnormalities such as occlusion, narrowing, tortuosity, dilatation, poststenotic dilatation, irregularity and incomplete filling of the lumen by radio-opaque material, were seen in more than two vessels in 50% of the arteriograms in wrist and palm; digital vessels showed abnormality in 75% to 94% of cases. The ulnar artery was more frequently involved (74%) than the radial (50%). Superficial and deep palmar arches were equally affected. Increased vascularity in hypothenar eminence area was seen in three arteriograms. Marked increase in arcuate vessels was noted in 60% of patients. Some arcuate vessels were serving as collaterals. Histologically, all grades of vessels including capilaries showed changes in nearly half of the patients. Reflex vasodilatation was lost in three patients of dimorphous leprosy, and impaired or absent in three of five patients of lepromatous leprosy. There was no predilection for any form of leprosy to show arterial changes more than others. This study clearly demonstrates that the vascular involvement in leprosy is very frequent and must be playing an important role in causing mutilations and deformities of hands and feet.