Reuben Thomas Kurien

Acute pancreatitis and hyperparathyroidism: A case series

Primary hyperparathyroidism is a rare cause of acute pancreatitis. Five consecutive patients with acute or recurrent acute pancreatitis and primary hyperparathyroidism were included. All patients had elevated serum calcium on admission and high levels of circulating parathyroid hormone. Both ultrasonography and Sestamibi scan was used to localize parathyroid adenoma. Except for one, all patients underwent parathyroidectomy and postoperative histology was consistent with parathyroid adenoma. One patient died while on treatment. Metabolic causes of acute pancreatitits, though uncommon, are important as early recognition helps management and prevents recurrence.

Hepatocellular carcinoma continues to be diagnosed in the advanced stage: profile of hepatocellular carcinoma in a tertiary care hospital in South India

Summary This report is an analysis of 231 patients with hepatocellular carcinoma (HCC) from a tertiary care hospital in India. Most of the HCCs were diagnosed in cirrhotics and at an advanced stage which limited the therapeutic options. Physician awareness of this complication of cirrhosis and regular ultrasound screening of cirrhotic patients will help in detection of early stage cancers and, thus, enhance the survival rates.

Cyclosporine in steroid refractory acute severe colitis.

This is a pilot study to test the hypothesis that polymorphisms that may be linked to cyclooxygenase production may affect the likelihood and the nature of bleeding in patients with ulcer disease. Of the two polymorphism that have previously been studied for links we chose the A842G polymorphims. Of the 50 patients with ulcer bleeding who were studied, 8 had a heterozygous polymorphisms and 42 had the normal configuration. On comparing these two groups. there were no significant differences in clinical presentation except that there was a tendency to have less gastric ulcers among those with the A842G/C50T polymorphism. Based on these studies we need to undertake a larger studies comparing these groups with those with ulcers without GI bleeding and those without ulcers

Squamous papilloma of esophagus

Esophageal papillomas are rare benign epithelial lesions, occurring in 0.01 % to 0.45 % of people undergoing endoscopy [1]. These are more common in middle-aged men. Proposed possible etiologies are chronicmucosal irritation (due to gastroesophageal reflux, smoking, alcohol, chronic food impaction, caustic injury, and mechanical irritants like nasogastric tubes or post bougie assisted esophageal dilatation) and infection with human papilloma virus. Esophageal papillomas are generally single, but multiple lesions have been described [2]. Shown here is a lesion from a 36-year-old lady with dyspepsia without alarm symptoms. White light examination showed small, white-pink, warty exophytic projections in mid esophagus (Fig. 1). On narrow band imaging, the lesion appeared as papillary projections of mucosa without dilated microvessels (Fig. 2). Histopathology confirmed the diagnosis of squamous cell papilloma.

Plasma hydrogen sulphide does not predict severity of acute pancreatitis in humans.

The primary aim of this study was to assess the usefulness of plasma hydrogen sulphide (H2S) level at admission as a predictor of severity of acute pancreatitis. The secondary aims were to examine whether the level of H2S after 48 h correlated with severity and whether level of H2S correlated with pulmonary, renal or infectious complications. Plasma hydrogen sulphide was measured within 24 h of admission and 48 h later, in patients with acute pancreatitis. Patients were classified as having mild or severe pancreatitis, and H2S levels in the two groups were compared. A total of 55 patients had H2S estimation carried out within 24 h of admission. H2S levels were similar in patients with mild (mean 31.8 ± 18.8, range 7.1 to 81.4 µmol/L) and severe pancreatitis (mean 28.2 ± 21.6, range 6.1 to 74.4 µmol/L; p = 0.339). There was no difference found between the groups after 48 h (mild n = 28, mean 26.8 ± 19.4 µmol/L, and severe n = 20, mean 34.6 ± 21.0 µmol/L; p = 0.127). There was also no difference in the levels between patients with or without lung injury, kidney injury or sepsis. Performing H2S estimation to predict severity in acute pancreatitis is not beneficial.

Metastasis of renal cell carcinoma to the duodenal papilla.

Metastatic tumors of the duodenal papilla (ampulla of Vater) are rare. The images here are from a middle-aged gentleman with progressive cholestatic jaundice and recurrent cholangitis, with a past history of nephrectomy for renal cell carcinoma (RCC) 6 years earlier. Endoscopy revealed a bulky duodenal papilla, and the biopsy showed features consistent with RCC (Figs. 1 and 2). Metastatic tumors of the duodenal papilla are rare. RCC constitute 80 % to 85 % of primary