Etiologic diagnosis of pleural effusion by punch biopsy of the parietal pleura

Needle biopsy of the pleura using Harefield pleural biopsy punch, has been performed in 100 subjects, 58 of whom were 40 years of age or over, in order to arrive at a histologic diagnosis. Ancillary investigations such as bronchoscopy and lymph node biopsy have been done where necessary and feasible. In 18 of the 58 in the older age group and in 15 of the 42 in the younger age group, the biopsy showed lesions suggestive of tuberculous infection; 13 in the older age group and two in the other showed evidence of malignancy; 23 in the older and 21 in the younger group showed nonspecific changes. Vegetative forms of Entamoeba histolytica were demonstrated in the biopsy material in one case. Biopsy, performed on one occasion only was a failure in five cases. No untoward effects were noticed as a consequence of the procedure

Surgically induced necrotizing scleritis after retinal detachment surgery masquerading as scleral abscess

Scleral necrosis is a rare occurrence after many ocular procedures. In the absence of infection or use of surgical adjuncts such as antimetabolites or radiation, the necrosis is presumed to be directly related to surgical trauma and is hence termed surgically induced necrotizing scleritis (SINS). A high index of suspicion is required for an early diagnosis of SINS and its differentiation from infective scleritis is important as the treatment modalities of these two related conditions are different. We report a case of SINS at sclerotomy site following 23-gauge transconjunctival retinal detachment surgery that was initially suspected to be a scleral abscess. Prompt recognition and institution of topical and systemic steroid therapy helped in limiting the extent of scleral damage

Tropical calcific pancreatitis in Southern India

This article does not have an abstract

Plasma glucagon responses in tropical fibrocalculous pancreatic diabetes

Plasma insulin and glucagon responses to a glucose load were measured in a group of patients with fibrocalculous pancreatic diabetes (FCPD) and compared with patients with noninsulin-dependent diabetes mellitus (NIDDM) and control subjects. Both diabetic groups had markedly diminished insulin responses but the differences between FCPD and NIDDM groups were not significant. In control subjects, in response to the glucose load, plasma glucagon levels decreased while they increased in NIDDM patients. In FCPD patients there was no significant change in glucagon levels in response to the glucose load. The study shows that FCPD patients lack pancreatic α-cell responses to a glucose load. This may play a role in protecting these patients against ketosis

Risk of pancreatic carcinoma in tropical calcifying pancreatitis: an epidemiologic study

To assess the risk of pancreatic cancer in subjects with tropical calcifying pancreatitis (TCP), we have followed 185 patients with TCP from the Diabetes Research Center in Madras, India for an average of 4.5 years. The diagnosis of TCP was based upon longstanding epigastric pain, laboratory tests, presence of pancreatic calculi, endoscopic retrograde cholangiopan-creatography (ERCP) findings, and ultrasonography. During the follow-up period, 24 patients died from all causes, with 6 deaths (25%) from cancer of the pancreas. Three pancreatic cancers were biopsy positive. Average age at onset of pancreatic cancer was 45.6 * 7.3 years-considerably younger than for Western populations. When compared with the background pancreatic cancer rate, subjects with TCP appear to have a significantly increased risk of pancreatic cancer: relative risk = 100, 95% CI = 37-218. Even under the most stringent assumptions (restricting the analysis to biopsy-proven cases, assuming that the true background rate of pancreatic cancer in Madras resembles high-risk Western populations, assuming that tropical pancreatitis begins at birth) the risk is still elevated: relative risk = 5, 95% CI = 1.03-3-14.6. The exact mechanism linking various forms of pancreatitis to pancreatic cancer remains to be elucidated