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Biomedical subjects

B K Mandal

Publications and source records attributed to B K Mandal.

15 recordsLinked to original sources

Campylobacter colitis.

Eleven consecutive patients with diarrhoea from whose stools campylobacter were isolated were investigated by sigmoidoscopy and rectal biopsy. Eight had definite proctitis, and in seven biopsy specimens were abnormal with histological changes ranging from non-specific colitis to gross colitis with goblet-cell depletion and crypt-abscess formation. Nine of the patients passed blood in their stools, and in all but one abdominal pain was a feature of the illness. Severe campylobacter colitis may be clinically, sigmoidoscopically, and histologically difficult to differentiate from ulcerative colitis and is a differential diagnosis in acute colitis.

Adolescent

Mecillinam in enteric fever.

Twelve consecutive patients with enteric fever entered a trial of 14 days' treatment with mecillinam. Only three patients became afebrile within three days; four continued unimproved with fever and toxaemia for seven to nine days, when treatment was changed to chloramphenicol with good results. In one case the fever did not settle until the 13th day, and five days later the patient had a clinical relapse. Although all organisms recovered were fully sensitive to mecillinam, this drug is not an effective or consistent treatment for enteric fever.

Administration, Oral

The declining incidence of infantile hypernatremic dehydration in Great Britain.

The feeding habits of 70 infants under 6 months old hospitalized with acute gastroenteritis were studied to determine whether current efforts to discourage high-solute feeding were having an effect on the incidence of hypernatremic dehydration. Fifteen infants (21%) were fed modified (low-solute) milks and 55 (79%) unmodified (high-solute) milks. Of 47 infants under 3 months old, 15 (32%) had commenced mixed feeding. Plasma sodium level was estimated in 60 infants. Mean values in the modified and unmodified groups were the same, at 137 mEq/liter. Only one infant was hypernatremic (sodium level, 152 m/eq/liter). Osmolalities of 65 samples of milk were measured to provide a measure of milk concentration. Only ten (16%) exceeded by more than 25% that recommended by the manufacturers. Twenty-two (34%) were less than 75% of the recommended concentrations. These improved feeding practices have probably contributed largely to the very low incidence of hypernatremia by preventing dangerously high solute intakes at a time of particular vulnerability.

Acute Disease

Toxic dilatation of the colon in salmonella colitis and inflammatory bowel disease.

Toxic dilatation of the colon may be due to inflammatory bowel disease, either ulcerative colitis or Crohn's disease of the colon, but recent experience has shown that infective colitis due to salmonella can produce this complication. We present 13 cases with toxic dilatation (9 inflammatory bowel disease and 4 salmonellosis) and outline the diagnostic features and treatment in these patients. It is important to distinguish salmonellosis at an early stage because, whilst toxic dilatation in inflammatory bowel disease is an absolute indication for surgical treatment, cases with this complication due to salmonellosis may be treated conservatively in the majority of instances.

Adolescent

The rectal biopsy appearances in Salmonella colitis.

Rectal biopsies were examined from 22 patients with Salmonella infection of food-poisoning type and from seven patients with inflammatory bowel disease and coincidental Salmonella infection. In the former group the changes observed were mucosal oedema with acute inflammation of varying severity but with preservation of the crypt architecture. Crypt abscesses were present in a few cases but were usually localized in the crypt and mucus depletion only occurred with severe inflammation. These features are not specific and are similar to those seen in other types of infective colitis such as Shigella dysentery, gonococcal proctitis and amoebic colitis. In the majority of cases of infective colitis the appearances are usually sufficiently distinctive, however, to distinguish them from those seen in ulcerative colitis and Crohn's disease. The changes in the biopsies from the seven patients with coincidental Salmonella infection were in general those of the underlying idiopathic inflammatory bowel disease.

Adolescent

Colonic involvement in salmonellosis.

Although small intestine is generally regarded as the principal site involved in human salmonella infection of food-poisoning type, the pathophysiology of salmonella diarrhoea remains obscure. A sigmoidoscopic and biopsy study of 23 hospital inpatients with acute salmonella infection revealed presence of active colitis in 21. It is suggested that colonic involvement is common in human salmonellosis and probably plays an important role in the causation of diarrhoea.

Adolescent

The dilemma of partially treated bacterial meningitis.

An analysis of 62 patients with pyogenic meningitis is presented, 23 (37%) of whom had received pre-diagnosis antibiotic therapy. Positive bacteriological identification could be achieved in 73% of the partially treated group as opposed to 97% in the previously untreated group but otherwise such pre-treatment made little impact on the diagnosis, characteristic cerebrospinal fluid changes sufficient for diagnostic purpose being present in all but one case. The study also fails to demonstrate any advantage of immunoelectroosmophoresis over conventional bacteriology in the problem cases of partially treated bacterial meningitis.

Adult

Abdominal tuberculosis in Britain.

A series of fifteen patients with abdominal tuberculosis, managed personally by two clinicians over a five-year period, is presented. These fall into three broad groups: tuberculous peritonitis, gastrointestinal tuberculosis and tuberculous hepatitis. In more than half of the patients the chest radiographs were normal and three patients had negative tuberculin reactions. In emphasizing the fact that abdominal tuberculosis is not longer a rarity in Britain, attention is drawn to the many different ways in which the disease may present. One patient in the series, who presented as a possible case of cholera, had duodeno-colic fistula (only the third proven case in the literature) and two other patients presented with jaundice due to hepatic tuberculosis, again a rare form of abdominal tuberculosis.

Adolescent