An 11 year old male presented with headache, vomiting and weakness of right side of body. One day after admission he developed right focal seizures. He had 5 previous episodes of stroke, the first at 11 months age. His milestones were normal upto the first episode but subsequent mile stones were delayed. His serum and CSF lactic acids were raised. Muscle biopsy showed ragged red fibres on modified Gomori-trichrome staining. His EEG, CT scan and MRI were normal this time. The child improved spontaneously after 7 days. His recovery time progressively became shorter with each episode of stroke. Maximum time for recovery was noted during first episode and least in current episode. This is the first report of Melas syndrome in Indian literature.

Child↗

PubMedDate not supplied

Comparative bioavailability and in-vitro antimicrobial activity of two different brands of rifampicin.

A comparative bioavailability study was undertaken between a new formulation of rifampicin 'Famcin' and a standard formulation of rifampicin 'R-cin' in eight healthy male volunteers at two dose levels: 300 mg and 450 mg given orally under both single dose and steady state conditions. Plasma rifampicin was assayed spectrophotometrically. The study documented comparable rate and extent of bioavailability. (Cmax, Tmax and AUC0-infinity) and elimination half-lives (t1/2) of the two brands of rifampicin when compared at similar dose levels. The study establishes the bioequivalence of Famcin to that of the standard brand R-cin. Further, a comparative in vitro microbiological sensitivity of the two brands of rifampicin was undertaken against several strains of two test micro-organism viz. Staphylococcus aureus and Mycobacterium tuberculosis. For both the micro-organisms the minimal inhibitory concentration of Famcin was lower than that of R-cin, suggesting a somewhat greater potency of Famcin in suppressing the growth of test micro-organisms.

Administration, Oral↗

PubMedDate not supplied

Adrenal histoplasmosis: clinical presentation and imaging features in nine cases.

BACKGROUND: We describe a retrospective analysis of the clinical presentation and imaging features in nine patients with adrenal histoplasmosis in nonimmunocompromised patients from a nonendemic region. METHODS: Clinically, a tuberculosis-like presentation in four patients and a tumor-like presentation in five patients were seen. All patients were seronegative for the human immunodeficiency virus. Ultrasound (US) in all patients, computed tomography (CT) in six, and magnetic resonance imaging (MRI) in three showed suprarenal masses. CT-guided (in five) and US-guided (in four) biopsy and fine-needle aspiration cytology established a definite diagnosis. The work-up for malignancy and tuberculosis was negative. RESULTS: On cross-sectional imaging, eight patients had bilateral adrenal masses and one had a unilateral adrenal mass. Imaging features were variable. All adrenal masses were hypoechoic on US, homogeneous in five, and heterogeneous in four patients. All adrenal masses were hypodense on CT, homogeneous in four, and heterogeneous in two. Heterogeneous enhancement was seen in three, homogeneous enhancement in two, and no enhancement in one patient. MRI in three patients showed that the masses were of variable signal intensity on all pulse sequences. CONCLUSION: Our case series showed that adrenal histoplasmosis does occur in immunocompetent persons living in areas not endemic for the disease. The imaging features were variable.

Adrenal Gland Diseases↗

PubMedDate not supplied

Hydrocolonic sonography in the evaluation of colonic lesions.

BACKGROUND: The present study was done to assess the sensitivity, specificity, ease of examination, and limitations of hydrocolonic sonography (HCS) to evaluate a heterogeneous spectrum of colonic disorders. METHODS: In a prospective study, 100 patients (53 male, 47 female) with clinical suspicion of colonic abnormality were examined by conventional abdominal sonography, HCS, and colonoscopy on the same day. The patients then underwent appropriately planned barium studies. Histopathologic diagnosis was established by colonoscopic/excision biopsies or fine needle aspiration cytology (FNAC) whenever indicated and results correlated. RESULTS: In 94% of patients, it was possible to evaluate the entire colon from the rectosigmoid junction to the cecum. Redundant parts of the colon were not well evaluated by this technique. The rectum could not be adequately evaluated, and rectal examination was not included in the study. HCS can evaluate in great detail both the colonic lumen and wall and, hence, could suggest the nature of the lesion in the majority (87.9%) of cases based on characteristic changes in wall stratification, echogenicity, lumenal changes, and site and length of involvement, although distinguishing between benign and malignant lesions was not always possible. In 93% of patients with tuberculous colitis/ileocolitis, the normal wall stratification was no longer in evidence, with moderate hypoechoic thickening of the wall (average = 8.34 mm). Malignant lesions (93.7%) showed grossly thickened bowel wall with loss of stratification and hypoechoic/heterogeneous echo texture. Intralumenal polypoid masses also were seen in 87.5% of cases, and there was extension beyond the adventitia and involvement of pericolonic tissues in 75% of cases. All patients with ulcerative colitis had only mild hypoechoic wall thickening; the five-layer structure could be clearly discerned in 87.5% of cases. HCS had an overall sensitivity of 90.9% and a specificity of 94.7% in this study. CONCLUSIONS: HCS can be advantageously used for diagnosis and differential diagnosis of inflammatory and malignant colonic lesions and also for follow-up of patients with chronic inflammatory large bowel diseases such as ulcerative colitis.

Adolescent↗