An in vitro assay technique was set up to determine the phagocytic and microbicidal activity of a monocyte-macrophage cell line using Candida species as test organisms. The norms were determined for the activity of peritoneal macrophages of rats (24.69 +/- 2.6% phagocytosis and 35.4 +/- 5.22% ICK) and human (27.89 +/- 3.63% phagocytosis and 50.91 +/- 6.3% ICK). The assay technique was used to test the degree of activation of macrophages induced by metronidazole, Tinospora cordifolia and Asparaqus racemousus and to compare their effects with a standard immunomodulator muramyl-dipeptide. All the three test agents increased the phagocytic and killing capacity of macrophages in a dose dependent manner upto a certain dose, beyond which either these activities were found to have plateaued or decreased. The optimal doses for MDP, Metronidazole, Asparagus racemosus and Tinospora cordifolia were found to be 100 micrograms, 300 mg/kg, 200 mg/kg and 100 mg/kg respectively. Patients with cirrhosis were screened for defects in monocyte function. The depressed monocyte function (20.58 +/- 5% phago and 41.24 +/- 12.19% ICK; P < 0.05) was observed indicating a compromised host defense. The utility of this candidicidal assay in experimental and clinical studies is discussed.

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A rare case of gastric lipoma presented to us with hematemesis and symptoms of obstruction. On oesophagoduodenoscopy, a mass projecting in the lumen of stomach was found. Barium meal examination revealed a mass in the antral region suggestive of malignancy. The diagnosis of lipoma was suspected only after exploration. It was confirmed following incision through the serosa. The lipoma was enucleated without any damage to mucosa.

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A cadaveric dissection study of 54 upper extremities to determine the incidence of occurrence, morphology and relations of the occasional head of the flexor pollicis longus muscle is presented. The occasional head of the flexor pollicis longus muscle was found to be present more frequently (66.66%) than absent. It mainly arose from the medical epicondyle of the humerus (55.55%) and the medial border of the coronoid process of the ulna (16.66%). It was found to be in close association with the median nerve (anteriorly) and the anterior interosseous nerve (posteriorly). The clinical implications of these findings are discussed viz. entrapment neuropathies of the median and anterior interosseous nerves, cicatricial contraction of the occasional head leading to flexion deformity of the thumb and the likely necessity to lengthen/release the occasional head in spastic paralysis of the flexor pollicis longus muscle.

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An 11 year old boy presenting with cystic lump in left hypochondrium was diagnosed to have splenic cyst and treated successfully by splenectomy. Large, infected cyst involving hilum was the indication.

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A 32 yr old male patient with history of convulsion and bitemporal headache was diagnosed as suffering from tuberculoma based on CT Scan. He worsened after anti-tuberculous therapy. The patient underwent parieto-occipital craniotomy with drainage of abscess. The histopathological examination of brain abscess revealed the infection with cladosporium bantianum. The details of this rare case of opportunist fungal cerebral lesions in healthy individual are reported.

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An unusual presentation of bilateral otogenic cerebellar abscesses observed in two of our patients is reported. Both gave a history of otorrhoea, fever, headache, vomiting and had bilateral cerebellar signs and conductive hearing loss. The abscesses were detected on computerised tomography. X-rays revealed bilateral mastoiditis. The therapy followed was excision of abscesses, mastoidectomy and antibiotic therapy.

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Thirty patients (ASA I or II) requiring spine surgery under general anesthesia were studied. To induce hypotension, halothane 0.5 to 2.5% (n = 15) or nitroglycerin infusion (1-2 micrograms/kg/min) (n = 15) was used. The parameters studied were blood pressure, blood loss, operating time and recovery score. The systolic blood pressure was maintained between 80-100 mmHg during surgery in both the groups. The blood loss with nitroglycerin was significantly less (202 +/- 114 ml) than halothane group (602 +/- 312 ml). All the patients were alert at the end of surgery in the nitroglycerin group (recovery score 9.8 +/- 0.76) as against the halothane group (7.98 +/- 0.9 p < 0.01). Tachycardia or tachyphylaxis was not observed with nitroglycerin. This study suggests that continuous intravenous infusion of nitroglycerin is effective and safe in reducing blood loss and operating time during spine surgery.

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This study analyses patients with vesical fistulae presenting at a teaching, referral hospital over the last ten years. There were 62 cases of vesical fistulae of which 60 were obstetric in origin (44 home and 16 hospital deliveries) and 2 were following gynaecological surgery. Of the hospital deliveries which culminated in fistula formation, 8 were vaginal and 7 forceps deliveries. In one patient, lower segment caesarean section was carried out. After a thorough urological work-up, patients were subjected to standard technique of layered closure (61 by vaginal approach and one by abdominal). Repair was successful in 53 (87.09%) patients. Of the 9 failures, 4 were repeat repairs.

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A young female who underwent nephrectomy for renovascular hypertension was diagnosed on histology to have tuberculosis of the renal artery. This was an isolated finding as there was no tuberculous infection elsewhere including tissues in the vicinity of the vessels. A survey of literature did not yield any reports of tuberculous renal arteritis, making this the first such case.

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On 13th March 1993 consequent to a series of explosions in the city a large number of casualties were attended to at this hospital. A total of 248 patients were treated for various injuries which included 85 minor and 34 major operations. Seventy-nine patients were brought in "dead on arrival". There were 12 deaths after admission out of which 6 patients died after surgery. The cause of death was hemorrhagic shock in 5 patients, burns in 2, severe head injury in 2, and shock lung in 3 patients.

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Bombay experienced a violent outbreak of communal rioting in January 1993. Four hundred and thirteen casualties were treated in the KEM hospital from January 7 to January 15, of which 194 required admission and further management. Twenty-seven were brought dead on arrival. The large influx of casualties sustained over a period of 9 days tended to overwhelm the medical facilities. The data of the admitted patients are analyzed to identify the frequency of admissions, cause and nature of injuries sustained, management and prognosis of casualties in such a catastrophe. An attempt is also made to identify the problems faced during such a crisis and a few suggestions made for their solution.

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A tumor was found to be arising from the right maxillary alveolar margin of a newborn baby. No other congenital abnormality was detected. Following excision and histopathological examination, diagnosis of benign congenital granular cell epulis was made. The post-operative course was uneventful.

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Acetic acid is used conventionally for enhancement of the colposcopic image. We used sulphosalicylic acid instead of acetic acid in 50 normal cases. The normal appearance was enhanced in all cases. The image was also enhanced in 70% cases of cervical intraepithelial neoplasia and 90% cases of cervical condyloma accuminata. The image was not inferior to that with acetic acid in any of the cases.

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In a period of ten years from January 1, 1979 to December 31, 1988, 54 cyanotic patients weighing less than 10 kg underwent shunt operations of Blalock Taussig type. The indications were hypercyanotic spells, failure to thrive and pulmonary arteries being too small for safe total collection. The commonest diagnosis was tetralogy of Fallot (63%). Thirty-three (64%) patients were older than 1 year but still weighed less than ten kg. Mortality was 16.67% (70% C.L. 8.94-26.60). During follow-up, there were 4(7%) late deaths. During the same period, 134 patients less than 5 years age came to autopsy without having any cardiological or surgical intervention. Ninety-seven (72.4%) of these deaths were due to cardiac causes. In order to save their lives, early identification is necessary which highlights the importance of parent and primary physician education.

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