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Acute liver failure (ALF) is a rapidly progressive critical illness with high mortality. Complex intensive care unit (ICU) protocols and emergency liver transplantation (ELT) are now often available, but rarity and severity of illness have limited its study and evidence-base for care. We reviewed patients treated over a 35-year period at a specialist high-volume ICU, quantifying changes in disease aetiology, severity and evolution of ICU support and ELT use and outcome.Review of adult patients admitted during the period 1973-2008, with acute liver dysfunction and coagulopathy with overt hepatic encephalopathy (ALF) and those without (acute liver injury; ALI).3305 patients fulfilled inclusion criteria, 2095 with ALF. Overall hospital survival increased from 30% in 1973-78 to 76% in 2004-08; in ALF from 17% to 62% (both p0.0001). In ALF patients treated without ELT, survival rose from 17% to 48% (p0.0001); in those undergoing ELT (n=387) from 56% in 1984-88 to 86% in 2004-08 (p0.01). Coincident with drug sales-restriction, paracetamol-related admissions fell significantly. Viral admissions fell from 56% to 17% of non-paracetamol cases (p0.0001). Admission markers of liver injury severity fell significantly and the proportion of patients with intracranial hypertension (ICH) fell from 76% in 1984-88 to 20% in 2004-08 (p0.0001). In those with ICH, mortality fell from 95% to 55% (p0.0001).The nature and outcome of ALF have transformed over 35 years, with major improvements in survival and a fall in prevalence of cerebral oedema and ICH, likely consequent upon earlier illness recognition, improved ICU care, and use of ELT.

This article presents a case of a patient with undiagnosed ulcerative colitis who presented with autoimmune haemolytic anaemia.

Multiple papilloma of larynx is caused by human papilloma virus. We treated sixteen such cases (10 males and six females) in the last 10 years. All presented with hoarseness while six presented with difficulty in respiration. Three patients needed tracheostomy, all had difficult decanulation, and one developed laryngotracheal stenosis and could not be decanulated. All were treated by surgical excision; ten had recurrence. Four patients were treated with post operative Acyclovir with no recurrence in three cases.

Objective The objective of this research was to estimate serum selenium levels in patients with head and neck cancer and to correlate them with tumour burden, as well as to study the effect of radiotherapy on serum selenium levels to determine its prognostic significance. Design This prospective study was carried out by selection of head and neck cancer patients using periodic random numbers. Setting This was a hospital-based study. Methods Estimation of serum selenium was done using the Atomic Absorption Spectrophotometer (Model AAS 4129; Electronic Corporation of India Ltd., Hydrabad, India) with a hydride generator after digestion of the serum sample. Main outcome measures Patients were followed for 1 year postradiotherapy for any change in serum selenium level and its correlation with the outcome of the treatment. Results All 30 patients had serum selenium levels significantly lower as compared with controls, and these levels decreased further as tumour burden increased. Levels came within normal range after 1 year of radiotherapy in 10 patients who were cured but in the remaining patients who had residual disease, levels remained persistently low. Conclusions The serum selenium level may serve as a useful marker in head and neck cancer.

The nasal mucociliary clearance time was studied using Andersen saccharin method in 50 normal children and 50 age and sex matched patients of adenotonsillar hypertrophy, which was repeated one month after adenotonsillectomy. The normal mucociliary clearance time in healthy children was found to be 8.55 +/- 2.11 minutes. A significant impairment in nasal mucociliary clearance time was noted in children suffering with adenotonsillar hypertrophy which was 16.97 +/- 3.1 minutes, and early adenotonsillectomy restored the mucociliary clearance to a normal 8.7 +/- 2.14 minutes.

Objectif: Les objectifs de notre etude etaient d'etudier la presentation de la stylalgie en Inde et d'etudier les resultats de la styloidectomie chez ces patients. Devis: Etude prospective avec selection aleatoire des patients vus a l'hopital. Methodes: Exerese chirurgicale des processus styloides chez les patients symptomatiques par approche transamygdalienne et en utilisant une curette pour dilatation et curettage (D et C). Mesures: Suivi post-operatoire quant au soulagement de la douleur. Resultats: De 40 patients operes, 31 (77.5%) sont devenus asymptomatique, 5 (12.5%) ont note une amelioration considerable dans leurs symptomes, et 4 (10%) n'ont note aucune amelioration. Conclusions: Nous avons trouve que l'incidence de styloide allongee est plus elevee chez les femmes Indiennes de la campagne probablement a cause des lourds fardeaux qu'elles transportent sur leur tete. La styoidectomie est tres satisfaisante. Nous avons trouve que la curette de D et C est un outil tres efficace pour la styloidectomie.