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[1] We present new data on the nitrate (new production), ammonium, urea uptake rates and f-ratios for the eastern Arabian Sea (10° to 22°N) during the late winter (northeast) monsoon, 2004, including regions of green Noctilucascintillans bloom. A comparison of N-uptake rates of the Noctiluca dominated northern zone to the southern non-bloom zone indicates the presence of two biogeochemical regimes during the late winter monsoon: highly productive north and less productive south. The conservative estimates of photic zone-integrated total N-uptake and f-ratio are high in the north (∼19 mmolNm−2d−1 and 0.82, respectively) during the bloom and low (∼5.5 mmolNm−2d−1 and 0.38 respectively) in the south. The present and earlier data imply persistence of high N-uptake and f-ratio during blooms year after year. This quantification of the enhanced seasonal sequestration of carbon is an important input to global biogeochemical models.

Needle knife precut papillotomy has been used to gain access or remove impacted common bile duct stones at the ampulla of Vater. However, precut papillotomy is a risky procedure with high complication rates and is presumably best dealt with by the expert. We attempted to find out the feasibility of performing conventional endoscopic sphincterotomy in patients with impacted stones at the ampulla.All patients undergoing endoscopic retrograde cholangiopancreatography for stones impacted at the ampulla between the years 2000 and 2005 were enrolled in the study. All attempts were made to achieve biliary cannulation through the conventional route including use of the long route or guidewire to cannulate the papilla. Needle knife papillotomy was resorted to only if attempts to cannulate the papilla through the conventional route failed. The success and complications of the procedures were recorded.Thirty-two patients were enrolled. The impacted bile duct stone could be removed in all the patients. Conventional endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy were performed in 23 patients with impacted stones. The long route had to be employed in seven patients while guidewire cannulation of the papilla was needed in four patients. Needle knife papillotomy was needed in only nine patients. None of the patients in whom the conventional route was employed developed complications, whereas bleed requiring endoscopic management was observed in three (33%) of the nine patients in whom needle knife papillotomy was performed.Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy can be performed by the conventional route in the majority of patients with impacted stones at the ampulla. This approach appears to be safer than needle knife papillotomy. However, needle knife papillotomy may be required in patients in whom biliary access cannot be gained through the conventional approach.

Jejunogastric intussusception is a known complication following gastrojejunostomy. However, only occasionally have they presented with haematemesis and we are unaware of any case where it led to recurrent haematemesis. We describe a case where the patient developed recurrent upper gastrointestinal bleeding due to recurrent episodes of jejunogastric intussusception following gastrojejunostomy performed 12 years earlier for duodenal ulcer disease.

BACKGROUND AND STUDY AIMS: Endoscopic sphincterotomy followed by extraction using a Dormia basket or an extraction balloon catheter is the procedure that is generally used for the removal of bile duct stones. This is not successful in all patients, however, and some stones have to be extracted using lithotripsy devices. In an attempt to avoid mechanical lithotripsy, we used large-diameter balloons after sphincterotomy for removing stones that could not be extracted using the conventional methods. PATIENTS AND METHODS: In this retrospective pilot study, large-diameter (15-mm, 18-mm, or 20-mm maximum sizes) balloon dilation of the sphincterotomy site was performed in 50 patients in whom bile duct stones could not be removed by endoscopic sphincterotomy and Dormia basket or balloon catheter extraction. RESULTS: The stones varied in size from > 15 mm to 25 mm. Common bile duct stones could be removed in all the patients using the large-diameter balloon technique. A Dormia basket or an extraction balloon catheter was required for removal of stones in 29 patients (58 %); and mechanical lithotripsy was required in five patients (10 %). Minor oozing of blood was seen in 16 patients (32 %), but the ooze stopped spontaneously during the endoscopy. Melena occurred in two patients and major bleeding requiring surgery occurred in one patient. Mild acute pancreatitis that resolved with conservative management occurred in four patients (8 %). There were no perforations and no deaths. CONCLUSIONS: Large-diameter balloon dilation of the sphincterotomy site is an effective procedure for removal of bile duct stones that cannot be extracted by endoscopic sphincterotomy and conventional extraction devices. Mechanical lithotripsy could be avoided in the majority of these patients using this approach.

Effective photoproduction of ammonia from dinitrogen has been achieved in a system consisting of a cell suspension of cyanobacteriumNostoc treated with a low concentration ofl-methionine sulfoximine (MSX). As a result of inactivation of cellular glutamate-ammonia ligase by MSX, growth was prevented, the rate of nitrogenase activity increased and about 90% of ammonia resulting from dinitrogen fixation was exported and accumulated in the ambient medium. The rate of NH4+ production was found to be regulated by different factors such as light-dark cycle, cell density, depth of culture and air bubbling. Ammonia production was stimulated by (i) a culture density corresponding to 1.5 μg chlorophyll a per mL, (ii) a depth of 10 mm, and (iii) continuous illumination for 24 h. The nitrogenase activity was found to be enhanced in the experimental sets where ammonia production was maximal.

Sequence of the images from IRS P4 / OCM satellite and extensive shipboard sampling programme are used to understand the seasonal variation of phytoplankton abundance and types in the Northeastern (NE) Arabian Sea and Lakshadweep Sea. An appreciable degree of spatial and temporal variability is observed in chlorophyll a distribution from November to April months, as well as coastal and offshore stations, indicating marked seasonality in phytoplankton distribution in NE Arabian Sea. During November month (fall intermonsoon) average chlorophyll a (Chl a) by fluorometer was (0.799 mgm^-3) and by OCM it was 0.584 mgm^-3. The higher chlorophyll a observed was due to Trichodesmium (cyanobacteria) blooms. During December the average chlorophyll a was 0.34 mgm^-3 also due to Trichodesmium filaments in water column. During January onwards winter cooling led to increase in nutrients which enhanced chlorophyll a value to 0.64 mgm^-3 due to growth of flagellates (as seen by high chlorophyll b besides chlorophyll a) in water column. February, March and April supported moderately high chlorophyll value (0. 3 to 0.5 mgm^-3) due to growth of prasinophytes (as seen by pigment prasinoxanthin) and blooms of the Noctiluca miliaris. Time series monitoring of Noctiluca bloom was also conducted using OCM based chlorophyll images in NE Arabian Sea. During February chlorophyll a retrieved by OCM was 0.3 to 0.9 mgm^-3. Pigment analysis of water samples indicated the equal important of accessory pigment like zeaxanthin, prasinoxanthin, beta-carotene. The relevance of these pigments estimated by HPLC like zeaxanthin (cyanobacteria), fucoxanthin (diatoms), peridinin (dinoflagellates) is presented and discussed. Similarly, exercise is conducted in Lakshadweep waters where Trichodesmium related peak in chlorophyll a was observed during March onwards in OCM data. The average chlorophyll a in NE Arabian Sea at surface during November was (0.726 mgm^-3), December (0.34 mgm^-3), January (0.723 mgm^-3), February (0.344 mgm^-3), March (0.963 mgm^-3) and April 0.665 mgm^-3. Similar trend was observed in primary productivity estimates. The attempt is made to work out seasonality in the productivity of the Arabian Sea using OCM derived chlorophyll and relation of enhancement in productivity due to development of winter blooms in the Arabian Sea. The environmental conditions (temperature, wind, nutrients and mixed layer depth) affecting these blooms responsible for year to year variation in bloom biomass and productivity is also presented in detail.

An artificial neural network (ANN) based procedure is developed to estimate concentrations of Chlorophyll-a, Suspended Particulate Matter (SPM) and absorption due to chromophoric dissolved organic matter (CDOM) in the seawater from satellite detected normalized water-leaving radiance (nLw) of the IRS-P4 Ocean Colour Monitor (OCM) satellite data. An ocean colour reflectance model was used to generate surface spectral reflectance corresponding to first five bands of IRS-P4 OCM sensor, using three optically active oceanic water constituents as inputs. ANN model making use of reflectance in five visible bands was trained, tested and validated to invert the spectral reflectance for the simultaneous estimation of three optically active constituents. The retrieved chlorophyll-a concentrations from ANN based algorithm were compared with the corresponding chlorophyll-a distribution obtained by global empirical algorithms e.g. Ocean Chlorophyll-4 (OC4) algorithm. ANN derived chlorophyll-a estimates were found to have reduced the over estimation in coastal waters often observed with the use of band ratio algorithms.

In-situ measurements of the bio-optical properties of the seawater are important to develop algorithms for seawater constituent estimation using satellite remote sensing. A data collection campaign was conducted for bio-optical characterization of the open and coastal waters of the Arabian Sea during April 15-29, 2006. Bio-optical measurements were made using the Satlantic hyper-spectral underwater radiometer (Hyperpro-II) for 13 sampling stations include oligotrophic, Trichodesmium bloom dominated and coastal waters in 400-800 nm spectral range. For open oceans stations 1% light was available at 50 to 70 meter depth, whereas, for coastal waters it varied from 18 to 35 meter. The deep chlorophyll maxima (DCM) was observed at 30 to 42 meter depth during the bloom conditions with surface chlorophyll-a concentration ranging between 0.1 to 0.85 mg m-3 whereas, for open ocean and non-bloom conditions the DCM depth varied from 35 to 60 m with surface chlorophyll ranging between 0.05 to 0.12 mgm-3. Particulate back scattering coefficient at 700-nm vary from 0.0011 to 0.0031 for bloom waters and 0.00046 to 0.0012 for open ocean waters. The normalized water leaving radiance computed from these spectra in the spectral bands of IRS-P4, OCM bands were examined. The global ocean chlorophyll-2 (OC2), and 4 (OC4) algorithms performed reasonably well for open ocean waters, however both the algorithms overestimated chlorophyll concentration for bloom dominated waters.

Arabian Sea is highly influenced by monsoon systems like SW monsoon (June-September) and NE monsoon (December-February). This affects distribution pattern of phytoplankton, availability of nutrients and changing temperature specially during winter cooling period (February-March). These and other conditions like quality and quantity of light influence phytoplankton (type and concentration) in the Arabian Sea. In our study we have observed monsoon related peaks in phytoplankton and chlorophyll a in the Arabian Sea. These chlorophyll a (Chl a) concentrations detected by OCM sensor onboard IRS-P4 satellite is helping us to work out seasonality of phytoplankton in the Arabian Sea, which is of the great importance in the field of biology and biogeochemistry of this region. However, during these study subsurface chlorophyll a maxima (SCM) was observed as characteristics feature of chlorophyll a distribution in the Arabian Sea. The subsurface chlorophyll a maxima varies from 30m to 55m in the Arabian Sea during various seasons. During November at St. 1 surface chlorophyll a was 1.503 mgm^-3 and subsurface chlorophyll maxima was 12.692 mgm^-3. Similarly, at St. 13 surface chlorophyll a was 0.584 mgm^-3 and surface chlorophyll maxima was 8.517 mgm^-3. During upwelling, nutrients remained unused at sub surface due to shortage of light which may lead to subsurface blooms, detection of which is critical for precise estimation of chlorophyll a from ocean colour sensor. During our 5 year study (covering all the seasons) in northeastern (NE) Arabian Sea, we have observed more than 50 % stations were with subsurface chlorophyll a maxima where chlorophyll a was approximately 10 times higher compared to surface value. The high chlorophyll some time detected by OCM is mainly because of detection of subsurface chlorophyll maxima by the satellite but may not actually sampled during ship studies. The satellite penetration depth (ze), subsurface chlorophyll maxima depth, OCM derived chlorophyll a for different seasons in NE Arabian Sea is presented and discussed in this paper.

Primary gastric lymphoma is a rare tumour. It is thought that low grade gastric mucosa associated lymphoid tissue lymphoma has not been previously reported to occur in a patient with gastrojejunostomy. This report describes such a case. The patient presented with bleeding from non-healing stomal ulcers. The ulcers healed and there was regression of the tumour after eradication of Helicobacter pylori.

An asymptomatic 64-year-old patient came for a routine check-up following inferior wall myocardial infarction (MI) and stent insertion in France 6 months previously. He had no cardiovascular risk factors or significant past medical history. Systemic examination was normal as were his haematological and biochemical parameters. A routine echocardiogram (TTE) revealed a mass on the non-coronary leaflet of the aortic valve (AV) with normal left ventricular function and no other valvular abnormalities. Subsequent transoesophageal echocardiography confirmed a pedunculated echogenic mobile mass 0.5–1 cm in diameter attached to the aortic side of AV (Fig. 1a and online video files). Further imaging with cardiac MR described the hypointense mobile mass as possible fibroelastoma. The patient underwent excision of the tumour (Fig. 1b) and AV replacement. Histopathology revealed a central fibrous core surrounded by a layer of loose connective tissue with variable elastic tissue with the surface covered by endothelial cells, consistent with papillary fibroelastoma (Fig. 2). His post-operative recovery was uneventful and was later discharged. Papillary fibroelastoma is a rare, benign cardiac tumour accounting for 10 % of all cardiac tumours [1]. They are generally found on aortic and mitral valves. Patients may present with neurological events, stroke, angina, myocardial infarction, sudden death or as incidental findings on autopsy or at surgery. TTE is useful in making the diagnosis. Treatment in asymptomatic patients is controversial. However, left-sided tumours may be considered for surgery as they can embolise causing strokes, MI, peripheral ischaemia and even vascular obstruction. Though rightsided tumours follow a more benign course, they can interfere with cardiac output if bulky enough.

Due to improvements in imaging techniques and immunodiagnostic methods there has been a spurt of cases of hepatic hydatidosis. Till now surgical management in the form of marsupialization and tube drainage, omentoplasty or hepatectomy was the mainstay of treatment. Recently treatment options have improved considerably after introduction of the PAIR (precutaneous aspiration, injection of scolicidal agent and reaspiration) procedure. In this study we report the results of ultrasound guided PAIR procedure in 39 hepatic hydatid cysts.All patients with hepatic hydatid cysts underwent the PAIR procedure under ultrasound guidance. The scolicidal agent used was 20% hypertonic saline. Type I and II (n=24) cysts were managed by precutaneous aspiration while type III and IV showing a multiloculated or pseudotumour appearance (n=15) cysts were managed by the percutaneous placement of a Malecot's catheter which was removed after 3-7 days.All patients responded to the PAIR procedure. The commonest ultrasonographic appearance in hepatic hydatid cyst patients was a solitary uniloculated cyst with prominent back wall echoes in the right lobe of the liver. The complications encountered were in the form of mild hypotension (two cases), urticaria in one patient and severe hypotension leading to shock in one case.The PAIR procedure was found to be effective, cheap and safe in the non-surgical management of hepatic hydatid cysts.

The association between apolipoprotein E (apo E) polymorphism and stroke has been controversial. So far there are no studies reported on the polymorphism of apolipoprotein E in cerebrovascular diseases in the Asian Indians. A blinded case-control study was therefore undertaken and the apo E genotypes and lipid profile of a total of 120 subjects (63 stroke patients and 57 healthy controls) were done. The frequency distribution of apo E alleles and genotypes were assessed and their relation with the occurrence of stroke in Asian Indian subjects was determined. A significantly high frequency of apo epsilon4 allele (30%) was observed in the stroke patients than the controls (11%) (p0.005), and patients with epsilon4 allele had a fourfold higher odds to develop stroke OR (95%CI) 4.2 (1.8-10.1) (p0.005). On multivariate analysis, after adjusting for age, triglycerides and hypertension, the association of epsilon4 allele with stroke was found to be no longer statistically significant, OR (95%CI) 1.2 (0.4-4.5) (p = NS). On multiple logistic regression analysis age, OR (95%CI) 1.1 (1.1-1.2) (p0.001), and hypertension OR (95%CI) 15.1 (2.6-89.1) (p0.005) were found to be independent risk factors for development of stroke. This is the first report to have examined the association of apo E gene polymorphism with stroke in the Asian Indians. This study suggests that apo epsilon4 allele, triglycerides, age and hypertension are the predictors for stroke development.

Two antral biopsies each from 104 patients of leprosy and 100 controls were studied to find out the prevalence of H. pylori and associated histopathological changes. Sections were stained with hematoxylene and eosin, AB/PAS (Ph 2.5) and Loeffler's methylene blue stains. Infection by H. pylori, inflammation and atrophy were found to be significantly more in leprosy patients as compared to controls (p0.01,0.005 and0.02 respectively). On comparing the histopathological changes in various subgroups of leprosy, H. pylori, inflammation and activity showed a statistically decreasing trend from tuberculoid to lepromatous subgroups (p0.05,0.001,0.01 respectively). Atrophy showed a significant increasing trend from tuberculoid to lepromatous group (0.001), it is concluded that despite a low prevalence of H. pylori and associated gastritis in patients with lepromatous leprosy, gastric epithelial damage is more marked due to altered immune response.

To determine the prevalence of spider angiomata in patients with cirrhosis, the factors influencing them and whether or not they are present in the retina of patients with cirrhosis, 93 cirrhotics were studied. Cutaneous spider angioma were seen in 19 (20%) patients. All patients with spiders had at least one episode of variceal bleeding and had grade III or IV oesophageal varices. Spiders were seen more commonly in patients with alcoholic cirrhosis than in those with non-alcoholic cirrhosis (53.5% vs 6%, p0.001), in patients with Child's C cirrhosis than those with Child's A and B cirrhosis (67% vs 4%, p0.001). However, although spiders were seen more often in patients undergoing sclerotherapy than those not, the difference was statistically not significant (23% vs 19%, p = NS). Spiders had no association with presence or absence of portal hypertensive gastropathy or gastric varices. None of the patients showed any abnormality or presence of spiders in the retina. It is concluded that spider angiomas are seen more commonly in patients with alcoholic cirrhosis, those with more severe liver disease and patients having large oesophageal varices and they are not seen in the retina of patients with cirrhosis.

To determine the clinical and ultrasound appearances of carcinoma gallbladder in Indian patients.The study included all patients suspected to have gallbladder malignancy, attending the gastroenterology department from January 1989 to February 1997. These patients underwent ultrasonographic examination with a grey scale sector scanner (Aloka SSD-630) with a 3.5 MHz transducer after an overnight fast. Histological confirmation was done at surgery, by US guided fine needle aspiration cytology or by direct biopsy/aspiration of the palpable mass.There were a total of 92 cases of cytologically and histologically proven carcinoma of gallbladder. A distinct female preponderance was seen with a male:female ratio of 1:3.6. The mean +/- SD age was 47.9 +/- 19.6 years (range 25-75 years). The histological confirmation was done at surgery in 10% of patients, by US guided fine needle aspiration cytology in 50 cases (54%) or by direct biopsy/aspiration of the palpable mass in 33 (36%) of cases. Pain in the right hypochondrium was the commonest presenting symptom (91%) followed by anorexia (88%) and weight loss (67%). Surgical obstructive jaundice was observed in 54% cases while 10.9% presented with biliary sepsis. A mass of mixed echogenicity protruding in the lumen of the gallbladder was seen in the majority of cases (52.8%). Less commonly infiltration of the gallbladder wall (33.7%) or a mass replacing the gallbladder (14.1%) was encountered. Gallstones were associated in 57% of patients with gallbladder malignancy. The elevated stone sign and peripancreatic nodal spread were important clues for gallbladder malignancy.A high index of suspicion of gallbladder malignancy in elderly Indian female patients presenting with features of choletithiasis, and awareness of the ultrasound findings may lead to early diagnosis and radical resection of this highly lethal malignancy.

To report the clinical features, endoscopic appearance, management and outcome of patients with upper gastrointestinal bleeding due to Mallory-Weiss tear seen at our institution during the last seven years.A retrospective study of all patients with upper gastrointestinal bleeding seen during the last seven years was performed. Patients who were bleeding from longitudinal non-perforating tear(s) of the gastro-oesophageal mucosa were included in the study and their clinical features, endoscopic appearance management and outcome were recorded.During the study period 426 patients with upper gastrointestinal bleeding were seen. Sixty-six (15.5%) of these were found to have bled or were bleeding from Mallory-Weiss tear(s). Twenty-seven (41%) patients with Mallory-Weiss tear had no antecedent nausea, retching, abdominal pain or vomiting. Two patients had portal hypertension and a solitary case bled from an iatrogenic tear induced during routine upper gastrointestinal endoscopy. Multiple bleeding episodes were seen in 12% of cases. Twenty (30%) patients needed endoscopic sclerotherapy. Haemostasis was achieved in all. Except retrosternal pain, no procedure related complications were seen.Mallory-Weiss tear is a common cause of upper gastrointestinal bleeding. Nearly half of the patients have no antecedent symptoms and presented for the first time with upper gastrointestinal bleeding. Endoscopic therapy is very effective and safe in producing haemostasis in these patients.

Acute appendicitis caused by Ascaris lumbricoides is an uncommon variant of a common disease. We describe a case in which sonography was used for preoperative diagnosis of ascaris appendicitis.

A 30-year-old female was seen with symptoms and radiological evidence of gastric outlet obstruction. Endoscopic examination revealed findings suggestive of gastric outlet obstruction with nodularity of the antral mucosa leading to deformity of the pylorus. Endoscopic biopsies from the nodular antral mucosa showed presence of Helicobacter pylori-induced lymphonodular hyperplasia without evidence of mucosa-associated lymphoid tissue lymphoma. Anti-H. pylori therapy resulted in eradication of the H. pylori infection and the signs and symptoms of gastric outlet obstruction. The case demonstrates that H. pylori-induced lymphonodular hyperplasia can also cause gastric outlet obstruction. We believe this is the first such case to be reported.

Since it was first described in 1974, endoscopic sphincterotomy has been the procedure of choice for management of choledocholithiasis, especially for retained common bile duct stones. However, it has the dubious distinction of being the most hazardous of all endoscopic retrograde cholangiopancreatographic procedures and carries an immediate complication rate of 8-10%. Concern has also been voiced about the long-term complications of sphincterotomy, as the sphincter of Oddi is cut during the procedure. To prevent, or at least lessen, the short- and long-term complications of endoscopic sphincterotomy, an alternative in the form of balloon dilatation of the papilla, has been advocated. However, the procedure of balloon dilatation is cumbersome, time consuming and, more importantly, a recent multi-centre study from the US comparing endoscopic sphincterotomy with balloon dilatation observed higher complications with balloon dilatation. The use of nitrites to relax the papilla is another novel method used for removal of common bile duct calculi. So how should a therapeutic endoscopist decide which method is to be used? The advantage of endoscopic sphincterotomy is that it has been around for more than two decades and most endoscopists are familiar with the technique as well as its complications. It can be accomplished quickly and with the advent of wire-guided and balloon-mounted sphincterotomes, the time taken for the procedure to be completed has been reduced further. The complications of the procedure are less when it is employed for removal of common bile duct stones and when used by experts. It, therefore, still appears to be the procedure of choice for endoscopic management of choledocholithiasis. The other two methods may, however, be useful in patients with coagulopathy.

Summary Fifty-five patients with oral submucosal fibrosis and an equal number of patients with no evidence of the disease were studied. All patients underwent upper gastrointestinal endoscopy and any abnormality was noted. Multiple oesophageal biopsies were obtained from the upper end of the oesophagus and from any endoscopically observed abnormality. The histological changes in the two groups were assessed blindly by an experienced histopathologist. Histological abnormalities were noted in the oesophageal mucosa in 2% of controls and 66% of patients with oral submucosal fibrosis (p < 0.0001). In the control group, acanthosis was seen in one patient, while in the patient group atrophy of the squamous epithelium was evident in 52%, hyperkeratosis in 52%, parakeratosis in 30%, dyskeratosis in 14%, acanthosis in 14%, and papillomatosis and mild dysplasia in 2% patients. Subepithelial collagenization was seen in 32 (64%) patients. The oesophageal abnormalities were seen more frequently in patients who had consumed Pan masala, Gutka, betel nut, tobacco or a combination of some or all of these, with or without betel leaf, for > or = 5 years compared to those consuming them for a shorter period of time (91% vs 46%, p < 0.001). It is concluded that oral submucosal fibrosis is not a disease confined to the oral cavity; the oesophagus may also be involved in about two-thirds of patients.

Imprint cytology of the gastric mucosa has been found to be very simple, inexpensive, and rapid for diagnosing Helicobacter pylori infection. However, there is a fear that preparing imprint smears may damage the biopsy specimen for subsequent histologic examination. This study was planned to investigate whether this damage happens. Four antral biopsy specimens were obtained from each of the 100 patients undergoing upper gastrointestinal endoscopy. Imprint smears were made from two biopsy specimens, which were then fixed in 10% formal saline and sent for histologic study. The third and fourth biopsy specimens were directed fixed in 10% formal saline for histologic examination. Two pathologists examined the imprint smears. Agreement between the two observers was observed in 97% of cases. Beyond-chance agreement was good with a kappa index of 0.90. H. pylori organisms were seen in 82% of biopsy specimens from which imprint smears were prepared and in the same percentage of biopsy specimens that were processed directly. The pathologists could not identify the histologic sections form which imprints were made. It is concluded that imprint cytology is an excellent method of diagnosing H. pylori infection and that preparing imprint smears does not alter the quality of the tissue. The same biopsy specimen can be used for histologic studies.

The injection of sclerosants and adrenaline in a bleeding peptic ulcer is known to arrest bleeding in the majority of patients. However, there are very few studies from India on this subject. Injection therapy was carried out using absolute alcohol in 21 patients with bleeding gastric ulcer and 55 with bleeding duodenal ulcer. Injection therapy successfully controlled bleeding in all 76 patients. Bleeding recurred in two patients who were successfully managed with a second injection of absolute alcohol. Post-injection blood transfusion was required in 16 (76%) patients with gastric ulcer compared with only 12 (22%) of those with a duodenal ulcer. The difference was statistically significant ( P < 0.001). No complication of injection therapy was noted. It is concluded that injection therapy using absolute alcohol is a safe and effective therapy for managing patients with bleeding peptic ulcer.

We report a patient who developed oesophageal stricture after accidental ingestion of acid. During one of the oesophageal dilation sessions, a Savary-Gillard guide-wire got entrapped in the stomach and had to be removed surgically. A Foley catheter, placed for feeding purposes, migrated into the proximal small intestine causing acute intestinal obstruction. The balloon of the Foley catheter had to be punctured using a sclerotherapy needle and the catheter withdrawn.

Sections from eighty nine specimens of gall bladder including 40 cases of chronic cholecystitis, 9 dysplasia 15 well differentiated adenocarcinoma, 14 moderately differentiated adenocarcinoma and 11 poorly differentiated adenocarcinomas were studied for argyrophilic nucleolar organizer regions (AgNOR's). The difference between mean +/- SD NOR counts of chronic cholecystitis (1.97 +/- 0.28), dysplasia (5.6 +/- 0.88) well differentiated adenocarcinoma (7.2 +/- 0.30) and moderately differentiated adenocarcinoma (8.0 +/- 0.63) was statistically significant (p0.001). NOR counts of poorly differentiated adenocarcinoma (8.5 +/- 0.78) were higher than moderately differentiated carcinoma but the difference was not statistically significant. Despite the significant difference in the mean values, a considerable overlap in the NOR counts of individual cases of different groups was observed suggesting that though NOR counts can not act as a specific diagnostic parameter for diagnosis of early carcinoma and dysplasia in isolated cases, they may prove to be a good adjunct to already existing parameters like imaging techniques or cytology.

Summary To compare the efficacy of imprint cytology, histology and CLO-test (for biopsy urease) in detecting Helicobacter pylori infection, antral biopsies were taken from 239 patients undergoing upper gastrointestinal endoscopy. Both imprint cytology and histology showed the presence of H. pylori in 215 (90%) patients. The sensitivity and specificity of imprint cytology vis-à-vis histology was noted to be 100%. The CLO-test was performed in 165 patients and was positive in 130 (79%) patients. The sensitivity and specificity of the CLO-test were 89% and 95%, respectively. The median time required for the CLO-test to become positive and for imprint was 60 minutes for each. The sensitivity of the CLO-test was reduced further in patients receiving colloidal bismuth subcitrate. Of the 27 patients receiving the drug the sensitivity of the CLO-test was only 9% after 4 weeks of therapy. However, the specificity was 100%. The sensitivity and specificity of imprint cytology were unaffected by the antimicrobial therapy and after 4 weeks of treatment were still 100%. It is concluded that the CLO-test has a lower sensitivity and specificity for diagnosing H. pylori infection compared to imprint cytology, which had a sensitivity and specificity equal to that of histology. Imprint cytology may be prepared as an adjunct to histology in patients in whom antral biopsies are taken as it offers a relatively quick diagnosis of H. pylori infection, is considerably cheaper than the CLO-test and does not require additional biopsy material.

Thirty two patients with cirrhosis of the liver of Child's B and C class and an episode of endoscopically proven variceal bleed were randomly assigned to receive endoscopic sclerotherapy (EST) or oral propranolol for the prevention of recurrent upper gastrointestinal bleeding. EST was performed at 3 week intervals using 1% polidocanol intravariceally, till eradication of varices. Propranolol dose was adjusted to reduce the resting heart rate by 25% of the basal value (mean +/- SD, 194.3 +/- 63.9 mg/day) Two patients in the propranolol group were excluded within 48 hours due to side effects of the drug. Thirty patients (EST-16, propranolol-14) completed the trial. Patients were followed up for a maximum of 480 days. Mean follow-up in the EST and propranolol groups was 217 and 243 days respectively. The median bleeding free intervals were 480 and 194 days and number of rebleeding episodes was eight and 16 respectively in the EST and propranolol groups (both p = ns). Our study suggests a trend in favor of EST in preventing variceal rebleeding in patients with hepatic cirrhosis who belong to Child's B and C classes.

Recombinant plasminogen activator inhibitor-1 (rPAI-1) purified from Escherichia coli, like its natural counterpart, can exist in either active or latent form. To elucidate the structural basis for these two forms, both active and latent rPAI-1 have been studied using ultra-violet (UV), circular dichroism (CD), and fluorescence spectroscopy. The secondary structures determined by CD show no significant differences and indicate that both the forms are predominantly alpha helical and random. The UV spectra are also very similar with absorption maxima around 278 nm. The structures of the two forms were further characterized by measuring tryptophan fluorescence emissions and their quenching with ionic (iodide) and neutral (acrylamide) quenchers. These data indicate clear differences in the tertiary structures of the two forms with the latent form being more compact and folded in comparison with the active form.

During the period 1978 to 1988, 4619 upper gastrointestinal fibreoptic panendoscopies were carried out. There were 106 (2.2%) histologically confirmed cases of carcinoma of the stomach. The annual incidence was 9.6. The peak incidence was in the fifth decade. The mean age of these patients was 49.4 years and the male: female ratio was 3.6:1. The most frequent symptoms were weight loss (81%) and anorexia (72.9%). Dysphagia was present in 30% of patients. Thirty two percent of patients had proximal carcinoma, 63.2% had distal carcinoma and in 4.7% the whole stomach was involved. Patients with distal carcinoma had a longer history (P less than 0.01) and were more likely to present with weight loss (P less than 0.001), anorexia (P less than 0.005), abdominal pain (P less than 0.05) and abdominal lump (P less than 0.05), compared to proximal carcinomas. Dysphagia was, however, more likely to be present in patients with proximal carcinomas (P less than 0.001).

The main pancreatic duct and the common bile duct open into the second part of the duodenum alone or after joining as a common channel. A common channel of greater than 15 mm (an anomalous pancreaticobiliary duct) is associated with congenital cystic dilatation of the common bile duct and carcinoma of the gall bladder. Even a long common channel (greater than or equal to 8 mm) is associated with a higher frequency of carcinoma of the gall bladder. Gall stones smaller than the common channel and a long common channel predispose to gall stone induced acute pancreatitis. Separate openings for the two ductal systems predisposes to development of gall stones and alcohol induced chronic pancreatitis. The role of ductal union has also been investigated in primary sclerosing cholangitis and biliary atresia.

Adenosine deaminase was estimated in ascitic fluids of 49 patients with ascites (19 tuberculous, 20 cirrhotic, and 10 malignant). The adenosine deaminase concentration in tuberculous ascitic fluid was 98.8 +/- 20.1 U/L (mean +/- SD), which was significantly more than that noted in cirrhotic (14 +/- 10.6 U/L) or malignant (14.6 +/- 6.7 U/L) ascitic fluids (p less than 0.001 for each). At a cut-off value of greater than 33 U/L, the sensitivity, specificity, positive and negative predictive value, and the overall diagnostic accuracy for diagnosing tuberculous ascites were 100%, 96.6%, 95%, 100%, and 98%, respectively. We conclude that estimation of adenosine deaminase in ascitic fluid is an easy and reliable method for diagnosing tuberculous ascites.