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Objective: To study the prevalence and predictive factors of spontaneous bacterial peritonitis (SBP) in patients of cirrhosis with ascites and to study the clinical characteristics and prognosis of patients with SBP., Materials and Methods: The present study was conducted on 122 cases admitted in Department of Medicine, through emergency, in Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India. Cases of cirrhosis (irrespective of aetiology) with ascites between the ages of 18-75 years were included in this study. Ascitic fluid of every patient was aspirated under all aseptic measures, before initiation of antibiotic therapy and was sent for biochemical analysis, culture and cytological analysis., Results: Mean age of patients enrolled was 50.30± 10.98 years. 85% were male and 15% were female. Alcohol (73.8%) was the leading cause of cirrhosis followed by HCV (37.7%) and HBV (4.9%). Of the 122 patients studied, 27 (20.4%) patients were diagnosed as having SBP and its variants. Monomicrobial Bacterascites (BA) was present in 5 patients and Culture Negative Neutrocytic Ascites (CNNA) was present in 22 patients. Escherichia coli were the most common isolated organism followed by Klebsiella. The various factors that predispose to development of SBP include low ascitic fluid protein concentration, a high level of serum bilirubin, deranged serum creatinine, high Child-Pugh score and high MELD score., Conclusion: Ascitic fluid analysis remains the single most important test for identifying and assessing a course of SBP. Bedside inoculation of 10-20ml of ascitic fluid into culture bottle at patient bedside will yield better results. Early diagnosis and treatment will reduce the mortality rate in these patients.

A total of 40 patients with endoscopically proved reflux esophagitis were treated in a randomised study. Treatment was given for six weeks and consisted of daily doses of either 1 gm sucralfate four times a day or one, 150 mg ranitidine tablet twice daily. Twenty patients received each drug. Clinical evaluation was done weekly and endoscopic evaluation after six weeks. Forty percent patients on ranitidine and 50% patients on sucralfate became asymptomatic at six weeks. Fifty percent patients on ranitidine and 60% patients on sucralfate were endoscopically healed. The results did not show any difference in the effect of ranitidine and sucralfate treatment (p > 0.05). Overall tolerance and compliance in the two forms of treatment was good. Though ranitidine has a more convenient dose schedule and is more cost effective, sucralfate needs further clinical trials.

Forty patients with endoscopically proved reflux oesophagitis were treated in a randomised study. Treatment was given for six weeks and consisted of either 1 g sucralfate four times a day or 150 mg ranitidine tablet twice daily. Twenty patients received each drug. Clinical evaluation was done weekly and endoscopic evaluation after six weeks. Eight patients on ranitidine and ten patients on sucralfate became asymptomatic at six weeks. Ten patients on ranitidine and twelve patients on sucralfate were endoscopically healed. There was no difference in the effect of ranitidine and sucralfate treatment (p greater than 0.05). Overall tolerance and compliance with the two forms of treatment were good. Though ranitidine has a more convenient dose schedule and is more cost-effective, sucralfate needs further clinical evaluation.

Twenty patients with endoscopically proved reflux esophagitis were studied. Each patient was given 1 gm sucralfate 4 times a day for 6 weeks. Clinical and endoscopic assessment of the effects of sucralfate on reflux esophagitis was done. 50% patients became asymptomatic and 60% healed endoscopically. The drug was well tolerated. We conclude that sucralfate is an effective and well tolerated drug for treatment of reflux esophagitis.

Malignant lymphoma of the heart was found at autopsy of two homosexual men with acquired immune deficiency syndrome (AIDS). Both patients had symptoms and signs of cardiac dysfunction, and it is likely that the immediate cause of their deaths was related to the cardiac tumors. In both cases, there was lymphomatous involvement of other organs, but the heart was the predominant site of disease. There was prominent endocardial and myocardial involvement, and both tumors were high grade large cell lymphomas with plasmacytoid features. In both instances, the lymphomas were diagnosed only at the autopsy, despite extensive antemortem cardiac evaluation in one patient. The clinicopathologic correlation, gross pathologic and histologic findings of the tumor, and their pattern and distribution suggest a de novo origin of the lymphoma in the heart in these two patients. Lymphomatous infiltration of the heart should be suspected in patients with AIDS who have cardiac symptoms.

The clinical and pathological findings in a group of 260 homosexual men comprising 10% of a private proctologic practice are reviewed. A clinical pattern of anorectal and colon diseases encountered with unusual frequency in these homosexual patients is termed the gay bowel syndrome. The clinical diagnoses in decreasing order of frequency include condyloma acuminata, hemorrhoids, nonspecific proctitis, anal fistula, perirectal abscess, anal fissure, amebiasis, benign polyps, viral hepatitis, gonorrhea, syphilis, anorectal trauma and foreign bodies, shigellosis, rectal ulcers and lymphogranuloma venereum. 60 anorectal and sigmoid biopsies from 51 patients failed to disclose evidence of specific infection other than condyloma acuminata. Of 21 patients with biopsy diagnosis of nonspecific proctitis, 8 had a specific infection which was detected by other means,--5 cases of shigellosis and one case each of gonorrheal proctitis, amebiasis and lymphogranuloma venereum. In evaluating proctologic problems in the gay male, all of the known sexually transmitted diseases should be considered. Shigellosis, amebiasis and viral hepatitis should be included. Microbiological evaluation is essential. Concurrent infections with 2 or more pathogens should be anticipated. Chlamydia trachomatis, an important cause of nonspecific urethritis in the general population, is high on the list of possible causes of the nonspecific proctitis present in 31 of the 260 patients.

Many bacterial species are responsible for sporadic cases and outbreaks of foodborne intoxication and infection. The foodborne diseases are classified on the basis of the pathogenetic mechanisms involved into four categories: performed toxin, enterotoxin formed in the colonized small intestine, mucosal invasion (enterocolitis) and mucosal invasion with bacteremia. Invasive and toxigenic strains of enteropathogenic Escherichia coli are discussed. In vivo test systems for the identification of enterotoxigenic organisms and tissue culture assays for the heat-labile enterotoxin of E. coli are described. Current laboratory methods for the diagnosis of foodborne diseases of major public health interest are reviewed - botulism, staphylococcal intoxication, Clostridium perfringens enteritis, salmonellosis, enteropathogenic E. coli infection, Vibrio parahaemolyticus infection and Bacillus cereus enteritis. The role of the laboratory in the epidemiologic surveillance and investigation of foodborne diseases is emphasized.

The first case, to our knowledge, of an integumentary form of botryomycosis is reported in a homosexual man with acquired immunodeficiency syndrome. Anal fistula and ischiorectal and gluteal abscesses developed following severe cryptosporidial diarrhea. Grains composed of gram-positive cocci were identified in the suppurative exudate. The grains had attached to multinucleated macrophages, many of which contained clusters of cocci in their cytoplasm. It is postulated that the cocci were able to survive and probably replicate in the cytoplasm of multinucleated macrophages, and were subsequently extruded as grains. These observations suggest a defect in intracellular killing of cocci by the monocyte-macrophage system. This may relate to failure in induction of control of macrophage activity by T4-inducer subsets.

We present a rare case of acute monocytic leukemia (AMoL) in which the initial finding consisted solely of cutaneous leukemic infiltrates without obvious bone marrow involvement. Eight months later a definitive bone marrow diagnosis of AMoL was made. Findings of histologic, immunohistochemical, cytochemical, and ultrastructural studies including postmortem examination are described. We believe that one should consider an extramedullary AMoL if the findings of a positive lysozyme stain and a mild to moderate monocytosis are present.