We determined the consumption of non-steroidal anti-inflammatory drugs (NSAIDs) and the prevalence of chronic renal impairment and renal papillary necrosis (RPN) in patients with various types of arthritis. Ninety-four patients with chronic arthritis who had consumed more than 1000 capsules and/or tablets of NSAIDs were studied. Renal profiles and radiological investigations such as intravenous urogram (IVU), ultrasonography (US) and computed tomography (CT) were performed to look for evidence of RPN. Twelve patients did not complete the study. Ten of the 82 patients who had completed the study (12.2%) had radiologic evidence of RPN. Five out of 53 patients (9.4%) with rheumatoid arthritis, three out of 11 patients (27.3%) with gouty arthritis and two out of seven patients (28.6%) with osteoarthritis had RPN. Renal impairment (serum creatinine levels of 125-451 mumol/l) was found in 20 patients (24.4%). The patients had consumed 1000-26,300 capsules and/or tablets over a period ranging from 1 yr to more than 30 yr. Patients with chronic arthritis who consume excessive amount of NSAIDs are at risk of developing RPN and chronic renal impairment.

The study was undertaken to establish the normal foot bimalleolar (FBM) angle in Indian infants and to correlate it with the severity of deformity and results of treatment in congenital talipes equinovarus (CTEV). Foot tracings with the level of both the malleoli of 182 feet (91 normal Indian infants) were taken. The anteromedial angle between the long axis of foot and the bimalleolar plane was taken as the FBM angle. The FBM angle in normal infants was calculated as 82.5 degrees. Eighty-four CTEV (51 patients) were clinically classified as grade I (five feet; FBM angle, 73.2 degrees), grade II (21 feet; FBM angle, 66.6 degrees), and grade III (58 feet; FBM angle, 54.7 degrees), depending on whether the foot could be passively corrected (grade I) or had a fixed equinus and/or varus of <20 degrees (grade II) or >20 degrees (grade III). Thirty-one feet (22 patients) were followed up prospectively after conservative (17 feet: grade I, three feet; grade II, three feet; grade III, 11 feet) and surgical release (all grade III, 14 feet). All feet with grade I and grade II deformity and 44% (11 feet) with grade III deformity were amenable to gentle graduated manipulations and cast application, whereas 56% (14 feet) with grade III deformity underwent soft tissue release. After nonsurgical treatment, the mean FBM angle was 82.3 degrees. Of the feet that underwent surgery, those with excellent (11 feet) and good correction (3 feet) had a mean FBM angle of 79.9 degrees and 74.3 degrees, respectively. There were no feet with fair or poor results. The clinical severity of foot deformity and results of treatment correlated well with the FBM angle. Foot tracing with the FBM angle is a simple, objective, and reproducible clinical criterion to classify the severity of foot deformity and evaluate the results of treatment.

Of a total of about 200 cases of complete Currarino triad found in the literature, in only 22 patients did the presacral mass contain both meningocele and teratoma. The features of these 22 patients and the current views on the surgical management of Currarino triad are discussed.

Different criteria have been used in literature to describe the anterior ectopic anus (AEA) anomaly, resulting in uncertainty over its prevalence, association with constipation and definition of the indications for surgery. It has been recently proposed that the term AEA should be restricted to anomalies in which a normal appearing anal orifice is located in the perineum in a more anterior location than normal, with an anal canal of normal calibre that is shown by electrical stimulation to be surrounded by the voluntary external anal sphincter (EAS). We report about four infants, three females and one male, who presented with constipation and had an anteriorly located anal orifice of normal calibre. The anal position index measured clinically was less than 0.34 in all the female patients and 0.44 in the male patient. In preoperative magnetic resonance imaging (MRI), the EAS was distributed all around the circumference of the anal canal, including the ventral aspect of the anal canal, in all the patients. Preoperative MRI documentation of sphincter distribution is recommended for the diagnosis of AEA, as it would help in better definition of its association with constipation and the results of surgical management.