Ischaemic necrosis of subcutaneous colonic neoesophagus: an unusual complication of presternal hypertrophic scar

Hypertrophic scars and keloids not only pose aesthetic problems but also cause functional and anatomical dysfunction by leading to contractures and sometimes by compression of underneath structures. A 76-year-old man presented with progressive dysphagia of two months duration. Examination showed the unusual complication of a presternal hypertrophic scar, causing ischaemic necrosis of a subcutaneously-transposed colon, used for oesophageal reconstruction in a patient with inoperable carcinoma of the oesophagus. Such a complication of hypertrophic scar has never been reported in the literature.

A case of ovarian metastasis of gall bladder carcinoma simulating primary ovarian neoplasm: diagnostic pitfalls and review of literature

The ovary is a relatively frequent site of metastases from malignant neoplasia arising elsewhere in the body, the majority of these originating from the gastrointestinal tract. The best-known tumor of this type is signet ring cell adenocarcinoma (Krukenberg tumor) of gastric origin and large bowel. The gall bladder and bile ducts are extremely rare sources of these metastases. The casuistic describes a female patient, presented with pelvic mass and jaundice. While clinical and imaging results suggested a primary ovarian carcinoma with incidental cholelithiasis and choledocholithiasis, the final diagnosis was obtained on the basis of histopathologic findings of resected specimen.

A Rare Case of Odontogenic Myxoma in a Dog

A case of odontogenic myxoma in an old Doberman bitch involving the periodontal region of the mandible was recorded. Grossly, the tumour mass was soft and slimy, having brownish-black foci on cut surface. Histopathologically, the tumour predominantly consisted of mesenchyme-like cells with prominent nuclei and nucleoli. The tumour had abundant ground substance, rich in acid mucopolysaccharides.

Assessment of hypertension control in chronic kidney disease patients by ambulatory blood pressure monitoring

BACKGROUND

Inadequate control of blood pressure (BP) increases cardiovascular mortality and morbidity in chronic kidney disease (CKD) and renal transplant patients. 24 hour ambulatory BP was recorded to evaluate the adequacy of BP control in these patients.

METHODS

60 CKD patients (25 conservative therapy, 16 maintenance hemodialysis, 19 renal transplant patients) were studied prospectively. After achieving clinic BP control, 24 hour ambulatory BP was recorded at 1 and 6 months. The patients were followed up for one year.

RESULTS

Mean daytime and nighttime systolic blood pressure (SBP) both at 1 month and at 6 month was higher in non-survivors than in survivors. The survivors had better control of their daytime (p=0.018) as well as nighttime SBP levels (p=0.018) at 6 months compared to those at 1 month. Survivors achieved nocturnal dipping of SBP at 1 and 6 months (p=0.047, p=0.025, respectively). Non-survivors failed to achieve lower daytime (p=0.375) or nighttime SBP (p=0.254) at 6 months as compared to SBP at 1 month in spite of optimizing antihypertensive therapy. Daytime (p=0.022) and nighttime (p=0.029) diastolic BP (DBP) in the non-survivors was higher than in survivors. Nocturnal dip in DBP was not seen in either survivors at 1 (p=0.177) and 6 months (p=0.434) or non-survivors at 1 (p=0.408) and at 6 months (p=0.081). Renal transplant patients did not exhibit nocturnal dipping of BP.

CONCLUSION

We conclude that, unlike survivors, there was worsening of 24 hour BP control in non-survivors. ABPM has a role in better management of total BP burden in CKD patients.

Regenerative mode locking via superposition of higher-order cavity modes in composite cavity fiber lasers

We demonstrate a new method of optical pulse generation in regeneratively mode-locked fiber ring lasers (RML-FRLs). The method is based on generating dominant longitudinal modes in the fiber ring cavity by means of a composite cavity structure and their intermode beating at the photodetector incorporated in the regenerative feedback loop. The beat signal is then used as a modulation signal to generate optical pulses in a regenerative mode-locking scheme, thereby eliminating the requirement for a high-Q rf bandpass filter in a conventional RML-FRL. Optical pulses with a repetition frequency of 3.6 GHz have been generated successfully with a supermode noise suppression of more than 48 dB and a low phase noise of -85 dBc/Hz at 10 kHz offset from the carrier frequency.

Angiogenesis: a curse or cure?

Angiogenesis, the growth of new blood vessels is essential during fetal development, female reproductive cycle, and tissue repair. In contrast, uncontrolled angiogenesis promotes the neoplastic disease and retinopathies, while inadequate angiogenesis can lead to coronary artery disease. A balance between pro-angiogenic and antiangiogenic growth factors and cytokines tightly controls angiogenesis. Considerable progress has been made in identifying these molecular components to develop angiogenesis based treatments. One of the most specific and critical regulators of angiogenesis is vascular endothelial growth factor (VEGF), which regulates endothelial proliferation, permeability, and survival. Several VEGF based treatments including anti-VEGF and anti-VEGF receptor antibodies/agents are in clinical trials along with several other antiangiogenic treatments. While bevacizumab (anti-VEGF antibody) has been approved for clinical use in colorectal cancer, the side effects of antiangiogenic treatment still remain a challenge. The pros and cons of angiogenesis based treatment are discussed.

Macroinvertebrates as indicators of pollution

Various pollution indicators of stream Ban-Ganga have been identified on the basis of presence/absence/numerical abundance at various stations. They have been categorized as pollution tolerant, facultative and pollution intolerant groups in relation with the water quality at different stations of stream.

Variability pattern and correlation studies in Silybum marianum Gaertn

Phenotypic and genotypic coefficient of variability, heritability in broad sense and genetic advance were determined investigating the characters of 15 accessions of Silybum marianum. Seed yield/plant and number of capsules/plant had highest estimates of genotypic variation, heritability and genetic advance which suggest that direct selection for these traits is suitable for the improvement of this crop. Number of capsules/plant had a significant positive correlation with the number of branches/plant and leaf length (r=0.3398, 0.7547), whereas seed yield/plant had a positive significant correlation with leaf length, stem diameter, capsule diameter and silymarin content (r=0.6830, 0.3140, 0.3484, 0.2925).

Metal contents in the groundwater of Sahebgunj district, Jharkhand, India, with special reference to arsenic

A detailed study has been presented on groundwater metal contents of Sahebgunj district in the state of Jharkhand, India with special reference to arsenic. Both tubewell and well waters have been studied separately with greater emphasis on tubewell waters. Groundwaters of all the nine blocks of Sahebgunj district have been surveyed for iron, manganese, calcium, magnesium, copper and zinc in addition to arsenic. Normal distribution statistic, exploratory data analysis and robust Z-score analysis have been employed to find out the distribution pattern, localisation of data, outliers and other related information. Groundwaters of three blocks of Sahebgunj, namely, Sahebgunj, Rajmahal and Udhawa have been found to be alarmingly contaminated with arsenic present at or above 10 ppb. Arsenic distribution patterns in these blocks are highly asymmetric in nature with the common feature of increasing width from first to fourth quartile. A very broad fourth quartile in each case represents a long asymmetric tail on the right of the median. Tubewell waters of at least two more blocks require regular monitoring to identify the outbreak of arsenic at the onset. Groundwaters of Sahebgunj district in general contain high iron and manganese. It is by and large soft in nature. Well waters have been found to be better with regard to arsenic but iron and manganese contents do not vary significantly. Normal distribution analysis (NDA), box and whisker (BW) plot and Z-score analysis together can provide a reasonably complete statistical picture of metal contents in Sahebgunj district groundwaters.

More 'cries from the joints': assessment of the musculoskeletal system is poorly documented in routine paediatric clerking

OBJECTIVES

The aim of this study was to describe the assessment of the musculoskeletal (MSK) system in comparison with other systems in routine paediatric medical clerking. Furthermore, to survey trainee paediatricians (SPRs, specialist registrars) about their self-rated confidence in assessing the MSK system.

METHODS

Case notes of consecutive general paediatric medical patients admitted to three UK hospitals over a 4-week period were assessed using a standard pro forma. All patients had been assessed by a consultant paediatrician during their admission. A postal questionnaire was sent to all SPRs in training in each of the hospitals, regarding their confidence in assessing the MSK system compared with other systems and their exposure to MSK teaching.

RESULTS

Case notes of 257 patients [117 females, median age 3 yr (range 1-18 yr)] were reviewed. The most common reason for admission was acute infection, although the spectrum of other recorded diagnoses varied between hospitals. Thirteen children (5%) had an acute problem (e.g. infection) against a background of chronic disease. The case note documentation showed that cardiovascular (CVS), respiratory (RS) and gastrointestinal (GI) systems were assessed in the vast majority (>90%) of patients, irrespective of the underlying diagnosis. However, other systems were less well recorded; the trend being the same in each hospital and in descending order, the neurological system (38%), skin (32%), eyes (10%) and musculoskeletal system (4%). Only 2.7% (7/257) patients were documented to have been asked about MSK symptoms, and only 1.6% (4/257) had any documentation of joint examination--in all cases this was limited (e.g. range of movement of the knee only), and no patients had documentation of gait being examined, even in those children presenting with 'limp'. The response rate to the postal questionnaire was 60% (67/112). The self-rated confidence in MSK assessment was markedly low in comparison with other systems, even though 61/67 recalled some teaching of the MSK system as an undergraduate (61/67) or postgraduate (50/67). Of note none could recall teaching as an undergraduate in paediatric MSK assessment and where there had been postgraduate rheumatology MSK teaching this had been delivered by paediatric rheumatologists in many cases (34/50), reflecting the centres participating in the study.

CONCLUSIONS

In routine general paediatric medical in-patient clerking and throughout the admission, MSK assessment was rarely documented, and even where present was limited. This contrasts markedly with other systems which were examined in most children irrespective of the presenting complaint. Self-rated confidence in MSK assessment is low amongst SPRs compared with other systems, despite most recalling some teaching. This discrepancy between teaching and clinical practice needs to be addressed in undergraduate and postgraduate training.

A thyroid tubercular abscess and bilateral symmetrical hilar lymphadenopathy: a rare association

An 18-year-old boy presented with a rare association of a thyroid tubercular abscess and bilateral symmetrical hilar lymphadenopathy. He was put on a Category I regimen with standard short course daily chemotherapy of four anti-tubercular drugs under the National Tuberculosis Programme. After a six-month of anti-tubercular treatment (ATT), the boy showed clinical and bacteriological improvement. The thyroid scan with Technetium 99 (Tc 99) and the chest skiagram also became normal.

Evaluation and standardisation of a simple HG-AAS method for rapid speciation of As(III) and As(V) in some contaminated groundwater samples of West Bengal, India

A simple HG-AAS technique has been evaluated and standardised for rapid speciation of As(III) and As(V) in a number of contaminated groundwater samples of West Bengal, India. Citric acid has been used for selective hydride formation of As(III). The sensitivity of the evaluated HG-AAS method is 7.91 mg(-1)l, standard deviation, 0.001 and detection limit, 0.4 microg l(-1). As(III) sensitivity remains constant in the sample pH range of 2.3-10.6. Concomitant mineral matrix of the water samples did not interfere with arsenic determination. Eight out of ten groundwater samples analysed for As(IlI)and As(V) contain more As(III), which lies in the range of 54-350 ppb. As(III) estimation in drinking water along with total arsenic should be invoked as a policy for a realistic risk assessment of the contaminated water.

Effect of single inhalation of a salbutamol, ipratropium bromide and beclomethasone on mucociliary clearance in patients with chronic obstructive airway disease

BACKGROUND

Chronic obstructive airway disease (COAD) is associated with hyperplasia and hypertrophy of the mucus producing glands. The beneficial effect of inhaled drug may be due to improved mucociliary function. The present study was done to evaluate the effect of salbutamol, ipratropium bromide and beclomethasone dipropionate inhalation on mucociliary clearance in patients with COAD.

METHODS

Ten patients of COAD were taken up, two patients however did not complete the study. Salbutamol, ipratropium bromide, beclomethasone dipropionate and placebo inhalation were given randomly to each patient on four separate days. Radioaerosol inhalation lung cine-scintigraphy after inhalation of the different drugs was followed up to two hours and than after 24 hours.

RESULTS

There was no significant visually noticeable increased mucociliary clearance on any of the days. Two patients showed definite steep slope in the time activity curves with salbutamol as compared to other drugs or placebo. All the quantitative indices analysed at the end of one hour and two hours for the three drugs were comparable to placebo.

CONCLUSIONS

A single dose of inhaled salbutamol, ipratropium bromide and beclomethasone dipropionate has no appreciable effect on mucociliary clearance in patients with COAD.

Binding and displacement of vascular endothelial growth factor (VEGF) by thrombospondin: effect on human microvascular endothelial cell proliferation and angiogenesis

Vascular endothelial growth factor (VEGF) is a specific angiogenic factor, and thrombospondin (TSP), is a potent inhibitor of angiogenesis. To better understand the role of TSP as an anti-angiogenic agent, we have identified its specific domains that participate in its anti-angiogenic activity and examined the mechanism of its inhibitory effect on VEGF(165) induced angiogenesis. Exogenously added TSP inhibited VEGF(165) induced angiogenesis (proliferation and tube formation of human dermal microvascular endothelial cells [HDMEC] and neovascular outgrowth from human arterial rings). Although both VEGF(165) and TSP are heparin binding proteins, TSP had a higher affinity for (125)I-heparin than VEGF(165) (K(d1) 4 nM and K(d2) 14 nM for TSP; K(d) 91 nM for VEGF(165)). TSP displaced 36% of (125)I-VEGF(165) from HDMEC and this was comparable to the 27% reduction in (125)I-VEGF(165) binding to HDMEC upon cleavage of cell surface heparan sulfate (HS). About 35% of the mitogenic activity of VEGF(165) was attributable to its heparin binding region. These results indicate that a proportion of the mitogenic activity of VEGF(165) is inhibited by TSP via competition for cell surface HS. Further, (125)I-VEGF(165) bound directly to TSP in a saturable, concentration dependent manner, and heparin modulated this binding. The mAbs to the heparin binding domain to the type 1 and type 3 repeats of TSP inhibited the binding of VEGF(165) to TSP, and also blocked the inhibitory effect of TSP on VEGF(165) induced HDMEC proliferation. We conclude that (i) the anti-angiogenic activity of TSP is localized in its heparin binding domain and type 1 and type 3 repeats (ii) TSP inhibits angiogenesis by at least two separate mechanisms, (a) displacement of VEGF(165) from endothelial cell HS and (b) direct binding to VEGF(165).