Sero-epidemiological study of severe forms of paralytic poliomyelitis

Poliomyelitis has assumed immense public health importance owing to the magnitude of problem. The present study describes clinical, epidemiological and virological profile of seventy four cases of severe forms of acute paralytic poliomyelitis admitted to Kalawati Saran Children Hospital, New Delhi, during the period from August, 1986 to May, 1987. Thirty two per cent of total paralytic poliomyelitis cases were diagnosed as severe cases. Highest incidence (45.95%) of the cases were in the age group of 6-12 months and male to female ratio was 2.08:1. There was preponderance of cases from urban area. Among all the cases, 12.2% had received three or more doses of oral poliovaccine. Fever and respiratory involvement were the commonest symptoms. Sixty seven patients (90.5%) were virologically or serologically confirmed as an acute poliomyelitis due to any of the three poliovirus type. On follow up of the cases, complete recovery could be seen only in 4.2% of cases with varying degree of residual paralysis in 95.8% cases.

Chemotherapy of metastatic Merkel cell carcinoma: case report and review of the literature

Merkel cell carcinoma is a skin cancer that bears histologic, ultrastructural, and immunohistochemical resemblance to small cell lung cancer. Although this tumor is often localized and may be treated with wide excision, metastatic Merkel cell carcinoma does appear in 18%-28% of patients and may be aggressive and lethal. We report a case of metastatic Merkel cell carcinoma who responded to treatment with cisplatin/etoposide. Review of the literature reveals that doxorubicin/cyclophosphamide-based regimens and cisplatin-based regimens have been most commonly studied. Complete and partial responses are often achieved although the duration of response tends to be short. Further investigation of chemotherapeutic regimens similar to those used in small cell lung cancer should be undertaken.

The radial forearm flap for reconstruction of the upper extremity

The radial forearm flap, owing to its good-caliber arteries of long length and equally well distributed venous system, has proved very reliable. It has not only earned its place and recognition in reconstructive hand surgery, but also has emerged as a workhorse for the microvascular surgeon. We have used 14 radial forearm flaps for upper extremity reconstruction, and we present herein our experience. The technique of extracorporeal tissue transfer, which has been published elsewhere, was used in two patients and is detailed. Four representative patients are presented.

Interferon-alpha maintenance therapy after cytotoxic chemotherapy for treatment of acquired immunodeficiency syndrome-related Kaposi's sarcoma

A prospective phase I clinical trial with recombinant interferon-alpha-2b as maintenance therapy after cytotoxic chemotherapy was conducted. Twenty-one homosexual and bisexual males with extensive mucocutaneous or visceral epidemic acquired immunodeficiency syndrome (AIDS)-Kaposi's sarcoma (KS) were studied. After a complete response (6 patients) or partial response (15 patients) from chemotherapy consisting of Adriamycin (20 mg/m2), bleomycin (10 U/m2), and vincristine (1.4 mg/m2; 2 mg maximum), patients were given interferon-alpha (IFN-alpha) in an attempt to prolong disease-free survival. Three dose levels of daily IFN-alpha were tested: 5, 10, and 15 million U. The maximum tolerated dose was 10 million units. Dose-limiting toxicities included recurrent grade 3 fatigue, diarrhea, and fever, which resulted in the termination of therapy in eight patients (38%). Hematologic toxicities were infrequent (four patients; 19%). Responses were observed in two patients on IFN-alpha, both at the 10-million-U dose level. The median duration of response on IFN-alpha therapy following chemotherapy was 8 weeks (range, 3-11). We conclude that the duration of IFN-alpha maintenance response following cytotoxic chemotherapy is short with response to residual disease observed in a minority of cases at this dose and schedule. Additional trials of maintenance therapy in patients with advanced AIDS-KS combining antiretroviral agents are in progress.

Experience with internal iliac artery ligation in obstetrics and gynaecological practice

Internal iliac artery ligation was performed in 6 patients (bilateral in 5), as a prophylactic procedure in 4 and as a life saving measure in 2 patients through transperitoneal approach. No morbidity or mortality resulted from this procedure. All the 6 patients in whom internal iliac artery ligation was done to control an otherwise uncontrollable bleeding from their pelvic tissues had ultimately an uneventful recovery. It is advisable to adopt this procedure as a routine in all difficult pelvic operations particularly radical operations for gynaecological malignancy.

Paramedian diencephalic syndrome. Report of 3 cases

We report three patients who lapsed into coma and subsequently manifested hypersomnolence, amnesia and vertical gaze paresis. Computed tomography revealed bilateral paramedian thalamic infarcts. This clinical symptomatology comprises the paramedian diencephalic syndrome.

A simple regression model for estimating gestational age in later pregnancy by ultrasonography

Three hundred and six antenatal women with confirmed LMP underwent a single real time ultrasonographic examination between 32-40 weeks of gestation. Four parameters viz. BPD, HL, FL and AP having a positive correlation with gestational age were studied. A multiple regression model for predicting gestational age by a single ultrasonographic examination was developed by forward selection method after eliminating multicollinearity; as a high degree of intercorrelation was found between FL and HL, HL was eliminated from the data. The BPD does not have a significant role in predicting gestational age in later pregnancy. The proposed regression equation with FL and AP predicts gestational age 75% of time within +/- 10 days of 95% confidence limit.

Hemiplegic migraine

Eight patients with hemiplegic migraine are described. Majority were in their second decade and suffered two or more episodes of dense hemiplegia outlasting the headache. Complete recovery was the rule.

Microsurgical practice on avulsed skin

The use of avulsed skin is recommended as a source of vessels for trainees to practise microvascular techniques. If it cannot be used immediately it can be stored in the refrigerator for later use.

Early detection of myocardial ischemia in hypertensive patients using exercise esophageal electrocardiography

Effects of submaximal exercise were studied on the unipolar esophageal electrocardiogram recorded at ventricular level in 15 patients with essential hypertension who complained of chest discomfort on effort but had negative exercise stress tests using standard leads and lead CM5. Six patients developed horizontal or downsloping depression of the ST segment in the esophageal lead. The ischemic response might result from subcritical coronary stenosis in face of the increased myocardial oxygen demand of hypertrophied myocardium.

Juvenile diabetes manifesting as epilepsia partialis continua

Epilepsia partialis continua was the chief initial complaint in a young diabetic who was found to have hyperosmolar non ketotic hyperglycaemia. Such a presentation in a juvenile diabetic is rare. Literature relevant to this interesting neurologic disturbance has been briefly reviewed.

Kala-azar mortality in hospitalized cases in north Bihar, India

The mortality in kala-azar was studied in 261 cases admitted in SKMCH during the years 1983-1987. 23 deaths (8.81%) were observed; 9 (39.1%) died due to complications of the disease, while 14 (60.9%) died of toxicity of Sodium Stibogluconate or Pentamidine.

Poliomyelitis in vaccinated children

Fifty-two children who had received at least 3 properly spaced doses of oral polio-vaccine and had developed acute poliomyelitis inspite of vaccination were studied clinically and serologically. This group (A) was compared with 28 children with poliomyelitis who had not received any vaccination (Group B). A much higher incidence of provocative injection and a better muscle power on presentation was seen in Group A as compared to Group B. Polio-virus type 2 was the commonest etiological agent in Group A (42.3%) whereas type I virus was most commonly seen in Group B (78.6%). A total 53.8% of cases of Group A had protective antibody titres to at least one poliovirus type in the acute phase sera, compared to only 4% from Group B. Six per cent from Group A had protective antibodies to all three virus types, disease in these cases was caused by non-polio agents. Two cases in Group A were possibly vaccine induced paralysis. Recovery, after 60 days, was much better in Group A as compared to Group B. Mortality in the two groups was comparable.

The role of esophageal leads in the detection of exercise-induced postero-basal ischemia

The effects of maximal hyperventilation and submaximal exercise were studied on the unipolar, esophageal electrocardiogram recorded at ventricular level in 25 'normal' persons and 15 patients having ischemic heart disease with a positive exercise stress test. In normal persons, hyperventilation decreased the amplitude of the R and T waves in 10 and 6 cases, respectively. Submaximal exercise increased the height of the P wave in 8 cases, decreased the amplitude of the R wave in 16 cases and increased the depth of the S wave in 10 cases. In patients with established ischemic heart disease, the esophageal lead could detect exercise-induced posterior ischemia in 8 cases when compared to lead V8, which could detect posterior ischemia in only 3 cases. It is inferred that the esophageal lead placed at the ventricular level is much more sensitive in detecting exercise-induced posterobasal ischemia. Lack of facilities for coronary angiographic and exercise thallium scintigraphic studies limited us from correlating this study and thereby establishing its independent usefulness.

"Top of the basilar" syndrome: a clinical and CT analysis

Fifteen patients presenting with visual, oculomotor and behavioural disturbances were diagnosed to be suffering from "top of the basilar" syndrome. Computed tomography confirmed the distribution of infarctions in the vascular territory of the rostral basilar artery. The clinical profile comprised cortical blindness and visual field defects, vertical gaze paresis, memory and behavioural disturbances and in one patient, the paramedian diencephalic syndrome.

Heterogeneous photochemical and chloroplasts mediated activation of spinach fructose-1,6-bisphosphatase

A heterogeneous photochemical electron relay system was constructed, mimicking the chloroplast electron transport reaction, in order to activate fructose-1,6-bisphosphatase in light. The photocatalyst acridine orange or proflavin sensitizes EDTA dependent reduction of ferredoxin. In a complete system, consisting of a dye-donor couple, ferredoxin, thioredoxin and ferredoxin-thioredoxin reductase, light activation of purified spinach fructose-1,6-bisphosphatase was observed in vitro. The ferredoxin was not essential for activation of fructose-1,6-bisphosphatase using heterogeneous photochemical system while chloroplasts mediated redox activation essentially required ferredoxin. The heterogeneous photochemical system activated fructose-1,6-bisphosphatase by about 6 fold similar to chloroplasts mediated ferredoxin dependent redox activation. These observations suggest that a thiol mediator is essential for the reductive activation of carboxylating enzymes of photosynthesis. The mechanism of activation is discussed.

Primary squamous cell carcinoma of the thyroid gland--a case report

Primary squamous cell carcinoma of the thyroid gland is rare. We report here a case of primary squamous cell carcinoma of the thyroid gland in a middle aged woman who had a thyroid nodule of 12 years duration with a recent rapid increase in size and associated with pressure symptoms. There was massive enlargement of the thyroid with retrosternal extension and fixity. Cervical nodes were also enlarged. The X-rays revealed calcification. A palliative thyroidectomy was done leaving the residual tumour behind. Endotracheal intubation and tracheostomy were required for respiratory distress in the postoperative period.

Full moon and crime

The incidence of crimes reported to three police stations in different towns (one rural, one urban, one industrial) was studied to see if it varied with the day of the lunar cycle. The period of the study covered 1978-82. The incidence of crimes committed on full moon days was much higher than on all other days, new moon days, and seventh days after the full moon and new moon. A small peak in the incidence of crimes was observed on new moon days, but this was not significant when compared with crimes committed on other days. The incidence of crimes on equinox and solstice days did not differ significantly from those on other days, suggesting that the sun probably does not influence the incidence of crime. The increased incidence of crimes on full moon days may be due to "human tidal waves" caused by the gravitational pull of the moon.

Comparison of regimens of treatment with sodium stibogluconate in kala-azar

One hundred and twenty six patients with kala-azar (visceral leishmaniasis) were allocated at random to one of two groups for treatment with sodium stibogluconate. One group was treated for 20 days; in the other group the patients were assessed after 20 days' treatment and treatment was continued if necessary. Both groups were followed up for six months. There was no significant difference in symptomatic outcome between the two groups at 20 days. At six months eight of the patients in the group treated for 20 days had relapsed and 54 were cured. Of the group given more than 20 days' treatment if necessary, 62 were cured and none had relapsed (12 required more than 20 days' treatment). This difference between the two groups was significant. One patient in each group did not respond to sodium stibogluconate, but both were were cured with pentamidine. Altogether 104 patients were cured after 20 days' treatment; 20, including the eight who relapsed, were cured after more than 20 days' treatment. There was no significant difference between the two groups in the side effects of the drug, which were minor. The longer courses of treatment (50 days in one patient) were well tolerated. It is suggested that the traditional six day course of treatment with sodium stibogluconate for kala-azar is grossly inadequate and that a longer course is required to prevent relapse.

Incidence, pattern and direction of hair distribution on the dorsum of phalanges of the hands of male medical students of Uttar Pradesh, India

In the present investigation direction and pattern of hair distribution were observed on the dorsum of phalanges of hands in 115 male medical students from Uttar Pradesh, India. Inproximal phalanges of the hands the direction of hair showed the relation with fingers. Observation of hair from little finger to thumb revealed the changes in direction from ulnar to radial (p less than 0.05). Probability of incidence of hair distribution was also studied among the fingers of both the hands. This correlation was significant on the proximal phalanges (p less than 0.05). However, no significant correlation coefficient was observed in the middle phalanges of the hands.

Protective barrier effect of the posterior lens capsule in exogenous bacterial endophthalmitis--an experimental primate study

Ten eyes of five Rhesus monkeys underwent extracapsular lens extraction. The right eye of each monkey was allowed to retain an intact posterior capsule. The left eye of each monkey had a wide primary capsulectomy with minimal anterior vitrectomy. In order to exclude operative contamination, we waited 2 to 3 weeks later to challenge the eyes with bacteria. Seventy-two hours after anterior chamber injection of equal numbers of Staphylococcus aureus, diagnostic cultures were obtained from the anterior chamber and vitreous and correlated with the clinical findings. Injection of 10,000 S. aureus produced culture-positive endophthalmitis in eyes that had undergone posterior capsulectomy, but it failed to produce endophthalmitis in fellow eyes with intact posterior capsules. This suggest that a significant barrier effect against the development of bacterial endophthalmitis exists in the eyes with intact posterior capsules.

Biomechanical stresses as related to motion trajectory of lifting

A laboratory study was conducted to assess the effects of lift angle on biomechanical stresses to the musculoskeletal system, and in particular, on the lower back. Male subjects were required to lift four different tote boxes from the floor to a height of 0.81 m using two different lifting techniques. Maximum acceptable weights were determined using a psychophysical method. The motion trajectory of lift was studied by means of stroboscopic photography. Moments and forces at various body joints were computed using a biomechanical strength model.

Maximum acceptable weights were 16% (range = 9 to 23%) greater for the free-style lifting technique as compared with the squat method of lifting. There were large differences between the maximum acceptable weights and the "maximum permissible limits" recommended by NIOSH. The results showed that the subjects pulled the load toward the body when lifting psychophysically determined maximum weights. The lift angle increased with an increase in box width. The lift angle was greater for the free-style lifting method as compared with the squat lifting technique for lifting compact loads. Lifting at an angle resulted in a decrease in moment at the elbow, shoulder, L5IS1 disc, and hips, and an increase in moment at the knees and ankles. The estimated compressive force on the lumbar spine was, on the average, 11% lower for lifting at an angle as compared with a straight vertical lift.

Protective barrier effect of the posterior lens capsule in exogenous bacterial endophthalmitis: an experimental pseudophakic primate study

Five Rhesus monkeys underwent cataract extraction and intraocular lens implantation. The right eyes had extracapsular extraction, implantation of a Shearing J-loop posterior chamber lens, and primary posterior capsulotomy. The fellow eyes had extracapsular extraction, subtotal posterior capsulectomy, a limited anterior vitrectomy, and anterior chamber implantation of a modified J-loop Sinskey-style intraocular lens. One to two weeks postoperatively, we inoculated the anterior chamber of each eye with 10,000 Staphylococcus aureus organisms. After enucleating the eyes, we obtained anterior chamber and vitreous cultures and examined the gross pathologic specimen for vitreous clarity 72 hours after inoculation. Twenty percent of right eyes had infection of the vitreous cavity, whereas in the fellow eyes, 80% demonstrated vitreal infection by examination of the sectioned gross pathologic specimens. Sixty percent of the left eyes had positive vitreous cultures. These findings suggest that the posterior capsule acts as a barrier to prevent the spread of infection from the anterior chamber to the vitreous cavity in experimental, primate pseudophakia.

Mental illness in 30 married couples

Diagnostic characteristics, personality pattern and certain psychosocial variables of 30 married couples where both partners were mentally ill (group A) were compared with the findings with another group of 30 couples where only one partner was psychiatric patient (Group B). Results revealed that couples in the Group A had significantly longer duration of marriage as compared to Group B. Significantly higher number of pairs in the Group A were from the higher socio-economic status. Nearly two third of the secondary partners (those developing illness later) in the Group A were wives. Primary partners of Group A (those developing illness earlier) had a significantly longer duration of illness than the sick spouses of Group B.