Deep vein thrombosis: A rare complication in oral and maxillofacial surgery: A review of two cases

Deep vein thrombosis (DVT) is caused by obstruction of blood flow of deep veins in upper and lower limb. One of the precipitating factors for DVT is surgery under general anesthesia exceeding 30 min. However, there are very few reports of DVT associated with surgery of oral and maxillofacial region. In this paper we report two cases of DVT involving left ilio-femoropopliteal deep vein in one patient treated for fractured left angle of mandible and left peroneal vein in the other patient treated for oral sub mucous fibrosis. Clinical and color Doppler examination were performed to diagnose the condition and were referred to vascular surgical unit of higher institute for further management. These cases illustrates any surgery of maxillofacial region is not free from risk of DVT, which can cause fatal pulmonary thromboembolism.

Trends in oesophagus and Stomach cancer incidence in Bangalore, India

BACKGROUND

During recent decades, an increase in the incidence of certain oesophago-gastric cancer has been reported in some countries and in India. This study sought to analyze oesophageal and gastric cancer incidence trends in Bangalore by sex and morphology for the period 1982-2007.

PATIENTS AND METHODS

Oesophageal and gastric cancer cases were drawn from Bangalore population-based cancer registry locating in Kidwai memorial Institute of Oncology started in 1982 under national cancer Registry Programme funded by Indian Council of Medical Research. Time trends in sex- and age-standardized cancer incidence rates were analyzed by site and histology over the study period, using relative change.

RESULTS

Age-standardised oesophageal cancer incidence rates increased in males, in females failed to register a significant trend over the study period. Overall, gastric cancer decreased from 9.81 and 5.48 rates per 100 000 person-years in 1982-86 to 9.45 and 5.25 in 2002-07, among men and women, respectively. Where as oesophageal adenocarcinomas increased sharply in both sex, among men, oesophageal squamous cell cancer rates increased steadily from the mid-1982s onwards a bit decline was observed from 1997, the same trend observed in females. The gastric cancer decreased over the study period. There was a marked decrease in the incidence of oesophago-gastric cancer presenting with unknown and unspecified morphology reported.

KEYWORDS

adenocarcinoma, Oesophageal and stomach, incidence, age specific rate, age adjusted rate, population-based registry, trends.

Is aggressive gap arthroplasty essential in the management of temporomandibular joint ankylosis?-a prospective clinical study of 15 cases

The purpose of this three-year, prospective, follow-up study was to evaluate whether aggressive gap arthroplasty is essential in the management of ankylosis of the temporomandibular joint (TMJ). Fifteen patients were treated by the creation of a minimal gap of 5-8mm and insertion of an interpositional gap arthroplasty using the temporalis fascia. Eleven patients had unilateral coronoidectomy and 4 bilateral coronoidectomy based on Kaban's protocol. Preoperative assessment included recording of history, clinical and radiological examinations, personal variables, the aetiology of the ankylosis, the side affected, and any other relevant findings. Patients were assessed postoperatively by a surgeon unaware of the treatment given for a minimum of 3 years, which included measurement of the maximal incisal opening, presence of facial nerve paralysis, recurrence, and any other relevant findings. Of the 15 patients (17 joints), 12 had unilateral and three had bilateral involvement, with trauma being the most common cause. The patients were aged between 7 and 29 years (mean (SD) age 20 (8) years). Preoperative maximal incisal opening was 0-2mm in 8 cases and 2-9mm in 9. Postoperatively adequate mouth opening of 30-40mm was achieved in all cases, with no recurrence or relevant malocclusion during 3-year follow up. However, patients will be followed up for 10 years. Aggressive gap arthroplasty is not essential in the management of ankylosis of the TMJ. Minimal gap interpositional arthroplasty with complete removal of the mediolateral ankylotic mass is a feasible and effective method of preventing recurrence.

High risk of essential hypertension in males with intron 4 VNTR polymorphism of eNOS gene

In this study 250 patients with essential hypertension were investigated in comparison to 218 normotensives for association with epidemiological parameters. Of these DNA samples from 176 patients and 168 controls were analyzed for intron 4 27bp repeat polymorphism of eNOS gene. The study revealed significantly high risk of essential hypertension for individuals who were obese, with a positive family history and with non-vegetarian food habits. Though the intron 4b/a polymorphism of eNOS gene did not reveal any association with essential hypertension in general, males with a/a genotype of the polymorphism did show significantly high risk for developing hypertension.

Acute toxoplasmosis in nonstem cell transplant patients with haematological malignancies: a study from a regional cancer institute in South India

The frequency of Toxoplasma gondii (Tgondii) infections was investigated during febrile episodes in nonstem cell transplant patients with haematological malignancies (HM). One hundred and sixty-two febrile episodes in 125 HIV-negative patients with HM undergoing treatment at Kidwai Memorial Institute of Oncology, Bangalore, India comprised the study group. Plasma from anticoagulated whole blood was used for amplifying the B1 gene of T. gondii by nPCR. Specific antibodies to T. gondii (IgM and IgG) were tested using commercial kits. Corticosteroid and cotrimoxazole usage during these episodes was 50 and 41%, respectively. Twenty-two of the febrile episodes (14%) were positive for T. gondii; nine of which did not have any other concomitant infecting pathogen and were seen in symptomatic patients. While majority of these (13%) were 'Toxoplasma infection', there was a single case of 'probable Toxoplasma disease' (0.6%). In four of the fatal febrile episodes, T. gondii was the causative agent; two of which did not have any other concomitant infection. None of the patients had undergone stem cell transplantation.

Lymphoscintigraphic evidence of lymph vessel dilation in the limbs of children with Brugia malayi infection

Lymphatic filariasis (LF) is targeted for global elimination by the year 2020. It was earlier believed that LF is mostly a disease of adults. Recent studies indicate that in endemic countries filarial infection starts mostly in childhood even though the disease manifestations occur much later in life. The initial damage to the lymph vessels where the adult worms are lodged is dilation, thought to be irreversible even with treatment. Most of these studies relate to bancroftian filariasis. Studies that address this early pathology in brugian filariasis in humans are scarce. We report here for the first time, the lymphatic abnormalities seen on lymphoscintigraphy (LSG) in children with Brugia malayi filariasis. LSG was performed in 100 children aged between 3-15 years, who were enrolled in the study either because they were microfilaremic; had present or past filarial disease or were positive for antifilarial IgG4 antibodies. Inguinal and axillary lymph nodes were imaged in most children. Dilated lymph vessels were visualized in 80 children and this pathology was evenly distributed in all the three study groups. Lymph vessels dilation was seen even in three year old children. The implications of these findings for management of LF and control programmes are discussed.

Doppler ultrasonography reveals adult-worm nests in the lymph vessels of children with brugian filariasis

Although ultrasonography has allowed 'nests' of live adult worms and dilated lymphatics to be detected in the early stages of infection with Wuchereria bancrofti, previous attempts to locate such adult-worm nests in brugian filariasis have been unsuccessful. In this study, the successful location of live adult Brugia malayi parasites, in the lymphatics of the axilla, thigh, epitrochlear region and/or popliteal fossa of children aged 3-15 years, is described for the first time. The 'filarial dance sign' (FDS), which indicates the presence of live adult worms, was observed in six children with microfilaraemia and in eight children who, though amicrofilaraemic, either had experienced an episode of lymphoedema (one) or were only positive for antifilarial IgG4 antibodies (seven). In bancroftian infection, the adult-worm nests have mostly been seen in asymptomatic but microfilaraemic subjects. The suspected worm nests, 18 in the 14 children, were all confirmed using colour-power and pulse-wave Doppler examinations. The worm nests were distinctly smaller and the wriggling movements were less rapid and less conspicuous than those seen in bancroftian filariasis. The importance of these findings in the management and control of lymphatic filariasis is discussed.

Preliminary findings from a cross-sectional study on lymphatic filariasis in children, in an area of India endemic for Brugia malayi infection

As the more obvious clinical manifestations of the disease are very uncommon in children, lymphatic filariasis has been considered to be primarily a disease of adults. In many recent reports, however, there is evidence indicating not only that filarial infection is commonly acquired in childhood but also that many infected children already have irreversible damage to their lymphatics. The preliminary results of a cross-sectional study on the patterns of Brugia-attributable pathology in 7934 children (aged 3-15 years) who live in an area of India with endemic B. malayi infection confirm these trends. The children were screened for microfilaraemia, evidence of filarial disease, and the presence of antifilarial IgG(4) antibodies. One hundred children who were microfilaraemic but asymptomatic (32), with filarial disease or an history of such disease or microfilaraemia (29) or amicrofilaraemic and asymptomatic but seropositive for antifilarial IgG(4) (39) were investigated further. They were given detailed clinical examinations, their levels of microfilaraemia were evaluated (by counting microfilariae filtered out of blood samples), their lymphatics were explored by Doppler sonography, and their limbs were checked by lymphoscintigraphy. The 'filarial dance sign', which indicates the presence of live adult worms, was detected by sonography in 14 children (apparently the first time this sign has been observed in brugian filariasis). Lymphoscintigraphy revealed dilated lymphatic channels in the limbs of 80 of the children. At the end of the study, each of the 100 hospitalized children was treated with a single combined dose of diethylcarbamazine and albendazole; the aim is to follow-up the treated children every 6 months for 3 years. Even these preliminary results have important implications for filariasis-control programmes and emphasise the need for disability-alleviation efforts among children as well as adults.

Taurine-diabetes interaction: from involvement to protection

Taurine is a sulfur amino acid (2-amino ethane sulfonic acid) and has been claimed for a number of beneficial actions ranging from anti-epilepsy to anti-hypertension. Taurine in diabetes has an age old story; taurine is involved in the development and protection of insulin apparatus. Taurine and insulin both have mutual stimulating actions with hypoglycemic properties. On the clinical front, taurine supplementation has an acceptable beneficial effect in platelet aggregation and, to name few more, in neuropathy, cardiomyopathy, and nephropathy to retinopathy. Recent studies have provided a role for taurine in fetal development and in blocking the transfer of diabetes from diabetic mother to offspring. A number of mechanisms for the actions of taurine have been advocated, from osmoregulation to anti-oxidation. Though sulfonylurea and recently introduced thiazolidinediones are effective, however they are not free from complications, thus there is a need to design new therapeutics. As taurine is also a sulfonyl derivative, it will be of great interest to develop taurine analogues as an alternative therapy. Considering the great involvement of taurine in diabetes, this review may provide a holistic view of taurine in diabetes and in its prevention in this century.

Therapeutic management strategies for type 2 diabetes

Diabetes mellitus type 1 and 2 affects people worldwide and is associated with further complications like macrovascular, microvascular and its effect is observed as retinopathy, cardiovascular diseases, nephropathy and many more diseases. There are numerous suggestions, treatments for presentation and controlling diabetes but no curative agents. Therefore the aim is to prevent or delay onset or control the complications. This work outlines the principle strategies for management of type 2 diabetes.

Evaluation of genetic potential of the polyvoltine silkworm (Bombyx mori L.) germplasm and identification of parents for breeding programme

In the present study, polyvoltine germplasm stock of Andhra Pradesh State Sericulture Research and Development, Institute (APSSRDI) was evaluated for its performance based on quantitative and qualitative traits. Twenty-one oval and 10 peanut cocoon shaped lines were reared in different seasons of the year. Since the polyvoltines are non-diapausing, six generations were reared and evaluated for various economically important traits based on evaluation index and sub-ordinate function statistical methods. Ten top ranked lines obtained by using both the methods were identified as potential parental strains. Among oval lines, APM14, APM11, APM18, APMW9, and APM19, and among peanut lines APMD5, APMD1, APMD3, APMD9 and APMD8 were selected as base material. The identified high yielding lines will be used in various breeding programmes as initial parents for the synthesis of superior polyvoltine breeds/hybrids.