Serous effusions: diagnosis of malignancy beyond cytomorphology. An analytic review

In this brief review, the role of various ancillary techniques to detect malignancy in effusion fluid are evaluated and discussed. The data were collected from a large number of research articles published in various medical journals. The role of these techniques to increase the diagnostic accuracy in serous effusions is emphasised.

Treatment of Casualties in a Forward Hospital of Indian Army : Nine year Experience

BACKGROUND

To analyze the outcome of the management of casualties in a level II trauma centre of a forward hospital of Armed Forces over a nine year period. Retrospective analysis of all casualties received in a single forward hospital of Indian Army was carried out.

METHOD

During 9 years (1990-1998), a total of 5737 casualties were received in a single level II zonal hospital of the Army in a forward area. Majority of the injuries were caused by bullets, or by fragments of improvised explosive devices. A policy of aggressive resuscitation and early primary repair of injuries was followed. General surgeons routinely performed craniotomies, thoracotomies, laparotomies, stabilization of fractures by fixators and repair of vascular injuries.

RESULT

38% of patients had injuries to several body parts (polytrauma), resulting in a total of 8578 injuries. Region-wise distribution of injuries was as follows : 14.2% head and neck injuries, 13.3% chest wounds, 13.5% abdominal injury and 59% extremity wounds. The overall mortality rate was 3.6%. The complication rate was about 7% with infection as the major complication. The results of primary repair of colonic injuries were similar to those of staged repairs. The results after primary closure of war wounds were better than those treated with delayed primary closure in selected cases.

CONCLUSION

Prompt evacuation, speedy resuscitation and early definitive repair of war injuries results in low mortality and morbidity. A motivated and dedicated team and adequate availability of blood and ancillary services adds to the excellent outcome. The policy of primary repair of colonic and selected soft tissue injuries appears justified in selected cases.

Comet assay measurements of DNA damage in cells by laser microbeams and trapping beams with wavelengths spanning a range of 308 nm to 1064 nm

DNA damage induced in NC37 lymphoblasts by optical tweezers with a continuous-wave Ti:sapphire laser and a continuous-wave Nd:YAG laser (60-240 mW; 10-50 TJ/m2; 30-120 s irradiation) was studied with the comet assay, a single-cell technique used to detect DNA fragmentation in genomes. Over the wavelength range of 750-1064 nm, the amount of damage in DNA peaks at around 760 nm, with the fraction of DNA damage within the range of 750-780 nm being a factor of two larger than the fraction of DNA damage within the range of 800-1064 nm. The variation in DNA damage was not significant over the range of 800-1064 nm. When the logarithm of damage thresholds measured in the present work, as well as values reported previously in the UV range, was plotted as a function of wavelength, a dramatic wavelength dependence became apparent. The damage threshold values can be fitted on two straight lines, one for continuous-wave sources and the other for pulsed sources, irrespective of the type of source used (e.g. classical lamp or laser). The damage threshold around 760 nm falls on the line extrapolated from values for UV-radiation-induced damage, while the data for 800-1064 nm fall on a line that has a different slope. The change in the slope between 320 and 340 nm observed earlier is consistent with a well-known change in DNA-damaging mechanisms. The change observed around 780 nm is therefore suggestive of a further change in the mechanism(s). The data from this work together with our previous measurements provide, to the best of our knowledge, the most comprehensive view available of the DNA damage produced by microfocused light.

Enterobacter cloacae: a predominant pathogen in neonatal septicaemia

A total of 120 blood samples from neonates presenting with clinical signs of septicaemia were subjected for culture using brain heart infusion agar biphasic medium (BHI BPM) and glucose broth. Bacterial agents were isolated from 48 numbers (40%) of cultures. Gram-negative bacilli were isolated in maximum percentage (88.45%) of cases whereas gram-positive bacteria (coagulase negative staphylococci and group B streptococci) in 11.6% of cultures. E. cloacae (39.5%) was maximally isolated among the pathogenic bacteria followed by K. pneumoniae (23.2%), E. coli (11.6%) and others like Acinetobacter spp. (6.9%), Citrobacter freundi (4.6%) and P. mirabillis (2.3%). All the gram-negative bacilli isolates showed 100% susceptibility to amikacin, whereas 85% of E. cloacae isolates were sensitive to the same. Thus E. cloacae was found to be a predominant moderately sensitive pathogen in neonatal septicemia.

Epidemic of Vibrio cholerae serogroup O139 in Berhampur, Orissa

During the months of May-June 2000, 194 patients with watery diarrhoea were admitted to the Infectious Diseases Ward of the M.K.C.G. Medical College, Berhampur. Ninety four rectal swabs were collected and processed according to the standard procedures. Vibrio cholerae strains were isolated from 20 samples. Of these 20 isolates, two were found to be V. cholerae O1 EITor Ogawa strain and 18 were confirmed to be V. cholerae serotype O139. All V. cholerae O139 isolates were of a single phage type (phage type 1) and the two O1 strains were of phage type 3 and phage type 27 respectively. All 20 V. cholerae isolates were positive for CAMP test, and showed uniform resistance to furazolidone and sensitivity to co-trimoxazole, amoxycillin, norfloxacin, tetracycline and gentamycin. V. cholerae O139 serotype has not been reported earlier in south Orissa. This is probably the first report of its isolation from this area.

Depolarization of autofluorescence from malignant and normal human breast tissues

We report on steady-state measurements on the anisotropy of autofluorescence from malignant and normal breast tissue as a function of tissue thickness. For thin tissue sections the anisotropy from normal tissue was found to be smaller compared with that from malignant tissue. However, the opposite result was obtained for thicker tissues. A phenomenological model was also developed to simulate the dependence of anisotropy on tissue thickness.

Measurement of optical transport properties of normal and malignant human breast tissue

We report measurement of optical transport parameters of normal and malignant (ductal carcinoma) human breast tissue. A spatially resolved steady-state diffuse reflectance technique was used for measurement of the reduced scattering coefficient (mu(s)?) and the absorption coefficient (mu(a)) of the tissue. The anisotropy parameter of scattering (g) was estimated by goniophotometric measurements of the scattering phase function. The values of mu(s)? and mu(a) for malignant breast tissue were observed to be larger than those for normal breast tissue over the wavelength region investigated (450-650 nm). Further, by using both the diffuse reflectance and the goniophotometric measurements, we estimated the Mie equivalent average radius of tissue scatterers to be larger in malignant tissue than in normal tissue.

Cloning, sequencing, and expression of the hepatitis E virus (HEV) nonstructural open reading frame 1 (ORF1)

Hepatitis E virus (HEV) causes enterically transmitted epidemic and sporadic viral hepatitis affecting millions of people in the developing world. Different geographical isolates of HEV show a high degree of homology at the nucleotide and amino acid levels. The approximately 7.2 kb RNA genome has three open reading frames of which ORF1 is predicted to code for the viral nonstructural polyprotein. The expression, processing and properties of the nonstructural ORF1 polyprotein have not been reported so far. In this study, the complete HEV ORF1 was reconstructed from overlapping fragments amplified by polymerase chain reaction (PCR) of total RNA isolated from the bile fluid of a rhesus monkey experimentally infected with HEV isolate from an epidemic. The complete assembled ORF1 was sequenced using HEV specific primers. The ORF1 polyprotein was expressed in E. coli, in a cell free translation system and in HepG2 cells, and was characterized by western blotting and immunoprecipitation using acute phase patient serum as well as polyclonal antibodies raised against defined parts of the ORF1 polyprotein. The nonstructural polyprotein of HEV was expressed as a 186 kDa protein. No processing was observed into discrete units, either in-vitro based on a kinetic analysis, or in HepG2 cells based on immunoprecipitation.

Monoclonal antibody based dot-enzyme linked immunosorbent assay (Dot-ELISA) and agar gel precipitation test (AGPT) for identification of Newcastle disease virus (NDV)

Two mouse monoclonal antibodies (MAbs), viz. 2B7 and 2 D10 raised against haemagglutinin-neuraminidase glycoprotein of Newcastle disease virus (NDV) were used to identify several other field isolates and vaccine strains of NDV. These MAbs reacted specifically with all the NDV strains/isolates in Dot-ELISA whereas, only MAb 2D10 reacted with all the NDV strains/isolates in agar gel precipitation test. These two tests employing the MAbs were standardised for rapid diagnosis and identification of NDV.

A COMPARATIVE STUDY OF REPAIR OF INGUINAL HERNIAS BY SHOULDICE TECHNIQUE VIS-A-VIS BASSINIS TECHNIQUE

A comparative study of repair of inguinal hernias by Shouldice technique (ST) vis-a-vis Bassinis technique (BT) was conducted on 100 patients who presented with inguinal hernia in the OPD services of our hospital. The patients were worked up and alternatively distributed to undergo repair by ST (n=50) or BT (n=50). Repair by ST required longer operating time (Avg 95 min vs 80 min), but involved lesser hospitalization (4.0 days vs 4.5 days), lesser complication rate (2 vs 4), lesser recurrence rate (0 vs 2) and higher rate of satisfaction. The study confirms the advantages of Shouldice repair in the treatment of inguinal hernia.

Epispadias repair using the Mitchell technique

PURPOSE

The results of epispadias repair using Mitchell's technique in nine patients is analyzed and the advantages of the procedure discussed.

METHODS

Nine boys aged between 6 weeks and 6 years underwent epispadias repair between November 1996 and March 1998 (Penopubic epispadias, inferior vesical fissure, and midpenile epispadias, one patient each; exstrophy epispadias complex, six patients). Eight patients had first attempt at repair of epispadias. Two patients had closure of exstrophy and epispadias at one stage.

RESULTS

At a mean follow-up of 10 months, all children had a conical glans, eight patients had ventral orthotopic meatus, and one had coronal hypospadiac meatus. Minor penopubic fistula developed in one patient. Six patients had downward angled penis, and three had horizontal penis in a flaccid state. All children were observed to have good erections during sleep.

CONCLUSIONS

Mitchell's technique of epispadias repair allows an anatomic reconstruction of the penis with superior cosmetic and functional results. Long-term follow-up studies are necessary to evaluate the genital functions.

Diagnosis of superficial mycoses by direct microscopy - A statistical evaluation

A mycological study was undertaken in 250 cases of superficial mycotic infections, which included 210 cases of dermatophytosis, 18 cases of cutaneous candidiasis and 22 cases of tinea versicolor. The scrapings from all the cases were subjected to direct microscopic examination in 10% KOH solution and culture was done in case of candidiasis and dermatophytosis. Out of 250 cases direct microscopy was positive (KOH +ve) in 88 cases of dermatophytosis, 11 cases of candidiasis and all cases of tinea versicolor. Culture for dermatophytes and candida species in SDA medium were positive in 76 and 9 cases respectively. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and the overall efficiency of the direct microscopy in the diagnosis of superficial mycotic infections were calculated to be 89.41%, 83.90%, 76.76%, 93.02% and 85.96% respectively.

Mesenteric cyst--an unusual presentation

Mesenteric and retroperitoneal cysts develop from ectopic lymphatic tissue. Most of them present as symptomless abdominal swellings or are found coincidentally during abdominal operations. One third of patients may present with acute abdominal pain, and few may present with chronic abdominal pain. However, mesenteric cyst presenting as inguinal hernia is extremely rare. Only four cases have been reported in the English-language literature. The present case is the fifth, and only the second from this subcontinent. The treatment of choice is complete surgical excision.