Comparison study of clinicoradiological profile of primary lung cancer cases: an Eastern India experience

CONTEXT

According to the first population-based cancer registry from eastern part of India, Kolkata and its surrounding areas have the highest prevalence of lung cancer in India. However, there is very limited data from this part of the country.

AIMS

The aim of this study is to find out the demographic and clinicoradiological profile of primary bronchogenic carcinoma.

SETTINGS AND DESIGN

This is a retrospective review of lung cancer cases diagnosed in two tertiary institutes of Kolkata over a period of 4 years.

MATERIALS AND METHODS

We have reviewed the cases with proven histological or cytological diagnosis of primary bronchogenic carcinoma and chi-square test is done to calculate statistical significance.

RESULTS

Out of 607 patients, male 489 and female 118, 67.7% are from rural area, 67.2% are smoker and only 9.4% are ≤40 years of age. Smoking is the major risk factor for primary lung cancer (P = 0.000) but no significance could be established with the different histological subtypes (P = 0.207). Though squamous cell carcinoma (SCC) is the most predominant variety (35.1%), adenocarcinoma and undifferentiated type are overrepresented in ≤40 years. SCC occurs at a significantly higher age group (60.84 ± 12.16 years) than other subtypes (P = 0.000). At least 55.2% cases of nonsmall cell lung cancer and 54% of small cell lung cancer presented in very advanced stage.

CONCLUSIONS

SCC is the most common histological subtype of primary bronchogenic carcinoma. The relatively increased frequency of adenocarcinoma in our study as compared to other studies from India is probably due to higher proportion of nonsmokers.

Putative genes mediating the effects of orexins in the posterior paraventricular thalamus on neuroendocrine and behavioral adaptations to repeated stress

Exposure to repeated stress is often associated with psychopathology. However, our understanding of the underlying neural circuitry that regulates responses to repeated stress is limited. The posterior paraventricular thalamus (pPVT) is a brain region responsible for transmission of multimodal sensory information to limbic structures that regulate responses to both acute and repeated stress. Orexin-containing cells originating in the hypothalamus heavily innervate the pPVT. Our previous work has shown that activation of orexin1 receptors in the pPVT during repeated swim stress is important for facilitation of the hypothalamic-pituitary-adrenal (HPA) axis response to subsequent novel restraint. However, the genes responsible for these orexin-mediated adaptations to repeated stress are not known. Using a custom PCR array we examined the expression of 186 specific mRNAs in the pPVT of animals exposed to repeated swim stress (4 days of 15min swim/day) with or without direct pPVT microinfusion of the orexin1 receptor antagonist SB334867 prior to each daily swim stress. Tissue was collected the next morning under basal non stressed conditions. Repeated stress and/or orexin receptor blockade significantly altered expression of only 9 specific genes including growth factors (Vegfa, Bax and Mt3), G-protein coupled receptors (Adora2a, Grm2 and Crhr1), immune-related genes (Ptgs2 and Cx3cr1) and an epigenetic-related gene (Hdac5). These genes represent potential targets for further characterization of orexin-mediated adaptations to repeated stress in the pPVT.

Estrogen inhibits D2S receptor-regulated Gi3 and Gs protein interactions to stimulate prolactin production and cell proliferation in lactotropic cells

The neurotransmitter dopamine (DA) is known to inhibit prolactin (PRL) secretion and the proliferation of lactotropes in the pituitary gland. Dopamine-2 (D2) receptor short (D2S) isoform is expressed in a reduced level while the D2 receptor long (D2L) isoform is expressed in an elevated level during estradiol (E(2))-induced PRL production and cell proliferation in lactotropes. To evaluate the role of these D2 receptor isoforms in E(2)-regulated lactotropic cell function, we compared E(2) effects on the level of PRL, cell proliferation, and G proteins in enriched lactotropes and lactotrope-derived PR1 cells containing only D2S isoform (D2S cells), D2L isoform (D2L cells), or no D2 receptor (V cells). Additionally, we determined the effects of G protein blockade on the E(2)-induced PRL production and cell proliferation in these cells. We here show that E(2) actions on G proteins, PRL production, and cell proliferation were maximally achieved in D2S cells, oppositely or marginally achieved in D2L cells, and absent in V cells. We also show that the DA and pertussis toxin modulations of E(2) actions on PRL, G proteins, and cell proliferation were maximally achieved in D2S cells compared with in D2L or V cells. Furthermore, we provide evidence for the existence of an inhibitory action of Gi3 on Gs that is under the control of the D2S receptor and is inhibited by E(2). These results suggest that the suppression of D2S-regulated Gi3 inhibition of Gs protein may be one of the mechanisms controlling E(2)-activated PRL synthesis and cell proliferation in lactotropes.

Pulmonary Cavity due to Chronic Eosinophilic Pneumonia Associated with Arsenicosis

In developing country like India arsenic poisoning is a major public health problem. Association of chronic eosinophilic pneumonia and chronic diarrhea with arsenicosis is rare. Also pulmonary cavity formation in chronic eosinophilic pneumonia is very uncommon. A 44-year-old male patient, resident of an arsenic affected area was admitted for evaluation of chronic diarrhoea, persistent peripheral eosinophilia along with radiologically visible cavity in right upper zone. There were dermatological manifestations of arsenicosis along with presence of noncirrhotic portal fibrosis and peripheral eosinophilia. On bronchoalveolar lavage study, eosinophil comprised 40% of total cellularity making the diagnosis of chronic eosinophilic pneumonia. After ruling out all possible causes of diarrhoea and chronic eosinophilic pneumonia, we came to conclusion that arsenic could be implicated as causative agent. Keywords: Arsenicosis, chronic diarrhoea, chronic eosinophilic pneumonia, noncirrhotic portal fibrosis.

Pulmonary cavity due to chronic eosinophilic pneumonia associated with arsenicosis

In developing country like India arsenic poisoning is a major public health problem. Association of chronic eosinophilic pneumonia and chronic diarrhea with arsenicosis is rare. Also pulmonary cavity formation in chronic eosinophilic pneumonia is very uncommon. A 44-year-old male patient, resident of an arsenic affected area was admitted for evaluation of chronic diarrhoea, persistent peripheral eosinophilia along with radiologically visible cavity in right upper zone. There were dermatological manifestations of arsenicosis along with presence of noncirrhotic portal fibrosis and peripheral eosinophilia. On bronchoalveolar lavage study, eosinophil comprised 40% of total cellularity making the diagnosis of chronic eosinophilic pneumonia. After ruling out all possible causes of diarrhoea and chronic eosinophilic pneumonia, we came to conclusion that arsenic could be implicated as causative agent.

Portable cost-effective EEG data acquisition system

Neuro-cognitive dysfunctions are common clinical abnormalities found in society. They require objective analysis by various instruments; an important technique involves monitoring electroencephalogram (EEG) signals. To date, EEG machines have been robust, costly and require patients to come to a hospital for test. Therefore, we have constructed a simple, cheap and portable EEG instrument for wider patient use. It consists of two active digital EEG probes with two channels each, making it a four-channel portable acquisition system. It is further connected through a two-wire serial bus to the acquisition unit, which comprises an analogue to digital converter (ADC) and an ARM board processor with 2 GB memory and USB interface. The whole system is placed in a small box making it highly portable for wider use in clinical settings.

The role of dynamisation vis-à-vis non-dynamisation after closed interlocking nailing in cases of closed tibial shaft fractures in adults

The importance of dynamisation after static locked nailing in comminuted closed tibial fractures is a matter of contention. A prospective study was undertaken among 178 patients in the department of orthopaedics at RG Kar Medical College, Kolkata from January 2002 to December 2006, to analyse the usefulness of this procedure with respect to the degree of comminution. In this study it was seen that dynamisation was found to be of statistical significance in relatively less comminuted fractures as per Winquist-Hansen's classification.

Iodopovidone pleurodesis: experience of a tertiary hospital in Kolkata

INTRODUCTION

The management of recurrent pleural effusion or pneumothorax has always been a cause for serious concern among chest physicians. Among the wide variety of agents that are available for pleurodesis, povidone iodine is now perhaps the most sought after agent as it is cheap, easily available, effective and safe. This study was conducted to establish the efficacy and safety of povidone iodine as an agent for pleurodesis in patients with recurrent pleural effusion and pneumothorax.

METHODS

A total of 38 consecutive patients with symptomatic malignant or recurrent pleural effusion and pneumothorax received povidone iodine for pleurodesis over a period of 18 months. The mean follow-up period was 10.2 months, with a standard deviation of 2.9 months.

RESULTS

Out of the 38 patients, 29 had malignant pleural effusion, eight had recurrent pneumothorax and one had tubercular pleural effusion which was nonresponsive to antitubercular therapy. A complete response with no recurrence during follow-up was obtained in 34 (89.5 percent) patients. All the cases of failure had malignant pleural effusion. Three (7.9 percent) patients experienced intense chest pains after the installation of sclerosing agent, but they recovered with immediate symptomatic management.

CONCLUSION

Recurrent pleural effusion or pneumothorax due to any cause may be managed effectively and safely by chemical pleurodesis with povidone iodine. It may be considered as the agent of choice to achieve pleurodesis, especially in resource constrained countries like India, as it is inexpensive and easily available.

A comparative study of different graft materials used in myringoplasty

Two hundred twenty cases of unilateral chronic suppurative otitis media (CSOM) with dry central perforation were chosen for this study and myringoplasty were done. Age group ranged from 13 to 48 years. Four types of autogenous tissues were used as graft material. Grafting was done by underlay technique when temporalis fascia, tragal perichondrium, areolar tissue were used as graft material and when fat graft was used the ear lobule fat was placed directly into perforation through transcanal route. Postoperative follow-up was carried out up to 6 months. In this study, it was found that the younger age group has less impairment of hearing and better chance of tympanic membrane perforation closure than the older age group in CSOM with central perforation. Anterior perforations has less impairment of hearing and better result in successful closure of tympanic membrane than posterior perforation group. It was also observed that larger the size of perforation greater is the hearing impairment preoperatively and postoperative hearing gain is also less compared to small perforation. Best hearing improvement occurred using temporalis fascia. Failure occurred may be due to postoperative infection, respiratory tract infection, neglected post-operative advice etc.