Abdominal wall endometriosis

Endometriosis of abdominal wall scar following operation on uterus and tubes is extremely rare. The late onset of symptoms after surgery is the usual cause of misdiagnosis. Scar endometriosis is a rare disease which is difficult to diagnose and should always be considered as a differential diagnosis of painful abdominal masses in women. The diagnosis is made only after excision and histopathology of the lesion. Preoperative differentials include hernia, lipoma, suture granuloma or abscess. Hence an awareness of the entity avoids delay in diagnosis, helps clinicians to a more tailored treatment and also avoids unnecessary referrals. We report a case of abdominal endometriosis. The definitive diagnosis of which was established by histopathological studies.

Leprosy and its socio-cultural perception in Indian religions and ancient texts

Leprosy is one of the oldest ailments known to the mankind. Many of the ancient texts and scriptures reveal that leprosy was not categorised as a specified disease but was grouped along with other skin diseases. However, in certain texts categorical mention of this disease does exist. The prime objective of this article is to highlight the age old traditional line of perception about this disease. A literature review was done to up-date the socio-cultural perception of leprosy in Indian religions and ancient texts. References were obtained through examining relevant bibliographies and the views/suggestions of eminent scholars engaged in this field were also included. An analysis of the secondary sources of data, particularly the ancient texts reveals that in good old days, leprosy had been considered to be an infliction of wrong-doings and sins. This viewpoint has been significantly reflected in these texts.

Participation level of the leprosy patients in society

The present study examines the soci-demographic profile and participation restriction level of the respondents and the association of gender socio-economic status (SES) and deformity status of the respondents with their respective participation restriction level. 245 leprosy patients have been selected for the present study. Socio-economic scale, participation scale and in-depth interviews were used for data collection. Data analysis was done by using statistical package for social sciences (SPSS). 57.1% belonged to poor SES followed by lower-middle (21.6%). Only 12% of respondents belonged to high SES. Out of 245 respondents, 32.20% had grade II deformity 31.40% grade I and the rest 36.3% non-deformed. The results of the participation scale showed that 54.28% had no significant participation restriction and only 3.67% had extreme participation restriction. SES and deformity status of the respondents have shown significant differences with the level of participation restriction. The lower the SES and the severe the level of deformity of the respondents, the extreme is the level of participation restriction among them.

Synthesis of monodispersed gamma-Fe2O3 nanoparticles using ferrocene as a novel precursor

We report synthesis of mono-dispersed nanoparticles of crystalline gamma-Fe2O3 using ferrocene as a novel precursor. Thermal decomposition of ferrocene was achieved using paraffin wax as solvent and oleic acid as surfactant. Conventionally used precursor in the thermal decomposition method is iron pentacarbonyl. The toxicity, volatility and flammability of iron pentacarbonyl are causes of concern for environment and safety. The method proposed in the present work is better in these counts. In addition, high temperature required for the decomposition of ferrocene compared to iron pentacarbonyl ensures better crystallinity of the grown nanoparticles. Also, the reaction in paraffin wax can be frozen suddenly to study the evolution of the nanoparticles. Nanoparticles, thus synthesized, were characterized using transmission electron microscopy (TEM), high resolution TEM (HRTEM) and photoelectron spectroscopy (PES). PES shows formation of iron oxide and electron diffraction reveals that the particles are crystalline and form gamma-Fe2O3 phase. TEM shows the nanoparticles are mono-dispersed in diameter (20 +/- 2 nm) and they self assemble in three-dimensional hexagonal closed packed superlattices, because of high degree of uniformity in diameter.

Restoration by aspirin of impaired plasma maspin level in human breast cancer

Maspin, an anti breast cancer protein, is produced in the normal mammary cells but not in malignant cells in breast cancer. We investigated the effect of aspirin induced increase of plasma nitric oxide (NO) on plasma maspin production in breast cancer patients. Fifteen breast cancer patients (35-65 years), who had not yet undergone any cancer therapy, and an equal number of age matched normal female volunteers participated in the study. They were asked not to take any medication for two weeks. All participants then ingested 150 mg of aspirin. Plasma NO and maspin levels were determined before and at 60 min after the ingestion of aspirin. It was found that the maspin level in plasma increased to 4.63+/-0.02 nM from the basal 0.95+/-0.012 nM (p<0.001) with increase of plasma NO from 0.60+/-0.03 microM to 2.08+/-0.030 microM (p<0.001) in breast cancer patients. In normal volunteers the basal maspin increased from 4.76+/-0.041 to 9.36+/-0.036 nM (p<0.001) with increase of NO from 2.15+/-0.08 to 3.36+/-0.04 microM (p<0.001) at the same period. These results indicated that the ingestion of aspirin might be beneficial for breast cancer through increased maspin production.

Prevalence of obesity and metabolic syndrome in Indigenous Australian youths

We conducted a cross-sectional study of Indigenous youths residing in the Torres Strait region of Australia to assess the prevalence of obesity and the metabolic syndrome. Data on body mass index (BMI), waist circumference, blood pressure, presence of acanthosis nigricans and blood glucose were collected. Fasting glucose, insulin, C-Peptide, HbA1c and lipids were measured, and an oral glucose tolerance test was performed in those with a BMI greater than 25 (childhood-equivalent cut-points) or fasting glucometer reading >5.5 mmol/L. Of 158 youths, 31% were overweight and 15% were obese, 38% had enlarged waist circumference consistent with central obesity, 43% had acanthosis nigricans and 27% were hypertensive. More females than males had enlarged waist circumferences (59% vs. 13%, P < 0.001). Among overweight or obese youth, 56% had significantly elevated insulin (P = 0.021); they also had higher HOMA-IR (P = 0.002). The metabolic syndrome was present in 17% of all youths (mostly females) and in 33% of the overweight or obese subgroup. Type 2 diabetes was diagnosed in two youths. These very high proportions of overweight or obese Torres Strait youth with metabolic risk factors have major public health implications.

Spontaneous resolution of a small extradural haematoma in a child

We report the rapid spontaneous resolution of a small extradural haematoma (EDH) in a 19-month-old child. The haematoma was managed conservatively. The child went on to make a full recovery. The authors discuss the significance of this surprising clinical finding.

21 century - still no standardization

SUMMARY

Standardization of anaesthetic equipment is needed for safe anaesthetic practice. Various organizations and regulatory bodies have been made throughout world to formulate and control standards for anaesthesia equipment including endotracheal tubes. All endotracheal tubes must conform to ASTM standards. This has medico-legal importance also. Regulatory bodies should look after the whole process right from the manufacturers to the actual users. The Indian Society of Anaesthesiologists promotes safe anaesthetic practice, by establishing purchase guidelines for equipments and drugs. It is working in collaboration with World Federation of Societies of Anaesthesiologists. Standards have made anaesthesia and critical care equipment much safer over the years. There is need to form standards for various equipment in India.

Non-gelatinized starch influences the deposition of n-3 fatty acids in the muscle of a tropical freshwater fish, Labeo rohita

A 60-day feeding trial was conducted to study the influence of gelatinized (G) to non-gelatinized (NG) starch ratio in the diet on fatty acids profiles and oxidative status in Labeo rohita fingerlings. Two hundred and thirty-four fingerlings (average weight: 2.53 g) were distributed in six treatment groups with each of three replicates. Six semi-purified diets either containing NG and/or G corn starch (42.43%) viz., T(1) (100% NG and 0% G starch), T(2) (80% NG and 20% G starch), T(3) (60% NG and 40% G starch), T(4) (40% NG and 60% G starch), T(5) (20% NG and 80% G starch) and T(6) (0% NG and 100% G starch) was fed to respective groups. Catalase, superoxide dismutase and malic enzyme activities decreased linearly with the increasing level of G starch, whereas reverse trend was found for glucose-6-phosphate dehydrogenase. Total saturated fatty acids in muscle increased with the increasing level of G starch in the diet. Total n-3 fatty acids decreased linearly with the increasing level of G starch in the diet. Among the n-3 fatty acids, linolenic acids content was more in NG starch fed group. Similarly, eicosapentaenoic acid contents gradually decreased with increasing level of G starch content. The n-6/n-3 ratio was higher in G starch fed group. This suggests that dietary starch type may be manipulated for quality improvement of fish flesh.

Role of Multimodal Evaluation of Cerebral Hemodynamics in Selecting Patients with Symptomatic Carotid or Middle Cerebral Artery Steno-occlusive Disease for Revascularization

BACKGROUND

The circle of Willis provides collateral pathways to perfuse the affected vascular territories in patients with severe stenoocclusive disease of major arteries. The collateral perfusion may become insufficient in certain physiological circumstances due to failed vasodilatory reserve and intracranial steal phenomenon, so-called 'Reversed-Robinhood syndrome'. We evaluated cerebral hemodynamics and vasodilatory reserve in patients with symptomatic distal internal carotid (ICA) or middle cerebral artery (MCA) severe steno-occlusive disease.

METHODS

Diagnostic transcranial Doppler (TCD) and TCD-monitoring with voluntary breath-holding according to a standard scanning protocol were performed in patients with severe ICA or MCA steno-occlusive disease. The steal phenomenon was detected as transient, spontaneous, or vasodilatory stimuli-induced velocity reductions in affected arteries at the time of velocity increase in normal vessels. Patients with exhausted vasomotor reactivity and intracranial steal phenomenon during breath-holding were further evaluated by (99)technetium(m)-hexamethyl propylene amine oxime single photon emission computed tomography (HMPAO-SPECT) with acetazolamide challenge.

RESULTS

Sixteen patients (age 27-74 years, 11 men) fulfilled our TCD criteria for exhausted vasomotor reactivity and intracranial steal phenomenon during the standard vasomotor testing by breath holding. Acetazolamide-challenged HMPAO-SPECT demonstrated significant hypoperfusion in 12 patients in affected arterial territories, suggestive of failed vasodilatory reserve. A breath-holding index of ≤0.3 on TCD was associated with an abnormal HMPAO-SPECT with acetazolamide challenge. TCD findings of a breath holding index of ≤0.3 and intracranial steal during the procedure were determinants of a significant abnormality on HMPAO-SPECT with acetazolamide challenge.

CONCLUSION

Multimodal evaluation of cerebral hemodynamics in symptomatic patients with severe steno-occlusive disease of the ICA or MCA is helpful in the identification and quantification of failed vasodilatory reserve. This approach may be useful in selecting patients for possible revascularization procedures.

Infantile myofibromatosis of the craniovertebral junction

Infantile myofibromatosis (IM) is a rare pathological entity characterized by solitary or multiple nodular skin, soft tissues or bony lesions. Craniovertebral (CV) junction lesions are rare. We report the successful management of a solitary IM involving the posterior elements of the CV junction in a 6-month-old child.

Intraparenchymal pericatheter cyst following ventriculoperitoneal shunt insertion: does it always merit shunt revision?

Intraparenchymal pericatheter cyst is a rare complication of shunt surgery. It occurs as a consequence of increased CSF outflow resistance distal to a patent ventricular catheter. Treatment has traditionally consisted of shunt revision. We report on two such cases managed conservatively. The role of shunt revisions in cases with asymptomatic intraparenchymal pericatheter cyst is debatable.

Chondroid syringoma

Pleomorphic adenoma, or chondroid syringoma (CS), is a rare, benign, skin appendageal tumour. Because of the unremarkable clinical presentation of this rare tumour, the diagnosis is made on microscopic examination. The usual presentation is of an asymptomatic, slowly-growing mass, typically located in the head and neck region. We present a case of a CS located over the forehead of a 32-year-old man. In the evaluation of a middle-aged male patient with a small cutaneous nodule in the head and neck region, chondroid syringoma should also be considered in the differential diagnosis. For such a lesion, excisional biopsy, without destroying the aesthetic and functional structures, is the preferred diagnostic, as well as therapeutic approach.

High-grade infiltrative myxofibrosarcoma in the forearm presenting as acute carpal tunnel syndrome

Myxofibrosarcoma is one of the most common sarcomas in the extremities of elderly people and is characterized by a high frequency of local recurrence. We report a rare case of high-grade myxofibrosarcoma involving the forearm and presenting as acute carpal tunnel syndrome where absence of a discrete mass lesion and diffuse infiltrative nature precluded early recognition of tumor. To our knowledge, such a presentation with an extreme infiltrative growth pattern in the forearm has not been reported before.

Rapidly destructive osteoarthritis of the hip joint: a case series

BACKGROUND

Rapidly destructive arthrosis of the hip is a rare and incompletely understood disorder with scarce literature about variations in natural history within a population.

METHODS

A series of cases from North Wales with rapid progressive joint destruction and extensive subchondral bone loss in the femoral head and acetabulum are presented. Radiographic findings mimicked those of other disorders such as septic arthritis, rheumatoid and seronegative arthritis, primary osteonecrosis with secondary osteoarthritis, or neuropathic osteoarthropathy, but none of the patients had clinical, pathologic, or laboratory evidence of these entities.

RESULTS

Rapid progression of hip pain and disability was a consistent clinical feature. The average duration of symptoms was 1.4 years. Radiographs obtained at various intervals before surgery (average 14 months) in 18 patients documented rapid hip destruction, involvement being unilateral in 13 cases. All patients underwent total hip arthroplasty, and osteoarthritis was confirmed at pathologic examination.

CONCLUSION

The authors postulate that these cases represent an uncommon subset of osteoarthritis and regular review, both clinically and radiologically, are required to assess speed of progression and prevent rapid loss of bone stock without the surgeon being aware. These cases are unsuitable for being placed on long waiting list due to technical difficulties in delayed surgery and compromised outcome following surgery.

Is magnetic resonance imaging (MRI) necessary to exclude occult hip fracture?

The possibility of occult hip fracture in older patients after a fall is a common problem in emergency and orthopaedic departments. Magnetic resonance imaging (MRI) scanning is the best investigation, but is expensive and may be difficult to obtain. The value of various clinical signs to determine which patients are at risk of occult hip fracture has not been reported. We reviewed all patients who had MRI scan for suspected hip fractures but had normal initial X-rays over a 6-year period. We identified 76 patients. Twelve patients were excluded. Two patients had MRI scan for suspected stress fracture and two patients had metastatic fractures. Eight patients had inadequate or untraceable clinical notes. Each patient's personal details, mobility, independence and detail clinical details were recorded. Following case review of 64 patients we excluded 5 patients with associated osteoarthritis of the hip joint, 1 patient with fibromyalgia and 1 patient with pre-existing multiple myeloma. Thirty-five patients had occult proximal femoral fractures. Of them four patients had isolated pubic ramus fractures and five patients had isolated greater trochanter fractures. Twenty-two patients had no fracture. The value of the individual tests was evaluated using Fisher exact and chi square analysis; with Bonferroni correction for multiple comparisons (10 tests) p<0.005 was deemed significant. Pain on axial loading of the limb and pre-fracture restricted patient mobility were both associated with the presence of a fracture (p<0.005). Both factors had identical positive predictive value=0.76, a negative predictive value=0.69 and post-test probability of disease given a negative test=0.30. Predictive values remained the same when both factors were considered together. Patients who were independently mobile before the fall and who do not have pain on axial compression of the limb are less likely to have a fracture, but these signs alone or in combination do not exclude a fracture. The clinical signs investigated cannot distinguish between patients with and without a hip fracture, and MRI scanning is necessary to establish whether some patients have an occult fracture.

Epidermoid cyst of anterior fontanelle with clear contents

BACKGROUND

Epidermal inclusion cysts very rarely occur in the midline in the area of the anterior fontanelle.

CASE DESCRIPTION

We report the second case of epidermal inclusion cysts in the midline in the area of the anterior fontanelle in world literature of a 7-month female infant who presented with a slow-growing soft mass located in the midline over the vertex of the head.

CONCLUSION

These lesions with clear contents can have all the features of encephalocele on clinical examination, and imaging will show the exact location, but histopathology will confirm the diagnosis.

Radioprotective and antioxidant activity of fractionated extracts of berries of Hippophae rhamnoides

Plants are an abundant source of medicinal compounds, some of which are useful in combating free radical-mediated oxidative stress. In the present study, initially two fractions designated REC-1001 (flavonoid-rich fraction) and REC-1002 (flavonoid-poor fraction) of Hippophae rhamnoides were screened on the basis of their reducing power in the aqueous phase. REC-1001 was selected for further study, since it exhibited 27.38 times higher antioxidant activity than REC-1002. REC-1001 also showed significant (P < .05) membrane protection potential at 50 microg/mL, which was attributed to its ability to scavenge peroxyl radicals (64.82 +/- 1.25% scavenging within 1,440 min). A significant (P < .05) difference of 67.02% in free radical scavenging activity at 1,000 ng/mL between REC-1001 and vitamin E demonstrated the extract fraction's worth in radiation protection. Such activities were attributed to the presence of quercetin, isorhamnetin, and kaempferol in this fraction. Further, REC-1001 was found to be nontoxic up to 200 mg/kg of body weight. This research suggests that the REC-1001 fraction of H. rhamnoides extract is a safe and effective antioxidant nutraceutical product.

SEM and raman spectroscopy of multiwalled carbon nanotubes grown by novel technique of ash supported catalysts

Multiwalled carbon nanotubes (MWCNTs) were grown on a novel ASC catalyst and on catalyst deposited by SCC method on silicon wafer, by thermal CVD of acetylene. Fe and Ni were used as catalyst for ASC. Samples were analyzed by SEM and Raman spectroscopy. SEM analysis shows that CNTs grown on ASC have narrower diameter distribution (64+/-6 nm) compared to CNTs grown on SCC (67+/-10.5 nm). However, SEM and Raman spectroscopy studies show CNTs grown on SCC are of better quality. The same samples were studied after standard purification procedure of oxidation after annealing at high temperatures. SEM and Raman spectroscopy show that overall quality of ensemble of CNTs has improved. After annealing, diameter decreases for larger diameter approximately 200 nm nanotubes while it increases for CNTs of smaller diameter approximately 70 nm. To explain the increase in diameter of approximately 70 nm CNT's, a phenomenological model has been proposed. The results of Raman spectroscopy and SEM corroborate the proposed model.

Intracranial metastases from carcinoma of the cervix

Uterine cervix carcinoma usually spread by local extension and through the lymphatics to the retroperitoneal lymph nodes. Brain metastases are extremely rare in the course, are usually seen late and have poor prognosis. We report a 49-year-old woman with squamous cell carcinoma of the cervix who developed right parieto-occipital lobe metastasis after three years of treatment of the primary disease. The presenting symptoms of the metastatic disease were hemiparesis, headache, and vomiting. Her hemiparesis improved after surgical excision of the metastasis. Treatment in these cases is mainly palliative but may offer symptomatic relief and improvement in the quality of life.

Impact of volume guarantee ventilation on arterial carbon dioxide tension in newborn infants: a randomised controlled trial

OBJECTIVE

To compare the effects of the two modes of ventilation, synchronous intermittent positive pressure ventilation (SIPPV) and SIPPV with Volume Guarantee (VG), on arterial carbon dioxide tension (PaCO(2)) immediately after neonatal unit admission.

STUDY DESIGN

Randomised study of ventilation mode for premature inborn infants admitted to two tertiary neonatal units. After admission, infants were randomised to receive either SIPPV or VG using a Dräger Babylog 8000 plus ventilator. In the SIPPV group, peak airway pressure was set clinically. In the VG group, desired tidal volume was set at 4 ml/kg, with the ventilator adjusting peak inspiratory pressure to deliver this volume. The study was completed once the first arterial PaCO(2) was available, with the desirable range defined as 5-7 kPa.

RESULTS

PaCO(2) was significantly higher in the VG group (VG: 5.7 kPa, SIPPV: 4.9 kPa; p=0.03). The VG group had fewer out-of-range PaCO(2) values (VG: 42%, SIPPV: 57%) and fewer instances of hypocarbia <5 kPa (VG: 32%, SIPPV: 57%) but neither difference achieved statistical significance. Regression analysis showed PaCO(2) was negatively correlated with gestation (r=-0.41, p=0.01) and also with the mode of ventilation (r=0.32, p<0.05). In the VG group, all infants 23-25 weeks' gestation had out-of-range PaCO(2) values. VG significantly reduced the incidence of out-of-range PaCO(2) and hypocarbia in infants over 25 weeks' gestation (VG: 27%, SIPPV: 61%; p<0.05).

CONCLUSION

Using this strategy, VG appears feasible in the initial stabilisation of infants over 25 weeks' gestation, with a halving of the incidence of hypocarbia. In the small number of babies studied below this gestation, VG was not found to be effective.

Application of a plain abdominal radiograph transition zone (PARTZ) in Hirschsprung's disease

Background

A standard contrast enema for Hirschsprung's disease can sometimes be inconclusive in delineating a transition zone especially in neonates and infants. The aim of this study was to determine the utility and diagnostic accuracy of a plain abdominal radiograph transition zone (PARTZ) in predicting the level of aganglionosis.

Methods

A prospective observational study of neonates and infants with biopsy proven Hirschsprung's disease was carried out from March 2004 through March 2006. All patients underwent a plain abdominal radiograph and a contrast enema followed by a rectal biopsy. The transition zone on a plain radiograph (PARTZ) and contrast enema (CETZ) were compared with operative and pathology reports. Results were analyzed by chi square test and expressed as their p values and 95% confidence intervals.

Results

PARTZ and CETZ suggestive of Hirschsprung's disease was seen in 24(89%) and 18(67%) patients respectively. The PARTZ and CETZ matched with the pathologic level of transition zone in 22(92%) and 13(72%) patients, p = 0.001, 95% CI (-1.87 to -0.79). In the 9 (33%) patients in whom contrast enema failed to reveal a transition zone, PARTZ was seen in 6/9(66%) patients and correlated with the pathological level of aganglionosis in 4/6(67%) patients, p = 0.001 95% CI (-1.87 to -0.79). The overall accuracy of PARTZ and CETZ was 96% and 84% respectively, p = 0.008, 95% CI (-6.09 to -3.6).

Conclusion

A plain abdominal radiographic transition zone is reliable in predicting the level of transition zone in cases of inconclusive contrast enema. It may be particularly helpful developing countries where laparoscopic techniques are not available to accurately identify the transition zone.