Utilization of glucose and amino acids in insect cell cultures: Quantifying the metabolic flows within the primary pathways and medium development

The current understanding of insect cell metabolism is very limited. In order to gain some insight into the growth and metabolism of insect cells Spodoptera frugiperda (Sf9), a comprehensive characterization of culture conditions for cells grown in the IPL-41 medium was made by measuring the amino acid composition of the growth medium and the cell extract, the macromolecular composition of the cells (DNA, RNA, and protein), medium concentrations of various metabolites and sugars, and the evolved CO(2). Since in the IPL-41-based serum-free medium all of the amino acids except cysteine are in great excess of what is needed by the cells for energy and protein production, a medium formulation with an osmolarity similar to the IPL-41 but with a lower amino acid content than IPL-41 was also developed. The new medium also lacks maltose and sucrose (contains only glucose), supported cell growth to a high cell density of 8 x 10(6) cells/mL. The cellular and energetic yields indicated that a tight coupling between the biosynthetic and energetic reactions was attained for cells grown in the new medium. Moreover, it was found that the intermittent feeding of glucose may not be required as the cell yield and growth rate were comparable whether the same total amount of glucose was provided intermittently or was included initially in the medium. The eventual cessation of growth in the new medium is believed to be due to the amino acid limitation because concentrations of both glutamine and glutamate were very low at the end of the growth phase. Thus, further optimization, which may include higher initial glutamine in the medium or its intermittent feeding, could lead to a further increase in the cell density. Finally, a stoichiometrically based analysis of metabolic reactions confirmed the operation of the key pathways and was used to quantify the distribution of metabolites among primary metabolic reactions. The quantitative flow values were used to highlight some key aspects of insect cell metabolism.

Nasal spirometery

Nasal obstruction is a common symptom which is difficult to quantify clinically. Rhinomanometry, Acoustic Rhinometry and Forced Oscillation methods are available for estimating nasal resistance but, these require sophisticated machines. Because of limited availability of these techniques, this potential physiological measure has not been tapped fully for research and clinical purposes. Here, we describe the use of pulmonary spirometer with little modification for quantification of nasal flow. Nasal inspiratory and expiratory flow rates along with oral inspiratory and expiratory flow rates are used to derive different nasal resistance indices. This way of reporting nasal resistance is not new but, the data for these variables is currently not available in published literature. The reproducibility of nasal flow rates were tested as variation after one day and the interclass coefficient for inspiratory and expiratory nasal flow rates were found to be with in acceptable limits. Thus, nasal spirometery is able to describe the nasal resistance in a reliable manner and may be used to quantify nasal obstruction in pathological condition and also to study the physiological phenomenon like nasal cycle.

Fetal radiation exposure and moyamoya disease

Moyamoya disease is a progressive occlusive disease of the cerebral vasculature with particular involvement of the circle of Willis. We present the first reported patient with moyamoya disease possibly due to radiation exposure during fetal development. A 10-year-old male, whose mother had undergone radiotherapy when pregnant, presented with moyamoya disease. The relevant literature is discussed.

Massive benign osteoblastoma of the suboccipital bone and foramen magnum region

Benign osteoblastoma is an uncommon primary bone tumor frequently found in the vertebral column and long tubular bones, and rarely occurring in the calvarium. A case of a massive benign osteoblastoma of the suboccipital bone and foramen magnum region in a 9-year-old boy is reported. He presented with progressively worsening nuchal pain and headaches secondary to a bony lesion in the suboccipital and foramen magnum region. Computed tomography (CT) of the brain showed a large midline occipital/suboccipital bony lesion extending to either side (R > L) and extending from the torcula till the foramen magnum region, causing moderate obstructive hydrocephalus. The atlas was uninvolved by the tumor. In addition, the cerebellum was pushed anteriorly squashing the fourth ventricle. The tumor was completely resected with wide margins via a suboccipital route. At follow-up after 7 years, the patient was asymptomatic, and CT imaging demonstrated no recurrence. The occurrence of benign osteoblastoma in the suboccipital bone and foramen magnum region has not been reported earlier in the pediatric population. Surgical extirpation of the lesion with wide margins is advocated and can produce an excellent long-term outcome. Serial vigilant follow-up along with sequential imaging is advocated even in cases with complete resection to detect early recurrence and possible malignant transformation.

Comparison of validity of DIAGNOdent with conventional methods for detection of occlusal caries in primary molars using the histological gold standard: an in vivo study

AIM

This study was conducted to compare the in vivo effectiveness of DIAGNOdent with other conventional methods (visual, tactile and bitewing radiographs) for the detection of occlusal caries in primary molars. Another objective of the study was to calculate new cut-off limits for the detection of caries by DIAGNOdent in primary teeth.

MATERIALS AND METHODS

Eighty-four primary molars in 52 children (aged 8-12 years), which were indicated for extraction, were selected and evaluated for dental caries using DIAGNOdent, visual and tactile examination and bitewing radiographs. Histological examination of the sections, prepared subsequent to extraction of the teeth, served as the gold standard for comparison of the above-mentioned methods.

RESULTS

When considering enamel caries, values obtained for sensitivity, specificity and accuracy were 48.15, 100 and 49.40% for visual examination, 48.15, 100.00 and 49.40% for tactile examination, 49.38, 50.00 and 49.40% for bitewing radiographs, 85.19, 50.00 and 84.34% for DIAGNOdent scores interpreted according to manufacturer's cut-off limits and 81.48, 100.00 and 81.93% for DIAGNOdent scores interpreted according to newly formulated cut-off limits, respectively. At dentin caries cut-off levels, the values of sensitivity, specificity and accuracy for visual examination were 52.78, 89.36 and 73.49%; 50.00, 91.49 and 73.49% for tactile examination; 30.56, 82.98 and 60.24% for bitewing radiographs; 72.22, 76.60 and 74.70% for DIAGNOdent scores when interpreted according to manufacturer's cut-off limits and 77.48, 74.47 and 75.90%, respectively, for the DIAGNOdent scores when interpreted according to the newly formulated cut-off limits.

CONCLUSIONS

DIAGNOdent showed higher sensitivity and accuracy as compared with other conventional methods for detection of enamel caries, whereas for detection of dentinal caries, even though the sensitivity was high, accuracy of the DIAGNOdent device was similar to other conventional caries diagnostic methods.

Extradural arachnoid cysts: a study of seven cases

Analysis of the management of 7 cases of extradural arachnoid cyst is presented. A brief review of the literature on the subject is presented. Seven cases of extradural arachnoid cysts were treated surgically between the years 1996 to 2002. These patients were analysed retrospectively. The average follow-up period was 32 months. Three patients were males and four were females and their ages ranged from 12 to 35 years. The patients presented with predominant complaint of progressive motor deficits. There were two cysts in the dorsal region, four in the dorsolumbar region and one in the cervicodorsal region. The extradural arachnoid cyst was located posterior to the dural tube and in the midline in six cases and all these cysts had bilateral multiple intervertebral foraminal extensions. In the case with a cervicodorsal cyst, the cyst was anterolateral to the dural tube and there was no foraminal extension. The surgery comprised of wide exposure of the cyst and radical marsupialization or resection of the cyst wall. There was no recurrence of the cyst during the period of follow-up. Radical resection of the walls leads to a lasting cure from extradural arachnoid cyst. The site of communication of the cyst contents with subarachnoid CSF could not be identified during the surgery in the series.

Anterior tentorium-based epidermoid tumours: Results of radical surgical treatment in 96 cases

A retrospective analysis of 96 surgically treated tentorium and anterior tentorial hiatus-based epidermoid tumours from 1997 - 2004 is presented. The most prominent symptoms were headache (53.1%) and ataxia (44.8%). The average tumour size was 4.4 cm. Surgical approaches included posterior cranial fossa route (85 cases), basal subtemporal middle fossa route (9 cases) and combined posterior fossa and subtemporal routes in two cases. Total tumour resection was performed in 46 patients. Eight and four patients developed transient and sustained postoperative neurological deficits respectively. There was mortality in two patients. There was non-symptomatic recurrence of the tumour in two cases. Ninety-four patients are leading active functional lives. Radical and safe resection of anterior tentorium-based epidermoid tumours is associated with symptomatic relief and lasting cure. Extensive drilling of the petrous bone can be avoided. Gentle dissection of the tumour and capsule from the critical neurovascular structures can limit post-operative morbidity.

Endodermal cyst anterior and anterolateral to the brainstem. A report of an experience with seven cases

We report our experience with seven cases of endodermal cysts located anterior and anterolateral to the brainstem. The ages of the patients ranged from 10 to 35 years. There were three males and four females. The cysts had characteristic imaging features, and contained fluid having a 'greenish-yellow pus-like' hue and consistency varied from thin watery fluid to colloid gel like material. The capsule of the tumour was relatively thin. A radical resection of the cyst contents was done in all cases. Because of the thin nature of capsule, wide extensions and intimate relationship with critical nerves and vessels, complete resection of the cyst wall was possible only in one case, whilst in others the wall was partially resected. All patients showed a rapid symptomatic and neurological recovery. During the average follow-up period of 53 months, there has been no recurrence in the cyst and all patients are leading normal lives. In this presentation, the clinical and radiological features and surgical management of endodermal cysts are discussed and the relevant literature is briefly reviewed. It appears that evacuation of the cyst contents and partial resection of the cyst wall could be a safe treatment option in these cases.

Five-year survival data in newly diagnosed glioblastoma treated with radiotherapy along with concurrent and adjuvant temozolomide

e13009

Background: We report 5-year survival data in patients with newly diagnosed glioblastoma treated with radiotherapy along with concurrent and adjuvant temozolomide (TMZ). Methods: Between March 2001 to April 2008, 81 patients with newly diagnosed histopathologically proven glioblastoma underwent surgery followed by external radiotherapy to a total dose of 60 Gy in 30 fractions over 6 weeks. Concurrent oral TMZ (75 mg/m2) was given daily with RT followed by adjuvant TMZ for 5 days every 28 days for six cycles (150 mg/m2 for the first cycle and 200 mg/m2 for rest of the cycles). Patients were monitored clinicoradiologically as per standard practice. Results: Patients aged between 11–73 years with a median age of 49 years (60 males, 21 females). Forty per cent of patients underwent a gross total resection of tumour, 44% had partial resection, and 16% an open or stereotactic biopsy only. 79% of the patients had a post-operative Karnofsky Performance Score (KPS) of >80. All six adjuvant cycles were completed in 68%. The 2-, 3-, 4-, and 5-year survival was 34%, 24%, 11%, and 11%, respectively (95% CI 14.03–21.96). The median overall and progression-free survival was 18 (2–92 months) and 16 months (2–72 months), respectively. On multivariate analysis, completion of all six cycles of adjuvant TMZ was associated with significantly better survival (p = 0.000). Neurological performance score (NPS) of 2–3 (p = 0.06) and Recursive Partitioning Analysis class V (p = 0.093) showed a trend towards poorer outcome. Treatment was generally well tolerated with only 2.5% of patients developing grade 3 anemia, leucopoenia, and neutropenia. Grade 3 or 4 thrombocytopenia was seen in 5% patients. Conclusions: Concurrent radiotherapy and TMZ followed by adjuvant TMZ results in encouraging survival even at a long follow-up.

No significant financial relationships to disclose.

Endoscope-assisted myringoplasty

INTRODUCTION

To date, myringoplasty conducted under the operating microscope has been found to have its limitations. With the introduction of the endoscope into other branches of surgery, there have been attempts at its utilisation in otology.

METHODS

Endoscope-assisted myringoplasty was carried out in 50 patients aged 18-45 years using the temporalis fascia graft. The middle ear was examined through perforation in order to exclude cholesteatoma.

RESULTS

The overall success rate of the graft uptake and improvement in conductive deafness as air-bone gap closure was achieved in 80 percent of cases.

CONCLUSION

Endoscopic myringoplasty was found to be equally effective, less morbid and very cost-effective in small central perforations. However, it is not applicable in all cases, especially in those with large perforations.

Supratentorial convexity dural-based cavernous hemangioma mimicking a meningioma in a child

A case of a convexity dural-based cavernous hemangioma in a 15-year-old male child is reported. The child presented only with headaches and had no neurological deficits. MRI features were suggestive of a meningioma. The tumor was completely resected and histology was conclusive of a hemangioma. At follow-up after 2 years, the child is asymptomatic and MRI showed no evidence of the lesion. Supratentorial convexity dural-based hemangioma in a child is rare and hitherto only 1 case has been reported in the world literature. Complete resection of the lesion is curative and long-term prognosis is excellent. The uniqueness of the present case is the supratentorial convexity dural-based location, innocuous presentation and unusual radiological features on MRI. The clinical profile, radiological features and management of cavernous hemangiomas in a child are discussed and the current literature is briefly reviewed.

JC virus infects the enteric glia of patients with chronic idiopathic intestinal pseudo-obstruction

BACKGROUND AND AIMS

Chronic idiopathic intestinal pseudo-obstruction (CIIP) is characterised by severe impairment of intestinal propulsive motility that mimics bowel obstruction. JC virus (JCV) is a polyomavirus that can infect brain glial cells causing a fatal disease, but may also be found throughout the normal gastrointestinal tract. The hypothesis that JCV infects the myenteric plexuses of patients with CIIP was tested.

METHODS

10 patients with CIIP and 61 normal specimens (30 ascending colon and 31 ileum) from patients with uncomplicated colon cancer were studied. DNA was extracted from the myenteric plexuses, and JCV T antigen (TAg) DNA and the viral regulatory region were detected by PCR and sequencing. Immunohistochemistry was performed to detect JCV viral protein expression, neuronal and glial markers. Fluorescence in situ hybridisation was performed for cellular localisation of the JCV infection.

RESULTS

Clinical studies demonstrated neurogenic impairment, and pathological analyses showed neuropathy in each patient with CIIP. JCV TAg DNA was found in the myenteric plexuses of 8/10 (80%) of the patients with CIIP and 3/31 (9.7%) of the control patients (p<0.001). All samples were JCV Mad-1 strains. Seven of the 10 CIIP specimens expressed both JCV TAg and the JCV viral protein VP1, while none of the controls expressed either. JCV infection co-localised with glial fibrillary acidic protein expression, a marker of enteric glial cells.

CONCLUSION

JCV infection occurs in the myenteric plexuses of patients with CIIP. The JCV localisation in enteroglial cells suggests a possible pathological role for this virus in enteric neuropathy.

Valgus extension overload syndrome of the elbow in a test cricket fast bowler

No Abstract South African Journal of Sports Medicine Vol. 20 (4) 2008: pp. 119-120

Retroclival arachnoid cyst with hemifacial spasm

Arachnoid cysts are rare lesions occurring anywhere in the cerebrospinal axis. The sylvian fissure remains the most favoured site for their occurrence, followed by cerebellopontine angle, suprasellar, and quadrigeminal cisterns. Retroclival arachnoid cysts are very rare. We report a retroclival arachnoid cyst with bilateral cerebellopontine angle extensions with hemifacial spasm in a 26-year-old woman. The patient underwent surgery and her hemifacial spasm improved.

Novel oxazole containing phenylpropane derivatives as peroxisome proliferator activated receptor agonists with hypolipidemic activity

alpha-Alkoxy arylpropanoic acids containing 2-phenyloxazole-4yl-alkyl moiety are found to be potent hypolipidemic agents. These compounds were potent activators of the peroxisome proliferator activated receptor gamma (PPARgamma), with moderate PPARalpha activity and known to cause adverse effects such as weight gain and edema, which are essentially attributed to PPARgamma activation. Although extensive work has been done on the phenylpropanoic acid class of compounds, other phenyl propane derivatives such as alcohols, amines, ethers etc. have not received much attention. In order to develop predominant PPARalpha agonists as hypolipidemic agents with minor chemical modifications on compound III, we have synthesised few (2S)-ethoxyphenylpropane derivatives containing a 2-phenyl-5-methyloxazole-4ylalkoxy moiety of the general formula IV and evaluated by PPARalpha and gamma transactivation assay in conjugation with in vivo studies in male Swiss albino mice model. Compounds 3c and 3d showed the desired predominant PPARalpha activity and excellent tryiglyceride reduction in vivo and were selected as lead compounds for further development as hypolipidemic agents.

Encouraging experience of concomitant Temozolomide with radiotherapy followed by adjuvant Temozolomide in newly diagnosed glioblastoma multiforme: single institution experience

The purpose of this study was to report our experience with concomitant and adjuvant temozolomide (TMZ) with radiotherapy in patients with newly diagnosed glioblastoma multiforme (GBM). Forty-two newly diagnosed histopathologically proven patients with GBM underwent maximal safe resection followed by external radiotherapy to a total dose of 60 Gy in 30 fractions over 6 weeks along with concomitant oral TMZ (75 mg/m2) daily followed by adjuvant TMZ for 5 days every 28 days for six cycles (150 mg/m2 for the first cycle and 200 mg/m2 for rest of the cycles). Patients were monitored clinicoradiologically as per standard practice. Patients were 13-69 years of age with a median age of 49.5 years (31 males, 11 females). Fifty per cent of patients underwent a gross total resection of tumour, 43% had partial resection, and 7% an open or stereotactic biopsy only. 53% of the patients had a post-operative Karnofsky Performance Score (KPS) of 60-80%. All patients received concomitant radiation and TMZ with 74% of the patients completing six cycles of adjuvant TMZ. At a median follow-up of 12.5 months, the 1- and 2-year survival was 67 and 29%, respectively. The median overall and progression-free survival was 16.4 and 14.9 months respectively. Patients with pretreatment KPS of >80% had significantly better overall survival as compared with those having KPS<or=80% (median survival 22.12 vs. 11.97 months; p=0.026). Treatment was generally well tolerated with 9% of patients developing grade 3 anaemia, 2% grade 3 leucopoenia, and 7% patients grade 3 or 4 thrombocytopenia respectively during the treatment. At last follow-up, among the surviving patients, 30% had a maintained KPS greater than 90%. Concomitant radiotherapy and TMZ followed by adjuvant TMZ prolongs survival in patients with glioblastoma multiforme and is well tolerated in our patient population.

Acoustic schwannoma and petroclival meningioma occurring as collision tumours: a case report

A case of a collision tumour comprising of an acoustic schwannoma and a petroclival meningioma in a 30-year old male patient is described. Both of these tumours were resected through a retrosigmoid route. The caudal portion of the mass was an acoustic schwannoma while the rostral portion was a distinct well-defined petroclival meningioma. The occurrence of an acoustic schwannoma and a petroclival meningioma in 'collision' has never been reported. The pathogenesis of such a rare entity is discussed and the relevant literature is briefly reviewed.

Circadian rhythm of peak expiratory flow rate in healthy north Indian men

Peak expiratory flow rate (PEFR) variability follows a specific pattern in asthmatics as well as in healthy individuals. There is scarcity of data for Indian healthy subjects. The PEFR (L/min.) was measured with Wright's portable peak flow meter at 05:00, 8:00, 11:00, 14:00, 17:00, 20:00 and 23:00 hours in 42 healthy, non-smoking adults of age group between 18-26 years. The variability of PEFR revealed a circadian pattern. PEFR levels tend to increase from morning at 5:00 hours till evening at 17:00 hours, with peak PEFR in evening at 17:00 hours, after which there was a progressive fall in PEFR levels, till morning 5:00 hours. This study provides the preliminary reference data of circadian pattern of PEFR in healthy individuals.

Airway foreign bodies in children: experience of 132 cases

INTRODUCTION

Foreign body inhalation in children is not uncommon, and may escape notice by the parents as well as the physicians, because of the lack of knowledge of the exact history and inconclusive radiographical findings.

METHODS

A retrospective analysis of airway foreign bodies in 132 children (80 males and 52 females) over a period of 20 years was conducted. Rigid bronchoscopy under general anaesthesia was done in 129 cases.

RESULTS

The majority of patients (46 percent) were younger than three years of age. Duration of symptoms varied from less than six hours to three months. Definitive history of foreign body inhalation or sudden choking episodes were present in 71 children. The foreign body was successfully removed in 93.2 percent of the cases. Peanuts were the commonest foreign body. Foreign bodies were found in the right main bronchus in 62 cases, in the left main bronchus in 46 cases, and at vocal cord level in 7 cases. Chest radiographs were normal in 46 cases.

CONCLUSION

Rigid bronchoscopy usually gives good results in detecting airway foreign bodies. It should be performed at the earliest opportunity even when the definitive history is not forthcoming and the chest radiograph is inconclusive.

Geographic variation in soft tissue sarcoma patient follow-up

20518

Background: Of all newly diagnosed malignancies, 1% are soft tissue sarcomas (STS) and 59% of STS occur in the extremities. Most patients (80%) suffer recurrence within two years of potentially curative resection. Late recurrences at five years and beyond are not uncommon. Surveillance programs are designed to identify recurrence or new primaries early enough to positively impact survival and quality of life. Though published guidelines exist for extremity STS follow-up, adherence varies among physicians. Geographic factors were hypothesized to be potential predictors of this variation. Methods: The SSO membership (N=1592) was surveyed regarding postoperative STS surveillance using standardized clinical vignettes. Practice patterns were analyzed by metropolitan statistical area (MSA), managed care organization (MCO) penetration rate, and U.S. census region using repeated measures analysis of variance. The study endpoint was surveillance intensity. Results: Forty-five percent of SSO members (714) completed the survey; 343 (48%) performed sarcoma surgery. Of those who perform surgery, 318 (93%) follow their patients long-term. Mean follow-up intensity for the 12 modalities was highly correlated by tumor size, grade, and years after surgery. Controlling for tumor stage, grade, and year after surgery, geographic factors infrequently predicted surgeon self-reported surveillance intensity (p < .05). MSA was a significant predictor of office visit frequency. MCO penetration rate significantly predicted the frequency of urinalysis and site MRI. U.S. census region significantly predicted the frequency of LFTs. Two-way interaction effects were frequently significant. Few three-way interactions were examined due to sample size limitations. Conclusion: Geographic factors were generally not predictive of surgeon self-reported surveillance practice patterns for patients after curative-intent sarcoma surgery. Internship, residency, and fellowship locations may be important surgeon-specific aspects for future surveys.

No significant financial relationships to disclose.

Pituitary tuberculosis

Tuberculous involvement of pituitary is extremely rare and is usually not suspected while dealing with pituitary adenomas, even in patients with history of systemic tuberculosis. We report a case of pituitary tuberculoma in a patient who was undergoing treatment for prostatic tuberculosis. Although diagnosis of sellar tuberculomas is difficult on clinical and radiological examinations, pituitary tuberculomas should be considered in the differential diagnosis of suprasellar masses, especially in developing countries as the condition is potentially curable with antituberculous treatment.

One stage reduction and fixation for atlantoaxial spondyloptosis: Report of four cases

We report four patients having an extremely rare and hitherto unreported clinical condition of spondyloptosis of the atlas over axis. Between the year 1999 and 2004, four patients with spondyloptosis were retrospectively analysed. The age of the patients ranged from 12 to 31 years. In three patients, the aetiology of spondyloptosis was probably congenital in nature and in one case it was secondary to rheumatoid disease. The patients presented with varying degrees of neck pain and spastic quadriparesis. All patients were successfully treated by atlantoaxial joint distraction, reduction of the dislocation and direct lateral mass plate and screw fixation by techniques described earlier by the senior author. Manipulation of the atlantoaxial joints and restoring the anatomical craniovertebral alignments is possible and probably an ideal treatment of cases with atlantoaxial spondyloptosis.

Syringomyelia in infants secondary to mobile congenital atlantoaxial dislocation

We report a characteristic pattern of 'waist-like' syringomyelia observed in three infants having mobile and reducible congenital atlantoaxial dislocation. The syringomyelia in at least two of these cases was diagnosed to be an intramedullary tumor. Following atlantoaxial fixation, all three patients had long-term recovery of their symptoms.

Posterior fossa dermoid cyst in a patient with Goldenhar syndrome

A 7-year-old boy with Goldenhar syndrome was diagnosed to have a posterior cranial fossa dermoid cyst. The presence of such a combination of clinical entities has not been reported earlier. The embryonic dysgenesis causing midline posterior fossa dermoid and other anomalies observed in Goldenhar syndrome occur between the third and fifth week of intrauterine life and are probably interrelated. This report emphasizes the need for a high index of suspicion and the value of cranial imaging in a case with Goldenhar syndrome.

Glioblastoma multiforme following cranial irradiation and chemotherapy for acute lymphocytic leukaemia. Report of 3 cases

The most common secondary neoplasms which occur following cranial radiation therapy are sarcoma and meningioma. The occurrence of glioblastoma multiforme following radiation and chemotherapy in acute lymphocytic leukaemia (ALL) is rare. We report 3 cases of glioblastoma multiforme in children developing 11-72 months following completion of chemotherapy/radiotherapy for ALL. The exact cause for the development of glioblastoma multiforme following therapy for ALL is not clear. A genetic predisposition may be essential for the occurrence of such a highly malignant primary brain tumour in leukaemia patients, irrespective of radiation and/or chemotherapy. The pathogenesis and surgical management are discussed, and the literature on the subject is reviewed.

Results of invasive cervical cancer patients undergoing inadvertent hysterectomy followed by salvage radiotherapy

15034

Background: Ca cervix is the leading gynecologic malignancy in India. Conventional treatment consists of radical hysterectomy or primary radiotherapy. Due to inadequate preop workup, invasive ca cervix has been incidentally found in surgical specimens after simple hysterectomy. Extrafascial hysterectomy is not curative as paracervical, paravaginal soft tissues & vaginal cuff are not removed. It is technically difficult to perform adequate radical surgery after a previous simple hysterectomy. It is critical that these patients receive postop RT immediately after surgery; otherwise the prognosis is much worse. Methods: Retrospective analyses of 68 patients of ca cervix referred to our Institute after simple hysterectomy for presumed benign or preinvasive cervical disease was done. The median age was 44 yrs (35–65). 18 pts (26.5%) were pre menopausal while 50 (73.5%) were post menopausal. Exact postop staging was not possible; however 40 pts (59%) had residual growth at vault, 4 had involvement of vagina and in 18 cases parametrial infiltration was evident. Postop USG showed median tumor size of 4.4 cm, hydronephrosis in 17.6% & bladder infiltration in 5.8% pts. Histopathology was squamous cell carcinoma in 97% cases. Results: All patients were treated with EBRT to whole pelvis (dose 50 Gy/25 Fr to 50.4 Gy/28 Fr) over 5-weeks, followed by central vaginal surface HDR brachytherapy (Dose 21 Gy/3 Fr). At an average follow up of 18 to 24 months post RT residual disease was present in 2 (2.9%), local recurrence in 6 (8.6%), scar recurrence in 2 (2.9%) and distant failures in 4 patients (5.8%). Radiation proctitis developed in 2, SAIO in 2, RVF in one and VVF in one patient. All local and distant failures were seen in patients with residual disease before starting RT. Poor response to RT was seen in patients elder than 40 years and when OTT was more than 75 days. No significant correlation was seen between local response rate and type or grade of tumor. Conclusion: Survival for patients with no residual cancer after simple hysterectomy is favorable; & poor for those with gross disease at the start of post hysterectomy treatment. EBRT combined with one or two fractions of intravaginal brachytherapy in the immediate postop period can achieve satisfactory disease control.

No significant financial relationships to disclose.

Endolymphatic sac carcinoma of the right petrous bone in Von Hippel–Lindau disease

A large endolymphatic sac papillary adenocarcinoma in a patient with Von Hippel-Lindau (vHL) disease is reported. A 31-year-old man was treated for a left eye retinal angioma 10 years previously and had been blind in that eye since. He was admitted with progressive tinnitus, lower cranial nerve paresis and ataxia. Investigations revealed a vascular and bone-eroding petrous tumour. The entirely extradural tumour involved a large part of the petrous bone and extended into the cerebellopontine angle. The vascular tumour was radically resected using a presigmoid approach after feeding vessel embolisation. The literature on this rare clinical entity is briefly discussed.