Head and neck cancer: possible causes for delay in diagnosis and treatment

OBJECTIVE

To explore the possible causes for delay in diagnosis and treatment of head and neck cancer at Sarawak General Hospital (SGH).

STUDY DESIGN

This is a prospective study of time interval between onset of symptom, first medical consultation, first specialist clinic consultation, diagnosis and treatment of head and neck cancer in otorhinolaryngology head and neck (ORL-HNS) and dental clinics at Sarawak General Hospital. Forty-two consecutive cases diagnosed to have cancer between July to December 2006 were studied.

RESULTS

Mean interval between onset of symptom and medical consultation was 3.8 months, mean interval between first medical consultation to ORL-HNS or dental clinic referral was 8.4 weeks, mean duration between first ORL-HNS or dental specialist consultation to histopathological diagnosis was 18.8 days while duration between diagnosis to definite treatment was 26.9 days.

CONCLUSION

Most cases were diagnosed at advanced stage. Patient delay was the main problem. There was significant delay by frontier health workers in identifying sinister symptoms of malignancy. Timing for diagnosis and treatment after specialist referral were comparable with other published studies.

Impact of cold ischemia on renal transplant outcomes following donation after cardiac death

Donation after cardiac death (DCD) provides grafts in renal transplantation but is associated with increased early graft dysfunction. Cold ischemia time (CIT) is a factor that is thought to affect outcomes in renal transplantation. We sought to assess the impact of the length of CIT among our DCD cohort of renal transplants performed between April 2002 and December 2009. Since the median CIT was 15.5 hours, we formed two groups CIT < 15.5 (n = 100) and CIT > 15.5 hr (n = 98). We demonstrated an increased incidence of DGF among the extended CIT group, but the long outcomes and the mean graft function were otherwise comparable. In conclusion, CIT affects early graft function; every effort should be made to minimize it in renal transplantation using DCD kidneys.

Sequential transplant of paired kidneys following donation after cardiac death: impact of longer cold ischemia time on the second kidney on graft and patient outcome

The United Kingdom has no national sharing scheme for kidneys received from donation after cardiac death (DCD). Therefore, both kidneys retrieved by a transplant team are implanted at a single unit, often sequentially. This study analyzes the impact of a prolonged cold ischaemia time on the second transplanted kidney and the effects on short-term and long-term outcomes in all our DCD renal implants from 2002 to 2009. Cold ischaemia time was significantly longer with the second kidney (P = .04) as was delayed graft function (P = .02). Acute rejection was increased in the first transplanted kidney (P < .001). Five-year patient survival was comparable between groups, but 5-year graft survival was higher in the second transplanted group (P = .04). The results confirm that, provided recipient centers are willing to accept higher initial rates of delayed graft function, it is acceptable to transplant DCD grafts sequentially without jeopardizing long-term graft or recipient outcome.

Predicting donor asystole following withdrawal of treatment in donation after cardiac death

Donation after cardiac death donation allows donor pool expansion. The period between withdrawal of treatment and donor a systole is extremely variable; its prolongation often results in unsuccessful organ procurement. We sought to assess a variety of donor variables to determine whether they predicted successful organ retrieval. We included all Donation after Cardiac Death (DCD) retrievals between 2002 and 2009, which were grouped as successful (n = 104) versus unsuccessful (n = 42). Factors that predicted unsuccessful organ procurement included older donor age, donor history of hypertension, higher at withdrawal, and absence of inotropic support. On multivariate analysis, mean arterial pressure retained its significance. Prediction of withdrawal-to-asystole time is complex, but our analysis suggested that donor blood pressure at withdrawal is an important predictor of whether retrieval would be successful.

Renal transplantation following donation after cardiac death: impact of duration from withdrawal to asystole

Donation after cardiac death (DCD) allows for expansion of the donor pool, however, the process for DCD donation can lead to a donor's physiological instability before asystole. This may have a detrimental effect on graft and patient outcomes. We analyzed all 201 DCD donations at our unit from 2002 to 2009 and compared short versus long durations to asystole around the median time (20 min). Delayed graft function was comparable between the groups (P = .13), primary nonfunction was increased in the long duration to asystole group (P < .0001), and acute rejection was increased in the short duration group (P < .001). Five year patient survival was comparable (P = .6). In conclusion, long duration asystole may have an immediate effect on graft survival, but it has no overall detrimental effect on longer-term outcomes. Further studies are required to investigate the acceptable time to wait from withdrawal to asystole.

Traveller's thrombosis: airlines still not giving passengers the WRIGHT advice!

INTRODUCTION

This study has examined the impact of the World Health Organization's Research into Global Hazards of Travel (WRIGHT) Project's phase 1 report on the information given by airlines to their passengers regarding traveller's thrombosis.

METHODS

Official websites of all airlines flying from Heathrow (UK) and John F Kennedy (USA) were located through links on the websites of these two busy international airports. In June 2007, each site was scrutinized by three independent researchers to identify if traveller's thrombosis and its risk factors were discussed and what methods of prevention were advised. This exercise was repeated a year after the publication of the WRIGHT report.

RESULTS

One hundred and nineteen international airlines were listed in 2007 (12 were excluded from analysis). A quarter (27/107) of airlines warned of the risk of traveller's thrombosis. A year later, five airlines were no longer operational and there had been no increase in the discussion of traveller's thrombosis (23/102). Additional risk factors discussed in June 2007 versus September 2008: previous venous thromboembolism (16%, 15%); thrombophilia (14%, 15%); family history (11%, 9%); malignancy (12%, 14%); recent surgery (19%, 16%); pregnancy (17%, 16%) and obesity (11%, 12%). Prophylaxis advice given in June 2007 versus September 2008: in-flight exercise (34%, 42%); Hydration (30%, 34%); medical consultation prior to flying (20%, 18%); graduated compression stockings (13%, 12%); aspirin (<1%, <1%) and heparin (5%, 7%).

CONCLUSIONS

The majority of world airlines continue to fail to warn of the risk of traveller's thrombosis or offer appropriate advice. Alerting passengers at risk gives them an opportunity to seek medical advice before flying.

Centrality dependence of the charged-particle multiplicity density at midrapidity in Pb-Pb collisions at sqrt[s(NN)] = 2.76 TeV

The centrality dependence of the charged-particle multiplicity density at midrapidity in Pb-Pb collisions at sqrt[s_{NN}]=2.76  TeV is presented. The charged-particle density normalized per participating nucleon pair increases by about a factor of 2 from peripheral (70%-80%) to central (0%-5%) collisions. The centrality dependence is found to be similar to that observed at lower collision energies. The data are compared with models based on different mechanisms for particle production in nuclear collisions.

Fertility following CIDR based synchronization regimens in anoestrous Nili-Ravi buffaloes

The objective of this study was to compare oestrus expression and fertility rate in used and new controlled internal drug releasing (CIDR) device treated anoestrous buffaloes. Furthermore, to determine the timing of ovulation, and fertility rate in estradiol benzoate (EB) and GnRH-administered CIDR-treated anoestrous Nili-Ravi buffaloes. In experiment 1, buffaloes received either a used CIDR (UCIDR, n = 35) or a new CIDR (NCIDR, n = 36) for 7 day and PGF2α on day 6. Oestrous expression was similar (p > 0.05) between UCIDR (88.5%) and NCIDR (96.6%) buffaloes. The pregnancy rate did not differ (p > 0.05) because of treatment (37.1% in UCIDR vs 36.6% in NCIDR). In experiment 2, buffaloes (n = 55) received CIDR device for 7 days and PGF2α, on day 6 and randomly assigned into three treatment groups: (i) CIDR-EB (n = 17) received EB on day 8, (ii) CIDR-GnRH (n = 18) received GnRH on day 9 and (iii) control (n = 20) received no further treatment. Mean interval from CIDR removal to ovulation in CIDR-EB, CIDR-GnRH and CIDR group were 61.3 ± 0.8, 64.9 ± 1.8 and 65.1 ± 16.7 h, respectively. However, the buffaloes in the CIDR-EB and CIDR-GnRH group had lesser variability in the timing of ovulation compared to control. The pregnancy rate of both CIDR-EB group (58%) and CIDR-GnRH group (61%) were tended to be higher (p < 0.1) than control (30%). In conclusion, compared to NCIDR devices, previously UCIDR devices are equally effective to induce oestrus in anoestrous buffaloes resulting optimal pregnancy rate. Administration of EB and GnRH after CIDR removal results in tighter synchrony (less variability) and improved fertility in anoestrous buffaloes. CIDR based synchronization regimens have great potential in fertility improvement in anoestrous buffaloes.

US-guided therapy of calcific tendinopathy: clinical and radiological outcome assessment in shoulder and non-shoulder tendons

PURPOSE

To analyze the effectiveness and complication rate of ultrasound (US)-guided perforation and lavage using a two-needle technique with 16 - 18 G needles in the treatment of patients with calcific tendinopathy in the shoulder, elbow, hip, and knee by radiological and clinical follow-up.

MATERIALS AND METHODS

A retrospective chart review was performed and 40 patients (13 male, 27 female; mean age, 53.5 years; range 24 -74 years) were identified as having received US-guided perforation and lavage due to symptomatic calcific tendinopathy of the rotator cuff tendons, triceps, extensor and flexor tendons at the elbow, rectus femoris tendon and patellar tendons. The radiographic outcome was assessed by comparison of the size and quality of the calcification before and 6 weeks after the procedure. On US images, the quality of the acoustic shadow was assessed, together with other alterations of the tendon and surrounding tissue. Patients were interviewed by telephone to assess the clinical outcome regarding pre-treatment and post-treatment pain and tendon function.

RESULTS

34 shoulder tendons and 6 non-shoulder tendons were identified. The mean calcium reduction was 39.9 mm(2) (range, 0 - 215; p < 0.001), while 80 % of patient showed a resolution of more than 60 % resulting in good clinical improvement. A very low complication rate was found (1 partial tear).

CONCLUSION

The US-guided perforation and lavage technique is an effective and safe treatment for rotator cuff calcifications as well as for other body tendons. Although the two-needle technique and large needles were used in this study, a very low complication rate was detected.

Elliptic flow of charged particles in Pb-Pb collisions at sqrt[S(NN)] = 2.76 TeV

We report the first measurement of charged particle elliptic flow in Pb-Pb collisions at sqrt[S(NN)] =2.76 TeV with the ALICE detector at the CERN Large Hadron Collider. The measurement is performed in the central pseudorapidity region (|η|<0.8) and transverse momentum range 0.2<p t<5.0 GeV/c. The elliptic flow signal v₂, measured using the 4-particle correlation method, averaged over transverse momentum and pseudorapidity is 0.087 ± 0.002(stat) ± 0.003(syst) in the 40%-50% centrality class. The differential elliptic flow v₂ p t reaches a maximum of 0.2 near p t =3 GeV/c. Compared to RHIC Au-Au collisions at sqrt[S(NN)] 200 GeV, the elliptic flow increases by about 30%. Some hydrodynamic model predictions which include viscous corrections are in agreement with the observed increase.

Charged-particle multiplicity density at midrapidity in central Pb-Pb collisions at sqrt[S(NN)] = 2.76 TeV

The first measurement of the charged-particle multiplicity density at midrapidity in Pb-Pb collisions at a center-of-mass energy per nucleon pair √ S NN = 2.76 TeV is presented. For an event sample corresponding to the most central 5% of the hadronic cross section, the pseudorapidity density of primary charged particles at midrapidity is 1584 ± 4(stat) ± 76(syst), which corresponds to 8.3 ± 0.4(syst) per participating nucleon pair. This represents an increase of about a factor 1.9 relative to pp collisions at similar collision energies, and about a factor 2.2 to central Au-Au collisions at √ S NN = 2.76 TeV. This measurement provides the first experimental constraint for models of nucleus-nucleus collisions at LHC energies.

Acute lower limb ischemia following pediatric renal transplantation

Live donor renal transplantation remains the best treatment option for end stage renal failure in pediatric patients (1-3). Better understanding of the hemodynamics of donor-recipient size discrepancy and advances in interventional techniques with improved surgical techniques have decreased the incidence and severity of surgical complications and enhanced graft survival (1, 2). We describe a rare complication occurring intra-operatively in a pediatric renal transplant resulting in acute limb ischemia and the surgical option taken.

Transplantation of adult-sized kidneys in low-weight pediatric recipients achieves short-term outcomes comparable to size-matched grafts

Low-weight pediatric recipients are disadvantaged by scarcity of size-matched donors. ASK have been successfully used for pediatric recipients. We report the results of renal transplantation using ASK in low-weight pediatric recipients and compare outcomes in weight-matched and unmatched donor-recipient pairs. The outcomes of renal transplants using ASK grafts in low-weight (<20 kg) recipients from a single center over a 10-yr period were reviewed. Two groups, comprising recipients of grafts from weight-matched and mismatched donors, were compared. Primary outcome was one-yr graft survival. Secondary outcomes were one- and two-yr calculated eGFR, changes in recipient body weight, perioperative cardiovascular stability, rates of AR and DGF. Twenty-three low-weight recipients were transplanted. Eleven received ASK grafts from high-weight donors and 12 grafts from low-weight donors. One patient in each group had early graft loss. No significant difference was observed in rates of DGF, AR, one-yr graft or patient survival and perioperative cardiovascular parameters. ASK with considerable donor:recipient weight discrepancies can be safely transplanted into small pediatric recipients with comparable outcomes to grafts with less weight discrepancy.

Characterization of community and hospital Staphylococcus aureus isolates in Southampton, UK

Staphylococcus aureus infections are a burden to healthcare systems. There remains a lack of understanding on the relative contributions of S. aureus infection in the healthcare and community settings. In this study, 59 S. aureus isolates were selected for molecular analysis. The mobile variant staphylococcal cassette chromosome mec type IV was present in both healthcare-associated meticillin-resistant S. aureus (HA-MRSA) and community-associated MRSA (CA-MRSA), as was the Panton–Valentine leukocidin gene. PFGE identified 24 distinct clonal groups whilst multi-locus sequence typing identified 26 different sequence types, including four with new combinations of alleles. This is the first time, to our knowledge, that a selection of CA and HA MSSA and MRSA strains have been subjected to molecular analysis and comparison in the UK. Definitions for CA-MRSA need further debate as the movement of strains between healthcare and community settings is confounding the use of epidemiological definitions.

Midrapidity antiproton-to-proton ratio in pp collisons at sqrt[s]=0.9 and 7 TeV measured by the ALICE experiment

The ratio of the yields of antiprotons to protons in pp collisions has been measured by the ALICE experiment at sqrt[s]=0.9 and 7 TeV during the initial running periods of the Large Hadron Collider. The measurement covers the transverse momentum interval 0.45<p_{t}<1.05  GeV/c and rapidity |y|<0.5. The ratio is measured to be R_{|y|<0.5}=0.957±0.006(stat)±0.014(syst) at 0.9 TeV and R_{|y|<0.5}=0.991±0.005(stat)±0.014(syst) at 7 TeV and it is independent of both rapidity and transverse momentum. The results are consistent with the conventional model of baryon-number transport and set stringent limits on any additional contributions to baryon-number transfer over very large rapidity intervals in pp collisions.

Generalization of adaptive neuro-fuzzy inference systems

The paper aims at several objectives. The adaptive network-based fuzzy inference systems (ANFIS) of Jang is extended to the generalized ANFIS (GANFIS) by proposing a generalized fuzzy model (GFM) and considering a generalized radial basis function (GRBF) network. The GFM encompasses both the Takagi-Sugeno (TS)-model and the compositional rule of inference (CRI)-model. A local model, a property of TS-model, and the index of fuzziness, a property of CRI-model define the consequent part of a rule of GFM. The conditions by which the proposed GFM converts to TS-model or the CRI-model are presented. The basis function in GRBF is a generalized Gaussian function of three parameters. The architecture of the GRBF network is devised to learn the parameters of GFM, since it has been proved in this paper that GRBF network and GFM are functionally equivalent. It is shown that GRBF network can be reduced to either the standard RBF or the Hunt's RBF network. The issue of the normalized versus the nonnormalized GRBF networks is investigated in the context of GANFIS. An interesting property of symmetry on the error surface of GRBF network is investigated in the present work. The proposed GANFIS is applied for the modeling of a multivariable system like stock market.

A study of testing‐effort dependent inflection S‐shaped software reliability growth models with imperfect debugging

Purpose

The purpose of this paper is to investigate how to incorporate the exponentiated Weibull (EW) testing‐effort function (TEF) into inflection S‐shaped software reliability growth models (SRGMs) based on non‐homogeneous Poisson process (NHPP). The aim is also to present a more flexible SRGM with imperfect debugging.

Design/methodology/approach

This paper reviews the EW TEFs and discusses inflection S‐shaped SRGM with EW testing‐effort to get a better description of the software fault detection phenomenon. The SRGM parameters are estimated by weighted least square estimation (WLSE) and maximum‐likelihood estimation (MLE) methods. Furthermore, the proposed models are also discussed under imperfect debugging environment.

Findings

Experimental results from three actual data applications are analyzed and compared with the other existing models. The findings reveal that the proposed SRGM has better performance and prediction capability. Results also confirm that the EW TEF is suitable for incorporating into inflection S‐shaped NHPP growth models.

Research limitations/implications

This paper presents the WLSE results with equal weight. Future research may be carried out for unequal weights.

Practical implications

Software reliability modeling and estimation are a major concern in the software development process, particularly during the software testing phase, as unreliable software can cause a failure in the computer system that can be hazardous. The results obtained in this paper may facilitate the software engineers, scientists, and managers in improving the software testing process.

Originality/value

The proposed SRGM has a flexible structure and may capture features of both exponential and S‐shaped NHPP growth models for failure phenomenon.

Response of buffalo spermatozoa to low temperatures during cryopreservation

This is the first detailed report on the response of buffalo spermatozoa to low temperatures during freezing. The study determined the critical temperature zone for buffalo spermatozoa and developed a suitable freezing rate for this species. Semen from four Nili-Ravi buffalo bulls diluted in Tris-citric acid was frozen in a programmable freezer. Motion characteristics, plasma membrane integrity and acrosome morphology were determined at +4, 0, –5, –10, –20, –30, –40, –50, –80 and –196°C by removing semen straws from the freezer at exactly these temperatures and rewarming them at 37°C. The first statistical decline in sperm motility and lateral head displacement was observed at –40°C. For all other parameters, there was biphasic decline: for curvilinear velocity, at 0°C and –50°C; and for plasma membrane integrity and acrosome morphology, at –30°C and –50°C. In a second series of experiments, buffalo spermatozoa were frozen using slow (–10°C min–1), medium (–20°C min–1) or fast (–30°C min–1) freezing rates, between –10°C and –80°C. Freezing of buffalo spermatozoa at a rate of –30°C min–1 yielded higher post-thaw motion characteristics, plasma membrane integrity and normal acrosomes. In conclusion, different sperm characteristics respond differently at low temperatures and the freezing of buffalo spermatozoa at a higher rate ensures higher post-thaw semen quality.

Effects of Starting Material and Reaction Temperature on the Morphology and Physical Properties of Polyurethane Foams

Polyurethane foams (PUFs) were prepared by mixing poly (ethylene glycol)-block-poly(propylene glycol)-block-poly(ethylene glycol) and isocyanates in the ratio of 1:1.03 in the presence of additives such as catalyst, blowing agent and surfactant. The effects of types of starting material in PUF formulation on cell morphology and properties were investigated using scanning electron microscopy (SEM). The results indicated that starting material highly affected the morphology of PUF cells. Process parameters such as concentration of starting material and reaction temperature were investigated using SEM, foam density and capacity of water absorption. It was found that foam density depends on the cell size. While, the capacity of water absorption is depends on the percentage of the open cells and cell size. PUF samples have cell size between 200 to 600 μm, density in the range of 0.03 to 0.06 g cm-3, percentage of open cell at 25 to 60% and capacity of water absorption between 6 to 30%.

Testicular development and establishment of spermatogenesis in Nili-Ravi buffalo bulls

Fifteen longitudinally reared Nili-Ravi buffalo bulls (Bubalus bubalis) were slaughtered at 1, 6, 12, 18, and 24 mo of age (n=3 per group) to observe testicular development and to examine qualitatively the establishment of spermatogenesis. With the age held constant, scrotal circumference and testes weight were correlated (0.95; P<0.05). Testes weight increased from 3.5+/-0.7 at 1 mo of age to 185+/-30g at 24 mo of age. Seminiferous tubules diameter developed in a linear fashion (57microm at 1 mo and 178microm at 24 mo), and the lumen formed at 12 mo of age. Differentiation of basal indifferent supporting cells to Sertoli cells started at 6 mo, and formation of Sertoli cells completed near 12 mo of age. Gonocytes predominated at 1 mo, but by 12 mo, most had been replaced by spermatogonia, thus rapid proliferation of tubular contents occurred at 12 mo (testes weight=75g). Spermatocytes were first observed at 12 mo, and their number increased through 18 and 24 mo. Establishment of spermatogenesis, as reflected by appearance of significant number of spermatids, occurred by 18 mo of age (testes weight 122g). Thus, the establishment of spermatogenesis was progressive from birth, and marked changes were observed during the last 6 mo.

Economical and environmental implications of solid waste compost applications to agricultural fields in Punjab, Pakistan

Application of municipal solid waste compost (MSWC) to agricultural soils is becoming an increasingly important global practice to enhance and sustain soil organic matter (SOM) and fertility levels. Potential risks associated with heavy metals and phosphorus accumulations in surface soils may be minimized with integrated nutrient management strategies that utilize MSWC together with mineral fertilizers. To explore the economic feasibility of MSWC applications, nutrient management plans were developed for rice-wheat and cotton-wheat cropping systems within the Punjab region of Pakistan. Three-year field trials were conducted to measure yields and to determine the economic benefits using three management strategies and two nutrient doses. Management strategies included the application of mineral fertilizers as the sole nutrient source and application of mineral fertilizers in combination with MSWC with and without pesticide/herbicide treatments. Fertilizer doses were either based on standard N, P and K recommendations or on measured site-specific soil plant available phosphorus (PAP) levels. It was found that combining MSWC and mineral fertilizer applications based on site-specific PAP levels with the use of pesticides and herbicides is an economically and environmentally viable management strategy. Results show that incorporation of MSWC improved soil physical properties such as bulk density and penetration resistance. The PAP levels in the surface layer increased by the end of the trials relative to the initial status. No potential risks of heavy metal (Zn, Cd, Cr, Pb and Ni) accumulation were observed. Treatments comprised of MSWC and mineral fertilizer adjusted to site-specific PAP levels and with common pest management showed highest cumulative yields. A basic economic analysis revealed a significantly higher cumulative net profit and value-to-cost ratio (VCR) for all site-specific doses.

The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies

INTRODUCTION

Postoperative hypocalaemia commonly occurs after extensive thyroid surgery and may require calcium and/or vitamin D supplements to alleviate or prevent the symptoms. In this study, we determined the risk factors for developing hypocalcaemia and whether early serum calcium levels can predict the development of or differentiate between temporary or permanent hypocalcaemia.

PATIENTS AND METHODS

A total of 162 patients who either had a completion or total thyroidectomy formed the basis of this prospective study. Serial serum calcium measurements were recorded as well as details of the operation, pathology, indications for surgery, number of parathyroids identified at operation and any complications.

RESULTS

Eighty-four (52%) patients did not develop hypocalcaemia but 69 (43%) were found to have temporary hypocalcaemia and 9 (5%) had permanent hypocalcaemia. Hypocalcaemia was more common after total than completion thyroidectomies and the identification of parathyroids at operation appears to have a significant adverse effect on outcome. The calcium levels measured on day 1 postoperatively and the slope (serum calcium levels of day 1 postoperative minus day of operation) were statistically significant in predicting the development of hypocalcaemia and possibly to differentiate between temporary or permanent hypocalcaemia.

DISCUSSION

Although almost half the patients having extensive thyroid surgery developed hypocalcaemia (as defined by any postoperative corrected serum calcium level of < 2.12 mmol/l) only 24% had a serum calcium of < 2.12 mmol/l associated with clinical symptoms of hypocalcaemia or a calcium level of < 2.0 mmol/l. Only 5% had persistent hypocalcaemia defined as requiring exogenous supplements at 6 months' postoperatively. Patients having a completion thyroidectomy appear to be less likely to develop hypocalcaemia perhaps as a result of any iatrogenic effects on the parathyroids at the first operation being reversed before the second operation. Identification and, therefore, exposure of parathyroids at operation may have an adverse effect on the blood supply to the glands affecting their function.

CONCLUSIONS

Serum calcium levels measured 6 hours' post-surgery and on day 1 postoperatively can be useful in predicting if the patient will develop hypocalcaemia and the slope may indicate whether the hypocalcaemia will be temporary or permanent. Patients with toxic goitres and those having a one-stage total thyroidectomy are most at risk of developing hypocalcaemia.

Design and development of a portable gamma radiation monitor

A portable gamma radiation monitor has been designed and developed. The monitor can be used effectively in the dose range from 0.07 to 500 mGy/h due to gamma rays of energy greater than 65 keV. The monitor overestimated radiation doses and the uncertainty in the measured dose rate has been found to be < or = 30%. The response of the monitor can be considered isotropic within an acceptable error of +/-30%. Provision has also been added to use the monitor as an installed radiation monitor. In installed mode, it can be operated from a remote location up to 1 km and the timing history can be stored on a personal computer.

Inflammatory pseudotumours of the liver: a spectrum of presentation and management options

PURPOSE

To review the current management options in inflammatory pseudotumours via analysis of ten cases from this unit the largest experience of this pathology in a Western series. To assess the medical and operative options available for this condition and the varying outcomes and the lessons learned in this unit over the time period.

RESULTS

Data from the ten cases were analysed and a comprehensive review of the published literature to date has detailed 128 case reports with 215 cases of inflammatory pseudotumour of the liver. Data analysed included patient demographics, diagnostic modalities, details of treatment and eventual outcome. The data was tabulated using an Excel spreadsheet (Microsoft Excel 2004 for Mac 2004.Version 11.0). Categorical variables were compared using Pearson's chi(2) test and p values <0.05 were defined as statistically significant. Statistical analysis was performed using SPSS for Windows (Version 9.0, SPSS Inc., Chicago, IL).

CONCLUSION

Emphasis is placed on a preferred medical management initially for this tumour with a good prognosis coupled with regular follow up. There may be a need for surgical resection cases where diagnosis is unclear or the patient is not responding to medical treatment with progression of disease or symptoms.

Fentanyl pre-treatment alleviates pain during injection of propofol-lipuro premixed with lignocaine

We studied the effect of fentanyl pretreatment on alleviating pain during the injection of Propofol-Lipuro. One hundred and seventy patients were randomly allocated to receive either 100 mcg of intravenous fentanyl or normal saline (placebo) followed by intravenous Propofol-Lipuro premixed with 20 mg lignocaine. The incidence of injection pain was 32% and 13% in the placebo and fentanyl groups, respectively. We found a statistically significant reduction in incidence of injection pain in the fentanyl group when compared with the placebo group (p<0.003). The number needed to treat was 6 (3.2< 95% CI <15.1). In conclusion, fentanyl pretreatment is effective in alleviating pain during injection of Propofol-Lipuro.

Trends in maxillofacial injuries in women, 2000-2004

Recent government statistics have suggested that there is a reduction in violent crime, but recorded crime figures have shown a 10% increase. Attendance figures at accident and emergency departments show that 75% of assaults that required medical treatment were not recorded by the police, and that 55% of assaults that led to facial injuries were alcohol-related. Drinking alcohol is a risk factor for violent behaviour. A poorly-studied area is alcohol-related violent crimes sustained by women. A restrospective study was made of all female patients referred to a busy regional maxillfacial unit between May and October 2000-2004. A total of 251 female patients with facial injuries was seen at the unit, and records obtained for 219. Accidents were the commonest cause of attendance, and violent crime the second. Interpersonal violence was the most common mode of injury in alcohol-related incidents. Domestic violence did not increase significantly over the study period, and did not seem to be alcohol-related. The incidence of violent crime, and in particular interpersonal violence away from the home, is increasing. Women are at considerable risk of becoming victims of violence.

Antimicrobial activity of clove oil and its potential in the treatment of vaginal candidiasis

In the present study, we evaluated antimicrobial activity of clove oil against a range of fungal pathogens including that responsible for urogenital infection. Clove oil was found to possess strong antifungal activity against opportunistic fungal pathogens such as Candida albicans, Cryptococcus neoformans and Aspergillus fumigatus, etc. The oil was found to be extremely successful in the treatment of experimental murine vaginitis in model animals. On evaluating various formulations, topical administration of the liposomized clove oil was found to be most effective against treatment of vaginal candidiasis.

Influence of number of retransplants on renal graft outcome

BACKGROUND

To assess the influence of number of transplants on the renal graft outcome.

METHODS

Retrospective analysis of various factors that could influence the outcome of kidney retransplantation in patients receiving more than one allograft between 1993 and 2005 at our center.

RESULTS

During the 12-year period (1993-2005), 196 patients received more than one renal transplant. Of these, 163 had two (group 1) and 33 had more than two transplants (group II). In group II, 24 patients had three, eight had four, and one had five consecutive allografts. The control group comprised of 100 randomly selected patients receiving a first graft during the same period. In group I, 53 (32.5%) grafts failed. Eighteen (11.0%) patients died with functioning grafts. In group II, 14 (41.2%) grafts failed while four patients (11.8%) died with functioning grafts. In group I, actuarial graft survival rates at 1, 2, 3, and 4 years were 82.3%, 67.3%, 55.97%, and 42.14%, respectively. In group II, the respective figures were 84.85%, 66.67%, 60.61%, and 51.52%. The difference was not statistically significant (P = .96). In the control group, 1-, 2-, 3-, and 4-year survival rates were 92%, 84, 74%, and 60%, respectively. The difference between the control and study groups was statistically significant (P = .0002).

CONCLUSION

Graft survival after retransplantation is relatively inferior when compared to the primary graft but still remains fairly high. Therefore, previous graft failure should not be considered as a relative contraindication for retransplantation.