Microbial flora in orodental infections

The present study was carried out to compare the normal aerobic and anaerobic bacterial oral flora with flora from deep seated dental caries, gingivitis and adult periodontitis. All the samples belonging to both the control and study groups yielded microbes. Aerobe / Anaerobe ratio was high in normal flora (1.48) as compared to dental caries (0.9), gingivitis (0.72) and periodontitis (0.56). Ninety seven percent of orodental infections were polymicrobial and three or more microbes were found in 84% cases of study group as compared to 28% in controls. Streptococcus mutans and anaerobic lactobacilli were common in dental caries, Actinomyces and Peptostreptococcus spp. in gingivitis, Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in periodontitis.

Absence of static phase separation in the high T(c) cuprate YBa(2)Cu(3)O(6+y)

We use 89Y NMR in YBa(2)Cu(3)O(6+y) in order to evaluate with high sensitivity the distribution of hole content p in the CuO2 planes. For y=1 and y=0.6, this hole doping distribution is found narrow with a full width at half maximum smaller than Deltap=0.025. This rules out any large static phase separation between underdoped and optimally doped regions in contrast with the one observed by STM in Bi2212 and by NQR in LaSrCuO. This establishes that static electronic phase separation is not a generic feature of the cuprates.

A formalism for independent checking of Gamma Knife dose calculations

For stereotactic radiosurgery using the Leksell Gamma Knife system, it is important to perform a pre-treatment verification of the maximum dose calculated with the Leksell GammaPlan (DLGP) stereotactic radiosurgery system. This verification can be incorporated as part of a routine quality assurance (QA) procedure to minimize the chance of a hazardous overdose. To implement this procedure, a formalism has been developed to calculate the dose DCAL(X,Y,Z,dav,t) using the following parameters: average target depth (dav), coordinates (X,Y,Z) of the maximum dose location or any other dose point(s) to be verified, 3-dimensional (3-dim) beam profiles or off-centerratios (OCR) of the four helmets, helmet size i, output factor Oi, plug factor Pi, each shot j coordinates (x,y,z)i,j, and shot treatment time (ti,j). The average depth of the target dav was obtained either from MRI/CT images or ruler measurements of the Gamma Knife Bubble Head Frame. DCAL and DLGP were then compared to evaluate the accuracy of this independent calculation. The proposed calculation for an independent check of DLGP has been demonstrated to be accurate and reliable, and thus serves as a QA tool for Gamma Knife stereotactic radiosurgery.

Colour Doppler flow imaging of focal hepatic lesions

Fifty-four patients with focal liver lesions were evaluated with colour Doppler flow imaging (CDFI) and CT to assess whether CDFI could be used to differentiate various types of lesions based on the flow pattern in terms of peritumoral and intratumoral blood flow. Peritumoral flow was found to be of no significance in the differential diagnosis of various liver lesions. Intratumoral flow was graded into mild, moderate or marked depending on the relative number of blood vessels demonstrated within the lesion. Marked intratumoral flow on CDFI was seen in 12.5% of primary hepatic malignancies and in infantile haemangioendothelioma, while a moderate flow pattern was seen in 56.2% of primary hepatic malignancies and in 18.7% of metastases. Mild flow was seen in 33.3% of primary malignancies; 18.7% of metastases; and 16.7% of haemangiomas. No intratumoral flow was seen in 100% of inflammatory lesions; 83.3% of haemangiomas; 62.5% of metastases; and only one hepatocellular carcinoma (5.6%). It was therefore concluded that the presence or absence of flow on CDFI is not a reliable feature for differential diagnosis of focal liver lesions when it is used alone. The flow pattern as assessed on CDFI may point to the nature of the lesion and, when used along with other morphological imaging features, can assist in diagnosis or in narrowing the list of different diagnoses in a particular clinical situation.

The contemporary role of the use of radiation therapy in the management of sarcoma

In this article the current role of radiation therapy in the management of soft-tissue sarcoma is evaluated. The importance of a multidisciplinary approach in the management of these patients is emphasized. The available literature supporting the possibility of limb salvage is reviewed. Finally, the newest developments in radiotherapy technology are also addressed.

Proptosis with orbital soft tissue and bone changes and unilateral papilloedema: unusual presentation of POEMS syndrome

POEMS syndrome is a rare manifestation comprising of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes. Orbital involvement in this syndrome is rare and manifestation with proptosis, even rarer. The imaging features in Poems syndrome and rarity of various features in our case are being highlighted here.

Traditional processing treatments as a promising approach To enhance the functional properties of rapeseed (Brassica campestris var. toria) and sesame seed (Sesamum indicum) meals

Different processing treatments were applied to rapeseed and sesame seed meals, and the functional properties of these products were assessed. All treatments except puffing for both meals and pressure cooking in sesame meal increased water absorption capacity (WAC). Fat absorption capacity (FAC) of rapeseed meals was enhanced significantly by all treatments. The full-fat meals of both sources showed maximum protein solubility when fermented and minimum protein solubility when pressure-cooked. Germinated and microwave-cooked meals enhanced foaming properties of rapeseed meals. Heat treatments, except microwave cooking, considerably reduced emulsifying properties of both meals. Fermentation and germination increased the specific viscosity of rapeseed meals, whereas processed sesame meals showed lower viscosity than dry sesame meals.

Polymicrobial etiology of dental caries

The present study was carried out to establish the normal bacterial oral flora and the aerobic and anaerobic bacterial flora from deep seated dental caries, and to determine the antimicrobial sensitivity of the clinical isolates so obtained Streptococcus mutans (48%) and Streptococcus sanguis (20%) were the main aerobic isolates whereas Lactobacillus spp. (52%), Veillonella spp. (24%) and Actinomyces spp. (12%) were the major anaerobic isolates. Hundred percent of the samples from dental caries yielded polymicrobial isolates while in two samples from healthy individuals S. mutans was the sole isolate. As the flora changed from healthy tooth to dental caries it changed from one predominated by anaerobic gram-positive cocci to anaerobic gram-positive bacilli. All the anaerobes isolated were sensitive to metronidazole and cefotaxime, whereas all the isolated streptococci were sensitive to penicillin, erythromycin and clindamycin. Incorporation of the antibiotics in baseline restoration, if technically feasible, has been advocated.

Efficacy and safety of heat exchanger added to venovenous bypass circuit during orthotopic liver transplantation

Hypothermia during orthotopic liver transplantation (OLT) is common despite measures to prevent this complication. We retrospectively analyzed two groups of patients; those managed with (n = 113) or without (n = 109) a heat exchanger (HE) incorporated in the venovenous bypass (VVB) circuit to test the hypothesis that normothermia before liver reperfusion minimizes hypotension during reperfusion and decreases neohepatic transfusion requirements. Use of the HE resulted in significantly warmer patients during reperfusion and at the end of surgery (P < .001). An increase in neohepatic transfusion requirement was observed in patients with HE use: packed red blood cells, 4 +/- 4 versus 3 +/- 3 units; fresh-frozen plasma, 5 +/- 5 versus 4 +/- 4 units; platelets, 8 +/- 8 versus 6 +/- 7 units; and cryoprecipitate, 5 +/- 7 versus 3 +/- 5 units. There was no difference between the two groups in the untoward hemodynamic events during reperfusion of the liver (P = .31). We conclude that during OLT, the use of an HE in a nonheparinized VVB circuit helps maintain normothermia. Our limited experience suggests that its use is safe but does not improve hemodynamic stability during reperfusion or decrease blood loss during the neohepatic period.

Combining aspirin with angiotensin converting enzyme inhibitors in heart failure: how safe is it?

The above discussion on the interaction of aspirin and ACE inhibitors seems to suggest that aspirin in high doses may have adverse interaction with ACE inhibitors in patients with heart failure but the data obtained is not sufficient or conclusive to recommended omission of aspirin in patients with heart failure. This raises a query in the mind of the physician whether to use a combination or not? The role of aspirin in the early period after myocardial infarction is well established so is the role of ACE inhibitors. Hence in patients with myocardial infarction and preserved left ventricular function it would not be wrong to administer combination of ACE inhibitors and aspirin. Albeit at a lower dose. In patients with large myocardial infarction or heart failure, warfarin may be an option but still needs to be documented in large trials. As suggested long term use of aspirin after infarction is still ambiguous and may be harmful in patients with heart failure with its anticedent side effects. But long term benefits of ACE inhibitors in heart failure are well documented. Hence if a choice has to be made whether to discontinue either of the two drugs it would be preferable to stop the aspirin. To answer the issue of use of aspirin in patients with heart failure it would be essential to conduct a double blind randomized trial comparing known anti-thrombotic treatment, aspirin and anti-coagulants on mortality in patients with heart failure, especially caused by coronary artery disease. Such a trial is underway at the present and till the results are available it should be left to clinical judgement of the physician whether to administer aspirin in patients with heart failure after weighing the benefits versus risk.

Assessment of pulmonary functions in young adults--three cross-sectional studies

This study reports the results of 3 cross-sectional surveys and demonstrates a birth cohort effect for pulmonary functions in students admitted to our Institute in 1974, 1986 and 1991. Improvement in height, weight and haemoglobin of students was accompanied with improvement in ventilatory (FVC, FEV1/FVC%,FEF25-75%) as well as diffusion functions (TLCO(SB), Dm, VC), specially in Group 2 and 3. Study of some vital statistics of state of Haryana from 1974 to 1992 significantly visualizes this period as period of green revolution and industrialization of the state. These quantitative indices are responsible for improvement of physical parameters and pulmonary functions of younger subjects. It is concluded that in view of the expected improvement in socio-economical status of developing countries and health of their individuals, physical and functional norms reported by different laboratories must be periodically reviewed.

Pulmonary functions in healthy females of Haryana

Pulmonary functions including lung volumes and pulmonary diffusing capacity were assessed in 137 healthy female subjects, 18-52 years of age. The results were analysed by age-wise division of subjects in six groups. It was observed that there were wide variations in pulmonary function values from one individual to another depending upon age and height of the subjects. Majority of ventilatory functions attained maximum values by the age of 25 years while diffusion functions improved upto 35 years of age. Pulmonary functions showed better correlation with age and height as compared to weight. Taking into consideration age and height of subjects, regression equations for different pulmonary functions have been derived for female subjects.

Ventilatory lung function tests in school children of 6-13 years

Spirometry was performed in 186 healthy school children, 6-13 years of age, selected from urban population of Rohtak city (India), to derive the regression equation for prediction of normal value of ventilatory lung function in this age group. Values of lung functions in the present study are well comparable to other North Indian studies and Western reports, but higher than the South Indian children. Lung functions have shown better linear correlation with age and height as compared to weight. Comparison of ventilatory function tests in boys and girls showed statistically higher FVC, FEV1, PEFR, FEF25% and MVV in boys, while FEF50% FEF75% and FEF75-85% were statistically higher in girls in different age groups. No specific pattern of variation in lung function tests was observed with sex. Regression equations for different ventilatory functions have been derived for either sex with the best possible combination of physical parameters.

Minimal change nephrotic syndrome associated with extrarenal neurilemmoma

Nephrotic syndrome may be associated not only with malignant neoplasia, but also rarely with benign solid tumours. Here we report a case of a young woman suffering from nephrotic syndrome, histologically classed as a minimal change glomerular lesion, associated with a posterior mediastinal neurilemmoma (ancient neurilemmoma). Surgical removal of the tumour led to complete cure of the nephrotic syndrome with total symptomatic improvement within 6 months. Scanning of the literature revealed only one case report of an association of spinal neurilemmoma with nephrotic syndrome.

Visual evoked responses in megaloblastic anemia

Pattern shift visual evoked responses (PSVER) were studied in thirty patients suffering from severe megaloblastic anemia (mean Hb level was 4.25 +/- 1.22 g/dL) of nutritional origin. All patients lacked clinical stigmata of visual and neurologic impairment. Mean P100 latency in thirty age and sex matched controls was 96.35 +/- 6.75 ms (range 86-108 ms) and mean amplitude was 10.37 +/- 3.88 microV (range 4.8-20.8 microV). Mean P100 latency in megaloblastic anemia was 114.77 +/- 11.68 (range 91-142) ms, P < 001 vs. control) and mean amplitude was 8.85 +/- 2.8 microV (range 5.1-16.2 microV). Seventy percent cases had prolonged latency of P 100. After correction of anemia with therapeutic doses of vitamin B12 and folic acid in three months (mean Hb level was 12.08 +/- 1.86 g/dL), the mean P100 latency was 105.13 +/- 9.30 ms (range 92-121 ms P < 0.001 vs. controls) and mean amplitude was 10.72 +/- 4.13 microV (range 5.1-21.4 microV). There was significant improvement in P100 latency after correction of anemia (P < 0.01). There was a negative correlation between P100 latency and hemoglobin levels, though it was statistically not significant.

A study of free radicals and scavenging enzyme in tonsillitis

The present study is a comparison of malonaldialdehyde (MDA) level and superoxide dismutase (SOD) activity between controls and in tonsillitis patients of different degree before (pre) and after (post) surgery (tonsillectomy). The SOD activity increases in pretonsillectomy cases according to severity of disease and there is a rise in MDA level whereas after tonsillectomy although the increase in SOD is marginal but MDA declines sharply as compared to pretonsillectomy patients indicating that the SOD exerts its protective effect after surgery.

Long source-skin distance rectal irradiation technique: a review of results

PURPOSE

This study reports the clinical outcome of fifteen patients with low rectal adenocarcinoma treated with the long source-skin distance (SSD) of endorectal irradiation technique. This method was designed at McGill University in 1986 as an alternative to the standard short SSD rectal irradiation that was developed by Papillon (Proc. R. Soc. Med. 66: 1179-1181, 1973).

METHODS AND MATERIALS

Between April 1986 and May 1993, six females and nine males were treated with this technique. Fourteen patients were treated with curative intent and one woman for palliation. The median total dose was 85 Gy (range 60-135 Gy) in a median of 3 fractions (range 3-5) over a median treatment time of 5 weeks (range 2-9.5 weeks).

RESULTS

With a mean follow-up of 39 months and a median of 24 months (range 3 months-8.7 years), actuarial overall survival and disease-free survival rates are 50.8% and 71.4%, respectively, at 8.7 years. No patients have died of recurrent disease, but one patient has distant metastatic disease. One patient treated with curative intent required an abdominoperineal resection for progressive disease. Treatments were tolerated well by all patients. Four patients required steroid enemas for localized proctitis for a short period of time. They all responded well and had complete resolution of symptoms.

CONCLUSIONS

Our results are comparable with those in other reports in the literature. The complications are similar in type and frequency to other published series. The long SSD technique may be an acceptable alternative to the standard short SSD technique.

Comparison of single breath and steady state methods for measurement of lung transfer factor for CO in normal subjects and smokers

Pulmonary diffusing capacity (lung transfer factor for carbon monoxide) has been assessed by the single breath (TLCOSB) and steady state (TLCOSS) techniques in well matched 90 females, 31 non-smoker and 29 smoker males, 18-50 years of age. Both TLCOSB and TLCOSS are significantly lower in females compared to non-smoker males (P < 0.001). Tobacco smoking statistically significantly reduces TLCOSB as well as TLCOSS in smokers as compared to non-smokers. There is a statistically significant correlation of age with TLCOSS and TLCOSB in all the three groups (r = -0.702, -0.360 and 0.300 for TLCOSB and r = -0.481, -0.355 and 0.380 for TLCOSS in non-smoker males, smoker males and females respectively). TLCOSB is 30.43 +/- 4.89, 27.29 +/- 4.54 and 26.13 +/- 3.60 ml/mmHg/min, while TLCOSS is 19.47 +/- 5.26, 16.69 +/- 3.27 and 18.24 +/- 3.78 ml/mm/Hg/min in non-smoker males, smoker males and females respectively. A fairly good correlation between the TLCOSB and TLCOSS in male, both non-smoker and smoker, as well as the female subjects was observed. TLCOSS is lower than TLCOSB in all the three groups. Even in smokers of moderate intensity both of these tests are influenced to a nearly similar extent.

Management of isoniazid poisoning--case report

A young girl was admitted with generalized tonic clonic seizures and unconsciousness, four hours after ingestion of 12 gm of isoniazid (INH). In the absence of injectable preparation of pyridoxine, she was treated with oral pyridoxine and made a complete recovery.

Comparison of processing treatments on the composition and functional properties of rapeseed preparations (Brassica campestris L. var. toria)

Rapeseed preparations viz. rapeseed meal, concentrates and isolates were prepared using different processing treatments involving organic solvents, acids, alkali, steaming and boiling. Their anti-nutritional constituents and functional properties were studied in comparison to undefatted meal. Percent decrease in phytic acid and phenolic content was maximum in seeds boiled for 30 min and isolates, respectively. Isolate II prepared by sodium hexa-metaphosphate had minimum glucosinolates, maximum content of total proteins and much improved nitrogen solubility, emulsifying and foaming properties. Water absorption and fat absorption capacities were enhanced by boiling seeds prior to grinding and ammonia-methanol extraction, respectively. Viscosity decreased in all the treatments as compared to control.

Releasable suture technique for trabeculectomy

We studied the effect of the releasable suture technique on immediate postoperative intraocular pressure (IOP). Nine eyes of nine patients with glaucoma had trabeculectomy with a releasable suture. In the six eyes that did not receive antimitotics, the suture was released by the fifth postoperative day; in the others suture release was delayed up to the fourteenth day. Of the nine patients, one had an acceptable postoperative IOP and did not need suture release; in another the suture broke and could not be released. In the remaining seven patients, the difference between the pre-release and post-release IOP was statistically significant (p < 0.001). The complications of this technique include failed suture release, subconjunctival hematoma and a distinctive "windshield wiper" keratopathy.

Quantitation of immunoglobulin-containing cells in the jejunal lamina propria in tropical sprue

Ten patients with tropical sprue (TS) and 10 with irritable bowel syndrome (IBS) as controls were studied to characterize the immunocytes in the jejunal mucosa. IgA cells numbered 516,155 +/- 48,715 cells/mm3 in TS and 729,308 +/- 146,011/mm3 in the IBS patients. IgG cell counts were 28,885 +/- 8,081/mm3 in TS and 10,615 +/- 4,100/mm3 in IBS; IgM counts were 170,729 +/- 25,015/mm3 in TS and 169,253 +/- 45,353/mm3 in IBS. A positive correlation was present between IgM-bearing plasma cells and corresponding serum immunoglobulins (r = +0.71; p less than 0.05). No correlation was evident between the different immunocytes (IgA, IgG, and IgM) and the duration of illness, serum albumin, and tests for absorption of fat, B-12, and D-xylose (p greater than 0.05). The gut immunocytes expressed in absolute numbers were higher in our controls and TS patients than reported in Western populations.

Neuralgic amyotrophy: a long term follow-up of four cases

Neuralgic amyotrophy or brachial plexus neuralgia is a condition of uncertain etiology. It needs to be differentiated from the usual brachial plexus injuries. Nerves outside the plexus especially the spinal accessory nerve are involved. Neuralgia is also a feature. Four cases were followed-up in detail over a period of two years. The condition usually resolves almost completely on its own.

Erythrocyte enzyme polymorphisms in the Kamboh caste of Patiala, Punjab

Data are presented on six erythrocyte enzyme polymorphisms (ADA, GLO I, EsD, AK, AP, GPI) in the Kamboh, a scheduled caste inhabiting the Patiala district of the Indian state of Punjab. With their high ADA2 (18.5%), Pa (42.5%) and GPI3 (5.3%) and a rather low GLO1 (18.8%) frequencies, the Kamboh differ from all other populations of Punjab.

Biochemical variation in the Sunni Muslims of Pulwama district, Jammu and Kashmir

Baseline data are presented on phenotype and gene frequency distributions of nine red-cell enzyme systems (ADA, AK, EsD, GLO I, PGM1, AP, GPI, PGM2, SOD) in the Sunni Muslims of Kashmir valley in the northernmost Indian border state of Jammu and Kashmir.

Some exercises with the learned helpessness scale (lh/scale) in hindi

Learned Helplessness Scale - Hindi version (Dhar, Kohli & Dhar, 1987) was administered to 50 graduates. Scoring was done using the original method as given in the manual and by two of its variations. Correlations among the three forms of scoring were found to be very high (.85 and above). In another excercise, 30 of the subjects were administered P.G.I. Health Questionnaire N-2 and P.G.I. General Well Being Scales and in the third excercise 20 subjects were administered P.G.I. Health Questionnaire N-l and P.G.I. Locus of Control Scale, in addition to the L-H scale. The obtained correlations between LH and other variables show that it is positively correlated with neuroticism and negatively with the sense of general wellbeing, both correlations showing relationship of moderate degree only (about 25% overlap with the neuroticism and even lower for general well being). This feeling of learned helplessness was not related to the internal or external locus of control and the scale showed little effect of social desirability response set.

Bacterial tracheitis, diagnosis and treatment

During a 22-month period, 5 children, 6-13 months of age, presented with an acute obstructive upper airway infection which resembled both croup and epiglottitis. All 5 failed to respond to standard treatment for croup, including aerosolized racemic epinephrine. In all patients, direct laryngoscopy revealed minimal or no change in the epiglottis and aryepiglottic folds but severe subglottic swelling and copious purulent tracheal secretions. Gram stains of the purulent secretions revealed many polymorphonuclear leukocytes with gram-positive cocci (3 patients) and small gram-negative rods (2 patients). Cultures subsequently confirmed the presence of S. Aureus and H. Influenzae. Initial therapy for all patients included endotracheal intubation, antibiotic therapy for both S. Aureus and H. Influenzae and frequent tracheal suctioning. Hospitalization varied from one to 3 weeks. We reported findings in these patients because: the initial diagnosis was unclear due to confusion caused by clinical features common to both croup and epiglottitis and bacterial tracheitis requires a prompt accurate diagnosis and aggressive antibiotic and airway management in order to prevent unnecessary morbidity and mortality.