Chemical composition and antimicrobial activity of essential oil from the rhizomes of Amomum cannicarpum

The essential oil obtained by hydrodistillation of the rhizomes of Amomum cannicarpum was analyzed by GC and GC/MS. Thirty-four compounds were identified, of which the major components were beta-terpineol (13.4%), beta-pinene (9.4%) and alpha-pinene (6.9%). The essential oil showed significant antimicrobial activity.

Villous papyraceous: an unusual cause of tamoxifen-induced postmenopausal bleeding

OBJECTIVE

We describe an unusual histological finding in a woman with postmenopausal bleeding who was being treated with tamoxifen for breast cancer.

METHOD

This patient presented with a history of postmenopausal bleeding, 4 years after her last period. Pelvic ultrasound showed a thickened cystic endometrium and bulky uterus. A diagnostic endometrial aspiration biopsy by Pipelle was performed; at this time, urinary beta-human chorionic gonadotropin was negative.

RESULTS

Histology showed villous papyraceous (sclerosed and mummified chorionic villi) in a background of scanty atrophic endometrium.

CONCLUSION

Tamoxifen has dual estrogenic and antiestrogenic effects; the estrogenic effects have been associated with ovulation induction in premenopausal women. This effect, however, has not been documented in postmenopausal women. We conclude that the presence of chorionic villi is, in this instance, likely to be a tamoxifen-mediated effect.

Surveillance colonoscopy in patients with colorectal cancer: how often should we be doing it?

BACKGROUND

The optimum protocol for colonoscopic surveillance following curative resection for colorectal cancer has not been established. The aim was to assess the incidence of recurrence and metachronous tumours in our less intensive colonoscopic surveillance programme and compare our results with those reported from intensive surveillance programmes.

METHODS

Colonoscopic records of patients who had surveillance colonoscopy following curative resection from April 1998 to March 2003 for cancer were available from the endoscopy department computer database. The variables studied included the tumour site, Duke's stage, number of recurrences, number of metachronous tumours, size and number of polyps and their biopsy results.

RESULTS

There were a total of 105 patients. Two patients were diagnosed with metachronous tumours and three with recurrence. Adenomatous polyps were identified in 24 patients of which nine had multiple/advanced adenomas (equal to or more than 1cm adenomatous polyps, or with severe dysplasia).

CONCLUSION

The risk of development of colonic pathology following curative resection for colorectal cancer is low. More intensive follow-up should be reserved for patients with additional risk of developing further cancers.

Septate fungal invasion in masked mastoiditis: a diagnostic dilemma

Invasive fungal mastoiditis is a rare entity, seen almost entirely in immunocompromized patients. It has been reported primarily in patients with leukaemia and more recently with acquired immunodeficiency syndrome. A literature search revealed only a few reports in diabetic patients, in whom the invasive fungus was identified as mucormycosis in all cases. We report the first case in the English literature of invasive septate fungal mastoiditis in a diabetic patient with intact tympanic membranes.

Complications of acute infective rhinosinusitis: experience from a developing country

INTRODUCTION

Complications of acute infective sinusitis are a therapeutic emergency. The purpose of this study was to determine the clinical presentation, microbiological pattern, treatment modalities and outcome of patients diagnosed to have acute rhinogenic orbital, intra- and extra-cranial complications from a developing country in Asia.

METHODS

A retrospective chart review from October 1999 to January 2004 was conducted.

RESULTS

Among 247 ENT surgical emergencies documented, 13 patients (5.3 percent) were diagnosed to have acute sinusitis with various complications either as in solitary or multiple forms. Orbital complications were the most common (61.5 percent) followed by acute subdural empyema (23.1 percent) and meningitis (15.2 percent). Subdural empyema was the most common intracranial complication. Staphylococcus was reported to be the most common offending organism (45.5 percent). Majority of the patients (84.6 percent) had surgical drainage of the affected sinuses, 38.5 percent being endoscopic drainage while external approach was done for those with coexisting osteomyelitis (30.8 percent). Two patients had combined approach, and one patient had post-operative facial paresis. There was no mortality in our series.

CONCLUSION

Early detection, aggressive medical and prompt surgical treatment by multidisciplinary approach involving ophthalmological, neurosurgical and rhinological procedures, can successfully treat the complications with a significant reduction in the morbidity and no mortality.

Tumescent infiltration versus femoral nerve block for skin graft harvest-a prospective randomized study

In this prospective, randomized study, 60 patients requiring a single sheet of graft were randomized into 2 groups. Tumescent infiltration was used for anesthesia in one group and femoral nerve block in the other. The pain during administration of anesthesia, the time required for onset of action, the pain during graft harvest and the failure rates were recorded. Statistical comparison was done using Fischers Exact probability test for the failure rates and Mann Whitney- U test for the other parameters. The pain during administration was significantly higher for tumescent infiltration. The time for onset of action was significantly faster with femoral nerve block. The pain during harvest and the failure rates did not show any significant difference. We conclude that tumescent infiltration is more painful than femoral nerve block but equally effective as anesthesia with no difference in the failure and complication rates.

Simple excision and primary closure of pilonidal sinus: a simple modification of conventional technique with excellent results

OBJECTIVE

Pilonidal sinus (PNS) is a common condition, which warrants surgical intervention. A number of surgical options have been suggested with variable recurrence rate. This study proposes a modification of a standard method.

METHODS

A total of 51 patients with sacrococcygeal PNS were sequentially treated by the standard method devised by one Consultant Colorectal Surgeon (IA). The principle is based on: 1, after excising the PNS ensure obliteration of the natal cleft by releasing the fat pad from the gluteal fascia; 2, avoid tension and 3, encourage patients to lie on their back immediately after the operation.

RESULTS

Follow-up was available from 51 patients ranging from 14 to 49 months. All patients were discharged within 48 h. There was only one recurrence, which was successfully treated.

CONCLUSION

Our results suggest that PNS can be successfully treated by our hitherto undescribed method, patients can be discharged early and there is very low recurrence rate.

Appendicular intussusception into a polyp

Intussusception of the appendix is a rare condition. We present the case of a 72-year-old woman with multiple polyps in the colon with an appendix completely intussuscepted into a polyp within the caecum. The clinical features, preoperative diagnosis, classification and treatment of this condition are discussed with reference to literature.

Audit on flexible sigmoidoscopy for rectal bleeding in a district general hospital: are we over-loading the resources?

OBJECTIVE

Patients with rectal bleeding are being over investigated because of the fear of missing colorectal cancers. This study aimed to identify the percentage of patients <45 years of age who undergo flexible sigmoidoscopy for rectal bleeding, and to assess and compare the incidence of colorectal cancers and polyps above and below this age.

METHODS

Patients who underwent flexible sigmoidoscopy for rectal bleeding between 1 January 2000 and 31 December 2002 were reviewed. Patients were divided into two groups: group 1 consisted of patients aged >or=45 years and group 2 patients <45 years. The histopathology of biopsy specimens taken was also studied.

RESULTS

Altogether 18.9% of the patients who had flexible sigmoidoscopy for rectal bleeding were <45 years. The incidence of colorectal cancers in group 1 was 3.5%; all these cases were confirmed on histopathology. Only one patient in group 2 was diagnosed with colorectal cancer on flexible sigmoidoscopy, but the histopathology disproved it. The incidence of polyps was 16.6% in group 1 and 7.9% in group 2. Following histopathology, the incidence of adenomatous polyps was 6.8% in group 1 and 2.1% in group 2. There was a significant difference between the two groups, with a p value of <0.0001.

CONCLUSION

The incidence of colorectal cancers and adenomatous polyps in patients aged <45 years with rectal bleeding is very low. A flexible sigmoidoscopy costs approximately pound 330. If new guidelines are implemented considering the age of the patient, considerable cost savings could be made, and the available resources could be appropriately used in groups with high incidences of colorectal cancers.

Snaring of submucosal tumors of gastric fundus

Submucosal tumors of the stomach are not uncommon. We present two cases of iatrogenic perforation after snaring large polyps in the gastric fundus. We discuss the probable etiology and review the literature regarding iatrogenic perforation in this location. Submucosal polyps situated in the fundus may produce pseudopedicle. Therefore, we recommend these be treated with caution, and a combined endoscopic and laparoscopic approach is suggested.

Postoperative nausea and vomiting in diagnostic gynaecological laparoscopic procedures: comparison of the efficacy of the combination of dexamethasone and metoclopramide with that of dexamethasone and ondansetron

BACKGROUND AND OBJECTIVE

This study was conducted in a tertiary hospital with the aim of comparing the efficacy of a combination of dexamethasone and metoclopramide with dexamethasone and ondansetron for the prophylaxis of postoperative nausea and vomiting [PONV] after diagnostic gynaecological laparoscopic procedures.

SUBJECTS AND METHODS

In this prospective, randomised, double-blind study, 120 women received either saline I.V. [Group I, n=40]; a combination of dexamethasone [8 mg] with metoclopramide [10 mg] [Group II, n=40]; or a combination of dexamethasone [8 mg] with ondansetron [4 mg] [Group III, n=40] prior to induction of general anaesthesia. PONV was evaluated at regular intervals. The results were analysed using one-way ANOVA, post-hoc, Chi-square, Kruskal-Wallace tests and Z test for proportions where appropriate through a SPSS V.9 package.

RESULTS

The 3 groups were well matched for demographic characteristics. The incidence of nausea and emesis was significantly lower in Group III [[17.5%, P <0.02] and [10%, P <0.01] respectively]. Nausea scores were also lower in Group III [P <0.02]. Rescue anti-emetic requirements were higher in Group I [P <0.05] as compared to Groups II and III.

CONCLUSIONS

A combination of dexamethasone and ondansetron was more efficacious as compared to that of metoclopramide and dexamethasone. The combination of metoclopramide and dexamethasone seems to offer no additional benefit as compared to saline placebo.

Antimicrobial activity of Amomum cannicarpum

The petroleum ether and methanol extracts of rhizomes of Amomum cannicarpum exhibited moderate inhibiting activity against both Gram-positive and Gram-negative bacteria. None of the extractives was active against the tested moulds.

Letter 1: Systemic inflammatory response predicts survival following curative resection of colorectal cancer (Br J Surg 2003; 90: 215-219)

The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses can be sent electronically via the BJS website (http://www.bjs.co.uk) or by post. All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length. Letters submitted by post should be typed on A4-sized paper in double spacing and should be accompanied by a disk.

An indigenously developed method for sweat collection and estimation of chloride for diagnosis of cystic fibrosis

An indigenously developed method for sweat collection and titration method for estimation of chloride was validated. The mean difference in estimated chloride value from the known strength of saline in 50 samples was -1.04 +/- 4.13 mEq/L (95% CI: -0.07 to 2.28). The mean difference in the estimated chloride values between two observers when the test was performed on known strengths of saline solution was -2.5 +/- 4.24 mEq/L (95% CI: -3.67 to 1.33). The inter observer variability between two observers when the test was performed on sweat samples obtained from 50 individuals was -1.12 +/- 4.34 mEq/L (95% CI: -2.23 to 0.8 ). Sweat weight of more than 100 mg could be collected in first attempt in 602 of 757 (80%) patient with an average sweat weight of 230 mg. This inexpensive method of sweat collection and chloride estimation has acceptable accuracy and repeatability and can be used in resource poor setting for making a diagnosis of cystic fibrosis.

Unexpected presentations--four cases of lead poisoning

OBJECTIVE

To describe the clinical presentation and response to treatment of four patients who presented with abdominal pain and were diagnosed to have lead poisoning.

METHODS

After ruling out the more obvious causes of abdominal pain by barium studies, gastrointestinal endoscopies, and biochemical studies, blood lead levels were estimated by atomic absorption spectrophotometry. The patients were treated with oral d-penicillamine.

RESULTS

The four patients had blood lead levels from 79 microg/dL to 365 microg/dL. All four of them showed marked improvement in their clinical condition and lowering of blood lead levels on follow up.

CONCLUSIONS

Clinicians need to develop a high index of suspicion of lead poisoning as a possible cause of unexplained abdominal pain or altered sensorium, especially against a background of environmental lead contamination in India.