Severe acute bleeding from portal colopathy controlled by somatostatin: a case report

Portal hypertensive colopathy (PHC) is a recently described entity in patients with portal hypertension which can cause even life-threatening lower gastrointestinal bleeding. In contrast to variceal bleed, there is no standardized treatment for the control of bleeding from these lesions. We report a case of alcoholic cirrhosis with portal hypertension, in whom bleeding from colonic angiodysplasia-like lesions was effectively controlled by somatostatin infusion.

Hemobilia as presenting manifestation of polyarteritis nodosa

Polyarteritis nodosa (PAN) is a multisystem necrotizing inflammatory vasculitis of medium-sized muscular arteries. Hepatobiliary complications secondary to thrombosis or aneurysm formation in PAN are rare and are associated with poor outcome. We describe an 18-year-old man with PAN who presented with hemobilia secondary to rupture of a hepatic artery aneurysm, which was successfully managed with coil embolization followed by immunosuppressive therapy.

Can mechanical ventilation strategies reduce chronic lung disease?

Chronic lung disease (CLD) continues to be a significant complication in newborn infants undergoing mechanical ventilation for respiratory failure. Although the aetiology of CLD is multifactorial, specific factors related to mechanical ventilation, including barotrauma, volutrauma and atelectrauma, have been implicated as important aetiologic mechanisms. This article discusses the ways in which these factors might be manipulated by various mechanical ventilatory strategies to reduce ventilator-induced lung injury. These include continuous positive airway pressure, permissive hypercapnia, patient-triggered ventilation, volume-targeted ventilation, proportional assist ventilation, high-frequency ventilation and real-time monitoring.

Association of ulcerative colitis with pulmonary sarcoidosis, subcutaneous lipomatosis and appendiceal adenocarcinoma

We report a 52-year-old man with left-sided ulcerative colitis for 5 years and pulmonary sarcoidosis diagnosed 3 years back. He presented with subcutaneous lipomatosis and a right iliac fossa mass, which was diagnosed histologically as appendiceal adenocarcinoma. He was treated with right hemicolectomy, followed by chemotherapy.

Diagnostic evaluation of extrapulmonary tuberculosis by fine needle aspiraton (FNA) supplemented with AFB smear and culture

One hundred forty-three patients, 72 males and 71 females, with extrapulmonary tuberculosis were aspirated and subjected to cytological (Ziehl-Neelsen stain) examination and culture in Lowenstein-Jensen media. Routine haematological examination and Mantoux test were done in all the cases, x-ray chest in 112, skeletal x-ray in 3 relevant cases and sputum was examined for AFB in 16 cases where pulmonary tuberculosis was associated/suspected with extrapulmonary tuberculosis. HIV status was evaluated in 51 cases and 9 (7.64%) were seropositive. FNA cytology in 102 cases (71.3%) had caseating epithelioid granulomas while smear for AFB was positive in 57 cases (39.8%). Both culture and smear were positive in 29 (20.2%) cases. Combining both smear and culture yielded positive results in 47.5% cases. It was observed that AFB positivity was higher in untreated patients and with HIV positive cases. Further more, the triad of FNAC, AFB smear and culture were cheaper, foolproof and confirmatory than costlier tests like TB IgG, IgM, RTPCR and BACTEC.

Observation of heterodyne mixing in surface x-ray photon correlation spectroscopy experiments

We report measurements of propagating capillary waves on a liquid water surface at T=5 degrees C with x-ray photon correlation spectroscopy. The experiment has been performed under grazing incidence conditions with an incoming x-ray beam below the critical angle of total external reflection. In the q region investigated the measured intensity-intensity autocorrelation functions of the liquid water surface were found to be heterodyne signals, i.e., a combination of first- and second-order correlation functions g(1)(tau) and g(2)(tau).

Effect of lead on growth and nitrate assimilation of Vigna radiata (L.) Wilczek seedlings in a salt affected environment

The inhibition of seedling growth and nitrate reductase activity in 5 d old Vigna radiata (L.) Wilczek cv. Pusa Baisakhi in the presence of 1.0 mM lead acetate increased drastically, if NaCl (6 and 12 EC) was also present in the nutrient media along with the metal salt. Correspondingly higher endogenous Na+ levels were accumulated in the roots and leaves of seedlings in presence of the two stresses. On the other hand, the levels of endogenous lead get reduced in presence of NaCl in both the roots and leaves. Roots accumulated more Pb2+ and Na+ than the leaves. The two stresses affect more drastically in the additive or even synergistic manner during the early growth phase of the seedlings.

Utility of Y-Chromosome Short Tandem Repeat Haplotypes in Forensic Applications

Patrilineally transmitted Y-chromosomal markers have been shown to resolve forensic cases under certain scenarios where autosomal markers provide limited or inconclusive evidence. Several Y-short tandem repeat (Y-STR) loci have been validated for forensic use, and Y-STR haplotype databases for a number of geographic locations are now available in the literature and online. In this review, examples are presented of situations where Y-STR loci can provide valuable supplemental forensic evidence when autosomal STR loci fail or provide little evidence. Also, different methods of interpreting Y-STR forensic evidence in casework analysis are outlined, suggesting that in spite of excessive conservativeness, the counting method is still the most simple and easily defensible method of interpreting Y-STR forensic evidence. While the need for developing more powerful interpretation methods should be considered, it is stressed that expansion of Y-STR databases should focus on increasing sample sizes and the inclusion of more anthropologically defined populations to improve the efficiency of interpretation of Y-STR markers in forensic applications.

Forensic Casework Applications Using Y-PLEX™ 6 and Y-PLEX™ 5 Systems

Analysis for Y-chromosome short tandem repeat (Y-STR) loci has become a useful tool in resolving difficult cases, particularly with evidence samples containing mixtures of male and female DNA. The Y-PLEX™ 6 and Y-PLEX™ 5 systems have been validated and used in forensic cases. A total of 188 samples, which included 127 evidence samples, have been analyzed using Y-PLEX™ 6 and Y-PLEX™ 5 systems. The evidence sample types included fingernails, sperm, epithelial cells, blood, and tissue. The results from five cases are discussed. The results from Y-PLEX™ 6 kits have accepted in several jurisdictions throughout the United States.

Pericardial synovial sarcoma

A 29-year-old young man presented with acute breathlessness. After investigative work-up he was found to have a massive pericardial tumour. Thoracotomy and near total surgical excision of the pericardial tumour was carried out. Histopathology and immunohistochemical markers study revealed it to be a synovial sarcoma arising from the left lateral pericardial surface. Postoperatively, he received external radiation and chemotherapy. Thirteen months after surgery he developed local recurrence which was unresectable.

X-ray scattering from freestanding polymer films with geometrically curved surfaces

We show that the x-ray surface scattering from a freestanding polymer film exhibits features that cannot be explained by the usual stochastic formalism for surfaces with random height fluctuations. Instead, a geometric description of the film morphology assuming two curved surfaces characterized by a radius of curvature and a lateral cutoff length successfully accounts for the phase difference between the Kiessig fringes of the nominal "specular" and "off-specular" components of the scattering. The formalism allows one to distinguish unambiguously between conformal and anticonformal curvature morphologies at long length scales.

Invasive and noninvasive neonatal mechanical ventilation

Neonatal respiratory failure consists of several different disease entities, with different pathophysiologies. During the past 30 years technological advances have drastically altered both the diagnostic and therapeutic approaches to newborns requiring mechanical assistance. Treatments have become both patient- and disease-specific. The clinician has numerous choices among the noninvasive and invasive ventilatory treatments that are currently in use. This article reviews the pathophysiology of respiratory failure in the newborn and the available methods to treat it, including continuous positive airway pressure, conventional and high-frequency mechanical ventilation, extracorporeal membrane oxygenation, and styles of ventilation and monitoring.

Usefulness of the minute ventilation test in predicting successful extubation in newborn infants: a randomized controlled trial

OBJECTIVE

We performed a prospective, randomized clinical trial to compare the usefulness of the minute ventilation test (MVT) with clinical judgement in predicting readiness for extubation in preterm newborns with respiratory distress syndrome requiring surfactant therapy and mechanical ventilation.

STUDY DESIGN

A total of 42 preterm infants with respiratory distress syndrome were randomized when they reached preselected ventilator settings. The primary outcome measure was the time from study entry to extubation, provided the infant remained extubated for at least 24 hours.

RESULTS

Infants evaluated by the MVT were extubated in a significantly shorter period of time (mean of 8 hours) than those evaluated clinically (mean of 36 hours). The extubation failure rate was similar in the two groups.

CONCLUSION

The MVT is an easily performed objective measure that can be used to predict readiness for extubation in preterm infants. In this study, it significantly shortened the time for extubation and was not associated with a higher rate of reintubation.

The controversies surrounding oxygen therapy in neonatal intensive care units

Despite the knowledge that excess amounts of oxygen in the blood (hyperoxia) can be damaging to preterm infants, there is a wide variation in approaches to oxygen therapy within neonatal intensive care units. This is predominantly determined by institutional or individual practices or preferences and might stem from a lack of understanding of the relative merits and demerits of the different techniques of oxygen monitoring in extremely preterm babies who are different from more mature babies. This article provides the physiological rationale and evidence from recent clinical studies suggesting that keeping the oxygen therapy to an "acceptable" minimum in premature babies does not do any harm and may be even advantageous.

Surface dynamics of polymer films

The dynamics of supported polymer films were studied by probing the surface height fluctuations as a function of lateral length scale using x-ray photon correlation spectroscopy. Measurements were performed on polystyrene (PS) films of thicknesses varying from 84 to 333 nm at temperatures above the PS glass transition temperature. Within a range of wave vectors spanning 10(-3) to 10(-2) nm(-1), good agreement is found between the measured surface dynamics and the theory of overdamped thermal capillary waves on thin films. Quantitatively, the data can be accounted for using the viscosity of bulk PS.

Necrotising infections of soft tissues--a clinical profile

OBJECTIVE

To study the clinical profile and outcome of patients with necrotising soft-tissue infections.

DESIGN

Prospective study.

SETTING

Teaching hospital, India.

SUBJECTS

75 patients (54 male and 21 female), mean age 40 years (range 8 months-85 years).

INTERVENTIONS

Patients were uniformly managed by initial resuscitation, debridement, topical wound care, systemic antibiotics, and enteral hyperalimentation.

MAIN OUTCOME MEASURES

Morbidity and mortality.

RESULTS

Aetiology of the infections included major and minor trauma, minor skin infections and postoperative infections. 22 patients were diabetic. The extremities were involved in 57 patients, the trunk in 26 and the perineum in 21. 68 presented with local tenderness (91%), 74 with oedema (99%), 54 with erythema (72%), 55 with ulceration (73%), and 54 with a purulent or serous discharge (72%). beta-haemolytic streptococci were isolated from only 10 patients. Staphylococcus aureus was the most common bacteria isolated (n = 30, 46%) followed by Bacteroides fragilis and anaerobic cocci (n = 22, 34% each). Cultures grew fungi in 9 patients. 20 patients died giving a mortality of 27%. Jaundice and serum albumin were the only factors to have a significant influence on mortality.

CONCLUSIONS

Necrotising soft tissue infections are potentially fatal. Early recognition and prompt aggressive debridement are the keys to successful management.

Newer techniques of mechanical ventilation: an overview

The introduction of newer, state-of-the-art, microprocessor controlled ventilator systems provides clinicians with opportunities to apply a number of advanced ventilatory modalities which were not previously available for treating newborns. Some of these techniques will need further scientific evaluation in controlled trials, but this should not preclude their use in clinical settings, as their safety has already been proved by "standard setters" for use in neonates. There is a firm physiological rationale for their use, and individual centres have already acquired substantial experience in the application of these modalities. The trend towards increasing sophistication and greater versatility is likely to continue, and clinicians involved in the care of sick newborn infants must keep abreast of these developments.

Weaning newborns from mechanical ventilation

While there is a relative consensus as to whether mechanical ventilation should be initiated, the management of babies during recovery from respiratory failure remains largely subjective and is predominantly determined by institutional or individual practices or preferences. This can lead to babies either being left on the ventilator too long, or extubated too hastily, thus requiring repeated re-intubation. The current scientific literature fails to provide a uniform view of the most appropriate way to wean babies from mechanical ventilation. This might stem from a lack of understanding of the relative merits of the different techniques of discontinuing mechanical ventilation, given the availability of a variety of primary ventilatory modes which were not available to a neonatal population before, and limited research into the pathophysiological mechanisms responsible for an unsuccessful extubation. The purpose of this paper is to review the physiological, mechanical, and clinical principles of weaning, and to highlight areas still in need of investigation.

Effect of external electrical field on mobile water fraction and physiological processes in wheat (Triticum aestivum) leaves

Experiments were conducted to study the effect of external electric field on physiological processes, moisture content and mobile water fraction in wheat leaves. Application of electric field increased the stomatal resistance immediately and it continued to increase upto 10 min. Photosynthesis and respiration of leaves decreased with the application of external electric field. Leaf moisture content and mobile fraction of water measured as relaxation times were marginally increased with electric field. Closure of stomata, in spite of maintaining higher leaf moisture content of the leaf with external electric field, suggested that electric field might have regulated stomatal movement through hormones or ion flux across the cells.

Momentum-resolved charge excitations in a prototype one-dimensional mott insulator

We report momentum-resolved charge excitations in a one-dimensional (1D) Mott insulator studied using high resolution inelastic x-ray scattering over the entire Brillouin zone for the first time. Excitations at the insulating gap edge are found to be highly dispersive (momentum dependent) compared to excitations observed in two-dimensional Mott insulators. The observed dispersion in 1D cuprates ( SrCuO2 and Sr2CuO3) is consistent with charge excitations involving holons which is unique to spin-1/2 quantum chain systems. These results point to the potential utility of momentum-resolved inelastic x-ray scattering in providing valuable information about electronic structure of strongly correlated insulators.

Study of primary amenorrhoea with special reference to cytogenetic evaluation

An attempt has been made to find out the proportion of genetic causes in cases of primary amenorrhoea and to analyse different chromosomal pattern. Cases were analysed according to clinical profile, X-ray, laparoscopy/pneumography, hormone profile, USG, Gonadal Biopsy and Cytogenetic study including Sex Chromatin (Barr body) and Karyotyping. Among the 72 cases studied, the aetiological factors were Mullerian duct abnormalities in 27 cases (37.5%) Gonadal agenesis in 13 cases (18.05%). Turner stigmata in 18 cases (25%), Y cell line in 6 cases (8.33%). Delayed menarche in 4 cases (5.55%), systemic disease like Tuberculosis and Idiopathic 2 cases (2.77%) each. Chromosomal aberration was seen in 24 cases (33.33%) and it comes second most common cause of primary amenorrhoea after mullerian duct abnormalities.