A comparative study of air pollution in Indian cities

Rapid and unplanned industrialization and urbanization has resulted in the deterioration of India's air quality according to air-quality monitoring carried out in seven major Indian cities in industrial and residential areas between 1995 and 2000. Suspended particulate matter (SPM) levels in Indian cities are in the range 50 to 550 microg/m(3). NO(x) values are high in Delhi's residential areas, with values of 33 microg/m(3) in 1995 and 34.6 microg/m(3) in 2000, while in an industrial area values of 29.4 microg/m(3) were found in 1995, increasing to 33.7 microg/m(3) in 2000. SO(2) values are very high in Pune city, ranging from 43.3 microg/m(3) in residential to 43.69 microg/m(3) in an industrial area in 2000.

Emergency thoracotomy after cardiac arrest from blunt trauma is not always futile

We report a case of blunt trauma leading to pulseless electrical activity (PEA) cardiac arrest that was successfully managed with emergency department thoracotomy. While the literature suggests an almost universally poor outcome from this clinical situation, in this case the patient survived with full neurological recovery. Several factors were present in this case, which have been reported as indicating an increased chance of good outcome. These were an arrest rhythm of sinus-based PEA, non-dilated reactive pupils and a short period of cardiopulmonary resuscitation. The case illustrates that in certain circumstances, emergency thoracotomy may not be futile after blunt trauma causing cardiac arrest.

Non-conventional uses of the Aintree Intubating Catheter in management of the difficult airway

We present 14 cases, of which three have been previously reported, in which non-conventional use was made of the Aintree Intubating Catheter (AIC). In seven cases the AIC was used via a ProSeal Laryngeal mask airway (PLMA). Two patients had anticipated difficult intubation, two unexpected difficult intubation and two required rescue of an obstructed airway prior to AIC-assisted intubation. In two cases of tracheal stenosis the AIC was used as a 'long narrow tracheal tube' during fibre-optic intubation: the AIC facilitated passage through the narrowed trachea and smooth railroading of a tracheal tube. In two cases the AIC was used in an awake patient. In three cases the AIC was used successfully despite gross laryngeal oedema. In three cases attempted AIC deployment failed: two patients had undergone radiotherapy to the mouth and PLMA placement failed; in the third, supraglottic oedema prevented visualisation of the larynx. The AIC via an LMA Classic was successful in one of these cases. In all cases where the larynx was visualised the AIC was rapidly successful without complications. In eight cases the anaesthetist had no experience of the technique outside workshops. These cases demonstrate general utility of the technique and successful use of the AIC via the PLMA, in awake patients, as an adjunct to fibre-optic intubation and in patients with an oedematous larynx. Finally, cases where the combination of the PLMA and AIC was unsuccessful demonstrate the technique, like many, is not always successful.

The role of magnesium as an adjuvant during general anaesthesia

Magnesium sulphate is used extensively in the treatment of eclampsia, and is also used to treat refractory arrhythmias, asthma, myocardial ischaemia and acute respiratory failure. We studied the interaction between magnesium sulphate and the anaesthetic agents propofol, rocuronium bromide and fentanyl citrate. This randomised, double blind study was conducted in 50 patients. The magnesium group A (n = 25) received 30 mg x kg(-1) magnesium sulphate before induction of anaesthesia and 10 mg x kg(-1) continuously intra-operatively until the end of surgery. Group B (n = 25) received the same volume of isotonic saline. Propofol, rocuronium and fentanyl infusions were started and the patients lungs' were ventilated with 33% oxygen in nitrous oxide. Anaesthetic depth was maintained at a bispectral index value of between 40 and 60. Muscle relaxation was maintained at a train-of-four count of 1 throughout surgery using neuromuscular monitoring. The fentanyl infusion was titrated to haemodynamic variables: heart rate and blood pressure. We concluded that magnesium sulphate has anaesthetic, analgesic and muscle relaxation effects and significantly reduces the drug requirements of propofol, rocuronium and fentanyl during anaesthesia.

A case of ovarian metastasis of gall bladder carcinoma simulating primary ovarian neoplasm: diagnostic pitfalls and review of literature

The ovary is a relatively frequent site of metastases from malignant neoplasia arising elsewhere in the body, the majority of these originating from the gastrointestinal tract. The best-known tumor of this type is signet ring cell adenocarcinoma (Krukenberg tumor) of gastric origin and large bowel. The gall bladder and bile ducts are extremely rare sources of these metastases. The casuistic describes a female patient, presented with pelvic mass and jaundice. While clinical and imaging results suggested a primary ovarian carcinoma with incidental cholelithiasis and choledocholithiasis, the final diagnosis was obtained on the basis of histopathologic findings of resected specimen.

Parotid TB

TB of the parotid is rare and only about 100 cases have been reported in the world literature. Often the diagnosis is made only after the surgery performed for a suspected neoplasm. We describe three patients with diffuse form of parotidTB without any evidence of tubercular focus elsewhere. Fine needle aspiration cytology confirmed the diagnosis in two cases, while the third case was diagnosed only after surgery.

Development of a fluorescence assay for the detection of L-ficolin-MASP in serum or purified samples

A fluorescence assay for the detection of L-ficolin-MASP in human serum or purified sample was developed by measuring the cleavage of fluorescent amide substrate by L-ficolin associated MASPs bound to the lipoteichoic acid (LTA). LTA (Staphylococcus aureus DSM 20233) was coated on NuncMaxisorp microtiter plates and serum or purified sample incubated overnight at 4 degrees C to allow the L-ficolin-MASP to bind LTA. Assay conditions for binding and complete cleavage of fluorescent amide substrate were standardized. The optimum temperature, incubation time and molarity of NaCl for LTA-ficolin binding were found to be 4 degrees C for 6 h at 1 M NaCl concentration. The optimum incubation time and pH for complete cleavage of fluorescent amide substrate by LTA bound L-ficolin associated MASP were found to be 2 h at pH 8.5. LTA-ficolin binding was found to be highly specific and was inhibited completely by LTA but not with mannose. A calibration curve was prepared by using the purified ficolin-MASP complex (1 to 12 mug/ml) and could be used to find concentration of ficolin-MASP complex in normal human serum.

Ischaemic necrosis of subcutaneous colonic neoesophagus: an unusual complication of presternal hypertrophic scar

Hypertrophic scars and keloids not only pose aesthetic problems but also cause functional and anatomical dysfunction by leading to contractures and sometimes by compression of underneath structures. A 76-year-old man presented with progressive dysphagia of two months duration. Examination showed the unusual complication of a presternal hypertrophic scar, causing ischaemic necrosis of a subcutaneously-transposed colon, used for oesophageal reconstruction in a patient with inoperable carcinoma of the oesophagus. Such a complication of hypertrophic scar has never been reported in the literature.

A case of ovarian metastasis of gall bladder carcinoma simulating primary ovarian neoplasm: diagnostic pitfalls and review of literature

The ovary is a relatively frequent site of metastases from malignant neoplasia arising elsewhere in the body, the majority of these originating from the gastrointestinal tract. The best-known tumor of this type is signet ring cell adenocarcinoma (Krukenberg tumor) of gastric origin and large bowel. The gall bladder and bile ducts are extremely rare sources of these metastases. The casuistic describes a female patient, presented with pelvic mass and jaundice. While clinical and imaging results suggested a primary ovarian carcinoma with incidental cholelithiasis and choledocholithiasis, the final diagnosis was obtained on the basis of histopathologic findings of resected specimen.

A Rare Case of Odontogenic Myxoma in a Dog

A case of odontogenic myxoma in an old Doberman bitch involving the periodontal region of the mandible was recorded. Grossly, the tumour mass was soft and slimy, having brownish-black foci on cut surface. Histopathologically, the tumour predominantly consisted of mesenchyme-like cells with prominent nuclei and nucleoli. The tumour had abundant ground substance, rich in acid mucopolysaccharides.

Angiogenesis: a curse or cure?

Angiogenesis, the growth of new blood vessels is essential during fetal development, female reproductive cycle, and tissue repair. In contrast, uncontrolled angiogenesis promotes the neoplastic disease and retinopathies, while inadequate angiogenesis can lead to coronary artery disease. A balance between pro-angiogenic and antiangiogenic growth factors and cytokines tightly controls angiogenesis. Considerable progress has been made in identifying these molecular components to develop angiogenesis based treatments. One of the most specific and critical regulators of angiogenesis is vascular endothelial growth factor (VEGF), which regulates endothelial proliferation, permeability, and survival. Several VEGF based treatments including anti-VEGF and anti-VEGF receptor antibodies/agents are in clinical trials along with several other antiangiogenic treatments. While bevacizumab (anti-VEGF antibody) has been approved for clinical use in colorectal cancer, the side effects of antiangiogenic treatment still remain a challenge. The pros and cons of angiogenesis based treatment are discussed.

Macroinvertebrates as indicators of pollution

Various pollution indicators of stream Ban-Ganga have been identified on the basis of presence/absence/numerical abundance at various stations. They have been categorized as pollution tolerant, facultative and pollution intolerant groups in relation with the water quality at different stations of stream.

More 'cries from the joints': assessment of the musculoskeletal system is poorly documented in routine paediatric clerking

OBJECTIVES

The aim of this study was to describe the assessment of the musculoskeletal (MSK) system in comparison with other systems in routine paediatric medical clerking. Furthermore, to survey trainee paediatricians (SPRs, specialist registrars) about their self-rated confidence in assessing the MSK system.

METHODS

Case notes of consecutive general paediatric medical patients admitted to three UK hospitals over a 4-week period were assessed using a standard pro forma. All patients had been assessed by a consultant paediatrician during their admission. A postal questionnaire was sent to all SPRs in training in each of the hospitals, regarding their confidence in assessing the MSK system compared with other systems and their exposure to MSK teaching.

RESULTS

Case notes of 257 patients [117 females, median age 3 yr (range 1-18 yr)] were reviewed. The most common reason for admission was acute infection, although the spectrum of other recorded diagnoses varied between hospitals. Thirteen children (5%) had an acute problem (e.g. infection) against a background of chronic disease. The case note documentation showed that cardiovascular (CVS), respiratory (RS) and gastrointestinal (GI) systems were assessed in the vast majority (>90%) of patients, irrespective of the underlying diagnosis. However, other systems were less well recorded; the trend being the same in each hospital and in descending order, the neurological system (38%), skin (32%), eyes (10%) and musculoskeletal system (4%). Only 2.7% (7/257) patients were documented to have been asked about MSK symptoms, and only 1.6% (4/257) had any documentation of joint examination--in all cases this was limited (e.g. range of movement of the knee only), and no patients had documentation of gait being examined, even in those children presenting with 'limp'. The response rate to the postal questionnaire was 60% (67/112). The self-rated confidence in MSK assessment was markedly low in comparison with other systems, even though 61/67 recalled some teaching of the MSK system as an undergraduate (61/67) or postgraduate (50/67). Of note none could recall teaching as an undergraduate in paediatric MSK assessment and where there had been postgraduate rheumatology MSK teaching this had been delivered by paediatric rheumatologists in many cases (34/50), reflecting the centres participating in the study.

CONCLUSIONS

In routine general paediatric medical in-patient clerking and throughout the admission, MSK assessment was rarely documented, and even where present was limited. This contrasts markedly with other systems which were examined in most children irrespective of the presenting complaint. Self-rated confidence in MSK assessment is low amongst SPRs compared with other systems, despite most recalling some teaching. This discrepancy between teaching and clinical practice needs to be addressed in undergraduate and postgraduate training.