14 Telomere length in cloned camels produced by somatic cell nuclear transfer is not different from that in their naturally produced counterparts

There are controversial reports on the restoration of eroded telomere length in offspring produced by somatic cell nuclear transfer (SCNT) in different animal species. To the best of our knowledge, no earlier studies report telomere length in naturally produced or cloned animals in any of the camelid species. Therefore, the present study was conducted to estimate the telomere length in dromedary camels produced by SCNT, and their age-matched naturally produced counterparts by terminal restriction fragment (TRF) analysis. Genomic DNA was extracted from venous blood collected from 6 cloned animals (aged 3, 12, and 24 months), and their age-matched counterparts by a conventional phenol/chloroform protocol. Denatured and neutralized DNA was blotted onto a positively charged nylon membrane and fixed by baking at 80°C for 3h. After washing in a prewarmed digoxigenin (DIG) easy hybridization solution at 42°C for 1h, DNA hybridization was carried out using a telomere (TTAGGG)n-specific, DIG-labelled hybridization probe (Roche Diagnostics, Germany) at 42°C for 4h. Stringent washes were carried out at the same temperature, followed by chemiluminescence reaction. The signals were captured using the Azure Biosystems C600 gel documentation system. Molecular weights of the unknown TRF bands on the gel were calculated using known molecular weight marker provided by Telo TAGGG Telomere Length Assay Kit (Roche Diagnostics). A TeloTool program from MATLAB software with a built-in probe intensity correction algorithm was used for TRF analysis. The experiment was replicated 3 times, and the data, presented as mean±s.e.m., were analysed using a 2-sample t-test (Minitab statistical software). No difference (P>0.05) was found in the mean telomere length of cloned camels compared with their naturally produced age-matched counterparts (21.7±0.3 vs. 22.1±0.3; 21.9±0.3 vs. 22.1±0.3; 22.2±0.5 vs. 22.0±0.1; 20.5±0.5 vs. 22.5±0.7; 20.1±0.1 vs. 22.5±0.7; 21.7±1.1 vs. 22.6±0.2), respectively. In conclusion, this is the first study where telomere length has been reported in naturally produced and cloned dromedary camels produced by SCNT. We found that telomere lengths in cloned camels were similar to those of their age-matched naturally produced counterparts, suggesting that the camel cytoplast reprograms the somatic cell nucleus and restores the telomere length to its totipotency stage.

73 Use of embryo transfer technology to salvage the germplasm of elite dromedary camels (Camelus dromedarius) infected with brucellosis

The present study was conducted to evaluate the potential of embryo transfer technology to salvage invivo-produced embryos from elite dromedary camels infected with brucellosis without transmission of the pathogen to the recipients or offspring. Ten elite racing champions who tested positive for brucella comprised the experimental group, whereas 3 donors negative for brucella acted as the control. Each donor animal received a combination of 2500IU of equine chorionic gonadotrophin (eCG; Folligon; Intervet), given as a single intramuscular injection on Day 1 of the treatment protocol, and 400mg of pFSH (Folltropin; Bioniche), injected twice daily in declining doses of 2×80mg, 2×60mg, 2×40mg, and 2×20mg over 4 days, also beginning on Day 1. They were mated with a fertile bull on the 11th day after the start of treatment. The donors of the group 1 received a combination of tetracycline, and streptomycin on alternate days for 2 weeks before mating with a fertile male. An injection of 20µg of gonadotrophin-releasing hormone (Receptal, Intervet) was given to them immediately after mating to induce ovulation. The embryos were collected by the non-surgical method on Day 7 day after ovulation as per the guidelines published by IETS. All embryos were washed at least 3 times in holding medium supplemented with antibiotics and then transferred individually into the left uterine horn of synchronized recipients. All recipients and calves born were tested for brucellosis every 3 weeks. The data were analysed using a two-sample t-test (Minitab statistical software, Minitab Ltd.). Results are shown in Table 1. No difference was observed in the number of embryos collected per flushing and pregnancies established at Day 60. The proportion of pregnancies reaching term from the total number of embryos transferred and from the pregnancies established on Day 60 did not differ from embryos obtained from brucella-infected and control donors. All recipients tested negative for brucellosis during their gestation and until weaning. All calves born were also negative for brucellosis on birth and until weaning and handing over to clients. In conclusion, this is the first study in camels wherein we have demonstrated that invivo-produced embryos from elite dromedary females infected with brucellosis could be collected and transferred to synchronized recipients without transmitting the pathogen to the recipients or offspring. Table 1. Pregnancies established from invivo-produced embryos collected from elite dromedary camels infected with brucellosis Donor group (N) Total number of flushings No. of embryos collected per flushing (n±s.e.m.) Pregnancies on Day 60 (% mean±s.e.m.) Pregnancies reaching term (% mean±s.e.m.) from: Embryos transferred Pregnancies on Day 60 Brucella (10) 30 5.4±0.6 55.1±2.6 44.4±2.3 83.2±3.6 Control (3) 6 5.3±0.6 65.7±6.3 53.3±6.8 80.9±7.7 P-value 0.969 0.173 0.262 0.797

74 Body condition of donor animal and recipients affects the outcome of embryo transfer program in dromedary camel (Camelus dromedarius)

The present study was conducted in dromedary camels to evaluate the effect of the body condition of donor animals on the outcome of superstimulation and embryo collection in experiment 1 and the establishment of pregnancies in the recipients in experiment 2. The animals were physically evaluated for their body condition and scored on a scale of 0 to 5 (0 being very thin and weak, while 5 being very fat). They were divided into three groups based on their body condition score (BCS). Animals with a score of 1–2, >2–3, and >3–4 were divided into groups 1, 2, and 3, respectively. Animals with a score of <1 and >4 were considered either too weak or too fat and were not included in the study. In Experiment 1, 32 donors in 3 groups were superstimulated with a combination of 2500IU of equine chorionic gonadotrophin (eCG, Folligon; Intervet), given as a single intramuscular injection on Day 1 of the treatment protocol, and 400mg of pFSH (Folltropin; Bioniche) injected twice daily in declining doses of 2×80mg, 2×60mg, 2×40mg, and 2×20mg over 4 days, also beginning on Day 1. The ovaries of all the donor camels were scanned on Day 4 after the start of treatment, and thereafter at intervals of one or two days until the majority of follicles had grown to between 1.3 and 1.8cm in diameter before mating with a fertile male. Each donor received an intramuscular injection of 20µg of gonadotrophin-releasing hormone (Receptal, Intervet) immediately after mating, and embryos were collected by non-surgical method on Day 7 after ovulation. In Experiment 2, 141 recipients divided in 3 groups, as described above, were synchronized with donors and received an embryo each in their left uterine horn. The pregnancy confirmation was done by an ultrasound examination on Day 50 after transfer. Data were analysed by ANOVA with Fisher protected least significant difference test (Minitab statistical software, Minitab Ltd.). In experiment 1, the mean±s.e.m. number of follicles (13.9±1.3; 12.7±2.9; 15.0±1.7), and the percent mean±s.e.m. of embryos collected (41.5±7.7; 57.0±12.3; 60.4±7.8) were not different among groups 1, 2 and 3, respectively. However, the percent mean±s.e.m. of transferrable embryos obtained were higher (P<0.05) in group 3 (77.7±4.8) compared with group 1 (57.5±10.1). Similarly, in experiment 2, the percent mean±s.e.m. of pregnancies achieved in group 3 (68.9±6.4) was similar to that of group 2 (57.9±14) but higher (P<0.05) than that of group 1 (50.5±10.0). In conclusion, to the best of our knowledge, this is the first study showing a direct correlation between the BCS and outcome of embryo transfer program in camels. Donors with a good BCS produced more transferrable embryos, and conception rates were higher in recipients having a better BCS. This clearly shows that not only is the selection of recipients critical in the embryo transfer program, but donors with a positive energy balance yield better transferrable embryos. Priming of donors before the start of the breeding season could help to improve the outcome of this technology in camels.

76 Effect of season on the superstimulation response, embryo quality, and pregnancy establishment in dromedary camel (Camelus dromedarius)

The present study was conducted to study the effect of season on the superstimulation response, embryo quality and pregnancy establishment in the dromedary camels. Two donors each were superstimulated in the month of June 2019 (non-breeding season) and January 2019 (breeding season) by a combination of 2500IU of equine chorionic gonadotrophin (eCG, Folligon; Intervet), given as a single intramuscular injection on Day 1 of the treatment protocol, and 400mg of pFSH (Folltropin; Bioniche) injected twice daily in declining doses of 2×80mg, 2×60mg, 2×40mg, and 2×20mg over 4 days, also beginning on Day 1. They were scanned by rectal ultrasonography and follicles counted before mating with a fertile bull on Day 11 after the start of treatment. An injection of 20µg of gonadotrophhin-releasing hormone (Receptal, Intervet) was given immediately after mating to induce ovulation. The number of corpora lutea (CL) were counted, and the embryos collected by the non-surgical method on Day 7 after ovulation. All embryos were washed and graded before they were transferred individually into the left uterine horn of recipient animals, synchronized to be on Day 6 after ovulation. All recipients were screened by ultrasonography on Day 22, Day 60, and Day 90 for pregnancies. The data were analysed using a two-sample t-test (Minitab statistical software, Minitab Ltd.). No difference was observed in the mean number of follicles developed (20.5 vs. 18.5) between the donors in breeding and non-breeding season, respectively. The percent mean±s.e.m. of ovulations as observed by counting the CL in nonbreeding season (80.7±3.4) were not different from those in breeding season (85.4±3.7). A total number of 16 embryos collected during non-breeding season and 20 embryos in breeding season were transferred to recipients. The percent mean±s.e.m. of pregnancies established on Day 22 (56.6±3.4 vs. 67.5±7.5) and on Day 90 (47.2±2.8 vs. 60±0.0) were similar in both groups. These observations indicate that embryo transfer technology can be applied to camels during the summer months, which is considered the non-breeding season, and pregnancies can be established at par with breeding season. In conclusion, to the best of our knowledge, this is the first study in camels wherein we have demonstrated that donor camels can be superstimulated, embryos can be collected, recipient animals can be synchronized, and pregnancies can be established in the summer (non-breeding) months. The embryos collected from elite donors can be transferred to synchronized recipients to establish pregnancies or preserved for future use. Some owners do not want calves to be born in summer months, so protocols need to be established for storing these embryos for a few months before their transfer to recipients, to have the calves delivered in the desired winter months.

160 In vitro maturation of pre-pubertal goat oocytes and their development after chemical activation

Experiments were conducted to study in vitro maturation of pre-pubertal goat oocytes and their developmental potential after chemical activation. Cumulus-oocyte complexes (n=1170) collected from the ovaries of pre-pubertal goats slaughtered at a local abattoir were matured in TCM-199 supplemented with 0.15mg mL−1 l-glutamine, 0.25mM sodium pyruvate, 0.1mM l-cysteine, 20ng mL−1 epidermal growth factor, 10mg mL−1 FSH, 10mg mL−1 LH, 1μg mL−1 oestradiol and 10% FCS for 24h at 39°C under 5% CO2 in humidified air. In Experiment 1, matured oocytes were activated (r=6) with either 5mM ionomycin (n=85) or 7% ethanol (n=91) followed by culture in 6-DMAP for 4h. All the activated oocytes were then cultured in KSOM supplemented with 3mg mL−1 BSA and were fixed and stained with Hoechst 33342 after 18h of culture to evaluate their activation status. In Experiment 2, oocytes activated with 5mM ionomycin and 6-DMAP were cultured for 7 days (r=6) in 1 of the 4 different culture media [Charles Rosenkrans medium (CR-1), modified TCM-199, KSOM and SOF] to study their developmental potential. All media were supplemented with 3.0mg mL−1 BSA for the first 3 days and 10% FCS for the subsequent 4 days. Of these pre-pubertal oocytes, 59% reached metaphase II stage, and 83% of these oocytes were classified as activated in the group using ionomycin in comparison with 69% in the group using ethanol as an activating agent (P<0.05). No difference was observed in the cleavage rate of activated oocytes cultured in any of the 4 culture media (65.7v. 55.0v. 61.0v. 56.2%, respectively). However, the development to blastocyst stage was observed in only KSOM (16%) and SOF (5%) media. In conclusion, the present study demonstrates that pre-pubertal goat oocytes can mature in vitro and can be activated with 5mM ionomycin, and KSOM, and to a lesser extent SOF, supports development to the blastocyst stage. We plan to use these oocytes as a cytoplast source for interspecies somatic cell NT; however, before that, more studies are needed to evaluate their requirements in culture media to enhance their development to the blastocyst stage.

Allosteric Site Inhibitor Disrupting Auto-Processing of Malarial Cysteine Proteases

Falcipains are major haemoglobinases of Plasmodium falciparum required for parasite growth and development. They consist of pro- and mature domains that interact via 'hot-spot' interactions and maintain the structural integrity of enzyme in zymogen state. Upon sensing the acidic environment, these interactions dissociate and active enzyme is released. For inhibiting falcipains, several active site inhibitors exist, however, compounds that target via allosteric mechanism remains uncharacterized. Therefore, we designed and synthesized six azapeptide compounds, among which, NA-01 & NA-03 arrested parasite growth by specifically blocking the auto-processing of falcipains. Inhibitors showed high affinity for enzymes in presence of the prodomain without affecting the secondary structure. Binding of NA-03 at the interface induced rigidity in the prodomain preventing structural reorganization. We further reported a histidine-dependent activation of falcipain. Collectively, for the first time we provide a framework for blocking the allosteric site of crucial haemoglobinases of the human malaria parasite. Targeting the allosteric site could provide high selectivity and less vulnerable to drug resistance.

34 Recent Advances in Cloning by Somatic Cell Nuclear Transfer in Camelids

In addition to its application for production of elite males, racing champions, animals with the highest potential for milk production, and the prized beauty camels, somatic cell nuclear transfer (SCNT) can be utilised for the conservation of endangered wild Bactrian camels and vicunas by using the technique of interspecies SCNT (iSCNT). In the present study, embryos were reconstructed by using skin fibroblast cells from a Bactrian camel (Camelus bactrianus), a llama (Llama glama), and a dromedary camel (Camelus dromedarius) as donor karyoplasts and dromedary oocytes as recipient cytoplasts to evaluate in vitro and in vivo developmental potential of these embryos. Mature oocytes were collected from super-stimulated dromedary camels by ultrasound guided transvaginal ovum pick-up. Serum-starved skin fibroblast cells were injected into the perivitelline space of enucleated oocytes. The fibroblast cell and recipient cytoplasm were fused by 2 DC pulses of 100V for 15 µs each. Reconstructs were activated 1 to 1.5 h post-fusion with 5 µM ionomycin, followed by exposure to 6-DMAP for 4 h. The activated oocytes were then cultured at 38.5°C in an atmosphere of 5% CO2, 5% O2, and 90% N2. The proportion of oocytes that cleaved was recorded on Day 3, and those that reached morula and blastocyst stages were recorded on Day 7 of culture. A lower blastocyst production rate was observed when llama fibroblast cells were used as karyoplast (13.3 ± 3.3) compared with those obtained from the embryos reconstructed with Bactrian (34.4 ± 3.9) and dromedary (32.2 ± 6.2) fibroblast cells; however, no difference was observed in their cell numbers. Out of 26 and 20 blastocysts from reconstructs with Bactrian and dromedary fibroblast cells, transferred to 23 and 12 synchronized dromedary recipients, 3 and 2 pregnancies were achieved at Day 60, respectively. One pregnancy from each group reached term and both (a Bactrian and a dromedary) calves were delivered normally after completing the gestation period. We demonstrated birth of a Bactrian calf conceived from the reconstructed embryo by iSCNT using the somatic cell from a Bactrian camel and enucleated dromedary oocyte. The present study also demonstrated that dromedary camel can be used as a surrogate to carry these pregnancies to term (Wani et al. 2017 PLoS One 12, e0177800; https://doi.org/10.1371/journal.pone.0177800). This study has opened doors for enhanced multiplication and preservation of the wild Bactrian camels, which are threatened with extinction, being the eighth most endangered large mammal on the planet.

Cranial Ultrasonography in Infantile Encephalitic Beriberi: A Useful First-Line Imaging Tool for Screening and Diagnosis in Suspected Cases

BACKGROUND AND PURPOSE

Brain imaging is central to the diagnosis of infantile encephalitic beriberi. Because cranial sonography findings have not been described in infantile encephalitic beriberi, our aim was to investigate its role in the diagnosis of this condition.

MATERIALS AND METHODS

We performed a retrospective review of head sonography of infants (admitted between November 1, 2014, and March 31, 2015) who presented with encephalopathy. Cranial ultrasonography scans were studied for the alteration of echogenicity of the basal ganglia.

RESULTS

Of the 145 consecutive infants who presented with encephalopathy, 58 had thiamine-responsive encephalopathy (infantile encephalitic beriberi) and 87 had encephalopathy due to other causes. Forty-eight of 145 infants with encephalopathy showed hyperechoic basal ganglia. A hyperechoic appearance of the basal ganglia on cranial ultrasonography was found to have a sensitivity of 71% (41/58) and a specificity of 92% (80/87) in diagnosing infantile encephalitic beriberi. The sensitivity of cranial sonography increased with age. It was a maximum of 93% (14/15) in the 5 months and older age group. Specificity was a maximum of 100% (18/18) in infants older than 5 months of age. Sensitivity was maximum in Wernicke encephalopathy at 90% (18/20) and least in the acidotic form at 43% (10/23). Follow-up showed gradual normalization of the hyperechoic appearance of the basal ganglia during 8 weeks in 26/41 (63%), with mild atrophy of the basal ganglia in 6/41 (15%)

CONCLUSIONS

Hyperechogenicity of the basal ganglia on cranial ultrasonography is a sensitive finding for the diagnosis of infantile encephalitic beriberi in infants who present with Wernicke encephalopathy.

Is there a two-humped stage in the embryonic development of the dromedary?

It has been postulated that the one-humped (Arabian) dromedary and the two-humped (Bactrian) camel originated from a single ancestor. Consequently, the dromedary was considered a breed of the two-humped camel, based on an anatomical study by Lombardini L, 1879: Ann. Del. Universita Toscane, 259, 147, who described a reduced second hump like structure in foetal and adult dromedaries. To resolve this lingering issue, we analysed dromedary foetuses and calves. In contrast to the situation in two-humped camels, we never observed any rudimentary second hump in the dromedary foetuses or calves.

Bilateral quadriceps tendon rupture as the presenting manifestation of chronic kidney disease

Bilateral painful knees with loss of extension in a patient with chronic kidney disease (CKD) may be due to spontaneous quadriceps tendon rupture. This rare complication is usually seen in patients on long term dialysis. We present a case of bilateral spontaneous quadriceps tendon rupture demonstrated by magnetic resonance imaging in a 20-year-old woman who on evaluation was found to have CKD.

Pseudoaneurysm of internal mammary artery caused by pulmonary actinomycosis

Although internal mammary artery pseudoaneurysms are a rare vascular abnormality, they are sometimes seen after sternotomy, diagnostic and therapeutic vascular access or penetrating chest trauma. To our knowledge, internal mammary artery pseudoaneurysm caused by pulmonary actinomycosis has not been reported previously. We report a case of pseudoaneurysm of the left internal mammary artery caused by pulmonary actinomycosis. A 50-year-old woman initially presented with clinical and radiological features of pneumonia, for which she was treated empirically with antibiotics. Later, she developed haemoptysis along with pain and swelling in the left upper chest wall. Multidetector CT (MDCT) with CT angiography showed a cavitating mass in the left upper lobe of the lung that infiltrated into the chest wall and a pseudoaneurysm of the left internal mammary artery. Imaging suggested that the lung mass resulted from pulmonary actinomycosis, which was confirmed by the histopathology of a fine-needle aspiration specimen.

MRI of oriental cholangiohepatitis

Oriental cholangiohepatitis (OCH) also called recurrent pyogenic cholangitis is characterized by intrahepatic duct calculi, strictures, and recurrent infections. In turn cholangitis can result in multiple hepatic abscesses, further biliary strictures, and in severe cases, progressive hepatic parenchymal destruction, cirrhosis, and portal hypertension. Magnetic resonance cholangiopancreatography (MRCP) and conventional T1-weighted (T1W) and T2-weighted (T2W) magnetic resonance imaging (MRI) findings have been described in patients with OCH. MRCP findings include duct dilation, strictures, and calculi. MRCP can help to localize the diseased ducts and determine the severity of involvement. T1 and T2W sequences reveal the parenchymal changes of atrophy, abscess formation, and portal hypertension in addition to calculi. Post-treatment changes are also well depicted using MRI. Comprehensive, non-invasive assessment is achieved by using conventional MRI and MRCP in OCH providing a roadmap for endoscopic or surgical management.

55 PRELIMINARY STUDIES ON THE DEVELOPMENT OF RECONSTRUCTED EMBRYOS AFTER NUCLEAR TRANSFER IN DROMEDARY CAMEL (CAMELUS DROMEDARIUS)

Experiments were conducted to study the in vitro development of reconstructed dromedary camel embryos after nuclear transfer by a modified zona-free method. Cumulus oocyte complexes, collected from slaughterhouse ovaries were cultured in TCM199 at 38.5°C in an atmosphere of 5% CO2 in air for 32 to 36 h. Matured oocytes were denuded of cumulus cells by repeated pipetting and the zona pellucida was removed by brief incubation in 5 mg mL–1 pronase dissolved in Ca- and Mg-free PBS. Zona-free oocytes were stained with 5 mg mL–1 Hoechst 33342 in H199 supplemented with 7.5 μg mL–1 cytochalasin B and 10% FCS. They were enucleated under constant UV-light exposure in H199 supplemented with cytochalasin B and 10% FCS. The granulosa cells at passage numbers 4 to 15 were used as nuclear donors. The zona-free cytoplasts were individually washed for a few seconds in 300 μg mL–1 of Phytohemagglutinin in H199, then quickly dropped on a single donor cell settled to the bottom of a drop of H199 with 0.5% FCS and pushed together with the mouth pipette. Couplets were electrically fused, at room temperature, with two DC pulses of 100 V cm–1 for 15 μs. Reconstructs were activated 2 h post-fusion, with 5 μm ionomycin for 3 min followed by culture in 6-diethylaminopurine for 4 h. The reconstructs were then cultured individually in either 5 μL drops under oil, in agar wells or in wells of wells (WOW) in a well of 4-well culture plate. Embryo culture medium consisted of TCM-199 supplemented with 0.15 mg mL–1 L-glutamine, 2.1 mg mL–1 sodium bicarbonate, 0.22 mg mL–1 pyruvate, 50 μg mL–1 gentamycine, 1% insulin-transferrin-selenium (ITS), and 15% estrous dromedary serum. The number of oocytes that had cleaved was recorded on day 2, whilst those developing to morulae and blastocysts were recorded on day 7 of culture. For cell count, the blastocysts were stained with Hoechst and cells counted under a fluorescent microscope at ×400. Data obtained was analysed by chi-square test. About 92% (349/380) of the oocytes were successfully enucleated and 76% (259/340) fused with the attached cells. The cleavage rate was significantly lower (P < 0.05) in reconstructed embryos cultured in droplets (10/72, 14%) as compared with those cultured in agar wells (37/87, 42%) or WOW system (42/96, 44%). The proportions of cleaved embryos reaching morula stage were 0, 83, and 89% in droplets, agar wells, and WOW, respectively. However, only 8% and 5% of the cleaved embryos developed to the blastocyst stage in the agar well and WOW culture systems, respectively. No difference was observed in the cell number of blastocysts produced in agar wells (77.3 ± 8.02) or WOW (78.0 ± 4.2) culture system. To the best of our knowledge, this is the first report of embryo production up to the blastocyst stage after NT in camelids and it shows that NT can be successfully applied for embryo production in camelids. Further studies are needed to optimize the parameters and to improve the efficiency for production of transferable blastocysts in this species. This study was kindly sponsored by H.H. General Sheikh Mohammed bin Rashid Al Maktoum, Ruler of Dubai.

Chemical activation of in vitro matured dromedary camel (Camelus dromedarius) oocytes: optimization of protocols

Experiments were conducted to study the efficiency of sequential treatments of ionomycine and ethanol combined with phosphorylation inhibitor (6-dimethylaminopurine) or the specific maturation promoting factor inhibitor (roscovitine) in inducing artificial activation in dromedary M-II oocytes. Cumulus oocyte complexes (COCs), collected from slaughterhouse ovaries were cultured at 38.5 degrees C in an atmosphere of 5% CO2 in air for 24-48 h. In experiment 1, the COCs were either fertilized in vitro or activated with 5 microM ionomycine for 5 min or 7% ethanol for 7 min, both followed by exposure to 6-diethylaminopurine or roscovitine for 4h. After 14-15 h of in vitro culture, the oocytes were fixed and stained with 1% aceto-orcein to evaluate their nuclear status. In experiment 2, the oocytes were activated in the same manner as in experiment 1 but were cultured for 7 days to evaluate their post-parthenogenetic development. In experiment 3, oocytes were exposed to the ionomycine for 2, 3, 4 or 5 min to evaluate the better exposure time while as in experiment 4, the oocytes matured for 28-48 h were activated to see the effect of aging on post-parthenogenetic development. Higher proportion (P<0.01) of oocytes was activated in ionomycine/6-DMAP and ionomycine/roscovitine groups when compared with ethanol/6-DMAP, ethanol/roscovitine and in vitro fertilized groups. However, there was no difference (P>0.05) in the proportion of oocytes activated with ethanol when compared with in vitro fertilized group. No significant difference was seen on the proportion of morula on day 7 of culture, however the development to blastocyst stage was higher (P<0.01) in ionomycine/6-DMAP and ionomycine/roscovitine when compared with ethanol/6-DMAP and ethanol/roscovitine treated oocytes. A higher proportion of oocytes reached blastocyst stage when they were exposed to ionomycine for 3 min but they were not significantly different from the others (P>0.05). The proportion of blastocysts obtained was higher (P<0.05) in oocytes activated after 28 h of maturation when compared with oocytes activated after 32, 36, 40, 44 and 48 h of maturation. In conclusion, a protocol for chemical activation of dromedary camel oocytes with ionomycine/6-DMAP is demonstrated and optimized in the present study for further use in the development of assisted reproductive techniques in this species.

235 DEVELOPMENT OF CAMEL (CAMELUS DROMEDARIUS) OOCYTES AFTER CHEMICAL ACTIVATION

Identification of an optimal protocol for activation of the MII oocytes in a species like camel not only allows us to evaluate the quality of oocytes after their in vitro maturation, but also is required for the success of advanced technologies like cloning. The present study was aimed to determine activation of in vitro-matured dromedary (Camelus dromedarius) oocytes using ionomycin or ethanol followed by sequential culture in phosphorylation inhibitor (6-dimethylaminopurine) or the specific maturation promoting factor inhibitor (roscovitine). Cumulus–oocyte complexes (COCs), collected from slaughterhouse ovaries, were randomly distributed to 4-well culture plates (20–25 COCs/well) containing 500 µL of the maturation medium. The maturation medium consisted of TCM-199 supplemented with 0.15 mg mL–1 L-glutamine, 2.1 mg mL–1 sodium bicarbonate, 0.22 mg mL–1 pyruvate, 20 ng mL–1 epidermal growth factor, 50 µg mL–1 gentamycin, 10 µg mL–1 bFSH, 10 µg mL–1 bLH, 1 µg mL–1 estradiol, and 10% estrous dromedary serum (EDS). The COCs were cultured at 38.5�C in an atmosphere of 5% CO2 in air for 36–40 h. The COCs were either fertilized in vitro (positive control) using epididymal spermatozoa collected from slaughtered males or activated with 5 µm ionomycin for 5 min or 7% ethanol for 7 min, both followed by exposure to 2 mm 6-DMAP or 50 µm roscovitine for 4 h. After being washed thoroughly in embryo culture medium, they were cultured for a period of 7 days at 38.5�C in an atmosphere of 5% CO2, 5% O2, and 90% N2 in air. The embryo culture medium consisted of TCM-199 supplemented with 0.15 mg mL–1 L-glutamine, 2.1 mg mL–1 sodium bicarbonate, 0.22 mg mL–1 pyruvate, 50 µg mL–1 gentamicin, 1% insulin-transferrin-selenium (ITS) media supplement, and 10% EDS. First cleavage was recorded on Day 2 and the number of embryos developing to morulas and blastocysts was recorded on Day 7 of culture. The proportions of oocytes cleaved were 58.6 � 4.4, 55.9 � 4.5, 49.1 � 5.3, 43.2 � 6.05, and 54.1 � 3.3%, while the proportions of cleaved oocytes reaching blastocyst stage were 22.5 � 0.9, 19.1 � 2.8, 9.04 � 3.3, 8.2 � 3.8, and 15.2 � 2.3%, and those at morula stage were 61.1 � 4.9, 54.6 � 6.2, 67.1 � 7.2, 57.8 � 4.6, and 53.6 � 5.6% in the ionomycin/ 6-diethylaminopurine, ionomycin/roscovitine, ethanol/6-diethylaminopurine, ethanol/roscovitine, and IVF groups, respectively. The proportions of blastocysts obtained in the ionomycin/6-diethylaminopurine and ionomycin/roscovitine groups were higher (P < 0.05) when compared with the ethanol/6-diethylaminopurine and ethanol/roscovitine groups. Also, the proportion of blastocysts obtained in the ionomycin/6-diethylaminopurine group was higher than that in the in vitro-fertilized group. In summary, methods for oocyte or cytoplast activation in dromedary camel incorporating ionomycin/6-diethylaminopurine and ionomycin/roscovitine giving better results than those incorporating ethanol/6-diethylaminopurine and ethanol/roscovitine.

Studies on liquefaction and storage of ejaculated dromedary camel (Camelus dromedarius) semen

The purpose of this study was to evaluate seminal liquefaction and quality of ejaculated camel semen during storage in different extenders at room (23 degrees C) and refrigeration (4 degrees C) temperature. Semen was collected using an artificial vagina and diluted immediately (1:1), using a split-sample technique, in five extenders [(1) Tris-tes egg yolk, (2) Tris-lactose egg yolk, (3) citrate egg yolk, (4) sucrose egg yolk and (5) Tris-fructose egg yolk], while one fraction was kept without an extender to act as control. The semen was transported to the lab at 37 degrees C, in a portable incubator within half an hour, and thereafter liquefaction of semen was monitored every 15 min. After complete liquefaction of the semen it was evaluated for sperm concentration and morphology and then was extended to a final ratio of 1:3. Aliquots of each semen sample were then stored at refrigeration and room temperature. The average volume of an ejaculate was 4.3+/-0.4 mL and it had a very viscous consistency. The average concentration of spermatozoa was 230.4+/-10.7 x 10(6)mL(-1) and the proportion of spermatozoa with protoplasmic droplets averaged 1.02+/-0.2, while 2.7+/-0.6 and 9.7+/-2.9% had mid-piece and tail abnormalities, respectively. All extended semen samples liquefied within 1.5h at 37 degrees C, however, there was slow liquefaction in the sample without an added extender (control). Best liquefaction was observed in Tris-lactose extender followed by Tris-fructose and citrate egg yolk diluents whereas in the other two extenders there was head-to-head agglutination of the spermatozoa. There was no difference in the initial motility of the spermatozoa in extenders 1-5 after its liquefaction, however, after 24 and 48 h of storage a higher proportion of spermatozoa were motile in extenders 1, 2 and 4 (P<0.05) at both the temperatures. There was a gradual decline in viability of the spermatozoa in all extenders at both the temperatures, although, a high portion of the spermatozoa had intact acrosomes throughout the storage period. It may be concluded that dromedary semen, when added to an extender (1:1) immediately after collection, liquefies within 60-90 min at 37 degrees C. It maintains a high proportion of motile and viable spermatozoa that can survive storage up to 48 h in Tris-lactose egg yolk, Tris-tes egg yolk and sucrose egg yolk diluents. However, best liquefaction and progressive sperm motility is achieved in Tris-lactose egg yolk extender.

Kinetics of nuclear maturation and effect of holding ovaries at room temperature on in vitro maturation of camel (Camelus dromedarius) oocytes

Experiments were conducted to investigate kinetics of in vitro nuclear maturation and the effect of storing ovaries at room temperature on initial chromatin configuration and in vitro maturation of dromedary camel oocytes. Cumulus oocyte complexes (COCs) were collected from slaughterhouse ovaries and matured in vitro for 4-48h. At every 4h interval (starting from 0 to 48 h), groups of oocytes were fixed, stained and evaluated for the status of nuclear chromatin. Oocytes were categorized as germinal vesicle (GV), diakinesis (DK), metaphase-I (M-I), anaphase-I (A-I), metaphase-II (M-II) stage and those with degenerated, fragmented, activated or without a visible chromatin as others. At the start of culture, 74% (66/89) oocytes were at GV stage, 13% (12/89) at DK and 12% (11/89) were classified as others. Germinal vesicle breakdown started spontaneously in culture and at 20 h of culture 97% oocytes had already completed this process. After 8 and 16 h of maturation the highest proportion of oocytes (42%, 48/114 and 41%, 51/123) were at DK and M-I stage, respectively. The proportions of oocytes reaching M-II stage at 32 (42%, 50/118), 36 (45%, 47/104), 40 (49%, 57/117), 44 (52%, 103/198) and 48 h (46%, 55/120) of culture were not different from each other (P>0.05). The proportion of oocytes categorized as others, however, increased after 40 h of culture and was higher (P<0.05) at 48 h compared with other maturation periods. There was no difference (P>0.05) in the proportion of oocytes reaching M-II stage from the ovaries collected and stored in normal saline solution (NSS) at room temperature for 12h (43%, 64/148) and those collected in warm NSS (37 degrees C) and processed immediately after arrival in laboratory (49%, 57/117). However, low number of oocytes reached M-II stage from ovaries collected in warm NSS but stored at room temperature (29%, 37/128) compared with other two groups (P<0.05). It may be concluded that dromedary oocytes require 32-44h of in vitro culture to have an optimum number of oocytes in M-II stage. However, further studies are required to find out the most appropriate maturation period, which will result in the further development of these oocytes after IVF, ICSI, parthenogenetic activation or nuclear transfer. Ovaries can be collected and stored in normal saline solution at room temperature for 12h without any appreciable effect on the nuclear maturation of the oocytes.

Maturation rates of vitrified-thawed immature buffalo (Bubalus bubalis) oocytes: effect of different types of cryoprotectants

Cryopreservation of oocytes collected from slaughtered animals of high genetic value, their subsequent utilisation for production of embryos for transfer may provide an opportunity to replenish the valuable germplasm lost. Experiments were conducted to study the effect of cryoprotectants, dimethyl sulfoxide (DMSO), ethylene glycol (EG), 1,2-propanediol (PROH) and glycerol at different concentrations (3.5, 4, 5, 6 and 7 M each with 0.5M sucrose and 0.4% BSA in DPBS) on morphological survival and in vitro maturation of vitrified-thawed immature buffalo oocytes. The cumulus oocyte complexes were harvested from the ovaries obtained from a local slaughterhouse by aspirating the visible follicles. Less number of oocytes reached metaphase-II stage from the oocytes cryopreserved in any of the concentrations of DMSO, EG, PROH and glycerol compared to fresh oocytes. Among the vitrified groups, highest maturation (40.3, 42.5, 40.4 and 23.5%) was obtained in 7 M DMSO, EG, PROH and glycerol, respectively. Oocytes reaching to M-II stage from the oocytes cryopreserved in 7 M glycerol were significantly lower than that of the oocytes vitrified in 7 M DMSO, EG and PROH. It can be concluded that 7 M solutions of DMSO, EG and PROH can be used for vitrification of immature buffalo oocytes for subsequent utilisation of these oocytes in IVM/IVF and embryo production for transfer.

Effect of cryoprotectants and their concentration on in vitro development of vitrified-warmed immature oocytes in buffalo (Bubalus bubalis)

Experiments were conducted to study the effect of cryoprotectants, dimethyl sulfoxide (DMSO), ethylene glycol (EG), 1,2-propanediol (PROH), and glycerol at different concentrations (3.5, 4, 5, 6, and 7 M each with 0.5 M sucrose and 0.4% BSA in DPBS) on survival, in vitro maturation, in vitro fertilization, and post-fertilization development of vitrified-thawed immature buffalo oocytes. The COCs were harvested from the ovaries by aspirating the visible follicles. The recovery of post-thaw morphologically normal oocytes was lower in 3.5 and 4 M DMSO, EG, and PROH compared to 5, 6, and 7 M. In all the concentrations of glycerol, an overall lower numbers of oocytes recovered were normal compared to other cryoprotectants. Less number of oocytes reached metaphase-II (M-II) stage from the oocytes cryopreserved in any of the concentrations of DMSO, EG, PROH, and glycerol compared to fresh oocytes. Among the vitrified groups, highest maturation was obtained in 7 M solutions of all the cryoprotectants. The cleavage rates of oocytes vitrified in different concentrations of DMSO, EG, PROH, and glycerol were lower than that of the fresh oocytes. The cleavage rates were higher in oocytes cryopreserved in 6 and 7 M DMSO, EG, PROH, and glycerol compared with oocytes cryopreserved in other concentrations. However, the percentage of morula and blastocyst formation from the cleaved embryos did not vary in fresh oocytes and vitrified oocytes. In conclusion, this report describes the first successful production of buffalo blastocysts from immature oocytes cryopreserved by vitrification.

Diffuse abdominal lipomatosis

We report a 22-year male who developed progressive distension of abdomen, clinically diagnosed as ascites. A diagnosis of abdominal lipomatosis was made on the basis of CT evidence of excessive fatty tissue in abdominal cavity which was confirmed on laparotomy.

Management of Mirizzi syndrome: a new surgical approach

BACKGROUND

In a prospective study of a patient population of 1,340 with biliary calculus disease, that ran from January 1993 to December 1997, 34 patients (2.53%) were identified as having Mirizzi syndrome. Eight patients were found to have type I (A and B) and 26 patients were found to have type II Mirizzi syndrome. A history of recurrent biliary colic and jaundice was present in the majority of patients.

METHODS

Ultrasonography was helpful in five patients and endoscopic retrograde cholangiopancreatography was helpful in 17 patients in the diagnosis of this condition. Because the amount of gall bladder tissue used in choledochoplasty is not yet standardized, a new policy regarding choledochoplasty was adopted. In type IA, retrograde cholecystectomy with simple closure of cystic duct was carried out. In type IB, retrograde cholecystectomy and choledochoplasty with 5 mm cuff of the gall bladder was carried out. In type II lesions the procedure depended on the size of fistula. Patients with fistula sizes of less than one-third of the common bile duct diameter underwent choledochoplasty with 5 mm cuff of the gall bladder, and patients with fistula sizes between one-third and two-thirds of the diameter of the common bile duct underwent choledochoplasty with 10 mm cuff of the gall bladder. Patients with fistula sizes of more than two-thirds of the common bile duct diameter underwent Roux-en-Y hepaticojejunostomy.

RESULTS

There was no operative mortality and the complication rate was 17.64%.

CONCLUSION

Although, out of 26 choledochoplasties, we encountered only one (3.84%) stump stone in a maximum follow-up period of 59 months, further long-term follow-up studies are required to prove the efficacy of the procedure.

Postoperative biliary ascariasis: presentation and management--experience

Subsequent to preoperative and perioperative indications the common bile duct was explored in 705 patients over a 12-year period, from January 1983 to December 1994. Consequent postoperative T-tube cholangiography revealed the presence of worms in 22 patients. Expulsion of the worms followed T-tube irrigation with 0.9% normal saline in 18 patients. Only one patient had to be reexplored to remove the ascaris. In two patients the worm was removed along with the T-tube, and in one patient the worm came out through the T-tube tract.

Hydatid cyst of the pancreas

A rare case of hydatid cyst of the pancreas is reported. Although ultrasonography and computerised tomography scan confirmed the presence of a cystic mass in the body and tail of the pancreas, diagnosis was made only on laparotomy. A distal pancreatectomy was done and the diagnosis of hydatid cyst of the pancreas was confirmed by histopathology. Though very rare, pancreatic hydatidosis should be considered in the differential diagnosis of cystic lesions of the pancreas in the appropriate epidemiological setting.

Therapeutic splenectomy in immune thrombocytopenic purpura

The effects of splenectomy in 41 patients managed from 1982 to 1995 at Sher-i-Kashmir Institute of Medical Sciences, Srinagar (Jammu and Kashmir), India, were studied. Immune thrombocytopenic purpura (ITP) was the main indication for therapeutic splenectomy among all the hematologic disorders. The mean age was 30 years (range 7-64), and the male to female ratio was 1.05:1. The mean platelet count in the preoperative period was 31,751/mm(3) (range 4000-85,000). All patients presented with thrombocytopenia, i.e., platelet count of <100,000/mm(3). In addition, 5 patients presented with anemia, i.e., Hb <10 g%. Among the patients with thrombocytopenia, 30 patients presented with counts <50,000/mm(3) and 11 patients presented with counts between 50,000-100,000/mm(3). None of the patients presented with leukopenia. The morbidity observed was 15% and mortality was 2%. The response to splenectomy was complete for thrombocytopenia in 3 patients and partial in 5 patients; 4 patients failed to show any response. In anemic patients, 4 patients showed complete response and 1 patient showed no response. The prognosis was excellent in patients with platelet count >50,000/mm(3), age <50 years, no concomitant disease, and disease of shorter duration.

Ascaris-induced liver abscess

The prevalence, symptomatology, and outcome of Ascaris-induced liver abscess was studied prospectively in Kashmir, India, which is an endemic area of ascariasis, from December 1987 to December 1997. Of 510 patients with liver abscess admitted during this period, 74 had biliary ascariasis as the cause (14.51%). Of these 74 patients, 11 had intact ascaridae (live or dead) within the abscess. Six patients had a single abscess, and five had multiple abscesses. Seven patients had associated worms in the bile ducts. Ultrasonography was the main diagnostic procedure used. Ten patients were diagnosed based on clinical and ultrasound findings, and one was diagnosed during laparotomy. Most of the patients were young (age range 3-40 years) with a mean age of 17.20 years. Seven were females, and four were males. Ten patients underwent surgery; nine recovered completely, and one died postoperatively due to septicemia. Another patient died as well: a young child who presented late, was in refractory septic shock following suppurative cholangitis and liver abscess, and could not be taken for surgery. The mortality thus was 9.9%. Liver abscess following invasion of intrahepatic biliary radicles by ascaridae through the ampulla is an unusual complication of an otherwise common disease in Kashmir Valley, affecting children and young adults. The outcome depends on early diagnosis and surgical drainage of the abscess with extraction of worms from the ducts.

Haemosuccus pancreaticus: a clinical challenge

BACKGROUND

Haemosuccus pancreaticus is a rare complication of pancreatitis. It is a diagnostic problem for even the most astute clinician and a challenge for the expert endoscopist. We report a 25-year-old male patient who had all the features usually seen in haemosuccus pancreaticus patients: recurrent obscure upper gastrointestinal bleeding, pancreatitis, pseudocyst formation, ductal disruption, fistula and pancreatic ascites. The patient was treated by subtotal pancreatectomy, splenectomy and drainage of the pseudocyst. Although pancreatic duct communication with the surrounding vasculature could not be ascertained, we strongly believe the patient had haemosuccus pancreaticus because, over a follow-up period of 3 years, the patient was not only ascites free, but did not experience any further upper gastrointestinal bleeding. We believe that in evaluating patients with recurrent obscure gastrointestinal bleeding, one should always remember that the pancreas is a part of the gastrointestinal tract and, like other organs, is prone to blood loss.

Continuing diagnostic challenge of acute appendicitis: evaluation through modified Alvarado score

BACKGROUND

Acute appendicitis with protean manifestations may simulate almost any other acute abdominal illness and in turn may be mimicked by a variety of conditions. Progression of symptoms and signs is usual in contrast to the fluctuating course of some other diseases that lead to heavy morbidity and mortality.

METHODS

A practical score for the early diagnosis of acute appendicitis was established by Alvarado in 1986 and was assessed in this study for its accuracy in pre-operative diagnosis. The usefulness of this scoring system in reducing the evaluated negative appendicectomy rate of acute appendicitis in 91 patients, diagnosed by clinical parameters only, over a period of 12 months is determined.

RESULTS

A total of 106 patients underwent Alvarado scoring in emergency surgical service at SK Institute of Medical Sciences, Srinagar Kashmir, India.

CONCLUSIONS

The high scores in men and children were found to be an easy and satisfactory aid in the early diagnosis of acute appendicitis, but a high false-positive rate for acute appendicitis was found in women.

Percutaneous drainage compared with surgery for hepatic hydatid cysts

BACKGROUND

In recent years percutaneous drainage has been used successfully to treat the hepatic hydatid cysts of echinococcal disease. We performed a controlled trial to compare the safety and efficacy of percutaneous drainage with those of surgical cystectomy, the traditional treatment.

METHODS

In a prospective study, we randomly assigned 50 patients with hepatic hydatidosis to treatment with percutaneous drainage (25 patients) or cystectomy (25). Albendazole (10 mg per kilogram of body weight per day for eight weeks) was administered to the patients who underwent percutaneous drainage. Serial assessments included clinical and biochemical examinations, ultrasonography, and serologic tests of echinococcal-antibody titers.

RESULTS

The mean (+/-SD) hospital stay was 4.2+/-1.5 days in the drainage group and 12.7+/-6.5 days in the surgery group (P<0.001). Over a mean follow-up period of 17 months, the mean cyst diameter decreased from 8.0+/-3.0 to 1.4+/-3.5 cm (P<0.001) after percutaneous drainage and from 9.1+/-3.0 to 0.9+/-1.8 cm (P<0.001) after surgery. The final cyst diameter did not differ significantly between the two groups (P=0.20). The cysts disappeared in 22 patients (88 percent) in the drainage group and in 18 (72 percent) in the surgery group (P=0.29). After an initial rise, the echinococcal-antibody titers fell progressively and at the last follow-up were negative (<1:160) in 19 patients (76 percent) in the drainage group and 17 (68 percent) in the surgery group (P=0.74). There were procedure-related complications in 8 patients (32 percent) in the drainage group and 21 (84 percent) in the surgery group, 17 of whom had fever postoperatively (P<0.001).

CONCLUSIONS

Percutaneous drainage, combined with albendazole therapy, is an effective and safe alternative to surgery for the treatment of uncomplicated hydatid cysts of the liver and requires a shorter hospital stay.

Fine needle aspiration of intra-abdominal masses for cytodiagnosis

Fine needle aspiration cytology was performed in 50 consecutive patients who presented with palpable intra-abdominal mass. Ninety-four per cent (47/50) of the aspirations yielded adequate material for cytological interpretation. Histopathological confirmation was made in all the 50 cases by means of laparotomy and various surgical procedures. Of the 45 proven malignant lesions, fine needle aspirates were diagnosed as positive in 44 (97.33%) cases. There was no false positive result and no complication was encountered.

Role of intraperitoneal drains on subhepatic collection following routine uncomplicated cholecystectomy

The effect of intraperitoneal drains on the incidence and significance of subhepatic fluid collection following elective cholecystectomy was prospectively evaluated by ultrasound scanning in 200 patients. Subhepatic area was drained in 100 patients by using corrugated and vacuum drains while no drains were used in 100 patients. Subhepatic collection was detected in 12 patients (12%) in the drainage group and only 4 patients (4%) in the non-drainage group. The difference is statistically significant (p < 0.05). Two patients (2%) in the drainage group required re-exploration. Overall morbidity (30%) was higher in the drainage group than non-drainage group (18%). It is concluded that routine use of drains following elective cholecystectomy should be abandoned and they should be used only when indicated.

Biliary ascariasis: surgical aspects

Presentation and management of 204 patients with biliary ascariasis seen over a period of 5 years is reported from a highly endemic area of Kashmir. Ultrasonography is the single most useful means of diagnosis. Endoscopic retrograde cholangiopancreatography is extremely helpful. Most patients respond to conservative management and around one-fifth of all patients require surgery.

A study of colorectal adenocarcinoma

One hundred and seven patients with resected colorectal adenocarcinoma were studied between 1983 and 1987. These formed 3.3% of all cancer cases and 19.4% of gastrointestinal malignancies seen during the period. A majority of patients (68.7%) were between 41 and 60 years of age; 31.8% were below the age of 40 years. There was a male preponderance (62.6%). Left sided cancers were more common (65.4%). The predominant histologic patterns were well differentiated adenocarcinoma (72%) and mucinous carcinoma (20.6%). Mucinous carcinoma was more common on the left side. A majority of cases (95.3%) were in Duke's stages B and C. Only 2.8% of cases were confined to the mucosa.

Pre-operative and post-operative evaluation of circulating immune complexes in patients with gastric adenocarcinoma

Circulating immune complexes (CICs) in the sera of patients with histologically proven adenocarcinoma of stomach were sequentially studied. Serial CICs levels, quantitated using a sensitive method F(ab')2 anti-C3 ELISA, were measured before surgery and in a post-operative follow up. CICs could be detected in 85% of the patients pre-operatively, while ten days after surgery positivity decreased to 71%. Thirty days after surgery, the mean CIC levels decreased significantly and positivity fell to 46%. The results indicate that removal of primary tumor mass results in a sharp decline of CIC levels.

Fibrosarcoma breast. A case report

The youngest case of Fibro-sarcoma of breast is reported. The review of literature and brief note of management is described.

Primary carcinoma of gall bladder--a review of thirty six cases

The study presents the clinicopathological findings in thirty six cases of primary carcinoma of gall bladder diagnosed at SKIMS Srinagar over a period of four years (1983-86). Particular attention was paid to age, sex, presenting symptoms, presence of gall stones and site of metastasis. Majority of patients were found to be middle aged females (24 out of 36 cases). Most common presenting symptom was abdominal pain and duration of symptoms was two months or less in majority of cases. Gall stones were found in 55.5% cases. Diagnosis of primary gall bladder carcinoma was an incidental histopathological finding in 22% patients. Well differentiated adenocarcinoma was found to be the commonest type of malignancy (77.7%). 33% cases had widespread metastatic disease at the time of operation and liver was the commonest site of invasion (47.2%). Follow up records of 21 out of 36 patients available show only two patients to be alive till date with more than two year follow up and in both these cases carcinoma was an incidental histopathological diagnosis at cholecystectomy. Rest of the patients had died within 5-6 months after surgery. This reinforces the poor outcome for primary gall bladder carcinoma patients irrespective of treatment unless diagnosed and treated at a very early stage. Long term survival can be expected in incidentally found carcinoma at cholecystectomy.

Leiomyoblastoma stomach

Three patients with epithelioid leiomyomatous tumors (leiomyoblastomas) of the stomach are presented.

Fracture of the penis

We report on 4 patients with fracture of the penis who were managed conservatively with oxyphenbutazone and diazepam. All of our patients recovered completely within 6 to 8 weeks.