Comprehensive Summary of Anastomoses between the Median and Ulnar Nerves in the Forearm and Hand

Four main presentations of median-ulnar anastomosis exist. Those manifesting in the forearm include Martin-Gruber and Marinacci, while those found in the hand are referred to as Riche-Cannieu and Berrettini. Martin-Gruber anastomosis involves branching of the median nerve proximally to ulnar nerve distally. Marinacci anastomosis, the rarest of all the presentations, is often termed reverse Martin-Gruber, with the ulnar nerve stemming proximally to meet the median nerve distally in the forearm. Riche-Cannieu anastomosis occurs as an interconnection between the recurrent branch of the median nerve and the deep branch of the ulnar nerve in the hand. Berrettini anastomosis is the most frequently encountered of the anomalies and is described as a neural connection between common digital nerves of the ulnar and median nerves. Due to altered innervation patterns, musculoskeletal disorders of the forearm and hand may present with misleading symptoms. Additionally, existence of an anastomosis may require an alteration of surgical methods or be a source of iatrogenic injury. Consequently, knowledge of these anastomoses is crucial to clinical practice. Therefore, the objective of this review is to concisely present the most relevant information regarding median and ulnar anastomoses in the forearm and hand.

Accelerated versus conventional radiation fractionation in early stage carcinoma larynx

INTRODUCTION

In our study, we have treated cases of early glottic carcinoma by two different dose-fractionation schedules in relation to overall treatment time.

MATERIALS AND METHODS

This is an analysis of 29 patients with invasive, previously untreated T1and T2squamous cell carcinoma of true vocal cord that was treated by radical radiation therapy.

DOSE AND FRACTIONATION

All patients were treated with a continuous course of radiation therapy with once-daily fractionation. All the patients were treated 5 days a week from Monday to Friday. The fractionation regime was either: (1) 62.5 Gy/25fractions/5 weeks at 2.5 Gy fractions (Regimen 1), (2) 70 Gy/35 fractions/7 weeks at 2 Gy/fraction (Regimen 2). Regimen 1 included 15/29 patients (51.72%) and Regimen 2 included 14/29 patients (48.27%). Patients were evaluated for: (1) Locoregional control, (2) acute and late radiation toxicities, (3) quality of voice.

RESULTS AND OBSERVATION

There was no significant difference in terms of locoregional control rate, acute and late radiation toxicities in both groups. Voice quality during and after radiation was comparable in both arms.

CONCLUSION

Use of high dose per fraction schedule with shorter duration of treatment results in comparable local control as well as the quality of voice to the protracted course of radiotherapy without increase in treatment-related toxicities. Shorter overall treatment time can be of great advantage in terms of time, cost, comfort, and acceptability by the patients.

Induction chemotherapy with cisplatin and ifosfamide in locally advanced inoperable squamous cell carcinoma of the head and neck: A single-institution experience

BACKGROUND

Induction chemotherapy (ICT) in patients with head and neck cancer has been studied since a long time. The addition of taxanes to the cisplatin and 5-fluorouracil (5FU) (PF) regimen results in superior antitumor activity. We did this study to see the response and toxicity of ICT with cisplatin and ifosfamide followed by concurrent chemoradiotherapy (CRT) in locally advanced, unresectable squamous cell carcinoma of head and neck (SCCHN).

AIMS

The aim of this study was to see the results of ICT using cisplatin and ifosfamide regimen in locally advanced unresectable SCCHN in terms of acute and chronic toxicity and response to treatment.

MATERIALS AND METHODS

Patients with Stage III and IV, nonmetastatic SCCHN were enrolled in the study. They were given two cycles of ICT with cisplatin and ifosfamide followed by CRT.

RESULTS

After ICT, the overall response rate (ORR) was 75.0% at the primary site and 70.0% at the nodal site. ORR for combined primary and nodal disease was observed to be 67.5%. The complete response (CR) and partial response (PR) for combined primary and nodal site were seen in 4 (10.0%) and 23 (57.5%) patients. Of 32 patients who received CRT after ICT, CR was 53.1% and PR was 31.3%. Mucositis, skin reaction, and pharyngeal and laryngeal toxicities were the most common but tolerable.

CONCLUSION

ICT with cisplatin and ifosfamide gives comparable results to the standard paclitaxel, PF regimen. We conclude that this combination regimen for ICT is not only an economical alternative of taxol-based regimen but also well tolerated by the patients.

Comparison of two different radiation fractionation schedules with concurrent chemotherapy in head and neck malignancy

INTRODUCTION

The worldwide incidence of head and neck malignancy exceeds half a million cases annually. In radiotherapy (RT), conventional fractionation comprises giving five fractions per week from Monday to Friday. Accelerated RT includes administration of six fractions per week is being advocated. It gives better locoregional control and the median overall treatment time is 39 days as compared to 46 days in conventional group. Our study involved comparison of conventional versus accelerated RT with concurrent chemotherapy, in evaluation of local control and toxicity in the two arms.

MATERIALS AND METHODS

Sixty patients of locally advanced squamous cell carcinoma head and neck region were studied. All the patients received cisplatin (30 mg/m2) weekly during the therapy. The patients received RT dose of 70 Gray (Gy) in 35 fractions (#). The patients were randomly assorted into two groups: Group 1 - Study group (n = 30) - Six fractions RT per week (Monday-Saturday). Group 2 - Control group (n = 30) - Five fractions RT per week (Monday-Friday). During and after the treatment, locoregional control, acute and late radiation toxicity were assessed. Results and Observation: There was no significant difference between the two schedules regarding locoregional control rate. The Grade 3 or higher acute toxicities were significantly higher in the accelerated arm although there was no significant difference in late toxicities between the two arms.

CONCLUSION

Accelerated fractionation regimen was not more efficacious than conventional fractionation in the treatment of previously untreated head and neck carcinoma.

A new, simple and precise method for measuring cyclotron proton beam energies using the activity vs. depth profile of zinc-65 in a thick target of stacked copper foils

The proton beam energy of an isochronous 18MeV cyclotron was determined using a novel version of the stacked copper-foils technique. This simple method used stacked foils of natural copper forming 'thick' targets to produce Zn radioisotopes by the well-documented (p,x) monitor-reactions. Primary beam energy was calculated using the (65)Zn activity vs. depth profile in the target, with the results obtained using (62)Zn and (63)Zn (as comparators) in close agreement. Results from separate measurements using foil thicknesses of 100, 75, 50 or 25µm to form the stacks also concurred closely. Energy was determined by iterative least-squares comparison of the normalized measured activity profile in a target-stack with the equivalent calculated normalized profile, using 'energy' as the regression variable. The technique exploits the uniqueness of the shape of the activity vs. depth profile of the monitor isotope in the target stack for a specified incident energy. The energy using (65)Zn activity profiles and 50-μm foils alone was 18.03±0.02 [SD] MeV (95%CI=17.98-18.08), and 18.06±0.12MeV (95%CI=18.02-18.10; NS) when combining results from all isotopes and foil thicknesses. When the beam energy was re-measured using (65)Zn and 50-μm foils only, following a major upgrade of the ion sources and nonmagnetic beam controls the results were 18.11±0.05MeV (95%CI=18.00-18.23; NS compared with 'before'). Since measurement of only one Zn monitor isotope is required to determine the normalized activity profile this indirect yet precise technique does not require a direct beam-current measurement or a gamma-spectroscopy efficiency calibrated with standard sources, though a characteristic photopeak must be identified. It has some advantages over published methods using the ratio of cross sections of monitor reactions, including the ability to determine energies across a broader range and without need for customized beam degraders.

Synthesis and characterization of π-conjugated copolymers with thieno-imidazole units in the main chain: application for bulk heterojunction polymer solar cells

In this paper the three new narrow bandgap D–A conjugated copolymers P1, P2 and P3 based on different weak donor fused thiophene-imidazole containing derivatives and the same benzothiadiazole acceptor unit were synthesized by Stille cross-coupling polymerization and characterized by 1H NMR, elemental analysis, GPC, TGA, DSC. These copolymers exhibit intensive absorbance in the range 350–900 nm and the optical bandgap lies in the range of 1.50–1.61 eV, which corresponds to the maximum photon flux of the solar spectrum. The electrochemical bandgap derived from cyclic voltammetry varies within the limits 1.47–1.65 eV and is approximately very close to the optical bandgap. The highest occupied molecular orbital (HOMO) energy level of all copolymers is deep lying (−5.24 eV and −5.37 eV and −5.25 eV for P1, P2 and P2, respectively) which shows that copolymers have good stability in the air and assured a higher open circuit voltage (Voc) for polymer BHJ solar cells. These copolymers were used as donors along with PC71BM and the BHJ polymer solar cells based on P1:PC71BM, P2:PC71BM and P3:PC71BM processed from chloroform (CF) solvent with 3 v% DIO as an additive showed an overall PCE of 4.55%, 6.76% and 5.16%, respectively.

Breast cancer management: past, present and evolving

Breast cancer is known from ancient time,and the treatment strategy evolved as our understanding of the disease changed with time. In 460 BC Hippocrates described breast cancer as a humoral disease and presently after a lot of studies breast cancer is considered as a local disease with systemic roots. For most of the twentieth century Halsted radical mastectomy was the "established and standardized operation for cancer of the breast in all stages, early or late". New information about tumor biology and its behavior suggested that less radical surgery might be just as effective as the more extensive one. Eventually, with the use of adjuvant therapy likeradiation and systemic therapy, the extent of surgical resection in the breast and axilla got reduced further and led to an era of breast conservation. The radiation treatment of breast cancer has evolved from 2D to 3D Conformal and to accelarated partial breast irradiation, aiming to reduce normal tissue toxicity and overall treatment time. Systemic therapy in the form of hormone therapy, chemotherapy and biological agents is now a well-established modality in treatment of breast cancer. The current perspective of breast cancer management is based on the rapidly evolving and increasingly integrated study on the genetic, molecular , biochemical and cellular basis of disease. The challenge for the future is to take advantage of this knowledge for the prediction of therapeutic outcome and develop therapies and rapidly apply more novel biologic therapeutics.

Characterisation of micro-sized and nano-sized tungsten oxide-epoxy composites for radiation shielding of diagnostic X-rays

Characteristics of X-ray transmissions were investigated for epoxy composites filled with 2-10 vol% WO3 loadings using synchrotron X-ray absorption spectroscopy (XAS) at 10-40 keV. The results obtained were used to determine the equivalent X-ray energies for the operating X-ray tube voltages of mammography and radiology machines. The results confirmed the superior attenuation ability of nano-sized WO3-epoxy composites in the energy range of 10-25 keV when compared to their micro-sized counterparts. However, at higher synchrotron radiation energies (i.e., 30-40 keV), the X-ray transmission characteristics were similar with no apparent size effect for both nano-sized and micro-sized WO3-epoxy composites. The equivalent X-ray energies for the operating X-ray tube voltages of the mammography unit (25-49 kV) were in the range of 15-25 keV. Similarly, for a radiology unit operating at 40-60 kV, the equivalent energy range was 25-40 keV, and for operating voltages greater than 60 kV (i.e., 70-100 kV), the equivalent energy was in excess of 40 keV. The mechanical properties of epoxy composites increased initially with an increase in the filler loading but a further increase in the WO3 loading resulted in deterioration of flexural strength, modulus and hardness.

First Report of Fusarium Wilt in the Broomrape Parasite Growing on Brassica spp. in India

Broomrape (Orobanche aegyptiaca Pers.), an important obligate root parasitic weed in India, has a wide host range including several members of the Solanaceae, Leguminaceae, and Brassicaceae families, among others. Orobanche plants produce thousands of tiny seeds (250 × 300 μm), which can remain viable in the soil for as long as 13 years (3). Rapeseed-mustard (Brassica spp.) is one of the major oilseed crops in India, cultivated on 5.77 million ha with 6.59 million t produced during 2009-2010. Broomrape has been observed in India as a major angiospermic parasitic plant on rapeseed-mustard, tobacco, tomato, and potato. During a field visit to an experimental farm at the Directorate of Rapeseed-Mustard Research, Bharatpur (27°12'N, 77°27'E) in the winter of 2009-2010, symptoms of wilt disease were observed on Orobanche plants, 32.6% of which had wilted completely following root infection. Initial symptoms appeared as a browning of the flowering stalk with wilting. Direct observation of below ground plant parasite tissues revealed a necrosis starting at the radical and advancing to the collar region that shredded later on. Tissue fragments, excised from the internal portions of the diseased tissue, were surface sterilized with 0.1% HgCl₂, plated on 2% potato dextrose agar (PDA) adjusted to pH 7.0, and incubated at 22 ± 2°C for 7 days. The colonies that grew on PDA plates produced a bright purple color. Single-spore culturing of the fungus yielded Fusarium solani on the basis of morphological characteristics (2). The Fungal Identification Service, Mycology and Plant Pathology Group, Agharkar Research Institute, Pune, India (Accession No. 2156) confirmed the identity. The pathogenicity of the fungus was tested by inoculating five healthy Orobanche plants that were parasitizing Brassica spp. at the radicle region with 10-ml spore suspensions (2 × 10⁵ conidia/ml of sterile distilled water) derived from 7-day-old cultures of the fungus. Control plants were treated with sterile distilled water. F. solani-inoculated radicles developed typical wilting symptoms within 2 weeks of treatment, while the control as well as the Brassica spp. plants remained healthy. F. solani was reisolated from inoculated wilted plants, thus fulfilling Koch's postulates. To our knowledge, on the basis of the literature, this is the first report from India showing that F. solani infects O. aegyptica on Brassica spp. There are reports of fungi (50 different species) infecting different hosts in Southern Italy, including F. oxysporum and F. solani, which have been found to be pathogenic to O. ramose. The most pathogenic Fusarium isolates significantly increased the number of dead spikes of broomrape (1). Control of Orobanche spp. poses a challenge because of the lack of effective and economic control measures. F. solani thus offers a potentially promising management strategy that should be explored in the future for the control of O. aegyptiaca. References: (1) A. Boari et al. Biol. Control 30:212, 2004. (2) P. E. Nelson et al. Fusarium Species: An Illustrated Manual for Identification. 1st ed. Pennsylvania State University Press, University Park, 1983. (3) M.C. Press et al. Parasitic Plants. Chapman and Hall, London, UK, 1995.

Suppression of infectious TMV genomes expressed in young transgenic tobacco plants

Full-length cDNAs of the wild-type (wt) Tobacco mosaic virus (TMV) and of the coat protein gene-deleted (DeltaCP) derivative of wt-TMV, under control of the 35S promoter and downstream ribozyme sequence to produce accurate viral transcripts, were transformed to tobacco plants to analyze plant-virus interactions through different stages of plant development. Surprisingly, young wt-TMV transgenics accumulated only very low levels of viral RNA, remained free of symptoms, and were moderately resistant against exogenous inoculations. This early resistance caused significant stress to the plants, as indicated by reduced growth. Approximately 7 to 8 weeks after germination, the resistance was broken and plants developed typical wt-TMV symptoms, with high accumulation of the viral RNAs and proteins. The DeltaCP-TMV plants likewise were initially resistant to the endogenous inoculum and were stunted, although to a lesser extent than the wt-TMV plants. The resistance was broken at the same time as in the wt-TMV plants, but the mutant replicated to much lower levels and produced much milder symptoms than the wt virus. TMV-specific small interfering RNAs as well as increased transgene methylation were detected in the plants only after the resistance break, indicating that the resistance in the young plants was not due to RNA silencing.

Dosimetry of a low-kV intra-operative X-ray source using basic analytical beam models

The low energy (30-50 kVp) beams from an intra-operative X-ray source are modelled using a basic analytical model considering just primary beam attenuation and absorption. Spatial dosimetry at such low energies is difficult due to the rapid changes in dose-rate from the radiation source. The purpose of the model was to determine the variation with distance in water of coefficients required for beam dosimetry and to validate beam measurements performed in water of high-gradient dose distributions. The model predicts a change in mean mass-energy absorption coefficient of up to 3 % over the range of clinically-relevant distances in water. Distance-dose distributions (variation in dose with distance in water) for the X-ray source were calculated with the model and found to be in agreement with measurement (at clinically-relevant distances), to within a spatial distance comparable to the dimensions and positional accuracy of the ionization chamber used, and comparable to the expected dosimetric anisotropy of the radiation source. Measured and calculated distance-doses begin to diverge at relatively large distances from the radiation source, which is where dose-rates are so low that detector signal levels are comparable with noise.

Structural basis for the activity of pp60(c-src) protein tyrosine kinase inhibitors

Conformational searches on three closely related pp60(c-src) protein tyrosine kinase inhibitors of varying potencies were performed to determine a structural basis for their activity. The first was a linear peptide (PDNEYAFFQf), the second its 10-membered cyclic analogue, and the third a cyclic analogue with a para carboxyphenylalanine in place of one the F residues. A common backbone conformation with an antiparallel beta-sheet-like geometry capped by similar beta-turns was found for all three peptides, which may be a binding conformation and gives a candidate pharmacophore for further testing. The interaction between some polar side chains and between some of the aromatic rings may be important for maintaining the correct conformation. The differences in potencies of these inhibitors may be attributed to certain thermodynamic and chemical reasons.

Dual ectopic thyroid: a report of two cases

Ectopic thyroid is an uncommon embryological aberration characterized by the presence of thyroid tissue at a site other than in its usual pretracheal region. Usually it occurs along the path of descent of the developing thyroid primodium from the foramen caecum, commonest being lingual followed by sublingual and in the anterior midline of neck at, or below, the level of the hyoid bone. It is unusual for lingual thyroid to present simultaneously with another ectopic thyroid; reported here are two such cases.

Changes in serum copper levels in patients with malignant diseases undergoing radiotherapy

Present study repots changes in serum copper levels (SCL) in various neoplastic diseases undergoing radiotherapy. We estimated SCLs in 140 individuals comprising of 90 previously untreated patients with various malignancies and 50 healthy controls. Patients received radiation in doses of 40-70 Gy in 4-7 weeks. SCLs were again estimated in patients following irradiation. The mean SCL was significantly higher (P<0.001) in cancer patients as compared to healthy controls. It declined significantly (P<0.001) following irradiation. However, it remained significantly higher as compared to healthy controls (P<0.01). Highest fall in SCL was seen in complete clinical responders and least in non-responders to radiation treatment. Serial estimation of SCLs may be useful in the treatment monitoring of the neoplasms undergoing radiation treatment.

Granulocytic sarcoma in patients with chronic myeloid leukaemia

Granulocytic sarcoma is an unusual variant of myeloid malignancy most commonly encountered in the course of chronic or acute myeloid leukaemia. Of 60 patients of chronic myeloid leukaemia studied over 21 months, we encountered 6 (10%) cases of granulocytic sarcoma. Four of these had granulocytic sarcoma on their first presentation. All those who were receiving hydroxyurea did not fare well but one who was put on DAT (daunorubicin, cyftosine arabinocide, 6 thioguanine)regimen went into remission with complete disappearance of lesions.

Incidence & immunological profile of multiple myeloma patients

Multiple myeloma was diagnosed in 84 residents of Jammu & Kashmir between 1984-1988. The data were analyzed for variations of demographic factors, ethnicity and location of residence (urban/rural). The average annual incidence per 100,000 residents was 1.28. The rates for males and females were 2.02 and 0.71 per 10(5) persons/year respectively. The average incidence rate for Muslims was significantly higher than that for Hindus. Urban residents had significantly higher rates than rural population. Highest incidence rate (14.39) was in the age group of 65 yr and above.

Haemostatic clips and clamps used in surgical neurology with special reference to non ferro magnetic Phynox spring clips by Aesculap

This paper concerns the historical developments and technical properties of haemostatic devices used in neurosurgery with the exception of coagulation. Therefore there are described haemostatic clips designed for the scalp, clips used on arteries and veins, a clamp for the reduction of the carotid diameter in the neck, and a clamp for closing the venous dural sinuses. Special reference will be made regarding non ferro magnetic Phynox clips by Aesculap.

A semi automated procedure for the measurement of 3-methoxy-4 hydroxy mandelic acid

A semi automated procedure for the determination of 3-methoxy-4-hydroxy-mandelic acid (HMMA) in urine has been evaluated. This procedure offers advantages in simplicity, speed and precision over existing manual techniques which utilize spectrophotometric fluorimetric and gas liquid chromatographic methods. The urine is extracted with ethyl acetate from a highly acidic sample, purified by extraction into acetate buffer and the diazo colour reaction developed. All stages of the procedure are carried out using the Brown and semi-automatic extractor equipped with partition tube. The within and between assay coefficient of variation obtained on pooled freeze-dried urine samples was 6.7% and 7.7% respectively.

Laboratory assessment of thyroid disorders - which test should be used?

There are a variety of laboratory investigations which have been used in the assessment of thyroid function and it is obvious that not all of these tests can be used on each occasion. Which, therefore, provides the best diagnostic index? Each test is designed to assess a particular aspect of the thyroid gland and it is often not possible to select a single test as an ideal and exclude the others. The data presented in this paper indicate the advantages of using a combination of various procedures as a screening profile to cover all thyroid abnormalities. The results of several thyroid tests accumulated over the past five years are critically examined to assess their diagnostic value separately and in selected groups. Introduction.

A comparative study of five laboratory tests for foeto-placental dysfunction in late pregnancy

Five foeto-placental function tests were studied in parallel in normal and abnormal late pregnancies with a view to establishing which test or tests is most satisfactorily able to identify the mother whose foetus is in danger.A critical examination of the levels in blood serum of two enzymes, placental phosphatase isoenzyme and cystine aminopeptidase, the polypeptide hormone placental lactogen (chorionic somatomammotrophin), and the oestrogen oestriol-17beta is described.A correlation was attempted beween clinical data and the results of the above laboratory analyses and also with the daily urine oestrogen output. The plasma and urine oestriol levels proved generally to be the more useful warning tests in late pregnancy, whilst the plasma cystine aminopeptidase was the least sensitive indicator of foeto-placental dysfunction.