Goblet cell carcinoid of appendix: A rare case with literature review

INTRODUCTIONThe goblet cell carcinoid, a rare tumor of the appendix, is a separate entity from adenocarcinoma and carcinoid tumors.PRESENTATION OF CASEWe report a case of goblet cell carcinoid in our institute who presented with acute abdominal symptoms simulating acute appendicitis.DISCUSSIONGoblet cell carcinoid is a rare neoplasm with distinct histological and clinical features. The diagnosis is essentially made on histological grounds. Still the exact biological behavior of this tumor is uncertain.CONCLUSIONConsidering the difficulty of clinical suspicion of this tumor, presenting as appendicitis and incidentally found during appendectomies, we review the goblet cell carcinoid of the appendix using an illustrative case report.     

Complete Tibial Aplasia with Preaxial Polydactyly: A Kindred of Affected Individuals in three Generations

Tibial aplasia with polydactyly of hands and feet is a rare congenital anomaly, affecting both sexes with reported prevalence between 5 and 19 per 10000 live births⁽¹⁾. The molecular basis of this defect is unknown, and autosomal dominant mode of inheritance ^(2,3,4,5,6) with variable expressivity is usually postulated.The first case, more or less similar to the aforesaid phenotype, was reported in 1915 by Werner⁽⁷⁾ in a 20 yrs old woman in her 6^th months of pregnancy; and in 1918 Davidson⁽⁸⁾ reported the second case, in a two yrs old baby. This type of congenital anomaly, reported by Werner and Davidson, is commonly referred to as Werner's syndrome⁽⁷⁾, or, Werner mesomelic syndrome⁽⁷⁾, or, Eaton-McKusick syndrome⁽⁹⁾. The first familial case of Werner type was reported by Reber (1968)⁽¹⁰⁾, and second familial case was reported by Eaton and McKusick(1969)⁽⁹⁾. Latter similar cases with familial inheritance were reported by various authors^(2,4,5); which suggests the variable expressivity and autosomal dominant mode of inheritance of this sort of congenital malformations. Gene responsible for preaxial polydactyly associated with tibial dysplasia/ aplasia, has been localized to chrosome 7q36⁽¹⁾.Very few cases are reported in India, and even fewer from our region. Here we report a case of a newborn on day-1, admitted in nursery with polydactyly of both upper and lower limbs, along with unilateral limb shortening and bilateral congenital talipes-equinovarus(CTEV); and also similar limb defects in the same family members spanning three generations.     

Emergency Department Visit Data for Rapid Detection and Monitoring of Norovirus Activity,United States

Noroviruses are the leading cause of gastroenteritis in the United States, but timely measures of disease are lacking. BioSense, a national-level electronic surveillance system, assigns data on chief complaints (patient symptoms) collected during emergency department (ED) visits to 78 subsyndromes in near real-time. In a series of linear regression models, BioSense visits mapped by chief complaints of diarrhea and nausea/vomiting subsyndromes as a monthly proportion of all visits correlated strongly with reported norovirus outbreaks from 6 states during 2007–2010. Higher correlations were seen for diarrhea (R = 0.828–0.926) than for nausea/vomiting (R = 0.729–0.866) across multiple age groups. Diarrhea ED visit proportions exhibited winter seasonality attributable to norovirus; rotavirus contributed substantially for children <5 years of age. Diarrhea ED visit data estimated the onset, peak, and end of norovirus season within 4 weeks of observed dates and could be reliable, timely indicators of norovirus activity.     

An inventory of the ethnobotanicals used as anti-diabetic by a rural community of Dhemaji district of Assam, Northeast India

Ethnopharmacological relevance

Traditional remedies used for treating diabetic ailments are very important in the primary health care of the people living in rural Dhemaji district of Assam, north-east India. Novel information gathered from the current survey is important in preserving folk indigenous knowledge.

Materials and methods

Interviews were conducted amongst 80 households comprising of 240 individuals using semi-structured questionnaires. The focus was on plants used in treating diabetes mellitus.

Results

The current survey documented 21 plant species (20 families) which are reportedly used to treat diabetes mellitus by the rural people in the study area. To the best of our knowledge, Amomum linguiforme, Cinnamomum impressinervium, Colocasia esculenta, Dillenia indica, Euphorbia ligularia, Garcinia pedunculata, Solanum indicum, Sterculia villosa and Tabernaemontana divaricata are recorded for the first time based on globally published literature as medicinal plants used for treating diabetes mellitus and related symptoms.

Conclusions

The wide variety of plants that are used to treat diabetes mellitus in this area supports the traditional value that medicinal plants have in the primary health care system of the rural people of Dhemaji district of Assam. The finding of new plant uses in the current study reveals the importance of the documentation of such ethnobotanical knowledge.     

Essentials of laboratory medicine for the nephrology clinician

The purpose of this review is to compile and bring to the attention of the pediatric nephrology community various aspects of laboratory medicine pertinent to nephrology. The review addresses different aspects in laboratory medicine that should be taken into account during interpretation of a test result, such as methodological and analytical issues, statistical considerations and the biological interpretation of a test result in the context of the clinical setting. An understanding of the considerations and limitations in laboratory medicine will be helpful to the pediatric nephrologist when ordering and interpreting biochemical tests. Supported by the Sam and Helen Kaplan Research Fund in Pediatric Nephrology.     

Sustained beneficial effect of intravenous bisphosphonates after their discontinuation in children

We studied if the beneficial effects of bisphosphonates are maintained after their discontinuation, and whether adverse effects may develop. Seventeen children in whom I.V. bisphosphonates were discontinued for at least 12 months were included. Fracture rate (FR), skeletal pain, bone mineral density of total body (TB) and spine L_2–4, skeletal radiographs, bone markers and kidney functions were compared between: (a) before treatment, (b) end of treatment, and (c) last follow-up. Mean treatment duration was 22±2 months (6–43) and follow-up 26±2 months (18–44). FR (mean ± SD) decreased from 0.74±0.21/year before treatment to 0.35±0.11/year after treatment and 0.20±0.09/year at follow-up (p<0.05). Three children had bone pain before treatment, six during treatment and none at end of follow-up (p<0.05). TB Z-score increased from −1.24±0.50 at baseline to −0.37±0.44 at end of treatment and −0.39±0.37 at follow-up (p<0.05). Spinal Z-score increased from −1.65±0.57 to −0.34±0.56 and 0.19±0.49, respectively (p<0.05). Bone turnover markers showed sustained effect of bisphosphonates. No adverse effects on kidney functions or skeletal radiographs were noted. We conclude that I.V. bisphosphonates continue to exert their beneficial effect for a mean of 26±2 months after their discontinuation; therefore, once therapeutic goals are achieved, the medication can be withheld, followed by periodic re-evaluation. Presented in part at the Pediatric Academic Societies meeting, San Francisco, April-May 2006. Supported by the Sam and Helen Kaplan Research Fund in Pediatric Nephrology.     

Universal Acquired Melanosis in Siblings

Generalized pigmentation in a child may be seen in a variety of disorders which can be clinically differentiated. Accuracy of diagnosis can be increased by classifications based on both clinical and histological findings. The authors report a case of siblings in whom hyperpigmentation started at age of about 6 mo and was progressing. Histology of skin revealed shortening and blunting of rete ridges with presence of melanocytes in stratum basal layer. This is a rare type of hypermelanosis and termed as universal acquired melanosis or carbon baby syndrome. This is a rare presentation and first case report in siblings.     

Influence of musculo-tendinous stiffness of the plantar ankle flexor muscles upon maximal power output on a cycle ergometre

The importance of maximal voluntary torque (T (MVC)), maximal rate of torque development (MRTD) and musculo-tendinous stiffness of the triceps surae for maximal power output on a cycle ergometre (P (max)) was studied in 21 healthy subjects by studying the relationships between maximal cycling power related to body mass (P (max)?BM(-1)) with T (MVC), MRTD and different indices of musculo-tendinous stiffness of the ankle flexor. P (max)?BM(-1) was calculated from the data of an all-out force-velocity test on a Monark cycle ergometre. T (MVC) and MRTD were measured on a specific ankle ergometre. Musculo-tendinous stiffness was estimated by means of quick releases at 20, 40, 60 and 80% T (MVC) on the same ankle ergometre. P (max)?BM(-1) was significantly and positively correlated with MRTD related to body mass but the positive correlation between P (max)?BM(-1) and T (MVC) did not reach the significance level (0.05). P (max)?BM(-1) was significantly and positively correlated with the estimation of stiffness at 40% T (MVC) (S(0.4)), but not with stiffness at 20, 60 and 80% T (MVC). The results of the present study suggest that maximal power output during cycling is significantly correlated with the level of musculo-tendinous stiffness which corresponds to torque range around peak torque at optimal pedal rate. However, the low coefficient of determination (r (2)?=?0.203) between P (max)?BM(-1) and S (0.4)?BM(-1) suggested that P (max)?BM(-1) largely depended on other factors than the musculo-tendinous stiffness of the only plantar flexors.