Biochemistry of carpal tunnel syndrome

Although carpal tunnel syndrome (CTS) occurs due to intrinsic or extrinsic causes, the idiopathic group outnumbers the rest by far. Compression of the median nerve may be due to mechanical or ischemic causation. The cause of idiopathic CTS is thought to be intermittent compression of the median nerve in predisposed people, especially working females, producing ischemia of the nerve. Reperfusion injury may occur during periods of recovery. Intermittent perfusion of the cellular tissue following ischemia releases free oxygen radicals. With continued oxidative stress, the normal antioxidant system is overwhelmed and cellular injury ensues, affecting both nerve and synovial cells. This is confirmed by changes seen locally in nerve and synovial tissue both serologically and histologically. These changes are reverted or checked by the use of antioxidants in vitro. Simulated compression of the nerve in laboratory animals also confirms these findings, further corroborating the pathophysiology and suggesting means of preventing idiopathic CTS.     

Multifocal scrofuloderma with disseminated tuberculosis in a severely malnourished child

Tuberculosis and malnutrition continue to be significant health problems in developing countries. Moderate to severe malnutrition can cause immunosuppression and predispose children to various infections. We report disseminated tuberculosis in a severely malnourished Indian child who presented primarily with cutaneous involvement.     

Management of upper gastrointestinal obstruction in advanced ovarian cancer with intraluminal stents

BACKGROUND: The course of many patients with end-stage gynecologic malignancy will be complicated by malignant bowel obstruction. Intraluminal stents are a novel alternative to standard surgical intervention which can involve considerable patient risk. CASES: Two cases are presented of patients with upper gastrointestinal obstruction due to recurrent ovarian cancer. In the first case, a stent was utilised to provide relief from nocturnal vomiting secondary to duodenal obstruction. In the second case, stent insertion for subtotal gastric outlet obstruction provided initial relief from vomiting. However, recurrence of symptoms occurred due to stent occlusion from tumour ingrowth. CONCLUSIONS: In patients with upper gastrointestinal obstruction due to recurrent gynecologic malignancy, intraluminal stents can provide useful palliation.     

Update on zona pellucida glycoproteins based contraceptive vaccine

Zona pellucida (ZP) glycoproteins, due to their critical role in mammalian fertilization, have been proposed as candidate immunogens for development of a contraceptive vaccine. Active immunization studies in a variety of animal species, employing either native or recombinant zona proteins, has established their contraceptive potential. Hence, ZP glycoprotein-based contraceptive vaccines have a very good potential for controlling wild life population. To make it a realistic proposition, additional research inputs are required to develop new potent adjuvants and novel practical strategies for vaccine delivery. The observed ovarian dysfunction, often associated with immunization by ZP glycoproteins, is one of the major obstacles for their application in the control of human population. Ongoing studies to delineate epitopes of ZP glycoproteins that will generate an immune response capable of inhibiting fertility without any untoward effects on ovarian functions will help in determining their feasibility for human use.     

Should laparoscopic cholecystectomy be performed in patients with thick-walled gallbladder?

Background/Purpose Laparoscopic cholecystectomy is the procedure of choice for patients with symptomatic cholelithiasis. This procedure is contraindicated in patients with gall-bladder cancer (GBC) because of fear of dissemination of the disease. One of the findings raising the suspicion of GBC is a thick-walled gallbladder (TWGB).Methods A prospective study of patients with TWGB was done over a period of 10 months at a tertiary-level referral hospital in northern India. We studied the clinical profiles, investigations (ultrasound [US] and computerized tomography [CT]) and management plans in these patients.Results A total of 60 patients were included in the study. After cholecystectomy, histopathology of gallbladders showed GBC in 2 (3.3%) patients. The remaining 58 patients had chronic cholecystitis, of whom 28 (48%) had xanthogranulomatous variant chronic cholecystitis. Cholecystectomy by the laparoscopic method was attempted in 46 (77%) patients and by open technique in the remaining 14 (23%) patients. Laparoscopic cholecystectomy was successful in 40 of the 46 (87%) patients in whom it was attempted. Obscure anatomy, suspicion of GBC, and bile duct injury were the causes of conversion, in the remaining 13% (6/46). None of the 11 patients who had a CT examination because of clinical or US suspicion of malignancy turned out to have GBC at final histology. Both the cases of GBC in this study were incidental findings on final histopathology.Conclusions Laparoscopic cholecystectomy can be successfully performed in the majority of patients with diffuse TWGB, with appropriate selection. There is, however, an increased chance of conversion to open cholecystectomy in these patients. If there is an intraoperative suspicion of GBC, early conversion to open cholecystectmy and frozen section/imprint cytology will help to decide the further treatment during surgery.     

Reversal of pancytopenia following kidney transplantation in a patient of primary hyperoxaluria with bone marrow involvement

Combined liver and kidney transplantation is the ideal treatment for patients with end-stage renal failure secondary to primary hyperoxaluria and systemic oxalosis, with a functioning liver providing replacement of the deficient enzyme and a functioning kidney providing the route of excretion for the oxalate crystals. Pancytopenia from bone marrow infiltration of oxalate crystals is a rare complication of primary hyperoxaluria, and its reversal following transplant has not been described. We report the first case of pancytopenia from marrow infiltration by oxalate crystals reversing following a successful kidney transplant alone. Although kidney alone transplants do not provide the best chance of survival or quality of life as compared to a combined kidney and liver transplant, a well functioning kidney transplant is able to take care of the systemic oxalate load and ameliorate, at least for a period of time, the systemic complications of oxalosis.