Endoscopic cartilage versus temporalis fascia grafting for anterior quadrant tympanic perforations — A prospective study in a tertiary care hospital

Objective

Management of anterior perforations of tympanic membrane is a surgical challenge. The objective of this study is to analyse and compare the results of composite cartilage perichondrium island (CCPI) graft and temporalis fascia graft by endoscopic technique in anterior quadrant perforations.

Role of Immunohistochemistry in Acute Leukemias with Myelonecrosis

Myelonecrosisis a rare antemortem finding most commonly seen in haematopoeitic neoplasms, especially in acute leukemia. When myelonecrosis occurs at the time of presentation, it imposes certain diagnostic issues in sub categorization of leukemias which is necessary for therapeutic as well as prognostic purposes. Flow cytometry, though is a powerful modality, has its own limitations especially when the cells are not fresh and viable; and when the specimen is not of adequate cellularity which is usual in cases of myelonecrosis. In such situations, immunocytochemistry (ICC) or immunohistochemistry (IHC) may play a major role in lineage specification in leukemias as the necrosed marrow with the ghost cells can still retain the antigenicity for certain immunomarkers. Four such interesting cases of common B acute lymphoblastic leukemia (ALL) where IHC was used for diagnosis were included. ICC and IHC done on the necrosed marrow contributed to the diagnosis of ALL in all the four cases and contributed to subsequent management. ICC and IHC if contributory can play a major role in identifying the primary cause of myelonecrosis as the ghost cells can retain the antigenicity despite being morphologically non-viable.     

Modern methods of treating hip fractures

Contemporary surgical and anaesthetic methods should enable almost all hip fractures to be treated surgically. Many of the implants used for the internal fixation of hip fractures or the arthroplasties for replacement of the hip joint have been in use for over 50 years. Marked improvements in surgical technique have led to lower fracture and surgical complications. Undisplaced intracapsular fractures and displaced fractures in the younger patient are best treated by internal fixation. For the elderly with a displaced intracapsular fracture then hemiarthroplasty is generally used. There is insufficient evidence that total hip replacements or bipolar hemiarthroplasties have any advantage over the more traditional designs. For trochanteric fractures the sliding hip screw remains the implant of choice, although the newer intramedullary nails are valuable for more specific fracture types and their use will become more common. Following surgery almost all patients should be allowed to mobilize without any restrictions on weight bearing or hip movements.     

Chronic arsenic poisoning in the rat: treatment with combined administration of succimers and an antioxidant

The influence of the coadministration of vitamin C or vitamin E on the efficacy of two thiol chelators, meso-2,3-dimercaptosuccinic acid (DMSA) or monoisoamyl DMSA, in counteracting chronic arsenic toxicity was investigated in rats. Vitamin C and vitamin E were only mildly effective when given alone or in combination with the above chelators in mobilizing arsenic from the target tissues. However, combined administration of vitamin C plus DMSA and vitamin E plus MiADMSA led to a more pronounced depletion of brain arsenic. The supplementation of vitamins was significantly effective in restoring inhibition of blood delta-aminolevulinic acid dehydratase (ALAD) oxidative stress in liver, kidneys, and brain as reflected by reduced levels of thiobarbituric acid reactive substance and oxidized and reduced glutathione levels. The results thus lead us to suggest that coadministration of vitamin E or vitamin C may be useful in the restoration of altered biochemical variables (particularly the effects on heme biosynthesis and oxidative injury) although it has only a limited role in depleting arsenic burden.     

Comparative effects of perindopril with enalapril in rats with dilated cardiomyopathy

Angiotensin-converting enzyme inhibitors have been shown to reduce morbidity and mortality in patients with heart failure. The angiotensin type-1 blocking and cardioprotective properties of perindopril and enalapril were studied in a rat model of dilated cardiomyopathy after autoimmune myocarditis. Enalapril at 20 mg/kg showed the same angiotensin type-1 blocking action as perindopril at 2 mg/kg in rats with heart failure. Twenty-eight days after immunization, surviving Lewis rats (90/120 = 75%) were divided into six groups and administered perindopril at 0.02, 0.2 and 2 mg/kg per day (Groups P0.02, P0.2 and P2), enalapril at 2 and 20 mg/kg per day (Groups E2 and E20) or vehicle alone (Group V, all groups n = 15). After oral administration for 1 month, four of 15 (27%) rats in Group V, and two (13%) in Groups P0.02 and E2 died. None of the animals in Groups P0.2, P2 and E20, or normal rats (Group N) died. Although both angiotensin-converting enzyme inhibitors improved ventricular function in a dose-dependent manner, the left ventricular end-diastolic pressure and area of myocardial fibrosis were lower, and +/- dP/dt was higher in Group P2 (4.9 +/- 0.6 mmHg, 7.5 +/- 1.4% and +2651 +/- 254/-2622 +/- 189 mmHg/s, respectively) than in Group V (16.7 +/- 1.3, 36 +/- 2.6 and +2659 +/- 176/-2516 +/- 205, respectively) and Group E20 (7.5 +/- 2.5, 15.6 +/- 2.0 and +2018 +/- 110/-2097 +/- 102, respectively). Although the expression levels of transforming growth factor-beta1 and collagen-III mRNA in Group V (36.3 +/- 5.7 and 157.6 +/- 12.7%) were significantly higher than those in Group N (19.6 +/- 3.0 and 65.2 +/- 1.5%, both p < 0.01), they were reduced in Group P2 (21.4 +/- 5.9 and 75.2 +/- 9.3%, both p < 0.01). These results suggest that although enalapril can block increases in blood pressure caused by circulating angiotensin type-1, perindopril at 2 mg/kg may confer greater protection than enalapril at 20 mg/kg against injury from the renin-angiotensin system in heart failure.     

Investigations on analgesic, anti-inflammatory and ulcerogenic potential of meloxicam solid dispersion prepared with skimmed milk

Meloxicam, a non-steroidal anti-inflammatory drug is used in the treatment of rheumatoid arthritis and osteoarthritis. It is practically insoluble in water leading to poor dissolution, variations in bioavailability and gastric irritation on oral administration. In order to modulate its gastric side effect and to increase aqueous solubility, physical mixture and solid dispersion of the drug were prepared with skimmed milk. The analgesic, anti-inflammatory and ulcerogenic effects were assessed for physical mixture and solid dispersion in comparison to pure meloxicam. The results indicate that solid dispersion possess better analgesic and anti-inflammatory properties with less ulcerogenic potential as compared to pure meloxicam.     

Preparation and evaluation of solid dispersion of meloxicam with skimmed milk

Meloxicam (MLX), a non-steroidal anti-inflammatory drug (NSAID) and a selective COX-2 inhibitor is a water insoluble drug (about 12 microg/ml). In order to improve the aqueous solubility of the drug and its dissolution rate, physical mixture and solid dispersions with skimmed milk were prepared and investigated. Enhancement of aqueous solubility of MLX was observed with solid dispersion of the drug with skimmed milk due to amino acids and surface active agents content in the milk, which can be used for the treatment of gastric disturbance. Rotary vacuum evaporation technique was used to prepare solid dispersion. Results showed that the solubility of solid dispersion of the drug was almost three times greater than the pure drug. Similarly, the solid dispersion of the drug indicated a significant improvement in the dissolution of the drug as compared to the physical mixture and the pure drug. Differential scanning calorimetry, X-ray diffraction and scanning electron microscopic analysis revealed the formation of solid dispersion of the drug with skimmed milk.