Antileukemic effect of Kalpaamruthaa,a modified Siddha preparation,in BCR–ABL + cell line induced chronic myeloid leukemic mouse model

Kalpaamruthaa is a modified Siddha (herbal) drug prepared in our laboratory. It has been proven to have therapeutic effect against arthritis, mammary cancer, and liver cancer. To evaluate the antileukemic effect of the drug, Kalpaamruthaa (KA), in chronic myeloid leukemia-induced mice, leukemia was induced in BALB/c mice by tail vein injection of BCR–ABL ⁺12B1 murine leukemia cell line. Leukemia-induced animals were treated with KA at a dosage of 200 mg/kg b.wt. dissolved in 0.5 ml of olive oil for 14 days, daily by gastric intubation. Imatinib mesylate was used as the reference drug. The drug KA significantly decreased the levels of marker enzymes and lipid peroxides and increased the levels of antioxidant enzymes. The bone marrow and histopathological abnormalities were also found to be normalized after treatment with the drug, KA. No significant adverse effect was observed in sole drug-treated group of rats. The present study suggests that KA, by means of its antioxidant and free radical quenching effect, has definite anti cancer effect in leukemic mice.     

Ifosfamide Induced Renal Rickets

Ifosfamide is commonly used as a chemotherapeutic agent in children. The authors report a 4-y-old boy who developed proximal renal tubulopathy with florid rickets a year after completion of ifosfamide therapy for Ewing's sarcoma. After initiation of treatment, there was complete healing of rickets and he did not need supplements beyond 18 mo. Growth monitoring and musculoskeletal system examination is important in all children who have received ifosfamide therapy. Routine monitoring for nephrotoxicity during and after ifosfamide therapy helps in early identification and intervention.     

Ameliorating effect of Semecarpus anacardium Linn. nut milk extract on altered glucose metabolism in high fat diet STZ induced type 2 diabetic rats

ObjectiveTo explore the protective effect of the drug Semecarpus anacardium (S. anacardium)on altered glucose metabolism in diabetic rats.MethodsType 2 diabetes mellitus was induced by feeding rats with high fat diet followed by single intraperitoneal injection of streptozotocin (STZ) (35 mg/kg b.w.). Seven days after STZ induction, diabetic rats received nut milk extract of S. anacardium Linn. nut milk extract orally at a dosage of 200 mg/kg daily for 4 weeks. The effect of nut milk extract of S. anacardium on blood glucose, plasma insulin, glucose metabolising enzymes and GSK were studied.ResultsTreatment with SA extract showed a significant reduction in blood glucose levels and increase in plasma insulin levels and also increase in HOMA – β and decrease in HOMA -IR. The drug significantly increased the activity of glycolytic enzymes and glucose-6-phosphate dehydrogenase activity and increased the glycogen content in liver of diabetic rats while reducing the activities of gluconeogenic enzymes. The drug also effectively ameliorated the alterations in GSK-3 mRNA expression.ConclusionsOverall, the present study demonstrates the possible mechanism of glucose regulation of S. anacardium suggestive of its therapeutic potential for the management of diabetes mellitus.     

Laparoscopic management of hepatic hydatid disease.

BACKGROUND: Hydatid disease is an endemic condition in several parts of the world. Owing to ease of travel, even surgeons in nonendemic areas encounter the disease and should be aware of its optimum treatment. A safe, new method of laparoscopic management of hepatic hydatid disease is described along with a review of the relevant literature. METHODS: Sixty-six cases of hepatic hydatid disease were operated on laparoscopically using the Palanivelu Hydatid System. The special trocar-cannula system used and the technique of operation are described. RESULTS: The majority of the patients presented with pain. Most of the patients had only a single cyst. The right lobe of the liver was most commonly involved. Cysts were bilateral in 4 patients. In 83.3%, simply evacuation of the hydatid cyst by the Palanivelu Hydatid System was done. In 13.7%, this was followed by a left lobectomy, as the cysts were large occupying almost the entire left lobe of the liver. The remnant cavity was dealt with by omentoplasty. The average follow-up period is 5.8 years. There have been no recurrences to date. CONCLUSION: We recommend Palanivelu Hydatid System for management of hepatic hydatid disease. We have found its efficacy to be optimum for preventing spillage, evacuating hydatid cyst contents, performing transcystic fenestration, and for dealing with cyst-biliary communications.     

Laparoscopic surgery for an unusual case of dysphagia: lower oesophageal leiomyoma co-existing with achalasia cardia

Benign tumours of the oesophagus are rare, with an incidence of ten percent. Leiomyomas are the most common benign tumours and are located frequently in the middle and lower third of the oesophagus. Coexisting achalasia cardia is very rare. We present a 63-year-old man with coexisting leiomyoma and achalasia presenting with dysphagia for 25 days. Endoscopy and manometry revealed achalasia cardia at the lower third. Barium swallow showed a tumour proximal to the narrowing. Laparoscopic transhiatal enucleation and cardiomyotomy with Toupet fundoplication was successfully performed. Several conditions have been described to coexist with achalasia cardia, such as cancer, paraoesophageal hernia and hiatal hernia. Based on our experience, we feel that lower oesophageal tumours are best approached by a laparoscopic transhiatal route and the presence of achalasia in this case did not change the approach as cardiomyotomy with fundoplication could also be simultaneously performed. Minimally-invasive surgery for benign oesophageal tumours reduces the morbidity of thoracotomy or laparotomy.     

An Innovative Technique for Colorectal Specimen Retrieval: A New Era of “Natural Orifice Specimen Extraction” (N.O.S.E)

Purpose  The common incisions for transabdominal specimen retrieval after laparoscopic colorectal surgery are lower quadrant, midline, or transverse suprapubic incision. This study was designed to evaluate a novel method of specimen extraction after totally laparoscopic proctocolectomies. Methods  We retrospectively studied seven women patients from 2004 to 2007. The indication for surgery was familial polyposis coexisting with adenocarcinoma of the upper rectum. A totally laparoscopic proctocolectomy with ileal pouch-anal anastomosis was successfully performed for all cases. The entire specimen was extracted via a transvaginal route. Results  The mean age of the patients was 49.5 years, and mean body mass index was 25.3 kg/m². The mean operating time was 222.5 minutes, and average blood loss was 172 ml. The average hospital stay was 25.5 days. Postoperative complications included ileus (n = 1), pouchitis (n = 1), and deep vein thrombosis (n = 1). The vaginal wound had healed completely by the first follow-up. There was no mortality. Conclusions  Our technique of transvaginal retrieval effectively prevents wound-related complications by completely eliminating minilaparotomies for specimen retrieval. It could be called “Natural Orifice Specimen Extraction,” or N.O.S.E. We stress the need for innovations in specimen extraction, for which importance is not given by surgeons. Presented at the meeting of the Association of Surgeons of India, Orissa, India, December 25 to 30, 2007.     

Laparoscopic Transhiatal Esophagectomy for ‘Sigmoid’ Megaesophagus Following Failed Cardiomyotomy: Experience of 11 Patients

Introduction Laparoscopic myotomy is a widely used procedure and is now considered to be the treatment of choice for achalasia. Esophagectomy for achalasia is usually performed only for megaesophagus. We present our experiences with laparoscopic transhiatal esophagectomy for ‘sigmoid’ megaesophagus due to failed Heller’s myotomy. Materials and Methods We managed a total of 11 patients with megaesophagus in our institute from 1993 to 2007. Work-up included investigations included endoscopy, barium swallow, and manometry. Laparoscopic transhiatal esophagectomy with gastric pull through was successfully performed for all cases. Results The mean operating time was 317.5 min, and the mean blood requirement was 525 ml. The mean duration between the first and second procedures was 13 months. Our overall failure rate for primary surgery (myotomy) was 3.1% and overall symptomatic improvement was achieved in 82% of patients. There were no conversions. Discussion About 10% of postmyotomy patients will have recurrence, and 5% of them need reoperation. Laparoscopic esophagectomy for sigmoid esophagus is a formidable operation due to adhesions/fibrosis at the hiatal area. Dissection of the S-shaped esophagus in the thorax is quite tedious and an accurate knowledge of the shape and location of the megaesophagus preoperatively is vital. If performed in specialized centers, laparoscopic excision is safe and effective, utilizing all the benefits of minimal access.     

Mycobacteria-primed macrophages and dendritic cells induce an up-regulation of complement C5a anaphylatoxin receptor (CD88) in CD3+ murine T cells

Complement C5a anaphylatoxin is a potent activator of macrophages, neutrophils, and dendritic cells (DC) and binds the C5a receptor (C5a-R; CD88). Although C5a is chemotactic for T cells, expression of C5a-R on murine T cells has been disputed. We report here that na?ve, Con A-activated, and cytokine (IL-12, IL-18)-stimulated murine CD3+ T cells from three strains of mice [C57Bl/6, B10.nSn (C5+/+), B10.on (C5-/-)] lacked C5a-R, as evaluated by immunophenotyping with an anti-C5a-R mAb. Ligation of CD3 induced a modest up-regulation with 3% of CD3+ T cells expressing cell surface C5a-R. T cells primed by APC differentiate into effector T cells. Activation of mycobacteria [bacillus Calmette-Guerin (BCG)]-sensitized T cells through MHC II and TCR interactions via BCG-infected macrophages enhanced the expression of C5a-R with approximately 14% of CD3+ T cells positive for C5a-R. Comparable expression was found in C5+/+ as well as C5-/- strains of mice (14% and 15%, respectively). Furthermore, anti-CD3-activated T cells were primed by BCG-infected DC, and a larger proportion of the primed T cells expressed C5a-R (30-40%). Finally, mice infected with BCG showed significant numbers of CD3+ T cells expressing C5a-R in the spleens during infection. As APC, such as macrophages and DC, can secrete C5 and cleave C5 to C5a and C5b through a peptidase, we suggest that macrophage and DC-T cell interactions can up-regulate C5a-R on T cells through MHC II-TCR and provide a C5a peptide for additional local activation of T cells via C5a-R.     

Trichobezoars in the stomach and ileum and their laparoscopy-assisted removal: a bizarre case

A trichobezoar is a ball of swallowed hair that collects in the stomach and fails to pass through the intestines. The risk is greater among the mentally retarded or emotionally disturbed children. We report a 12-year-old girl who presented with features of intestinal obstruction. Endoscopy revealed a trichobezoar in the stomach. Diagnostic laparoscopy also revealed a trichobezoar in the ileum. After gastrotomy and enterotomy, the two trichobezoars were removed through a minilaparotomy. Psychiatric problems associated with these disorders will need attention or recurrence can occur. Trichobezoars may need surgical removal if endoscopy fails. Endoscopical removal may not be possible if the lesion is large and hard. There are some reports of laparoscopy being used in removal surgery. It has the advantages of smaller incisions, better cosmesis and reduced pain.