The evolving role of cytoreductive surgery for metastatic renal cell carcinoma

Metastatic renal cell carcinoma is a devastating disease associated with poor survival. Immunotherapy is the mainstay of treatment, but response rates are low. The role of cytoreductive surgery in the presence of metastatic disease is evolving. From both retrospective and recently published randomized clinical trials, it is now apparent that among patients with metastatic renal cell carcinoma and good performance status, cytoreductive surgery followed by immunotherapy improves survival. However, this approach is likely to be detrimental in patients with poor performance status. Clinical trials of novel agents remain a priority in this disease.     

Vanilloid receptor expression and capsaicin excitation of rat dental primary afferent neurons

Little is known about the molecular mechanisms that cause excitation of neurons which innervate the teeth. We investigated whether rat dental sensory neurons express the vanilloid (capsaicin) receptor (VR1). Dental sensory neurons were identified by retrograde transport of the fluorescent dye DiIC18 placed in maxillary molars. Patch-clamp recordings in culture showed that 65% of DiIC18-labeled rat trigeminal ganglion neurons are excited by capsaicin. Responders covered the entire range of cell sizes examined (soma diameter, 24 to 48 microm). All non-responders had a soma diameter > 33 microm. Capsazepine (1 microM) reduced the capsaicin-evoked membrane current (6/6) and depolarization (7/7 responders). RT-PCR amplified a 375-bp product from DiIC18-labeled neurons which was identical to that expected for VR1. Thus, many rat dental primary afferent neurons are excited by capsaicin, and the response appears to be mediated by VR1. These results suggest that pharmacological blockers of VR1 may provide significant relief of dental pain.     

Biliary Complications of Pancreatic Necrosis

Summary Background. Involvement of the biliary tract in pancreatic necrosis is rare. The authors are presenting six patients with this unusual complication. Methods. Retrospective analysis of a case series. Results. The necrotic process involved the bile duct in four patients (bile duct alone in two and bile duct with duodenum in two) and the gall bladder in two patients. It was not possible to make a preoperative diagnosis of biliary tract involvement in any of these patients. The lesions in the biliary tract were caused by the direct erosion by the necrotic tissue in five patients, and in one patient with gangrene of the gall bladder, it was a “remote” complication of the necrotizing process. All patients underwent surgery. Necrosectomy and cholecystectomy were performed in patients with gall bladder lesions, and proximal biliary drainage was the method of choice in patients with erosion of the bile duct. One patient died postoperatively. During follow-up, another patient who had bile-duct involvement developed a stricture in the damaged part of the bile duct and needed hepaticojejunostomy Conclusions. Necrotizing pancreatitis can involve the biliary tract, both by direct extension and by its secondary effects. Although cholecystectomy is the treatment of choice in the presence of gallbladder involvement, proximal biliary diversion may be indicated in patients with erosion of the bile duct.     

Mutations in the alpha-synuclein gene in Parkinson's disease among Indians

OBJECTIVE: To investigate the prevalence of G88C, G209A and any other mutation(s) in exons 3 and 4 of the alpha-synuclein gene in Indian patients with Parkinson's disease (PD). METHODS: A total of 169 PD patients comprising 18 familial, 3 juvenile, 48 early onset and 100 sporadic cases were included in this study. Genomic DNA was amplified by PCR using primers specific for Exons 3 and 4. Mutations at G88C and G209A were screened following restriction enzyme digestion of the PCR product. Direct PCR product sequencing of entire exons 3 and 4 was carried out for at least one proband each from the 10 familial cases. RESULTS: Neither G88C and G209A mutations nor any other mutation in exons 3 and 4 was found in the PD patients analysed. CONCLUSION: The G88C and G209A mutations do not seem to be the predominant genetic determinant of PD among Indians.     

Cost-effectiveness of trachoma control measures: comparing targeted household treatment and mass treatment of children

OBJECTIVE: The present study compares the cost-effectiveness of targeted household treatment and mass treatment of children in the most westerly part of Nepal. METHODS: Effectiveness was measured as the percentage point change in the prevalence of trachoma. Resource measures included personnel time required for treatment, transportation, the time that study subjects had to wait to receive treatment, and the quantity of azithromycin used. The costs of the programme were calculated from the perspectives of the public health programme sponsor, the study subjects, and the society as a whole. FINDINGS: Previous studies have indicated no statistically significant differences in effectiveness, and the present work showed no significant differences in total personnel and transportation costs per child aged 1-10 years, the total time that adults spent waiting, or the quantity of azithromycin per child. However, the mass treatment of children was slightly more effective and used less of each resource per child aged 1-10 years than the targeted treatment of households. CONCLUSION: From all perspectives, the mass treatment of children is at least as effective and no more expensive than targeted household treatment, notwithstanding the absence of statistically significant differences. Less expensive targeting methods are required in order to make targeted household treatment more cost-effective.     

Comparison of two azithromycin distribution strategies for controlling trachoma in Nepal

OBJECTIVE: The study compares the effectiveness of two strategies for distributing azithromycin in an area with mild-to-moderate active trachoma in Nepal. METHODS: The two strategies investigated were the use of azithromycin for 1) mass treatment of all children, or 2) targeted treatment of only those children who were found to be clinically active, as well as all members of their household. FINDINGS: Mass treatment of children was slightly more effective in terms of decreasing the prevalence of clinically active trachoma (estimated by clinical examination) and of chlamydial infection (estimated by DNA amplification tests), although neither result was statistically significant. CONCLUSION: Both strategies appeared to be effective in reducing the prevalence of clinically active trachoma and infection six months after the treatment. Antibiotic treatment reduced the prevalence of chlamydial infection more than it did the level of clinically active trachoma.     

External rhinoplasty for dorsum swellings

As any swelling over dorsum nose is cosmetically unacceptable so is the post-operative scar. The external rhinoplasty approach proceeds in the natural tissue dissection planes in the nose, thus ensuring minimal bleeding, improved exposure and good healing with minimal scar formation. We present cases of three different swellings due to rhinophyma, dermoid cyst and a rare interesting foreign body all dealt with external rhinoplasty approach with good results.     

Functional endoscopic sinus surgery results in 69 patients

Sixty nine patients with sinonasal symptoms were subjected to diagnostic endoscopy. Functional endoscopic sinus surgery was done subsequently for chronic sinusitis in 42 patients, for ethmoidal polypi in 18 patients and for antrochoanal polypi in 9 patients. A follow up of 18 to 36 months ( mean 27 months) reveals a success rate of 84% in the overall study, 81.5% in patients with chronic sinusitis alone, 87.5% in ethmoidal polypi and 100% in patients with antrochoanal polyps.