Risk of Neoplastic Change in Ileal Pouches in Familial Adenomatous Polyposis

Introduction

Neoplastic change in ileal reservoirs after proctocolectomy has been reported in patients with familial adenomatous polyposis. We aim to determine the incidence and progression of neoplastic change in the ileal pouch of familial adenomatous polyposis patients at our institution.

Methods

A retrospective review of all patients who underwent proctocolectomy for familial adenomatous polyposis with construction of an ileal pouch from 1972 to 2007 was performed. Data and status at follow-up were retrieved from the Mayo Clinic Colorectal Surgery Pouch database.

Results

One hundred seventeen patients were identified with a median age of 26, 52 were male. Ileal reservoirs included J-pouch (a?=?104), Kock pouch (n?=?9), S-pouch (n?=?3), and W-pouch (n?=?1). Median follow-up was 125 months. Polyps were biopsied in 33 patients: non-dysplastic polyps (n?=?2), low-grade dysplasia (n?=?30), and adenocarcinoma (n?=?1). No patients had high-grade dysplasia. Median time to development of dysplasia was 149 months. Adenocarcinoma developed in one patient after 284 months. Risk of dysplasia at 10, 20, and 25 years was 17, 45, and 69 %, respectively.

Conclusion

Though there is a high incidence of low-grade dysplasia in the ileal reservoir in familial adenomatous polyposis patients, high-grade dysplasia and cancer occur rarely. Patients with low-grade dysplasia may still necessitate regular follow-up.     

India mental health country profile

India, the second most populated country of the world with a population of 1.027 billion, is a country of contrasts. It is characterized as one of the world's largest industrial nations, yet most of the negative characteristics of poor and developing countries define India too. The population is predominantly rural, and 36% of people still live below poverty line. There is a continuous migration of rural people into urban slums creating major health and economic problems. India is one of the pioneer countries in health services planning with a focus on primary health care. Improvement in the health status of the population has been one of the major thrust areas for social development programmes in the country. However, only a small percentage of the total annual budget is spent on health. Mental health is part of the general health services, and carries no separate budget. The National Mental Health Programme serves practically as the mental health policy. Recently, there was an eight-fold increase in budget allocation for the National Mental Health Programme for the Tenth Five-Year Plan (2002–2007). India is a multicultural traditional society where people visit religious and traditional healers for general and mental health related problems. However, wherever modern health services are available, people do come forward. India has a number of public policy and judicial enactments, which may impact on mental health. These have tried to address the issues of stigma attached to the mental illnesses and the rights of mentally ill people in society. A large number of epidemiological surveys done in India on mental disorders have demonstrated the prevalence of mental morbidity in rural and urban areas of the country; these rates are comparable to global rates. Although India is well placed as far as trained manpower in general health services is concerned, the mental health trained personnel are quite limited, and these are mostly based in urban areas. Considering this, development of mental health services has been linked with general health services and primary health care. Training opportunities for various kinds of mental health personnel are gradually increasing in various academic institutions in the country and recently, there has been a major initiative in the growth of private psychiatric services to fill a vacuum that the public mental health services have been slow to address. A number of non-governmental organizations have also initiated activities related to rehabilitation programmes, human rights of mentally ill people, and school mental health programmes. Despite all these efforts and progress, a lot has still to be done towards all aspects of mental health care in India in respect of training, research, and provision of clinical services to promote mental health in all sections of society.     

Etiological spectrum of hypokalemic paralysis: A retrospective analysis of 29 patients

Background:

Hypokalemic paralysis is characterized by episodes of acute muscle weakness associated with hypokalemia. In this study, we evaluated the possible etiological factors in patients of hypokalemic paralysis.

Materials and Methods:

We reviewed the records of 29 patients who were admitted with a diagnosis of hypokalemic paralysis. Modified Guillain-Barre´ Syndrome disability scale was used to grade the disability.

Results:

In this study, 15 (51.7%) patients had secondary causes of hypokalemic paralysis and 14 patients (42.3%) had idiopathic hypokalemic paralysis. Thyrotoxicosis was present in six patients (20.6%), dengue infection in four patients (13.7%), distal renal tubular acidosis in three patients (10.3%), Gitelman syndrome in one patient (3.4%), and Conn''s syndrome in one patient (3.4%). Preceding history of fever and rapid recovery was seen in dengue infection-induced hypokalemic paralysis. Approximately 62% patients had elevated serum creatinine phosphokinase. All patients had recovered completely following potassium supplementation. Patients with secondary causes were older in age, had significantly more disability, lower serum potassium levels, and took longer time to recover.

Conclusion:

In conclusion, more than half of patients had secondary causes responsible for hypokalemic paralysis. Dengue virus infection was the second leading cause of hypokalemic paralysis, after thyrotoxicosis. Presence of severe disability, severe hypokalemia, and a late disease onset suggested secondary hypokalemic paralysis.     

Guillain Barre syndrome as a manifestation of neurological melioidosis

Neurological melioidosis is a very rare and very few cases have been reported from India. Presentation is an extremely varied and as this disease is associated with high mortality, high index of suspicion is needed to diagnose and treat. In this context, we report a patient presenting as Guillain Barre syndrome evaluated as melioidosis.Key Words: Guillain Barre’ syndrome, infection, melioidosis     

ZnO thin film-nanowire array homo-structures with tunable photoluminescence and optical band gap

The growth and optical behavior of ZnO thin film-nanowire array homo-structures is reported. The ZnO films are deposited on glass substrates by thermal evaporation and subjected to heat treatment at 400 °C for 2 h to achieve crystallinity and stoichiometry. The surface comprises spherical grains or elongated flakes depending on thickness of films. These films are introduced in to a hydrothermal reactor in a medium of zinc acetate and HMTA to realize the nanostructures. The process results in the formation of ZnO nanowires with dimensions that are strongly dependent on the surface microstructure of the ZnO films. The role of temperature (90–180 °C) and duration (10 min to 10 h) of hydrothermal processing is investigated in detail. It is demonstrated that low temperature and short duration are ideal for producing nanowires with diameter < 100 nm, while longer durations and higher temperatures lead to large diameter and long length nanowires. Interestingly, all wires converge to a hexagonal shape with increase in duration or temperature. The lowest diameter of the vertically aligned nanowires is 50 nm and length upto 10 μm is achieved. Optical band gap of the homo-structures is of the order of 3.4–3.5 eV. Raman and photoluminescence spectra indicate the presence of defects in the films. The thin films exhibit a strong defect related photoluminescence peak centred around 550 nm. The nanowires grown on the films display both the UV-near band edge peak as well as the defect related peak. However, the intensity of the defect peak decreases with increase in length of the nanowires indicating that the photoluminescence of the homo-structures can be tuned by changing the surface microstructure of the films and also the aspect ratio of the nanowires.

ZnO homo-structures with tunable photoluminescence and band gap.     

Ganglion cyst arising from the transverse acetabular ligament (TAL): a rare cause of entrapment of the anterior branch of the obturator nerve. Case report and review of the literature

Skeletal Radiology - The transverse acetabular ligament is an unusual location for ganglion cysts. Only a few cases have been reported in the literature. They can be asymptomatic and represent an...