Care of post-traumatic spinal cord injury patients in India: An analysis

Background:

The spinal cord injured patients if congregated early in spinal units where better facilities and dedicated expert care exist the outcome of treatment and rehabilitation, can be improved. The objective of this study is to find out the various factors responsible for a delay in the presentation of spinal injury patients to the specialized spinal trauma units and to suggest steps to improve the quality of care of the spinal trauma patients in the Indian setup.

Materials and Methods:

Sixty patients of traumatic spinal cord injury admitted for rehabilitation between August 2005 and May 2006 were enrolled into the study and their data was analyzed.

Results:

Eighty-five per cent of the spinal cord injured patients were males and the mean age was 34 years (range 13-56 years). Twenty-nine (48.33%) of the spinal injuries occurred due to fall from height. There was an average of 45 days (range 0-188 days) of delay in presentation to a specialized spinal unit and most of the time the cause for the delay was unawareness on the part of patients and/or doctors regarding specialized spinal units. In 38 (62.5%) cases the mode of transportation of the spinal cord injured patient to the first visited hospital was by their own conveyance and the attendants of the patients did not have any idea about precautions essential to prevent neurological deterioration. Seventeen (28.33%) patients were given injection solumedrol with conservative treatment, 35 (60%) patients were given only conservative treatment and seven patients were operated (11.66%) upon at initially visited hospital. Of the seven patients operated five were fixed with posterior Harrington instrumentation (71.42%) and two (28.57%) were operated by short segment posterior pedicle screw fixation. None of the patients were subjected to physiotherapy-assisted transfers or wheel chair skills or even basic postural training, proper bladder/ bowel training program and sitting balance.

Conclusion:

Awareness on the part of the general population, attendants of the patients, clinical and paraclinical team regarding spinal cord injury needs to be addressed. Safe mode of transportation of spinal cord injured patient and early presentation at tertiary spinal care center with comprehensive spinal trauma care team should be stressed upon.     

Giant nonfunctioning carcinoma of the adrenal cortex mimicking renal cell carcinoma: a diagnostic dilemma

Adrenocortical carcinoma is a rare, highly malignant neoplasm that originates in the adrenal cortex and is difficult to differentiate from renal cell carcinoma, especially if it is gigantic and nonfunctional. We report the case of a 40-year-old man with an incidental mass in the right upper abdomen. Magnetic resonance imaging revealed that the mass originated from the right kidney and was highly suggestive of renal cell carcinoma. However, histologic examination after radical nephrectomy confirmed the mass to be an adrenocortical carcinoma compressing the kidney. We discuss the obscurity and implications of such a diagnosis.     

Intense pulsed light vs. pulsed‐dye laser in the treatment of facial acne: a randomized split‐face trial

Background Various laser and light therapy have been increasingly used for the treatment of acne vulgaris. Patients and methods Twenty patients with facial acne were treated using intense pulsed light (IPL) on one side of the face and pulsed dye laser (PDL) on the other to compare the efficacy and safety of IPL and PDL. Treatment was performed 4 times at 2‐week intervals. Treatment effectiveness was determined using lesion counts, acne severity, patient subjective self‐assessments of improvement, and histopathological examinations, which included immunohistochemical staining for transforming growth factor‐β (TGF‐β). Results Numbers of total acne lesions decreased following both treatments. For inflammatory lesions such as papules, pustules and nodules, IPL‐treated sides showed an earlier and more profound improvement than PDL‐treated sides. However, at 8 weeks after the 4th treatment, a rebound aggravation of acne was observed on IPL‐treated sides. On the contrary, PDL produced gradual improvements during the treatment sessions and these improvements lasted 8 weeks after the 4th treatment. Non‐inflammatory lesions as open and closed comedones also showed improvement following both treatments and PDL‐treated sides showed better improvement as the study proceeded. Histopathological examinations showed amelioration in inflammatory reactions and an increase in TGF‐β expression after both treatments, which were more prominent for PDL‐treated sides. Conclusion Both PDL and IPL were found to treat acne effectively, but PDL showed a more sustained effect. TGF‐β might play a key role in the resolution of inflammatory acne lesions.     

高血压血管重构及高血压状态下的颈动脉血管重构

目的:研究高血压颈动脉重构特点、机制,为临床控制高血压并逆转颈动脉重构提供新靶点。资料来源:应用计算机检索维普全文电子期刊数据库所有相关高血压动脉重构及颈动脉重构方面的文献,检索词“动脉重构,颈动脉重构,高血压”,限定文献语言种类为中文。同时计算机检索Entrez PubMed所有相关高血压动脉重构及颈动脉重构方面的文献,检索词“artery remodeling,carotid artery remodeling,hypertention”,限定文献语言种类为English。资料选择:对资料进行初审,选取包括高血压大动脉重构机制及颈动脉重构方面的文献,开始查找全文。纳入标准:有关高血压颈动脉形态学、平滑肌细胞及细胞外基质重构及其机制的文献。排除标准:与高血压颈动脉重构无关的文献。资料提炼:共检索到168篇关于高血压动脉重构及颈动脉重构的文献,最终纳入39篇符合标准的文献。资料综合:颈动脉血管重构导致高血压的发展和并发症的出现。高血压颈动脉的重构形态学上以壁厚/腔径比值增高、顺应性下降为特点。血管中层平滑肌细胞总体积增加及动脉壁细胞外基质组成成分的变化是高血压颈动脉重构的重要内容。高血压颈动脉重构的机制与细胞增殖、凋亡及血管炎症、纤维化有关。结论:高血压的治疗必须重视血管的保护及血管重构的逆转。通过药物干预及基因治疗,逆转血管重构,将成为多种心血管疾病治疗的重要措施。     

Endo-urological techniques in the management of stent complications in the renal transplant patient

Complications following renal allograft transplantation have been well documented and, despite improvements in technique, continue to cause significant morbidity and mortality. The placement of indwelling ureteric stents is becoming more common both during primary neo-ureterocystostomy and in the management of subsequent ureteric complications. We present two cases of stent encrustation and urolithiasis treated by a combined percutaneous and flexible ureterorenoscopic approach. These cases illustrate the problems of stents in renal transplant patients and offer endo-urological solutions. It is imperative that stents are correctly placed in these patients and that appropriate plans are made for their removal or exchange.     

4－氨基吡啶诱发组胺释放及某些药物的拮抗作用

４－氨基吡啶（４－ＡＰ）有组胺释放作用。小鼠ｉｐ４－ＡＰ５ｍｇ·ｋｇ－１后，肺中组胺含量明显减低，血中组胺含量显著增高。钙拮抗剂硝苯啶、ＴＭＢ－８及钾通道开放剂米诺地尔均能明显抑制４－ＡＰ诱发的小鼠ＰＭＣ释放组胺。结果提示，ＭＣ可能存在钾通道，４－ＡＰ诱发ＭＣ释放组胺可能与它阻滞钾通道，从而使钙通道开放，增加Ｃａ２＋内流有关。     

刺蒺藜果中一种新桂皮酰胺类成分的分离和鉴定

从刺蒺藜(Tribulus terrestris L)果实中分得两个化合物,经理化常数测定和光谱(UV,IR,¹HNMR,¹³CNMR,¹H-¹³CCOSY和MS)解析。化合物I鉴定为N-对羟基苯乙酮基-3-甲氧基-4-羟基取代桂皮酰胺,为一新化合物,命名为蒺藜酰胺(terrestriamide)。化合物II为8-甲基氢化茚酮-1,首次从该植物中获得。