Routine blood counts in children with acute lymphoblastic leukaemia after completion of therapy: are they necessary?

Children who have completed treatment for acute lymphoblastic leukaemia (ALL) are commonly followed up for the first 5 years with regular full blood counts (FBCs) to monitor for relapse of disease. There is little evidence to suggest that this practice improves the detection rate of unexpected relapse. Surveillance FBCs, performed on 43 children with relapsed ALL between 1990 and 1999, were analysed. Of the 42 relapses in children off therapy, only two were detected by an abnormal FBC. Routine FBCs in asymptomatic children off therapy lacks specificity in detecting unexpected relapses and maybe safely discontinued.     

Herpes zoster infection: a rare cause of acute urinary retention

Herpes zoster (HZ) infection has been reported as a rare cause of acute urinary retention. HZ infection involving sacral, thoracolumbar, and rarely high thoracic dermatomes is believed to occasionally cause motor and sensory neuropathy of the bladder. This is specifically achieved by the interruption of the detrusor reflex causing subsequent bladder atonia. As the course and management of this entity is quite benign, HZ should remain a diagnostic consideration in the management of urinary retention. We report a case of acute urinary retention of approximately 2.5 liters associated with HZ infection and review the proposed pathogenesis and therapeutic considerations in the management of this entity.     

Ethical issues in public health policy

Ethics in public health policy is given the least importance and rarely discussed. Resolving ethical issues in public health is often an arduous task as these are complicated and require careful handling. Using four case studies, we discuss issues pertaining to pertussis and brain damage, water fluoridation and dental caries, infection with the human immunodeficiency virus and the right to marriage, and the debate surrounding universal salt iodization. The core issue in all these examples pertains to the relevance of ethics in public health policy.     

Redox reactions of tocopherol monoglucoside in aqueous solutions: a pulse radiolysis study

The reactions between tocopherol monoglucoside (TMG), a water-soluble vitamin-E derivative, with Br2.-, N3., (SCN)2.-, NO2., OH. and various halogenated peroxyl radicals were examined using a pulse radiolysis technique. The results demonstrate that TMG forms a stable phenoxyl radical at pH > 6.8. The thus-formed phenoxyl radical shows pH-dependent decay kinetics and is disproportionated by 2nd order kinetics at pH 2.3. It was observed that the TMG reactivity towards a halogenated peroxyl radical increases with the number of halogen atoms at the carbon atom having a peroxyl group. The reaction between the TMG phenoxyl radical and ascorbic acid was also examined using a pulse radiolysis technique. The results indicate that the TMG phenoxyl radical is repaired by ascorbate. Kinetic studies indicate that TMG may act as an antioxidant to repair free-radical damage to some biologically important compounds. The one-electron reduction potential for TMG was found to be 0.522 V +/- 0.06 vs. NHE.     

Endoprostatic stents for management of benign prostatic hyperplasia

Endoprostatic stents have been developed for relieving bladder outlet obstruction secondary to benign hyperplasia of the prostate. The stents are designed either for permanent or for temporary placement. The short-term temporary stents of various biostable and biodegradable polymers are needed after minimally invasive therapy of prostate with heat. The temporary stents are a management option, whereas the permanent stents are a treatment option. Permanent stents offer immediate relief and their sustained results for 4-7 years make them ideally suited for medically compromised patients.     

Ureteral reconstruction: small intestine submucosa for the management of strictures and defects of the upper third of the ureter

PURPOSE: We evaluated the effectiveness of small intestine submucosa in ureteral reconstruction. MATERIALS AND METHODS: We report an experimental study in 6 female pigs weighing between 50 and 60 pounds. The animals were anesthetized, midline laparotomy was performed and two-thirds of the diameter of the upper third of the left ureter were incised parallel to the ureteral axis, leaving intact only a third of the ureteral wall for a segment of 7 cm. A 5Fr double-J*; stent was positioned to secure patency at all times. The created gap was then bridged with an small intestine submucosa patch in a cylindrical format, which was subsequently sutured to the proximal and distal ureteral segment. The right ureter served as our control and simple intubated Davis ureterotomy was performed. RESULTS: All animals survived the whole followup of 7 weeks. Histologically there was evidence of epithelial regeneration along the segments reconstructed with small intestine submucosa, supported by a well vascularized collagen and smooth muscle background. There was no evidence of foreign body reaction to the graft material. In vivo patency was confirmed by retrograde pyelography in the bridged ureters 7 weeks after the initial procedure. All the ureters without an small intestine submucosa bridge had ureteral stenosis without evidence of epithelial regeneration. CONCLUSIONS: The use of small intestine submucosa is a novel, effective material for the scaffolding of ureteral defects and/or strictures of the upper ureteral segment in the pig model.     

Incidence of occult primary—their diagnosis and non surgical management

Twenty one (16.5%) cases of Occult primary (18 males and 3 females) were analysed out of 121 cases of secondaries in the neck regarding their diagnosis and non-surgical management over a period of six years, from March, 1990 to Feb., 1996 in the department of ENT and Radiotherapy of I.G.M.C. and Hospital Shimla. Majority of these cases were in the age group of 50-70 years and 95% of these cases had squamous cell carcinoma and in one case there was adenocarcinoma. 12 (57%) of these patients were in N3 stage. 13 patients were treated by radiotherapy, 3 by chemotherapy whereas remaining 5 cases absconded and therefore no treatment could be given to them.     

Role of curcumin in idiopathic inflammatory orbital pseudotumours

The present report, describes for the first time the clinical efficacy of curcumin, the active constituent of rhizomes of Curcuma longa, in the treatment of patients suffering from idiopathic inflammatory orbital pseudotumours. Curcumin was administered orally at a dose of 375 mg/3 times/day orally for a period of 6-22 months in eight patients. They were followed up for a period of 2 years at 3 monthly intervals. Five patients completed the study, out of which four recovered completely and in one patient the swelling regressed completely but some limitation of movement persisted. No side effect was noted in any patient and there was no recurrence. It is suggested that curcumin could be used as a safe and effective drug in the treatment of idiopathic inflammatory orbital pseudotumours.     

Detection of neutrophil inhibition factor (NIF) in patient with carcinoma of larynx using skin-window technique

Tumour antigen-induced leucocyte inhibition was studied in vivo in patients with laryngeal carcinomas (squamous-cell type in 13 and transitional cell type in 1 case) and benign tumours (squamous cell papilloma in 2, fibroepithelial polyp in 1 and mixed mesenchymal tumour in 1 case). All the patients were biopsied and autologous tumour-antigen (ATA) was used in vivo skin window test. Release of of ATA-induced neutrophil inhibition factor (NIF) was detected in 12 of 14 (85.7%) malignant cases. Basophilic chemotaxis occurred in 4 malignant cases, following exposure to ATA. Furthermore, 4 other malignant cases also gave positive ATA-induced delayed hypersensitivity (DH) response. Results of this study suggest possible role of immunological factors in limiting tumour dissemination.