Functional variants of IL4 and IL6 genes and risk of tobacco-related oral carcinoma in high-risk Asian Indians

Oral Diseases (2011) 17 , 720–726 Background: Tobacco‐related oral squamous cell carcinoma (OSCC) is one of the most common cancers involving Indian males. We assessed the association of IL4 promoter –589 T>C, –33 T>C, and IL6–174 G>C functional genetic polymorphisms with tobacco‐related OSCC in Asian Indians. Patients and Methods: The IL4 and IL6 promoter polymorphisms were assessed in 140 patients with OSCC and 120 normal subjects by PCR–RFLP technique, and significance of the data was determined using chi‐square test. Results: The frequency of TC, CC genotype, and C allele at IL4 promoter sites –589 and –33 were higher in patients when compared with controls. Consequently, TC/CC genotypes and C allele at both sites appeared as susceptible. However, IL6–174 G>C single‐nucleotide polymorphisms (SNP) appeared to be protective in patients with OSCC. Of eight haplotypes, five were associated with two‐ to seven‐fold increased risk of tobacco‐related OSCC. These SNPs further showed heterogeneity among different ethnic population, but their distribution in Asian Indians stand closer to other Asian populations. Conclusions: In this study, IL4–589 CC, –33 CC genotype, and *C allele at both sites appeared to be susceptible, while IL6–174 CC genotype and *C allele appeared to be protective in patients with OSCC; hence, these SNPs may be a potential prognostic markers for tobacco‐related OSCC in Asian Indians.     

Midabdominal aortic coarctation presenting with severe pre-eclampsia

This is a case report of a 23-year-old pregnant woman with uncontrolled hypertension, resulting in delivery of her baby at 28 weeks. Postpartum, she further developed claudication and postprandial abdominal discomfort and was diagnosed with coarctation of the midabdominal aorta. She underwent thoracoabdominal aortic repair from the descending thoracic to infrarenal aorta. A bifurcated graft was used to complete the aorto-common hepatic artery and aorto-superior mesenteric artery bypasses. A third graft limb was sewn to revascularize the left renal artery. At 1-year follow up, all symptoms had resolved. This is an interesting coarctation patient treated successfully with thoracoabdominal reconstruction.     

Current concepts in managing fractures of metacarpal and phalangess

Fractures of the metacarpal and phalanges constitute 10% of all fractures. No where in the body, the form and function are so closely related to each other than in hand. Too often these fractures are treated as minor injuries resulting in major disabilities. Diagnosis of skeletal injuries of the hand usually does not pose major problems if proper clinical examination is supplemented with appropriate radiological investigations. Proper preoperative planning, surgical intervention wherever needed at a centre with backing of equipment and implants, selection of appropriate anaesthesia and application of the principle of biological fixation, rigid enough to allow early mobilisation are all very important for a good functional outcome. This article reviews the current concepts in management of metacarpal and phalangeal fractures incorporating tips and indications for fixation of these fractures. The advantages and disadvantages of various approaches, anaesthesia, technique and mode of fixation have been discussed. The take-home message is that hand fractures are equally or more worthy of expertise as major extremity trauma are, and the final outcome depends upon the fracture personality, appropriate and timely intervention followed by proper rehabilitation. Hand being the third eye of the body, when injured it needs a multidisciplinary approach from the beginning. Though the surgeon''s work appears to be of paramount importance in the early phase, the contribution from anaesthetist, physiotherapist, occupational therapist, orthotist and above all a highly motivated patient cannot be overemphasised.