Unusual presentation of nasopharyngeal carcinoma — a case report

Nasopharyngeal carcinoma may present with bewildering arrays of signs & symptoms. Diagnosis often become difficult and requires a high degree of clinical suspicion for the disease. We here by present a case of 11 year old girl which have unusual presentation.     

Incidental diagnosis of gastric cancer in transplant recipients improves patient survival

BACKGROUND: Gastric cancer in the United States is often diagnosed at advanced stages, resulting in dismal outcomes. In the immunosuppressed transplant recipient population, little is known about the clinical staging and outcome of these compromised patients. METHODS: All US cases reported to the Israel Penn International Transplant Tumor Registry were retrospectively examined for patient demographics, immunosuppressive therapy, tumor characteristics, therapeutic modalities, and mortality. Statistical analysis was performed with Students t test, chi-square analysis, and log-rank analysis by the method of Kaplan-Meier. RESULTS: Gastric cancer was identified in 34 recipients: 28 (82%) were male; 24 (71%) were white. Mean age at diagnosis was 58 +/- 11 years. Twenty-four (71%) patients received kidney transplants, 7 (21%) received heart transplants, and 3 (9%) received liver transplants. Fifty percent received induction therapy, whereas 94% were maintained on calcineurin inhibitors and corticosteroids. Thirty-five percent of patients were diagnosed during evaluation for gastrointestinal symptoms, with the remaining cases discovered incidentally during endoscopy (53%) or during computed tomography (12%) performed for other reasons. Stage varied at presentation as follows: stage I (n = 6), stage II (n = 11), stage III (n = 13), and stage IV (n = 4). Incidental diagnoses resulted in a lower stage malignancy (P <.001) and greater 1-year and 5-year survivals (P <.05) compared with those patients whose were diagnosed after being evaluated of gastrointestinal symptoms. CONCLUSION: In the United States, because gastric cancer in the transplant recipient is frequently identified at an earlier stage (50% were stages I and II) than in the general population, survivals are equivalent despite continued administration of immunosuppression. This early identification may be attributed to more frequent presymptom diagnosis and staging, resulting from incidental detection of these malignancies during posttransplant upper endoscopy or computed tomography. Early detection has resulted in a 29% 5-year survival for the entire transplant recipient group compared with a 5% to 15% 5-year survival in the general population.     

Saliva versus serum estradiol: implications for research studies using postmenopausal women

OBJECTIVE: The authors investigated saliva as a potentially reliable medium for estradiol (E2) measurements in postmenopausal women. The goal of this study was to determine whether or not saliva could be used in studies of postmenopausal women in place of serum samples. Specifically, the authors wondered whether or not saliva and serum E2, obtained simultaneously from samples collected from postmenopausal women, would correlate. DESIGN: Samples of saliva and serum were collected simultaneously from 43 postmenopausal women. 31 were regular users of estrogen therapy (ET), 12 used no ET. Pearson's correlation coefficients were conducted to determine the degree of relationship between saliva and serum samples among ET users and non-users. RESULTS: Among ET users saliva and serum E2 levels were significantly and positively correlated (r = 0.81, p < 0.0001). The two E2 values were not significantly correlated among ET non-users (r = 0.32, p < 0.31). CONCLUSIONS: These data suggest that saliva E2 may be a fairly robust predictor of serum E2, but only among postmenopausal women who use ET.     

Propofol or sevoflurane anesthesia without muscle relaxants for thymectomy in myasthenia gravis

Background Myasthenia gravis is a challenging clinical condition due to its neuromuscular involvement. We sought to compare two non-muscle relaxant anesthetic techniques in patients undergoing trans-sternal thymectomy, evaluating the intra and postoperative conditions including extubation in the operating room. Methods Eight consecutive myasthenic patients undergoing trans-sternal thymectomy were prospectively randomized into two groups: propofol and sevoflurane. In both groups anesthesia was induced with propofol (2mg. Kg⁻¹) and intubation performed after topical anesthesia of the airway with lignocaine. Anesthesia was maintained in the propofol group (4 patients) with continuous propofol infusion (3–10 mg. Kg⁻¹., hr⁻¹) with oxygen and nitrous oxide and in the sevoflurane group (4 patients), with sevoflurane (end tidal 1–1.5%) in oxygen and nitrous oxide. Fentanyl was used for analgesia in both the groups. Intubating conditions, haemodynamic changes, neuromuscular transmission along with postoperative intensive care unit stay were evaluated. Data were evaluated using ANOVA, Chi-square test and Student'st test. Results Intubating conditions were good in all patients. There were no significant haemodynamic changes. All patients were extubated in the operating room and none had to be re-intubated for postoperative respiratory depression. Neuromuscular transmission showed minimal changes and at the end of the procedure the recovery was complete in all the patients. There were no other significant differences between the two groups studied. Conclusion These two anesthetic techniques allow early extubation of myasthenic patients in the operating room.     

Co-occurrence of Wilson's disease and glioblastoma multiforme--is it a chance association?

We report a patient with glioblastoma multiforme who was subsequently diagnosed to have Wilson's disease. Immunohistochemical studies of the tumor revealed high (> 60%) labeling index for p53 and Rb retinoblastoma protein. Whether this association is like the co-occurrence of retinoblastoma and Wilson's disease due to possible somatic mutation in chromosome 13 needs to be explored.     

The cytotoxic activity of the total alkaloids isolated from different parts of Solanum pseudocapsicum

The total alkaloid fractions of the methanolic extracts of the leaves, ripe fruits, roots, seeds and stem of Solanum pseudocapsicum were subjected to in-vitro cytotoxicity, short-term toxicity and long-term survival studies. All the five fractions exhibited potent activity. The total alkaloid fraction of leaves was found to be the most potent. The HT-29 cell line was the most sensitive to the fractions. The cytotoxic concentration (CTC(50)) values for all these fractions ranged between 0.39-0.91, 0.68-2.8, 0.92-3.56, 4.05-8.2, 3.28-5.65 and 0.95-5.55 microg/ml, respectively for HT-29, RD-228, A-549, HEp-2, B(16)F(10) and Vero cell lines. In short-term toxicity studies, the fractions showed 50% viability at 93-128 microg/ml for DLA cells and 141-189 microg/ml for human lymphocytes. In the long-term survival studies on the cell lines RD-228, HEp-2 and Vero, cells retained their regenerative capacities at concentrations below 8 microg/ml. The total alkaloids of the plant, especially from the leaves merit further investigations to identify the active constituents in animal models.     

Tracheobronchial foreign bodies

Ojective : Foreign body inhalation is an extremely serious problem in children and sometimes result in sudden death. The current mortality rate from foreign body inhalation is between 0% and 1.8% according to various studies. In spite of this, undiagnosed and unsuspected foreign bodies still occur in the airway.dMethods : Pediatric patients with documented foreign body inhalation, treated in the Department of Pediatrics, Bapuji Hospital, JJM Medical College during 1997-2000 are included in the analysis. Children with or without positive history of aspiration were examined and the diagnosis was made on the basis of history, clinical findings, radilogic evaluation and strong index of suspicion in those children where reasonable appropriate treatment failed to resolve the respiratory symptoms. Bronchoscopy was performed for a suspected foreign body on 165 children.Result : A review of 165 pediatric cases of suspected foreign body aspiration revealed, children between 1 and 3 years were found to be very vulnerable for aspiration. Majority of children were boys. Over 70% of the patients had positive history of inhalation. Only 60% of the patients presented immediately, that is within 24 hours after aspiration. Common symptoms were cough and respiratory distress. Physical examination showed abnormal finding in 91% of cases. Decreased air entry was the significant clinical sign. Obstructive emphysema was found in majority of the cases (49.5%). Rigid bronchoscopy under general anaesthesia was the preferred method for removal of aspirated foreign body. In 65 (61.9%) cases foreign body was lodged in the right main bronchus and majority of these were organic in nature, that is 96(91.43%).Conclusion : Tracheobronchial foreign bodies should be strongly suspected in pediatric age group who present with a suggestive history, even when physical and radiographie evidence is absent. The modalities of diagnosis, management and outcome are discussed.     

Trypsin inhibitory effect of wedelolactone and demethylwedelolactone

Wedelolactone (WL) and demethylwedelolactone (DWL) isolated from Eclipta alba were tested in the trypsin inhibition bioassay (in vitro). Both compounds showed potent activity. IC(50) values of WL and DWL were found to be 2.9 and 3.0 microg/mL respectively.     

Intercostal nerve blockade versus thoracic epidural analgesia for post thoracotomy pain relief

Background Post thoractomy pain is a major source of concern in the postoperative period. The purpose of this study was to evaluate the effectiveness of intraoperative temporary intercostal nerve blockade versus thoracic epidural analgesia for control of post thoracotomy pain. Methods 40 patients undergoing elective pulmonary resection through a postero lateral thoractomy were randomly allocated to receive epidural analgesia using 0.25% bupivicaine (Group A, n=20) or temporary intercostal nerve blockade using 0.25% bupivicaine (Group B, n=20). Adequacy of analgesia was assessed over a period of 24 hours using a visual analogue score and an observer verbal ranking scale. Results Pain scores were similar in both the groups for the first 4 hours after surgery. Thereafter, the pain scores were significantly higher (p<0.05) in Group B as compared to Group A for the remainder of the observation period. There was significantly higher (p<0.01) usage, of nonsteroidal analgesic consumption in Group B. No neurological complications were encountered, in both the study groups. Conclusion We conclude that in the early postoperative period there is no significant difference in pain relief in both the techniques but there after, epidural analgesia significantly reduces post thoracotomy pain.