Management of tuberculosis of the spine with neurological complications.

Tuberculosis is still a major cause of spinal compression in the developing countries. In this study 200 patients presenting with neurological lesions secondary to tuberculosis of the spine have been classified according to the Frankel classification and the results evaluated. A combination of surgical decompression and chemotherapy is advocated. The dangers of non-operative treatment are discussed.     

Cervical approach for large thyroid mass with substernal extension

The large thyroid mass with substernal extension often requires a combination of cervical and thoracic approach for its access and removal. We have developed a technique that uses a cervical incision and combines clear access to the mass with low morbidity. The principle features include complete sternocleidomastoid mobilization, early identification of the neurovascular pedicle through a lateral approach, and finger dissection to deliver the substernal component of the mass. This article also describes the elements of our technique in detail, from preoperative considerations through wound closure and discusses the debate concerning the ideal treatment of these challenging tumors.     

A rare case of primary Ewings sarcoma of the nasal bone

Primary Ewing’s sarcoma of the nasal bone has not been previously described. This case presented as a mass in the left ala of the nose in a five year old female child. The clinical, radiological, microscopic features are described and a review of literature is presented. The case was treated with neoadjuvant chemotherapy and local electron beam radiation therapy. The child was free of disease when she reported for follow up in July 1997. Although wide excision is part of the treatment approach in Ewing’s sarcoma, in sites where surgery is not suitable local radiotherapy and chemotherapy adequately controls primary disease.     

A rare case of primary Ewings sarcoma of the nasal bone

Primary Ewing’s sarcoma of the nasal bone has not been previously described. This case presented as a mass in the left ala of the nose in a five year old female child. The clinical, radiological, microscopic features are described and a review of literature is presented. The case was treated with neoadjuvant chemotherapy and local electron beam radiation therapy. The child was free of disease when she reported for follow up in July 1997. Although wide excision is part of the treatment approach in Ewing’s sarcoma, in sites where surgery is not suitable local radiotherapy and chemotherapy adequately controls primary disease.     

Frontal sinus surgery 2004: update of clinical anatomy and surgical techniques

Endoscopic frontal sinus surgery is still considered difficult, risky to perform, and likely to result in a high failure rate. We have previously reported on our technique of endoscopic frontal sinus surgery, stressing the importance of identification and preservation of natural outflow tract. Our study of frontal sinus anatomy shows that the mean frontal ostium anterior—posterior and transverse dimensions are 7.22 ± 2.78 mm and 8.92 ± 2.95 mm, respectively; therefore, dissection of obstructive structures in frontal recess leads to a wide opening of frontal sinus outflow. A key surgical landmark in our technique is the superior attachment of the uncinate process. This article provides an update of the surgical anatomy of the frontal recess region and our surgical technique, as well as a discussion of our approach to frontal sinus revision surgery.     

Solubility enhancement of rosiglitazone by using melt sonocrystallization technique

The poor solubility and low dissolution rate in gastro-intestinal fluid, especially for class-II drugs according to Biopharmaceutics Classification System (BCS) the bioavailability enhanced by increasing the solubility and dissolution rate. A novel melt sonocrystallization technique of particle engineering to enhance solubility as well as dissolution of hydrophobic drug and to study its effect on crystal properties of drug. The present study leads to use investigate solubility of melt sonocrystallization technique to modify the undesirable properties of Rosiglitazone is antidiabetic drug in thiozolidione category with (BCS II) to forms agglomerates with number of shallow circular pits on the surface leads to increase solubility. Melt sonocrystallization process was developed for Rosiglitazone in which Rosiglitazone melt was poured in deionized water and simultaneously subjected to ultrasonic energy for 20 min at amplitude 80 %. The product obtained was evaluated using scanning electron microscopy, differential scanning calorimetry, X-ray powder diffractometry (XPRD), Fourier transformed infrared spectroscopy (FTIR), solubility and dissolution rate. The irregular agglomerates with porous surface were obtained having different crystal habit which increases solubility and dissolution rate. FTIR shows thermal behavior of untreated Rosiglitazone and treated Rosiglitazone have no significant difference low intensity peaks in XPRD of treated Rosiglitazone were noticed crystals habit changes and lattice defects during processing have causes favorable changes in the physicochemical properties of Rosiglitazone. The use of melt sonocrystallization technique is promising technique that may affords powder with improved flow as well as improved solubility and dissolution.     

A critical analysis of the concept of secondary Oral Hypoglycemic Agent (OHA) failure in type 2 diabetes at a tertiary care hospital

Data from UKPDS study suggests that the onset of ß cell dysfunction in diabetes occurs well before the development of hyperglycemia. To study the concept of secondary OHA failure in type 2 diabetes patients of more than 10 years duration in a tertiary care hospital. A retrospective analysis of all the cases of type 2 diabetes mellitus of more than 10 years duration from 2002 to 2003 was done and the data was divided into three groups: oral hypoglycemic agents (OHA) only, Insulin only, OHA + insulin. ANOVA/Students t test was the primary statistical test used. Odds ratio and 95% CI were calculated to compare risks of other diseases and drug use. 62.35% were on only OHAs, 8.82% on only insulin and 28.82% on both insulin and OHAs. This confirms good efficacy of OHAs. Diabetic population in our study tends to have a preserved beta cell function and secondary OHA failure is a late feature.     

Natural killer cells as a promising tool to tackle cancer—A review of sources,methodologies, and potentials

Immune cell-based therapies are emerging as a promising tool to tackle malignancies, both solid tumors and selected hematological tumors. Vast experiences in literature have documented their safety and added survival benefits when such cell-based therapies are combined with the existing treatment options. Numerous methodologies of processing and in vitro expansion protocols of immune cells, such as the dendritic cells, natural killer (NK) cells, NKT cells, αβ T cells, so-called activated T lymphocytes, γδ T cells, cytotoxic T lymphocytes, and lymphokine-activated killer cells, have been reported for use in cell-based therapies. Among this handful of immune cells of significance, the NK cells stand apart from the rest for not only their direct cytotoxic ability against cancer cells but also their added advantage, which includes their capability of (i) action through both innate and adaptive immune mechanism, (ii) tackling viruses too, giving benefits in conditions where viral infections culminate in cancer, and (iii) destroying cancer stem cells, thereby preventing resistance to chemotherapy and radiotherapy. This review thoroughly analyses the sources of such NK cells, methods for expansion, and the future potentials of taking the in vitro expanded allogeneic NK cells with good cytotoxic ability as a drug for treating cancer and/or viral infection and even as a prophylactic tool for prevention of cancer after initial remission.