High incidence of oesophageal and gastric cancer in Kashmir in a population with special personal and dietary habits.

Over a three year period (1 July 1986 to 30 June 1989) all newly diagnosed and histologically proved cases of oesophageal and gastric cancer were recorded prospectively. Some 1515 cases of oesophageal cancer (1050 men and 465 women) and 966 cases of gastric cancer (789 men and 177 women) were registered. Seven patients had simultaneous oesophageal and gastric cancer. Age standardised incidence rates for oesophageal cancer were: men 43.6/100,000 per year; women 27.9/100,000 per year. The rates for gastric cancer were: men 36.7/100,000 per year, women 9.9/100,000 per annum. These figures were three to six times higher than those recorded by cancer registries in Banglore, Madras, and Bombay. The incidence rates for oesophageal and gastric cancer in Islamabad (southern district of Kashmir) were 4.1 to 5.4 times higher in men and 1.5 to 2.0 times higher in women than those for Kupwara (northern district of Kashmir). The incidence rates for oesophageal and gastric cancer in Muslims, Hindus, and Sikhs were different. The epidemiology of oesophageal cancer in Kashmir was similar to that found in the 'Asian oesophageal cancer belt'. At the same time Kashmir also had an unprecedented high incidence of gastric cancer. Kashmiries have special personal and dietary habits. Further studies are needed to define the relation between these habits and the occurrence of oesophageal and gastric cancer.     

Serum sialic acid levels in healthy individuals

Serum sialic acid values, estimated by thiobarbituric acid method of Warren as modified by Saifer and Gerstenfeld in 50 normal healthy persons of both sexes are reported. The average values were 68.47 +/- 4.85 mg% and 67.77 +/- 7.87 mg% for males and females respectively and for both sexes the value was 68.12 +/- 6.70 mg%. Age and sex have no influence on sialic acid levels in serum.     

Identification of a Strong Promoter of Bacteriophage MB78 that Lacks Consensus Sequence Around Minus 35 Region and Interacts with Phage Specific Factor

A strong promoter of bacteriophage MB78 does not have minus 35 consensus sequence although it has a TGn motif immediately upstream of minus 10 sequence as well as the AT rich UP element. It is efficiently recognised by the sigma 70 RNA polymerase, however, a phage-specific factor competes with sigma 70 RNA polymerase for binding to this region, the binding of the factor being stronger than that of the polymerase. Contrary to the reports in the literature the polymerase appears not to bind to the UP element whereas the phage-specific factor does. The latter seems to be involved in the regulation of the promoter activity. This revised version was published online in July 2006 with corrections to the Cover Date.     

Hydatid cyst of the pancreas

A rare case of hydatid cyst of the pancreas is reported. Although ultrasonography and computerised tomography scan confirmed the presence of a cystic mass in the body and tail of the pancreas, diagnosis was made only on laparotomy. A distal pancreatectomy was done and the diagnosis of hydatid cyst of the pancreas was confirmed by histopathology. Though very rare, pancreatic hydatidosis should be considered in the differential diagnosis of cystic lesions of the pancreas in the appropriate epidemiological setting.     

Ingestion of Strong Corrosive Alkalis: Spectrum of Injury to Upper Gastrointestinal Tract and Natural History

We have prospectively studied 31 patients who ingested strong alkalis for location, extent, severity, and outcome of the injury to the upper gastrointestinal tract. Alkalis ingested were sodium hydroxide (n = 28) and potassium hydroxide (n = 3). The injury was assessed within 36 h of alkali intake by endoscopy or surgery, or at autopsy. Symptoms and signs did not give a reliable forecast of the extent and severity of injury. The corrosive burns were classified as grade 2a in six patients, grade 2b in eight, and grade 3 in 17. The esophagus was injured in all patients, the stomach in 93.5%, and the duodenum in 29.6%. Acute complications occurred in 32.3% of the patients and death in 12.9%; all but one of such patients had grade 3 burns. All patients with 2a injury recovered without sequelae. Four of the eight patients with grade 2b injury and all survivors of grade 3 injury developed esophageal or gastric cicatrization, or both, which needed endoscopic or surgical treatment. We find endoscopy is not only a safe and reliable tool for diagnosis in such patients, but also is of importance in treatment and prognosis. We conclude that ingestion of strong alkalis is a very serious condition that inflicts severe contiguous injury to the esophagus and stomach and results in high morbidity and mortality.     

Laparoendoscopic single‐site (LESS) vs laparoscopic living‐donor nephrectomy: a systematic review and meta‐analysis

The aim of this study was to provide a systematic review and meta‐analysis of reports comparing laparoendoscopic single‐site (LESS) living‐donor nephrectomy (LDN) vs standard laparoscopic LDN (LLDN). A systematic review of the literature was performed in September 2013 using PubMed, Scopus, Ovid and The Cochrane library databases. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta‐analyses criteria. Weighted mean differences (WMDs) were used to measure continuous variables and odds ratios (ORs) to measure categorical ones. Nine publications meeting eligibility criteria were identified, including 461 LESS LDN and 1006 LLDN cases. There were more left‐side cases in the LESS LDN group (96.5% vs 88.6%, P < 0.001). Meta‐analysis of extractable data showed that LLDN had a shorter operative time (WMD 15.06 min, 95% confidence interval [CI] 4.9–25.1; P = 0.003), without a significant difference in warm ischaemia time (WMD 0.41 min, 95% CI –0.02 to 0.84; P = 0.06). Estimated blood loss was lower for LESS LDN (WMD ?22.09 mL, 95% CI –29.5 to –14.6; P < 0.001); however, this difference was not clinically significant. There was a greater likelihood of conversion for LESS LDN (OR 13.21, 95% CI 4.65–37.53; P < 0.001). Hospital stay was similar (WMD –0.11 days, 95% CI –0.33 to 0.12; P = 0.35), as well as the visual analogue pain score at discharge (WMD –0.31, 95% CI –0.96 to 0.35; P = 0.36), but the analgesic requirement was lower for LESS LDN (WMD –2.58 mg, 95% CI –5.01 to –0.15; P = 0.04). Moreover, there was no difference in the postoperative complication rate (OR 1.00, 95% CI 0.65–1.54; P = 0.99). Renal function of the recipient, as based on creatinine levels at 1 month, showed similar outcomes between groups (WMD 0.10 mg/dL, –0.09 to 0.29; P = 0.29). In conclusion, LESS LDN represents an emerging option for living kidney donation. This procedure offers comparable surgical and early functional outcomes to the conventional LLDN, with a lower analgesic requirement. However, it is more technically challenging than LLDN, as shown by a greater likelihood of conversion. The role of LESS LDN remains to be defined.