Study of p53 and bcl-2 Oncoproteins in Ulcerative Colitis with Dysplasia

Background

Dysplasia in ulcerative colitis has been graded on haematoxylin and eosin stain using Riddle''s criteria. This system was formed to nullify the inter-observer variation. Few cases of early dysplasia were missed when purely screened on morphology. This study was carried out to detect early dysplasia using p53 and bcl-2 oncoproteins.

Methods

A retrospective study was carried out on paraffin blocks of 100 histologically diagnosed cases of ulcerative colitis at a large service hospital. Haematoxylin and Eosin stained (H &E) slides of these cases were re-examined as per standard techniques.

Results

On correlating histological grades with p53 immunoscore it was found that 90.76% of cases graded as negative for dysplasia on H & E, got an immunoscore of 0 and other 9.24% cases which were graded as negative for dysplasia got a score 1+. This shows that the immunohistochemistry was able to pick up 6 cases, which were missed by routine histology. Nine out of 11 cases in which the pathologists could not rule out a dysplasia and graded them as indefinite (probably negative for dysplasia) got a score of 0. In these cases possibly the histological features may be construed as an acute inflammation or repair induced dysplasia which were suspicious for neoplastic dysplasia on routine histology sections. On analyzing our findings on bcl-2 immunohistochemistry it was seen that there was no significant concordance (p>0.05) of immunoscore with the grades of dysplasia estimated morphologically.

Conclusion

Our study recommends that p53 should be used as regular immunohistochemical marker while grading the dysplasia of ulcerative colitis, especially in indefinite cases as it brings objectivity in grading. Our study also came to a conclusion that use of bcl-2 for grading dysplasia of ulcerative colitis is not of any significant help.Key Words: Ulcerative colitis, Dysplasia, p53, bcl-2     

Tracheo-esophageal puncture (TEP) for voice rehabilitation in laryngectomised patients blom-singer® Vs Provox® Prosthesis: Our experience

Background: Stage III and IV cancers of larynx and hypopharynx often require total laryngectomy which leaves the patient with severe communication handicap. In such laryngectomised patients tracheo-esophageal puncture is the best way for voice rehabilitation using either Blom-Singer® prosthesis or Provox® indwelling valve.     

Profile of culture positive enteric fever from bangalore

Background: Enteric fever is endemic in India. The aim of this study was to analyse the clinical, laboratory, antibiotic sensitivity profile and response to antibiotics of culture positive enteric fever patients from Bangalore.     

Ex-servicemen medical aid group (ESMAG) : The hidden force

Natural calamities such as cyclones, floods and earthquakes are common occurrences in the Indian sub continent which require super human effort to contain damage to men and material. Such events put the dedication, endurance capabilities and organizational skills available in the country to a litmus test. It is not surprising therefore, that the Armed Forces are often asked to spearhead the relief work in such disaster situations. So far, the potential for utilization of disciplined and trained exservicemen population for such situations has remained untapped due to the lack of an organizational framework. A concept of tapping this large pool of trained manpower is presented.     

Day Care Surgery in Otolaryngology : a three year Prospective Study

Day care surgery is now an integral part of otolaryngology and is widely practised in the West. But in our military setup it still has to gain popularity. A Day Care Surgical Centre was established at Armed Forces Clinic in 1996. In the period May 1998 to Apr 2001, a total of 752 otolaryngology cases were operated at the centre, of which 474 cases were major and 278 cases were minor. All cases were performed under local anaesthesia supplemented by sedation. Strict patient selection criteria were adopted resulting in a low immediate post-operative complication rate (1.46%). None required admission to hospital for the management of complications. The feasibility of performing otolaryngological surgery on a day care basis is demonstrated, especially in nasal and aural cases. The experience gained shows that high medical standards can be achieved with low resource expenditure. Patient selection criteria and guidelines are suggested.Key Words: Day care, Otolaryngology, Surgery     

Sero-epidemiological and behavioural survey of HIV,HBV and HCV amongst indian armed forces trainees

Background: Information on the emerging epidemics of Human immunodeficiency virus (HIV), Hepatitis B (HBV) and C (HCV) viruses in younger age groups in India is scanty due to paucity of representative, population based surveys and varied estimation methodology. This study was done to assess the point prevalence of HIV, HBV and HCV infections alongwith the epidemiological factors associated with these infections. Attitudes, beliefs and behaviour related to sexual and injecting drug practices, with a view to assess the need for introduction of screening program for the new entrants of the armed forces was also studied.     

Treatment of Casualties in a Forward Hospital of Indian Army : Nine year Experience

Background

To analyze the outcome of the management of casualties in a level II trauma centre of a forward hospital of Armed Forces over a nine year period. Retrospective analysis of all casualties received in a single forward hospital of Indian Army was carried out.

Method

During 9 years (1990-1998), a total of 5737 casualties were received in a single level II zonal hospital of the Army in a forward area. Majority of the injuries were caused by bullets, or by fragments of improvised explosive devices. A policy of aggressive resuscitation and early primary repair of injuries was followed. General surgeons routinely performed craniotomies, thoracotomies, laparotomies, stabilization of fractures by fixators and repair of vascular injuries.

Result

38% of patients had injuries to several body parts (polytrauma), resulting in a total of 8578 injuries. Region-wise distribution of injuries was as follows : 14.2% head and neck injuries, 13.3% chest wounds, 13.5% abdominal injury and 59% extremity wounds. The overall mortality rate was 3.6%. The complication rate was about 7% with infection as the major complication. The results of primary repair of colonic injuries were similar to those of staged repairs. The results after primary closure of war wounds were better than those treated with delayed primary closure in selected cases.

Conclusion

Prompt evacuation, speedy resuscitation and early definitive repair of war injuries results in low mortality and morbidity. A motivated and dedicated team and adequate availability of blood and ancillary services adds to the excellent outcome. The policy of primary repair of colonic and selected soft tissue injuries appears justified in selected cases.Key Words: Casualties, Improvised Explosive Devices, Militancy, Trauma     

Tracheo-esophageal Puncture (TEP) for Voice Rehabilitation in Laryngectomised Patients Blom-singer? Vs Provox? Prosthesis : Our Experience

Background

Stage III and IV cancers of larynx and hypopharynx often require total laryngectomy which leaves the patient with severe communication handicap. In such laryngectomised patients tracheo-esophageal puncture is the best way for voice rehabilitation using either Blom-Singer® prosthesis or Provox® indwelling valve.

Methods

A prospective comparative study of Blom-Singer® prosthesis and Provox® indwelling valves placed in Tracheo-esophageal Punctures (TEP) for voice rehabilitation following total laryngectomy was carried out at the Tata Memorial Hospital, Mumbai and Malignant Diseases Treatment Centre of Armed Forces, to assess their efficacy. This report comprises of our experience in 41 (39 males and two females) laryngtectomees who underwent TEP of which 15 patients were fitted with low pressure Blom-Singer® prostheses and 26 with Provox® indwelling prostheses.

Results

Prostheses related problems like granuloma formation, leakage, candidal growth over the valves and prosthetic decay were significantly less in the patients fitted with Provox® prosthesis. Dislodgement of prosthesis with closure of the tract or persistent fistula formation and creation of false passage, while reinsertion were problems encountered in the Blom-Singer group. After three months, speech assessment revealed a better quality of voice production and patient compliance in maintaining the prosthesis in the case of Provox® indwelling valve.

Conclusion

In Indian scenario where illitracy amongst the patients hinders in maintainence of Blom-Singer® prosthesis, Provox® indwelling value is an appropriate choice for voice rehabilitation.Key Words: Tracheo-esophageal puncture (TEP), Blom-Singer® prosthesis, Provox® Valve