An Evaluation of the Applicability of the Risk of Malignancy Index for Adnexal Masses to Patients Seen at a Tertiary Hospital in Chandigarh, India.

BACK GROUND: The discrimination between benign and malignant ovarian tumors is important considering to optimally plan for an appropriate surgical treatment. AIMS: To determine the applicability of risk of malignancy index (RMI 2) for triaging patients with adnexal masses seen at tertiary care hospital in India. SUBJECTS AND METHODS: A retrospective case note review of patients with adnexal masses admitted in Gynecology department was done. RMI 2 was calculated for each patient using ultrasound score, menopausal status, and CA-125 levels (U/ml), and the value of RMI was compared to the histological diagnosis. Statistical analyses were performed using SPSS version 17.0 by descriptive and inferential statistics. The p value ≤0.05 was considered significant. RESULTS: The Mean age and SD of hundred patients was 52.8 (10) years. Most of the patients were postmenopausal (68/100). A significant relationship of ovarian malignancy was found with increasing age, high ultrasound score, and high serum CA-125. The average value of CA-125 in benign and malignant ovarian tumor was 7.4 and 625, respectively. The RMI 2 at a cut-off value of 200 had a sensitivity of 96.7 %, specificity of 84 %, positive predictive value of 85.5 %, and negative predictive value of 67.7 %. CONCLUSION: Our study confirms the applicability of RMI 2 >200 in diagnosing adnexal masses with high risk of malignancy. It can be easily introduced into clinical practice to facilitate the selection of the patients for surgery and also helpful in triaging patients to different treatment groups.

Ischemic complications after pituitary surgery: a report of two cases.

BACKGROUND: Cerebral ischemic complications after pituitary surgery are not frequently reported. These vascular complications may be related to (1) direct trauma to the vessel wall, (2) compression of the internal carotid artery (ICA) due to pituitary apoplexy, (3) vasospasm secondary to subarachnoid hemorrhage or vasoactive tumor extract, or (4) hypothalamic injury. PATIENTS: We describe two cases where major vessel infarcts occurred after removal of pituitary tumor. One case has repeated episodes of thrombembolism probably due to a internal carotid artery (ICA) dissection triggered by minor intraoperative ICA injury during transsphenoidal excision. The other cases had a late-onset cerebral ischemia due vasospasm of middle cerebral artery after transcranial excision of a large pituitary tumor. RESULT: Both patients had a long hospital stay and were managed successfully with anticoagulant and antiplatelet drugs, aggressive supportive care in the intensive care unit, and rehabilitation. CONCLUSION: These cases highlight two different mechanisms of infarcts after pituitary surgery. The first case highlights the importance of ICA evaluation before surgery in elderly patients with risk factors, such as chronic smoking, hypertension, and atherosclerotic disease. Even minimal manipulation of the ICA can generate a cascade of thrombembolic events in such patients. The second case highlights the importance of observing the patient of a highly vascular giant pituitary adenoma in the hospital for a longer than usual time. Delayed vasospasm can occur like in aneurysmal subarachnoid hemorrhage and have a good outcome if detected early and managed judiciously.

Mortality predictors in severe hyponatraemia in emergency inpatients.

Hyponatraemia, one of the most common electrolyte abnormality when severe (<120 meq/l), has poor prognosis and fatal outcome. Published data on identification of mortality predictors in severe hyponatraemia is however insufficient. The aim of the study was to determine the characteristics, causes and outcome of severe hyponatraemia (<120 meq/l) in hospitalised patients and to identify the mortality predictors. A retrospective case note review of patients (n=175) admitted in emergency ward of a tertiary care hospital during a period of 12 months having severely hyponatraemic (<120 meq/l) were undertaken. Both at the time of admission and those developing during their stay were included. Severe hyponatraemia was found to be common in elderly males. Aetiology was predominantly multifactorial (60.5%), and single aetiologies were mainly, congestive cardiac failure (9.7%), alcoholic liver disease (8.6%) and obstructive airway disease (7.4%). Overall mortality in study group was 25.7%. The mortality was found to be higher (30.8%) in patients developing severe hyponatraemia during hospitalisation as compared to that on admission (24.2%). Mortality was also found to be significantly (p<0.05) higher in patients whose sodium levels were not normalised after treatment. A strong relation between lowest sodium levels rather than admission sodium levels was seen. Severe hyponatraemia (<120meq/l) is a commonly encountered clinical problem, associated with a poor prognosis. The data suggest that outlook in severe hyponatraemia is governed by aetiology and by the serum sodium levels. Identification of mortality predictors should not be overlooked, as correct diagnosis of the aetiology and early recognition of risk factors is critical both to determine correct management and for better prognosis.

NAD(P)H oxidases in coronary artery disease.

Reactive oxygen species (ROS), especially superoxide anion and hydrogen peroxide, are important signaling molecules in cardiovascular cells. ROS participate in growth, apoptosis, and migration of vascular smooth muscle cells, in the modulation of endothelial function, including endothelium-dependent relaxation and expression of proinflammatory phenotype, and in the modification of the extracellular matrix. They have also been linked to hypertension and to pathological states associated with uncontrolled growth and inflammation leading to coronary artery disease (CAD). The NAD(P)H oxidase is a multisubunit enzyme that catalyzes the reduction of molecular oxygen to form superoxide (O2*-). Although first described in phagocytes, NAD(P)H oxidases have also been demonstrated as major sources of superoxide in vascular cells and myocytes. Enhanced superoxide production increases nitric oxide inactivation and leads to an accumulation of peroxynitrites and hydrogen peroxide. An entire new family of NAD(P) H oxidase (Nox) homologs has emerged, which vary widely in cell and tissue distribution as well as in function and regulation. Recent and ongoing research tends to highlight the biochemical characters, activation paradigms, structure, and function of this enzyme. In this review, we provide a brief overview of structural features of NAD(P)H oxidases and then discuss their role in pathophysiology of CAD.

Biochemical effects of irbesartan in experimental diabetic nephropathy.

BACKGROUND: Diabetic nephropathy (DN) is one of the most common causes of end-stage renal failure. The pathogenesis of progressive renal damage is multifactorial and the mechanism by which hyperglycemia causes microangiopathy in diabetic glomeruli is still poorly understood. Because the renin angiotensin system has been reported to be an important contributory factor in the pathophysiology of DN, exogenous administration of angiotensin II receptor antagonist may be beneficial in counteracting some biochemical or functional changes of DN. AIMS: The present study was therefore undertaken to evaluate the preventive role of irbesartan in streptozotocin (STZ)-induced DN in rats. METHODS AND MATERIAL: STZ-induced DN in rats was assessed biochemically by measuring urine volume, protein and electrolytes as well as blood urea and creatinine clearance. RESULTS: Marked hyperglycemia, polyuria, proteinuria and uremia along with a reduction in urine electrolytes and creatinine clearance were observed in STZ diabetic rats. Pre-treatment with irbesartan (20 mg/kg, p.o. 5 days prior to STZ and continued for 16 weeks) also significantly altered these parameters towards normal, except blood glucose. CONCLUSION: Pre-treatment with insulin reversed the parameters of DN. The data suggest that irbesartan prevents the development of STZ-induced DN in rats.

Effect of irbesartan on streptozotocin induced diabetic nephropathy: An interventionary study.

Effect of irbesartan, an angiotensin II receptor antagonist, was studied in streptozotocin (STZ) induced diabetic nephropathy. Polyuria, proteinuria, blood urea, creatinine clearance, and urinary electrolytes were determined to assess kidney damage. There was a significant increase in urine volume, urinary protein and blood urea in STZ induced diabetic rats. On the other hand, irbesartan treatment resulted in a significant reduction in urinary protein and blood urea in these rats. Irbesartan treatment also improved creatinine clearance and exhibited a natriuretic effect in these animals. Results suggest that irbesartan treatment ameliorate STZ induced diabetic nephropathic changes, in rats.