Rosai Dorfman Disease: A Rare Case Report.

To study the presentation and plan of treatment of patient with Rosai Dorfman Disease. Rosai-Dorfman disease(RDD), is rare, non-neoplastic, multisystemic histiocytic disorder. Nodal form is more common. It's self-limiting disorder of unknown etiology. Symptomatic treatment is mainstay. Bardet-Biedl syndrome (BBS) is rare ciliopathic, autosomal-recessive disorder, affecting multiple organs. Characterized by marked central obesity, retinal dystrophy, polydactyly, mental retardation, hypogonadism and renal dysfunction. Treatment is symptomatic with hormone supplementation & regular follow-ups. 10 year male presented with swelling over left side of neck and intermittent fever since 2 years, diminished vision in night since 5 years. History of similar complaints on right side 5 years back. Fine needle aspiration cytology(FNAC)-features consistent with Rosai Dorfman Disease. Examination showed short stature, squint eyes, polydactyly. Multiple palpable neck nodes of variable sizes. Ophthalmic evaluation showed Retinitis Pigmentosa. Paediatric consultation for syndromic evaluation, features were consistent with Bardet Biedel syndrome. Since the presentation is same as that of opposite side in past, because of recurrence of symptoms even with regular antibiotic and steroid therapy, and no local recurrence of disease on right side, surgical excision is planned for the patient. Rosai-Dorfman disease and Bardet-Biedl syndrome are rare disorders presenting many diagnostic and therapeutic challenges. High degree of clinical suspicion (RDD & BBS) with typical histopathological features (RDD) are diagnostic. Symptomatic treatment is useful and surgical excision can be done for recurrent/ complicated cases of RDD while symptomatic treatment with regular follow-up for BBS.

Understanding the role of keratins 8 and 18 in neoplastic potential of breast cancer derived cell lines.

BACKGROUND: Breast cancer is a complex disease which cannot be defined merely by clinical parameters like lymph node involvement and histological grade, or by routinely used biomarkers like estrogen receptor (ER), progesterone receptor (PGR) and epidermal growth factor receptor 2 (HER2) in diagnosis and prognosis. Breast cancer originates from the epithelial cells. Keratins (K) are cytoplasmic intermediate filament proteins of epithelial cells and changes in the expression pattern of keratins have been seen during malignant transformation in the breast. Expression of the K8/18 pair is seen in the luminal cells of the breast epithelium, and its role in prognostication of breast cancer is not well understood. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we have modulated K8 expression to understand the role of the K8/18 pair in three different breast epithelium derived cell lines: non-transformed MCF10A, transformed but poorly invasive MDA MB 468 and highly invasive MDA MB 435. The up-regulation of K8 in the invasive MDA MB 435 cell line resulted in a significant decrease in proliferation, motility, in-vitro invasion, tumor volume and lung metastasis. The down-regulation of K8 in MDA MB 468 resulted in a significant increase in transformation potential, motility and invasion in-vitro, while MCF10A did not show any changes in cell transformation assays. CONCLUSIONS/SIGNIFICANCE: These results indicate the role of K8/18 in modulating invasion in breast cancer -its presence correlating with less invasive phenotype and absence correlating with highly invasive, dedifferentiated phenotype. These data may have important implications for prognostication of breast cancer.

Evaluation of Caesalpinia bonduc seed coat extract for anti-inflammatory and analgesic activity.

In the present work, Caesalpinia bonduc seed coat extract (CBSCE) has been evaluated for anti-inflammatory and analgesic activity C. bonduc seeds have been attributed with anti-inflammatory and analgesic properties in the folklore medicine. Here in our study, we have tried to carry out the systematic evaluation of the seed coat extract of C. bonduc to substantiate these claims. C. bonduc seed coat was extracted with 95% ethanol and concentrated; further, the extract was screened for anti-inflammatory and analgesic activity. The studies were carried using Carrageenan-induced Paw Edema, Egg albumin-induced paw edema, Eddy's Hot Plate Test, Tail Immersion Method so as to prove acclaimed properties. The data was analyzed statistically by Students' 't' test. The results indicate that seed coat extract has the ability to decrease the induced inflammation at varied doses in Carrageenan model as well as in the Egg albumin model in rats. The antinociceptive results indicate that the extract has the ability to increase the pain threshold of the animals and reduce the pain factor, thereby inducing analgesia. Thus, it can be concluded that CBSCE posses analgesic and anti-inflammatory activity.

Fascin overexpression promotes neoplastic progression in oral squamous cell carcinoma.

BACKGROUND: Fascin is a globular actin cross-linking protein, which plays a major role in forming parallel actin bundles in cell protrusions and is found to be associated with tumor cell invasion and metastasis in various type of cancers including oral squamous cell carcinoma (OSCC). Previously, we have demonstrated that fascin regulates actin polymerization and thereby promotes cell motility in K8-depleted OSCC cells. In the present study we have investigated the role of fascin in tumor progression of OSCC. METHODS: To understand the role of fascin in OSCC development and/or progression, fascin was overexpressed along with vector control in OSCC derived cells AW13516. The phenotype was studied using wound healing, Boyden chamber, cell adhesion, Hanging drop, soft agar and tumorigenicity assays. Further, fascin expression was examined in human OSCC samples (N = 131) using immunohistochemistry and level of its expression was correlated with clinico-pathological parameters of the patients. RESULTS: Fascin overexpression in OSCC derived cells led to significant increase in cell migration, cell invasion and MMP-2 activity. In addition these cells demonstrated increased levels of phosphorylated AKT, ERK1/2 and JNK1/2. Our in vitro results were consistent with correlative studies of fascin expression with the clinico-pathological parameters of the OSCC patients. Fascin expression in OSCC showed statistically significant correlation with increased tumor stage (P = 0.041), increased lymph node metastasis (P = 0.001), less differentiation (P = 0.005), increased recurrence (P = 0.038) and shorter survival (P = 0.004) of the patients. CONCLUSION: In conclusion, our results indicate that fascin promotes tumor progression and activates AKT and MAPK pathways in OSCC-derived cells. Further, our correlative studies of fascin expression in OSCC with clinico-pathological parameters of the patients indicate that fascin may prove to be useful in prognostication and treatment of OSCC.

Prognostic value of tissue polypeptide antigen in oral squamous cell carcinoma.

Human oral cancer has a high risk of locoregional relapse which is difficult to diagnose early due to lack of prognostic markers. We and others have shown aberrant expression of cytokeratin (CK) 8 and 18 in human oral cancer. Aberrant supra-basal expression of CK19 has been shown earlier. In this study, our aim was to develop a non-invasive test for prognostication of human oral cancer. Immunoradiometric assay (IRMA) was used to measure the circulating levels of TPA in the sera of 80 oral cancer patients before surgery and seven days after surgery. Elevated serum TPA levels were noted in the post surgery samples of 28 out of the 50 patients for whom clinical follow-up was available, as compared to their pre-surgery samples. TPA levels in the pre-surgery serum samples of patients were significantly higher than levels in the sera of healthy controls (p=0.001). Elevated levels in patients correlated significantly with stage (p=0.02), development of recurrence (p<0.006), and impacted survival (p<0.033). IHC analysis showed statistically significant correlation between expression of CK8, 18 and 19 in surrounding uninvolved tissues of the tumour and post surgery elevated serum TPA levels (p<0.001). This suggests the possibility that CK fragments are released from the surrounding uninvolved tissues into the sera of patients after surgical removal of the tumour. Thus, our study indicates that TPA can be a useful tumour marker for the prediction of recurrence and poor prognosis in human oral cancer.

Nasogastric tube insertion using different techniques in anesthetized patients: a prospective, randomized study.

BACKGROUND: It is often difficult to correctly place nasogastric (NG) tubes under anesthesia. We hypothesized that simple modifications in technique of NG tube insertion will improve the success rate. METHODS: Two hundred patients were enrolled into the study. The patients were randomized into four groups: control, guidewire, slit endotracheal tube, and neck flexion with lateral neck pressure. The starting point of the procedure was the time when NG tube insertion was begun through the selected nostril. The end point was the time when there was either a successful insertion of the NG tube or a failure after two attempts. The success rate of the technique, duration of insertion procedure, and the occurrence of complications (bleeding, coiling, kinking, and knotting, etc.) were noted. Chi2, analysis of variance, and Student's t-test were used to analyze the data. RESULTS: Success rates were higher in all intervention groups compared with the control group. The time necessary to insert the NG tube was significantly longer in the slit endotracheal tube group. Kinking of the NG tube and bleeding were the most common complications. CONCLUSION: The success rate of NG tube insertion can be increased by using a ureteral guidewire as stylet, a slit endotracheal tube as an introducer, or head flexion with lateral neck pressure. Head flexion with lateral neck pressure is the easiest technique that has a high success rate and fewest complications.

Comparative study of postoperative analgesia and sedation after upper abdominal surgery with thoracic epidural administration of bupivacaine with/without midazolam.

Currently continuous epidural administration of local anaesthetics with opioids is widely used for postoperative analgesia. To avoid the side-effects of opioids a drug that can replace opioids is most welcome. Midazolam not only has no side-effects but also has the advantages of sedation and amnesia. In a prospective randomised clinical study ASA class 1 or 2 patients undergoing upper abdominal surgeries were studied to compare the analgesic and sedative effect of continuous thoracic epidural infusion of bupivacaine versus continuous thoracic epidural administration of bupivacaine with midazolam postoperatively. They were divided into 2 groups. Via thoracic epidural route patients in group A (n = 24) were given 60 ml of 0.25% bupivacaine while those in group B (n = 25) were given 58 ml of 0.25% bupivacaine + midazolam 2 ml (10 mg). Each patient was infused using a syringe pump at the rate of 5 ml/hour. Variables studied postoperatively were pulse, BP, RR, SpO2, analgesia score and sedation score. Statistically significant differences in pulse, BP, RR and SpO2 were not seen. Better sedation, analgesia scores and amnesia were noted in patients belonging to group B as compared to patients of group A. This combination may thus replace routinely used combinations of opioids and local anaesthetics.

Efficacy of cuff inflation media to prevent postintubation-related emergence phenomenon: air, saline and alkalinized lignocaine.

BACKGROUND AND OBJECTIVE: We wished to examine the efficacy of different media used for inflation of tracheal tube cuffs. METHODS: In our prospective randomized, controlled study over 3 months, there were 150 patients of either sex undergoing surgery under general anaesthesia with controlled ventilation with nitrous oxide and oxygen. The patients were divided into three equal groups (air, isotonic saline and alkalinized lignocaine as inflation media) using sealed envelope technique. The volume of the inflation medium, intracuff pressure, duration of intubation, volume of the inflation medium withdrawn from the cuff and complications like tube intolerance, coughing on tube, restlessness, hoarseness, sore throat, breathlessness and laryngospasm were analysed. Continuous data are presented as mean +/- SD, whereas categorical data are presented as frequencies and percentages. A [chi]2, analysis of variance and student's t-test were used to analyse the data. A P value less than 0.05 was considered as statistically significant. RESULTS: Age, sex, duration of intubation, intracuff pressure at the time of intubation were comparable. After intubation at all intervals, the intracuff pressure was higher in the air group with statistical significance at 5 min, 30 min, 1 h and just before extubation when air and saline groups were comparable and at all intervals after intubation up to just before extubation when air and lignocaine groups were comparable. The volume of air increased just before extubation in the air group, as compared with a fall in volume in the other groups. Tube intolerance, hoarseness and sore throat were least in the lignocaine group. CONCLUSION: We found that alkalinized 2% lignocaine and saline are better cuff inflation media, than air.