Association of Chest Pain with Rate Pressure Product and ST-segment Changes after Sub Arachnoid Block in Caesarean Section.

When healthy women undergo caesarean section (CS) under sub arachnoid anaesthesia, transient electrocardiographic changes, such as ST-segment depression and T-wave abnormalities, are observed. During an elective caesarean section under sub arachnoid anaesthesia, about one-third of healthy parturient experience chest pain and ECG changes suggestive of myocardial ischemia. To assess the ST-segment and Rate Pressure Product changes with chest pain in patients with elective caesarean section under subarachnoid block. The Department of Anesthesia, Analgesia and Intensive Care Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh was the site of this prospective observational study. The study included 86 healthy women between the ages of 20 and 35 who needed an elective caesarean section under a single shot sub arachnoid block and who visited the Department of Anesthesia, Analgesia, and Intensive Care Medicine at BSMMU in Shahbagh, Dhaka from January 2019 to June 2019. In comparison to the no chest pain group, ST-segment changes among the chest pain group at delivery, 5 minute, 10 minute after delivery and at the end of the surgery were highly significant (p=0.001). Comparatively, Rate Pressure Product changes were found to be significantly higher in the group with chest pain than in the group without chest pain (p=0.001). It is concluded that there is a substantial association of chest pain with rate pressure product and ST-segment changes after subarachroid block in caesarean section.

Magnetic Resonance Imaging Evaluation of Common Spinal Intramedullary Tumours: Ependymoma and Astrocytoma.

This cross-sectional study was carried out in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January 2015 to June 2016 in collaboration with Department of Neurosurgery and Department of Pathology of same hospital, to assess MRI findings of common IMSCTs and to find out the validity of MRI in the diagnosis of spinal ependymoma and astrocytoma, thereby differentiating these two common intramedullary entities. For this purpose, 40 patients aged from 15 to 60 years, who were diagnosed or suspected cases of having intramedullary spinal cord tumours were enrolled. These patients underwent preoperative MRI for evaluation of the spinal cord tumours during the study period in department of Radiology and Imaging. Also, patients were diagnosed by MRI as having IMSCTs incidentally was included. All of them were followed by histopathological examination of the same lesions after surgery. Among these 40 patients after exclusion for valid reason 28 cases were included as study population. MR images were obtained on a 1.5 Tesla (Avanto Magnatom, Siemens) unit with a spine surface coil. MRI findings were compared with histopathology after surgery keeping histopathology as gold standard. Out of 28 clinically and MRI diagnosed IMSCTs cases, 19 cases of ependymoma, 8 cases of astrocytoma and one diagnosed as hemangioblastoma by MRI. The mean age was 34.11±9.55 years, ranging from 15 to 56 years for ependymoma, 26.88±8.08 years ranging from 16 to 44 years for astrocytoma. Highest incidence (47.4%) was in between 31 to 40 years for ependymoma, 50.0% were in between 21-30 for Astrocytoma. On MRI majority 12(63.2%) of the cord ependymomas and majority 5(62.5%) of astrocytomas were in cervical region. While considering axial location ependymomas are mostly 17(89.5%) central and astrocytomas 5(62.5%) are eccentric in location. It was observed that out of 19 cases of ependymoma more than half 10(52.6%) had elongated shape, 12(63.1%) had well defined margin. Associated syringohydromyelia was present in 16(84.2%) cases. On T1WI 11(57.9%) and 8(42.1%) cases were iso and hypo respectively. On T2WI 14(73.7%) cases were hyper intense. After Gd-DTPA in most cases, 13(68.4%) cases showed diffuse enhancement. Noticeable and sizeable solid component observed among 13(68.4%) of the cases. Hemorrhage with cap sign was found in more than one third 7(36.8%) cases. Out of 8 cases of astrocytomas 4(50.0%) had lobulated shape, ill-defined margin 5(62.5%). T1WI: Iso 5(62.5%), hypo 3(37.5%), T2WI: hyper 5(62.5%), After Gd-DTPA: focal and heterogenous enhancement 3(37.5%) and rim enhancement 4(50.0%). Component: mixed 4(50.0%), cystic 3(37.5%) and solid 1(12.5%). Hemorrhage without cap sign 2(25.0%), associated syringohydromyelia 1(12.5%). In the case of evaluation of intramedullary ependymoma sensitivity of MRI in the present series is 94.44%, specificity 80.0%, Positive predictive value (PPV) 89.5%, Negative predictive value (NPV) 88.9% and accuracy 89.28%. In case of MRI evaluation of intramedullary astrocytoma sensitivity of MRI in the present study is 85.71%, specificity 90.47%, PPV 75%, NPV 95% and accuracy 89.2%. Thus present study shows MRI is a sensitive and effective noninvasive imaging modality in diagnosing common intramedullary spinal cord tumours.

Dexmedetomidine as an Adjuvant to Bupivacaine in Caudal Analgesia in Children Undergoing Infra-Umbilical Surgery.

When performing infra-umbilical procedures, caudal epidural analgesia with bupivacaine is frequently used to provide both intra- and post-operative analgesia. Dexmedetomidine, an alpha 2 agonistsare extensively used in neuraxial blocks and peripheral nerve blocks to prolong the action of bupivacaine. To find out the effects of dexmedetomidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing infra-umbilical surgery. This was a randomized, controlled double-blinded prospective observational study and was performed from July 2019 to December 2019. A total of 60 (Sixty) patients with different infra-umbilical surgical problems underwent different procedure under caudal anaesthesia in different operation theatre in Bangabandhu Sheikh Mujib Medical University, Dhaka were enrolled in this study. Elaborate personal history, meticulous clinical examinations and relevant laboratory investigations was done. Post-operative adverse effects also were monitored. All information from history of illness, clinical, laboratory findings, duration of analgesia and post-operative adverse effects were recorded in a preformed data sheet (Appendix-I) and statistical analysis was done by SPSS 22.0. Mean age of the children in Group A (dexmedetomidine + bupivacaine) was 5.50±2.61 years and in Group B (bupivacaine) was 5.66±2.75. Mean weight of the children in Group A was 19.22±8.58 kg and in Group B was 19.70±8.94 kg in this study. Mean duration of anaesthesia was 27.5±6.5 minute in Group A and 28.5±5.5 minute in Group B. The mean duration of analgesia was 4.32±0.54 hours for Group A and 2.12±0.32 hours in Group B. In Group A, 46.7% patients required 1 and 3.3% required 2 rescue analgesic but in Group B, 43.3% patients required single rescue analgesic and 33.3% required two rescue analgesics (p<0.05). In Group A, 6.7% patients had nausea/ vomiting and in Group B, 16.7% patients had nausea/ vomiting (p>0.05). It can be concluded that dexmedetomidine with bupivacaine for caudal analgesia in infra-umbilical surgery significantly prolongs the duration of postoperative analgesia when compared to bupivacaine alone without any side-effects.

Diagnostic Accuracy of Magnetic Resonance Imaging in Evaluation of Anterior Cruciate Ligament Tear.

The anterior cruciate ligament (ACL) is the most generally injured one of the major knee ligaments. These injuries plague both athletes and non-athletes. This cross-sectional and comprehensive study was conducted in the Department of Radiology and Imaging collaborating with Department of Orthopedics of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, completed from January 2014 to December 2015. The study evaluated the role of MRI in the diagnosis of anterior cruciate ligament injury of knee joint, keeping Arthroscopy as standard, compared the MRI and arthroscopic findings to determine accuracy, sensitivity and predictivity of MRI in the diagnosis of ACL injury in knee joint. For this purpose, a total of 50 patients having clinical suspicion of ACL injury in knee joint were enrolled in this study to perform MRI and Arthroscopy. MRI was done in all these patients. Clinically suspected but MRI diagnosed as no ACL injury, patients who were not willing to undergo arthroscopy examination and patient who were not fit for arthroscopy were excluded from the study. More than half (52.0%) of the patients were in 3rd decade and male to female ratio was 3.5:1. Less than one fourth (24.0%) of the patients were service holder. Forty two percent patients had duration of suffering for 2 weeks. Most 49(98.2%) patients had history of trauma, 45(90.0%) had pain in Knee joint, 24(48.0%) had difficulty in walking, 19(38.0%) had swelling in Knee joint and 13(26.0%) had restricted range of motion. Anterior drawer test was 37(74.0%) and Lachman test 16(32.0%). Loss of normal contour of ACL was found in 50.0%. Signal change of ACL in PD and T2W1 was found 42(84.0%) patients, and thickened ACL in 33(66.0%) patients. In MRI diagnosis tear was present in 80.0% of the patients. ACL tear diagnosed by MRI among the patients, 20(40.0%) had partial tear and 20(40.0%) had complete tear. In arthroscopy diagnosis 38(76.0%) had tear present. ACL tear diagnosed by arthroscopy of the patients 15(30.0%) had partial tear and 23(46.0%) had complete tear. Majority 20(40.0%) patients had medial meniscus injury, 15(30.0%) had lateral meniscus injury, 11(22.0%) had PCL injury, 4(8.0%) had lateral co-lateral ligament injury and 2(4.0%) had medial co-lateral ligament injury. In MRI diagnosis of anterior cruciate ligament tear, 37 cases were true positive, three cases false positive, one case false negative and nine cases was true negative. The validity of MRI diagnosis evaluation for anterior cruciate ligament tear was 97.4% sensitivity, 75.0% specificity, 92.0% accuracy, 92.5% positive predictive values and 90.0% negative predictive values.

Doppler Evaluation of Carotid Vessels in Type 2 Diabetes.

Type 2 diabetes considered as a compound of metabolic syndrome. It can cause both micro and macrovascular complications. Diabetes is a strong risk factor in the development of atherosclerosis and likewise carotid artery disease. Carotid artery stenosis may cause stroke. Doppler ultrasound is the most common imaging technique for the diagnosis of carotid disease. Objective of the study was to assess the percentage of atherosclerotic carotid disease in asymptomatic Type 2 diabetics (T2D) by Doppler sonography and to find out the association of different risk factors of diabetic patient with atherosclerosis. A cross sectional study was done. A total of 43 type 2 diabetic patients (27 male, 16 female) referred from the out patient department and admitted patients in Mymensingh Medical College Hospital (MMCH) during January 2017 to December 2017 for the purpose of evaluation of intima media thickness (IMT) and carotid artery stenosis by Duplex color Doppler ultrasonography examination were enrolled in this study. Patients with previous history of recent stroke or transient ischemic attack (<6 weeks), history of carotid surgery or cervical radiotherapy were excluded. Carotid artery disease was found 65.1% in asymptomatic type 2 diabetics. Among them increased IMT in 48.8% and carotid stenosis was present in 37.2% and >50% stenosis (Peak systolic velocity >125cm/sec) was present in 9.3%. Age >50% years, smoking, duration of DM >10 years, hypertension, history of ischaemic heart disease and history of diabetic retinopathy were found to be associated with carotid atherosclerosis as well as carotid stenosis. High percentage of carotid artery disease (65.1%) was found in asymptomatic type 2 diabetes mellitus. This result suggests the need for carotid Doppler evaluation of all Type 2 diabetics as a first measure of stroke prevention, with the hope that timely intervention might avert stroke and its accompanying disability.

Diagnostic Evaluation of Isotropic 3D MRCP Images in the Diagnosis of Cholangiocarcinoma.

This is a cross sectional study to establish that Magnetic resonance cholangiopancreatography (MRCP) could be accepted as the most effective imaging modality for the diagnosis of cholangiocarcinoma. Cholangiocarcinoma is the most common malignant tumor of the bile duct. It is much less common than hepatocellular carcinoma, accounting for 5-30% of all hepatic malignancies. Clinically suspected patients with obstructive jaundice due to cholangiocarcinoma were referred to the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study was carried out in 60 patients, of which 38(63%) were male and 22(37%) were female. Out of 60 cases 56 cases were truly diagnosed by MRCP, 4 were normal, among these 1 case was diagnosed as cholangiocarcinoma as compared with histopathology. Forty four (44) patients (73.2%) of the patients were in sixth decade of life. The overall sensitivity and specificity were found to be 98.2% and 75%. The diagnostic accuracy was 96.7% & positive predictive value was about 98%.

Variation in the Position and Diameter of Basilar Artery in Different Ages of Bangladeshi People.

Basilar artery is formed by the fusion of right and left vertebral artery and terminates as right and left posterior cerebral arteries. The aim of the study is to observe the diameter of basilar artery at three different levels (at its formation, at its midlevel and at its termination). This cross sectional descriptive study was performed on total 60 postmortem human hindbrain to find out the variation of position and diameter of the basilar artery of Bangladeshi people in relation to age. The specimens were collected from morgue in the department of Forensic Medicine, Mymensingh medical College, Mymensingh, Bangladesh by purposive sampling technique. All the specimens were grouped into four categories: Group A (20 to 29 years), Group B (30 to 39 years), Group C (40 to 49 years) and Group D (50 to 59 years). Diameter of basilar artery was measured with the help of digital slide calipers at three different levels. At the level of its formation, mean±SD diameter was 3.76±0.37 mm, 3.75±0.32 mm, 3.68±0.24 mm & 3.54±0.46 mm in Group A, B, C & D respectively. At mid-level, it was 3.49±0.36 mm, 3.48±0.30 mm, 3.45±0.21 mm & 3.36±0.44 mm in Group A, B, C & D respectively. At the termination, it was 3.55±0.35 mm, 3.51±0.30 mm, 3.48±0.22 mm & 3.38±0.38 mm in Group A, B, C & D respectively. This knowledge of variations of the diameter of basilar artery is of diagnostic importance for the neurosurgeons and radiologists for clinical investigation and surgery.

Effect of increasing body condition on oxidative stress and mitochondrial biogenesis in subcutaneous adipose tissue depot of nonlactating dairy cows.

With the onset of lactation, dairy cows with a body condition score >3.5 are sensitive to oxidative stress and metabolic disorders. Adipose tissue (AT) can adapt to varying metabolic demands and energy requirements by the plasticity of its size during lactation. In AT, angiogenesis is necessary to guarantee sufficient oxygen and nutrient supply for adipocytes. Cellular energy metabolism is reflected mainly by mitochondria, which can be quantified by the mitochondrial DNA copy number per cell. In the present study, we aimed to investigate the effect of overconditioning on angiogenesis and mitochondrial biogenesis in AT of nonlactating cows, irrespective of the physiological influences of lactation and pregnancy. Eight nonpregnant, nonlactating cows received a ration of increasing energy density for 15 wk, during which body weight and body condition increased substantially. Subcutaneous AT was biopsied every 8 wk, and blood was sampled monthly. The blood concentrations of indicators of oxidative stress increased continuously throughout the experimental period, possibly damaging mitochondrial DNA. Concomitantly, HIF-1α, a major marker for hypoxia, increased until wk 8, indicating insufficient angiogenesis in the rapidly expanding AT. Based on the observation that the number of apoptotic cells decreased with increasing hypoxia, the increasing mitochondrial DNA copy numbers might compensate for the hypoxia, reinforcing the production of oxidative stressors. Key transcription factors of mitochondrial biogenesis were largely unaffected. Thus, increased oxidative stress does not impair mitochondrial DNA.

Tumoricidal activity of low-energy 160-KV versus 6-MV X-rays against platinum-sensitized F98 glioma cells.

The purposes of this study were (i) to investigate the differences in effects between 160-kV low-energy and 6-MV high-energy X-rays, both by computational analysis and in vitro studies; (ii) to determine the effects of each on platinum-sensitized F98 rat glioma and murine B16 melanoma cells; and (iii) to describe the in vitro cytotoxicity and in vivo toxicity of a Pt(II) terpyridine platinum (Typ-Pt) complex. Simulations were performed using the Monte Carlo code Geant4 to determine enhancement in absorption of low- versus high-energy X-rays by Pt and to determine dose enhancement factors (DEFs) for a Pt-sensitized tumor phantom. In vitro studies were carried out using Typ-Pt and again with carboplatin due to the unexpected in vivo toxicity of Typ-Pt. Cell survival was determined using clonogenic assays. In agreement with computations and simulations, in vitro data showed up to one log unit reduction in surviving fractions (SFs) of cells treated with 1-4 µg/ml of Typ-Pt and irradiated with 160-kV versus 6-MV X-rays. DEFs showed radiosensitization in the 50-200 keV range, which fell to approximate unity at higher energies, suggesting marginal interactions at MeV energies. Cells sensitized with 1-5 or 7 µg/ml of carboplatin and then irradiated also showed a significant decrease (P < 0.05) in SFs. However, it was unlikely this was due to increased interactions. Theoretical and in vitro studies presented here demonstrated that the tumoricidal activity of low-energy X-rays was greater than that of high-energy X-rays against Pt-sensitized tumor cells. Determining whether radiosensitization is a function of increased interactions will require additional studies.

Oncolytic viruses in head and neck cancer: a new ray of hope in the management protocol.

This paper intends to highlight the different types of oncolytic viruses (OVs), mechanism of tumor specificity, its safety, and various obstacles in the design of treatment and combination therapy utilizing oncotherapy. Search was conducted using the internet-based search engines and scholarly bibliographic databases with key words such as OVs, head and neck cancer, viruses, oral squamous cell carcinoma, and gene therapy. Revolutionary technologies in the field of cancer treatment have gone through a series changes leading to the development of innovative therapeutic strategies. Oncolytic virotherapy is one such therapeutic approach that has awaited phase III clinical trial validation. OVs are self-replicating, tumor selective and lyse cancer cells following viral infection. By modifying the viral genome, it is possible to direct their toxicity toward cancer cells. Viruses that are used for treatment of head and neck cancer are either naturally occurring or genetically modified. OVs are tumor selective and potential anticancer agents. Virotherapy may become the standard of care and part of combination therapy in the management of head and neck cancer in the future.

Sonographic evaluation of thyroiditis with color flow study.

This cross sectional study was carried out in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University, Bangladesh in collaboration with the Department of Endocrinology and Department of Histopathology of the same hospital during the period of March 2007 to February 2008 to determine efficacy of ultrasonogram in the evaluation of thyroiditis and to compare its results with color flow Doppler study. For this purpose, a total of 50 patients having clinical suspicion of thyroiditis were enrolled in this study. Ultrasound and color Doppler were done in all these patients. Then all patients underwent for FNAC in the Histopathology department. Correlation between sonographic diagnosis and histopathological diagnosis were observed. Out of these 50 patients 10(20%) were male and 40 (80%) were female with age ranging from 12 to 50 years, highest between 21 to 30 years. The mean age of the patients was 30.42±9.57 years. On unltrasonographic findings of thyroid gland 42.0% patients had regular and 58.0% had irregular margin. Seventy percent had fibrosis, 14.0% had feature of necrosis, 48.0% had lymphadenopathy. Out of all patients 6.0% had normal echogenic feature, 16.0% had increased and 78.0% decreased echogeneic feature. Twelve percent (12.0%) patients had homogeneous and 88.0% had heterogeneous pattern of echogenecity. Thirty eight percent (38%) patients had focal nodules. Sixty percent (60.0%) patients had focal swelling and 40.0% had diffuse swelling. On color flow Doppler 28.0% had normal, 38.0% had increased and 34.0% decreased vascular flow pattern. USG reports revealed that 48.0% had thyromegaly, 36.0% had thyroid nodule, 10.0% had multinodular goiter and 6.0% had thyroid abscess. FNAC diagnosis revealed that 34.0% patients had Hashimoto's thyroiditis, 24.0% had lymphocytic thyroiditis, 18.0% had granulomatous thyroiditis, 6.0% had abscess, 8.0% had goitre and 10.0% nonspecific. USG and CFD are recommended modalities for the diagnosis of thyroiditis as these cost-effective and non invasive procedures.

Ultrasonographic evaluation of breast mass.

Breast cancer is the second most common cause of cancer-related mortality among women. The aim of the present study is to investigate the diagnostic accuracy of ultrasonography in correlation with histopathology in suspected patients of breast mass. In this cross-sectional study, ultrasonography and histopathology was done on 50 clinically suspected patients of breast mass in the Department of Radiology and Imaging Mymensingh Medical College Hospital, Mymensingh from 1st April 2008 to 30th March 2009 for the period of one year. Women of all ages were included in the study. Findings of USG and histopathology were correlated. In diagnosis of malignant mass by USG, 32(64%) of cases were diagnosed as malignant and 18(36%) cases as other than malignant. Here 31(86.1%) of sonographically diagnosed malignant lesions were also proved as malignant lesion by histopathologically and 1(7.1%) other than malignant. Out of 18 sonographically diagnosed cases of other than malignant lesions 13(92.9%) were proved histopathologically and 5(13.9%) did not match with sonographic findings as other than normal. USG, in diagnosis of malignant lesion, sensitivity was 86.1%, specificity 92.9%, positive predictive value (PPV) (96.6%), negative predictive value 72.2% and accuracy was 88.0% and comparable to other study. In the conclusion this study permits to conclude that ultrasonography has significant sensitivity, specificity, accuracy, positive predictive value and negative predictive value in the diagnosis of both benign and malignant breast mass.

Effectiveness of radioiodine therapy in treatment of hyperthyroidism.

The present non randomized clinical trial was conducted in the Center for Nuclear Medicine and Ultrasound, Mymensingh, Bangladesh for duration of one year. Total 30 patients with hyperthyroidism diagnosed by clinical and biochemical profile were included in the study. All patients received radioiodine treatment and regular follow up at 1st month, 3rd month, 6th month & 9th month were done to evaluate clinical and biochemical status and complications. Data were analyzed by computer with SPSS programme using 't' test and chi-square test. In the present study, out of 30 respondents more than three fourth of the respondents (76.6%) were in the age group of 31-50 years followed by less than 30 years are group (16.7%) and rest of respondents were in the age group of more than 50 years (06.7%). Mean±SD and range of age of the respondents were 39.80±10.02 years and 17-65 years respectively. Among the 30 respondents 11(36.7%) were male and 19(63.3%) were female. Male to female ratio was 1:1.73. Out of 30 patients 26(86.7%) presented with goiter and among them 21(80.8%) has diffused goiter and five (19.2%) had nodular goiter. Baseline mean±SD, median, range of serum T3 level were 5.24±3.62, 4.34, 1.48-14.65nmol/L respectively. Base line mean±SD, median range of serum T4 level were 192.25±99.17, 201.77, 1.75-336.25nmol/L respectively. Baseline mean±SD, median range of serum TSH level were 6.33±23.93, 0.15-0.07, 130.46nmol/L respectively. In the present study serum T3, T4 level among the respondents sharply decrease from baseline to 2nd follow up then gradually decrease from 2nd to 4th follow up. Serum TSH level gradually increases from baseline to 3rd follow up and then gradually decreases from 3rd to 4th follow up. The result showed radioiodine is an effective option for the treatment of thyrotoxicosis.

Growth performance and nutrient composition of juvenile Nile tilapia (Oreochromis niloticus) fed Spirulina flakes, rice bran and mustard oil cake.

INTRODUCTION: Tilapia (Oreochromis niloticus) is an important cultured fish that is widely distributed in Bangladesh. This study was conducted to improve the growth performance and nutrient contents of the fish using five different types of feeds. METHODS: Tilapia fingerlings were fed two types of commercial fish feeds (Feed-1 and Feed-2), Spirulina flakes (Feed-3), Feed-2 mixed with Spirulina flakes (Feed-4) and manually mixed feed made from a mixture of mustard oil cake and rice bran (Feed-5). After 4 weeks of being fed with the diets, growth parameters and meat nutrient composition of the tilapia fingerlings were recorded. RESULTS: Significant growth in length and weight was observed in juvenile tilapia fish fed with commercial Feed-1 only, while growth performance varied significantly among fingerlings fed other types of feeds. Body tissue calcium (92.8 mg/100 g), iron (1.29 mg/100 g) was higher in fishes fed with dry Spirulina flakes (Feed 3), while the highest amount of zinc (2.09 mg/100 g) was recorded in fishes fed Feed-5. Protein (13.32%) content was highest in fish fed Feed-2 mixed with Spirulina flakes (Feed-4). CONCLUSION: Meat nutritional quality of tilapia can be improved by combining commercial feeds with Spirulina flakes, compared with feeding commercial feeds in isolation.

Sezary syndrome.

Sezary syndrome is a rare form of primary cutaneous T cell lymphoma. A male patient of 37 years old was reported with multiple subcutaneous swelling at different parts of the body which were asymptomatic for the last 2 years. But he had persistent generalized itching, induration in skin surface and erythema for months. The disease was diagnosed by the presence of Sezary cells in the skin biopsy, peripheral blood smears and epidermotrophism of lymphocytes. The patient was treated by CHOP (Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone) therapy.

Paraovarian leiomyosarcoma with scalp metastasis: a case report.

PURPOSE: Leiomyosarcoma is a rare neoplasm. There is paucity of literature in regards to paraovarian leiomyosarcoma with metastases to the scalp. We present a 72-year-old woman with metastases to the scalp from a primary paraovarian high grade leiomyosarcoma. METHODS AND RESULTS: The patient underwent a total abdominal hysterectomy, pelvic and aortic lymphadenectomy, excision of Meckel's diverticulum, and radical pelvic tumor debulking with sigmoid colectomy and end-to-end anastomosis and six cycles of taxotere/carboplatin. She presented 18 months later with metastatic high-grade leiomyosarcoma to the scalp. The lesions were excised and she is now receiving palliative taxotere and gemcitabin. CONCLUSION: High-grade leiomyosarcoma is known for its resistance to chemotherapy, radiation therapy, and propensity for hematological dissemination with an overall poor prognosis.

Resonant X-ray enhancement of the Auger effect in high-Z atoms, molecules, and nanoparticles: potential biomedical applications.

It is shown that X-ray absorption can be considerably enhanced at resonant energies corresponding to K-shell excitation into higher shells with electron vacancies following Auger emissions in high-Z elements and compounds employed in biomedical applications. We calculate Auger resonant probabilities and cross sections to obtain total mass attenuation coefficients with resonant cross sections and detailed resonance structures corresponding to Kalpha, Kbeta, Kgamma, Kdelta, and Keta complexes lying between 6.4-7.1 keV in iron and 67-80 keV in gold. The basic parameters were computed using the relativistic atomic structure codes and the R-matrix codes. It is found that the average enhancement at resonant energies is up to a factor of 1000 or more for associated K --> L, M, N, O, P transitions. The resonant energies in high-Z elements such as gold are sufficiently high to ensure significant penetration in body tissue, and hence the possibility of achieving X-radiation dose reduction commensurate with resonant enhancements for cancer theranostics using high-Z nanoparticles and molecular radiosensitizing agents embedded in malignant tumors. The in situ deposition of X-ray energy, followed by secondary photon and electron emission, will be localized at the tumor site. We also note the relevance of this work to the development of novel monochromatic or narrow-band X-ray emission sources for medical diagnostics and therapeutics.

Monte Carlo simulations and atomic calculations for Auger processes in biomedical nanotheranostics.

We present numerical simulations of X-ray emission and absorption in a biological environment for which we have modified the general-purpose computer code Geant4. The underlying mechanism rests on the use of heavy nanoparticles delivered to specific sites, such as cancerous tumors, and treated with monoenergetic X-rays at resonant atomic and molecular transitions. X-ray irradiation of high-Z atoms results in Auger decays of photon emission and electron ejections creating multiple electron vacancies. These vacancies may be filled either be radiative decays from higher electronic shells or by excitations from the K-shell at resonant energies by an external X-ray source, as described in an accompanying paper by Pradhan et al. in this volume. Our Monte Carlo models assume normal body material embedded with a layer of gold nanoparticles. The simulation results presented in this paper demonstrate that resonant excitations via Kalpha, Kbeta, etc., transitions result in a considerable enhancement in localized X-ray energy deposition at the layer with gold nanoparticles, compared with nonresonant processes and energies. The present results could be applicable to in vivo therapy and diagnostics (theranostics) of cancerous tumors using high-Z nanoparticles and monochromatic X-ray sources according to the resonant theranostics (RT) methodology.

A comparative study of body iron status and lipid profile in acute myocardial infarction patients.

This study was carried out to evaluate the relationship between body iron status and lipid profile in hospital admitted clinically diagnosed AMI patients considering the concept that there is a potential association between body iron status and coronary heart disease (CHD). Total 80 subjects were selected, of which 40 were healthy adults and 40 were AMI patients. Fasting blood samples were collected from healthy adults. Blood samples of AMI patients were collected within 24 hours of the attack of myocardial infarction. Body iron status was measured in term of 3 variables serum total iron concentration, TIBC and transferrin saturation. Lipid profile variables measure were total cholesterol, triglyceride, LDL-cholesterol and HDL-cholesterol. No correlation was found between serum iron and the variables of lipid profile. TIBC was found to maintain negative correlation with total cholesterol, triglyceride and LDL-cholesterol but positive correlation with HDL-cholesterol. Transferrin saturation was found to maintain strongly positive correlation with total cholesterol, triglyceride and LDL-cholesterol but strongly negative correlation with HDL-cholesterol. This correlation of TIBC and transferrin saturation with lipid profile supports the hypothesis that there is a potential association between body iron status and coronary heart disease.

Prenatal diagnosis of beta-thalassaemia in Pakistan: experience in a Muslim country.

A service for prenatal diagnosis of beta-thalassaemia was introduced in Pakistan in May 1994. Two renowned Islamic scholars, consulted before the service was introduced, ruled that a pregnancy can be terminated if the fetus is affected by a serious genetic disorder, and if termination is before 120 days (17 weeks) of gestation. During the first 3(1/2) years of the service 300 couples requested the test. Almost all the couples had been informed by their treating doctors. Most diagnoses were made between 10 and 16 weeks of gestation, and only 15 (5%) were reached after the 16th week. DNA analysis was by the amplification refractory mutation system (ARMS). A multiplex ARMS was developed in which three primer combinations identified the mutations in 91.5% of the couples. In 13 couples (4. 3%) linkage analysis was required for the fetal diagnosis. In 47/53 (88.7%) women carrying an affected fetus the pregnancy was terminated. In six cases it was declined principally on religious grounds. Postnatal confirmation of the prenatal diagnosis was possible in 117 unaffected children. One year after the start of the service, interviews with 141 couples with an affected child showed that 72% knew of the availability of prenatal diagnosis. Thirty-two of the informed couples had had a pregnancy, but only 18 (56%) used prenatal diagnosis. The main reasons for non-utilization of prenatal diagnosis were the cost of the test and fear of undergoing the test, though some gave no clear explanation. This study demonstrates that prenatal diagnosis is feasible and acceptable in a Muslim country such as Pakistan.