Round Block Technique in Management of Breast Lesions.

The basic tenets of oncoplastic surgery essentially includes volume displacement and volume replacement. The round block technique, so-called donut mastopexy or Benelli mastopexy, is frequently used as a volume displacement technique in breast conserving surgery for benign multicentric fibroadenomas and early breast cancers. Such techniques are still underused in Nepal. In this article we present on four cases managed with original round block technique and followed prospectively with their outcome.

Retrograde signaling by a mtDNA-encoded non-coding RNA preserves mitochondrial bioenergetics.

Alveolar epithelial type II (AETII) cells are important for lung epithelium maintenance and function. We demonstrate that AETII cells from mouse lungs exposed to cigarette smoke (CS) increase the levels of the mitochondria-encoded non-coding RNA, mito-RNA-805, generated by the control region of the mitochondrial genome. The protective effects of mito-ncR-805 are associated with positive regulation of mitochondrial energy metabolism, and respiration. Levels of mito-ncR-805 do not relate to steady-state transcription or replication of the mitochondrial genome. Instead, CS-exposure causes the redistribution of mito-ncR-805 from mitochondria to the nucleus, which correlated with the increased expression of nuclear-encoded genes involved in mitochondrial function. These studies reveal an unrecognized mitochondria stress associated retrograde signaling, and put forward the idea that mito-ncRNA-805 represents a subtype of small non coding RNAs that are regulated in a tissue- or cell-type specific manner to protect cells under physiological stress.

Laparoscopic common bile duct exploration using a rigid nephroscope.

BACKGROUND: Patients with cholelithiasis and choledocholithiasis are increasingly managed with laparoscopic bile duct exploration and cholecystectomy. Large impacted bile duct stones continue to defy laparoscopic extraction. This study explored the feasibility of laparoscopic bile duct clearance using a rigid nephroscope, which is suited to extracting large stones. METHOD: This prospective study recruited patients with large bile duct stones and a bile duct wider than 8 mm on ultrasonography. In addition to standard ports for laparoscopic cholecystectomy, a custom-made 9-mm port was introduced in the epigastrium for the rigid nephroscope, which was negotiated into the bile duct through a choledochotomy. Rigid graspers and lithotripters were introduced through the nephroscope to fragment and remove the calculi. RESULTS: Between December 2005 and September 2008, 18 patients had nephroscope-guided bile duct exploration (mean(s.d.) age 49(13.9) years, bile duct diameter 11.3(2.3) mm). Three patients had solitary stones and 15 had multiple calculi. Most of the stones were removed with graspers, but the lithotripter was required in five patients. The mean(s.d.) hospital stay was 6(2.3) days. Two patients required postoperative endoscopic retrograde cholangiopancreaticography for residual stones. CONCLUSION: The rigid nephroscope was useful for laparoscopic bile duct exploration, particularly for large impacted stones.

Prevalence of diabetes and impaired fasting glucose in a selected population with special reference to influence of family history and anthropometric measurements--the Kolkata policeman study.

AIMS AND OBJECTIVES: The aim of this study was to estimate the prevalence of diabetes as well as IFG in a population of policemen and to evaluate the possible influence of some risk factors. MATERIAL AND METHODS: It was an epidemiological study on a group of policemen in Kolkata. Diagnosis of diabetes was based on history and fasting plasma glucose. The study population was divided in three categories: normoglycaemic, IFG and diabetes. BMI, waist circumference, WHR and waist-to-height ratio were estimated. RESULTS: Out of 2160 subjects with a mean age of 36.4 yrs (between 20 and 60 yrs), diabetes was found in 11.5% (10.4% known and 1.1% newly diagnosed) and 6.2% had IFG. Prevalence of diabetes was found to be increasing with age (p < 0.001). There was no statistically significant difference in BMI when compared between groups (normoglycaemic, IFG and diabetes). Waist circumference, waist-to-height ratio and WHR of normoglycaemic group were significantly less than those with IFG and diabetes; however there was no statistically significant difference between the diabetes and IFG groups. Parental history had significant influence on the prevalence of diabetes; a 37.5% prevalence was found in persons with history of biparental diabetes and 20.8% with uniparental diabetes, whereas it was only 9.9% without any family history (p < 0.01 and p < 0.05, respectively.). CONCLUSION: The prevalence of diabetes in the study population was high and was strongly influenced by family history, age and abdominal adiposity, without having any appreciable impact of BMI.

Prevalence of dental caries and associated teeth cleaning habits among children in four primary schools.

A study was conducted in four primary schools of Mehrauli block of rural Delhi. Four hundred and fifty eight primary school children of both sexes in the age group of 5-14+ were medically examined in daylight using a mouth mirror and probe. The children came from low socioeconomic backgrounds. Presence of clinical caries was recorded by naked eye examination. Dental caries prevalence was 33.19% and DMF index was 0.52. Teeth cleaning habits of the school children in terms of regularity and associated caries prevalence was also noted. The 'Regular' teeth cleaning group showed significantly less caries prevalence while 'Not Regular' and 'Never Cleaning' groups had higher caries prevalence. Since childhood is such an impressionable age all students were made aware of the need for proper oral hygiene to minimize the incidence of caries among them.

Disease and dislocation: the impact of refugee movements on the geography of malaria in NWFP, Pakistan.

Studies of the health implications of refugee movements have generally focused on the effects of dislocation on the health of refugees and the impacts on health care provision at the destination. A somewhat more neglected aspect of the refugee-health research has been the impact of refugee flows on the geography of disease, i.e., how the spatial patterns of disease prevalence are modified through the influx and settlement of refugee populations. We examine this issue by examining the changing geography of malaria in Pakistan's North West Frontier Province (NWFP) between 1972 and 1997. Until the late 1970s, the highest incidence of malaria in the region was seen in the southern and eastern parts. During the 1980s, however, two and a half million Afghan refugees entered the NWFP and were housed in tented villages along the border and in some interior areas. As the decade progressed, there was a significant shift in the spatial pattern of malaria, with the regions of highest incidence shifting to the west and north, coinciding strongly with refugee concentrations. Our study draws attention to the manner in which refugee influx and settlement can alter the ecology of the disease system, leading to long-term changes in the geography of malaria.

Capsular hyaluronic acid in Pasteurella multocida type A and its counterpart in type D.

Hyaluronic acid was demonstrated in the capsule extract of 39/39 Pasteurella multocida type A strains by sodium chloride gradient chromatography followed by Alcian blue staining, and by a turbidometric method using acidified horse serum. Treatment with hyaluronidase from various sources eliminated these reactions. An Alcian blue staining substance of closely similar chromatographic properties occurred in capsule extracts of 14/16 type D strains but it resisted hyaluronidase and was thought to be an acidic polysaccharide differing from the hyaluronic acid of type A. Turbidometric values were lower than with type A strains, but were unaltered by hyaluronidase treatment. The type D substance could be precipitated from capsule extract by acriflavin. Both type A and D strains were mucoid and displayed large capsule zones in stained preparations. Photomicrographic measurements showed that hyaluronidase treatment of cell suspensions markedly reduced capsule dimensions of type A but not type D strains. When type A strains were cross streaked against a hyaluronidase + Staphylococcus aureus, their growth became non-mucoid at the intersection: mucoid type D strains were unaffected. Neither hyaluronic acid nor the hyaluronidase resistant type D substance could be detected in type B or E strains.

Correlation of endoscopic interpretation of endometriosis with histological verification.

INTRODUCTION: In this study we correlate the laparoscopic findings of endometriosis with the histological confirmation of the disease over a period of two years. MATERIALS AND METHODS: One hundred and sixty-four laparoscopies performed at the Department of Gynecology & Obstetrics, University of Kiel, over a two-year period were reviewed for laparoscopic findings and histological confirmation of endometriosis. RESULTS: The majority of patients suspected of endometriosis at laparoscopy were confirmed by histological examination, i.e. 138 out of 164 patients (84.1%). CONCLUSION: Laparoscopy is the easiest diagnostic tool for the diagnosis of endometriosis which can be confirmed by histological examination.

Unilateral renal agenesis associated with urinary outflow tract obstruction in a diabetic pregnancy.

We report a case of diabetic pregnancy where the foetus had enlarged cystic left kidney with agenesis of right kidney. The urinary bladder was dilated and urethra revealed posterior urethral valve an postmortem.

Knowledge of fresh medical graduates about immunization: impact of posting in community medicine.

Immunization being the most cost effective health intervention rightly forms an integral part of MCH health activities spectrum. Of late medical colleges in the country are directly involved from the planning to evaluation stages in the immunization programmes in their respective catchment areas. Immunization knowledge of 91 interns during their course of involvement in community work, was tested on the first day and last day of their three months posting in the Community Medicine Department. The study showed positive impact of training in the Department of Community Medicine on the performance levels of interns. This was found mainly attributable to effective interaction of interns with the community in the field and taking independent decisions as per the case requirements.

Process evaluation of pulse polio immunisation in Delhi.

The aim of the study was to assess the functional aspects and the staffing at Pulse Polio immunisations posts. Interns and medical students conducted the survey in eighty seven pulse polio immunisation posts scattered all over National Capital Territory of Delhi on 18th January 1997. A pre-tested structured format containing information pertaining to dose utilisation and staffing was filled. Number of children given pulse polio was on an average 459.2 per immunisation post (474.7 rural, 516.35 slums and 435.0 urban). Average number of neonates (below one month) per immunisation post given polio drops was 5.1 (1.1%). The break-up for rural area, slums and urban area was 3.0 (0.63%), 6.7 (1.30%) and 4.9 (1.13%) respectively. By 12 pm, 67.8% and by 2 pm 88.7% of the doses had been administered. Staffing at most of the immunisation posts was adequate for all categories of staff except doctors (0.48 per booth).