Can dose reduction to one parotid gland prevent xerostomia?--A feasibility study for locally advanced head and neck cancer patients treated with intensity-modulated radiotherapy.

AIMS: Dryness of the mouth is one of the most distressing chronic toxicities of radiation therapy in head and neck cancers. In this study, parotid function was assessed in patients with locally advanced head and neck cancers undergoing intensity-modulated radiotherapy (IMRT) with or without chemotherapy. Parotid function was assessed with the help of a questionnaire and parotid scintigraphy, especially with regards to unilateral sparing of the parotid gland. MATERIALS AND METHODS: In total, 19 patients were treated with compensator-based IMRT between February 2003 and March 2004. The dose to the clinical target volume ranged between 66 and 70 Gy in 30-35 fractions to 95% of the isodose volume. Ipsilateral high-risk neck nodes received an average dose of 60 Gy and the contralateral low-risk neck received a dose of 54-56 Gy. Eight of 19 patients also received concomitant chemotherapy. RESULTS: Subjective toxicity to the parotid glands was assessed with the help of a questionnaire at 0, 3 and 6 months and objective toxicity was assessed with parotid scintigraphy at 0 and 3 months. The mean dose to the ipsilateral parotid gland ranged from 19.5 to 52.8 Gy (mean 33.14 Gy) and the mean dose to the contralateral gland was 11.1-46.6 Gy (mean 26.85 Gy). At a median follow-up of 13 months, 9/19 patients had no symptoms of dryness of the mouth (grade I), 8/19 had mild dryness of the mouth (grade II) and only 2/19 had grade III xerostomia, although the parotid gland could only be spared on one side in most of the patients. CONCLUSIONS: Minimising the radiation dose to one of the parotid glands with the help of IMRT in patients with advanced head and neck cancers can prevent xerostomia in most patients and parotid scintigraphy is a useful method of documenting xerostomia.

Upregulation of inducible nitric oxide synthase (iNOS) expression in faster-healing chronic leg ulcers.

OBJECTIVE: Chronic leg ulcers represent a growing clinical problem in the light of today's ageing population. Nitric oxide (NO), which is mostly produced by inducible nitric oxide synthase (iNOS) in healing wounds, exerts beneficial effects on many processes of healing, including bactericidal effects, angiogenesis, epithelialisation and ECM formation. This study sought to investigate whether iNOS expression in chronic leg ulcers can be correlated with the healing process. METHOD: Sixteen patients with chronic leg ulcers were recruited and attempts were made to take punch biopsies at two separate time points (however, a second biopsy could not be obtained on seven patients). A linear healing rate was derived using the obtained ulcer area and perimeter. The iNOS levels in the biopsy samples were assessed using immunoblotting. RESULTS: The mean linear healing rate of patients with high iNOS levels was significantly higher (p < 0.01) than that of patients with low iNOS levels. An incidental finding was that the linear healing rate was significantly higher (p < 0.05) post-biopsy than before biopsy in the same patients. CONCLUSION: This study therefore shows for the first time that high iNOS levels are associated with higher healing rates and have the potential to be used in prognostication. This also opens the possibility of augmentation of ulcer healing through the manipulation of wound NO levels.

A correlation of secondary aerosol (nitrate and sulfate) with respirable particulate matter (RPM) in ambient air at different traffic junctions of Vadodara city.

The correlation study of secondary aerosol (nitrate and sulfate) with RPM in ambient air at different traffic junctions of Vadodara city is reported. RPM was analyzed using Ion Chromatography technique and measured the level of nitrate and sulfate in ambient air. The correlation studies of these particulates with RPM have been established. The average concentration of sulfate and nitrate in ambient air was found 35.74 microg/m3 and 24.22 microg/m3, which ranged of 5.33-84.69 and 1.93-77.86 microg/m3 respectively. The correlation of RPM and SO4 (r = 0.813, P<0.01), RPM-NO3 (r = 0.5549, P<0.01) and SO4-NO3 (r = 0.6133, P<0.01) were found significant. The presence of sulfate and nitrate in RPM is 8.25% and 5.60% . The pH of water extract of RPM averaged 6.81, which ranged 6.17-7.28. Regression analysis result showed that the relationship between RPM-SO4 was significantly (R2=0.66215) correlated. This indicate that probably the secondary aerosols such as nitrate and sulfate in excess may cause irritation and increasing lung disease.

Vitamin A nutritional status of rural community of Khol block in Haryana, North India. A collaborative study.

A nutritional and diet survey was carried out in 2,192 persons belonging to all age groups in a rural community. Vitamin A consumption was less than the recommended daily allowance in persons of all age groups. Bitot's spots and night blindness were detected in 7.1% and 7.2% of the population, respectively. Ocular signs of vitamin A deficiency were more frequently observed in age groups above 5 years as compared to the preschool children. There was no association of vitamin A deficiency with different grades of protein-calorie malnutrition in preschool children. Keratomalacia was extremely rare and was observed only in one child. The study suggests that the rural area studied was a high prevalence zone for vitamin A deficiency which did not have its serious consequences due to relatively adequate protein-calorie nutritional status of the population.

Unusual syndrome among premature infants: association with a new intravenous vitamin E product.

Eight small, premature infants developed an unusual symptom complex of pulmonary deterioration, thrombocytopenia, liver failure, ascites, and renal failure. Five infants died; the health of the other three infants improved and they were discharged from the hospital. This unusual syndrome occurred after introduction of a new intravenous vitamin E product (E-Ferol, alpha-tocopherol acetate) for routine use in the intensive care nursery. Even though no definite conclusion was reached as to its cause, the administration of this intravenous vitamin E product appears to be a significant risk factor.

Illness with fatalities in premature infants: association with an intravenous vitamin E preparation, E-Ferol.

Three clusters of an unusual syndrome in premature infants were investigated in three intensive care nurseries in 1984. A retrospective cohort study of 68 infants weighing less than or equal to 1,250 g at birth and surviving at least 72 hours revealed that in 13 infants ascites developed and in four at least two of the following abnormal laboratory values were found within a seven-day period: serum direct bilirubin greater than or equal to 2 mg/dL, blood urea nitrogen greater than or equal to 40 mg/dL or serum creatinine greater than or equal to 2 mg/dL, and platelet count less than or equal to 60,000/microL. All cases occurred after the introduction and use of intravenous E-Ferol, a vitamin E preparation that was new on the market when the clusters were reported. All 17 case infants but only 23 of 51 (45%) noncase infants received E-Ferol (P less than .0001). Case and noncase infants were similar with respect to other complications and to receipt of medications and parenteral nutrition. A dose-response relationship was found; cases occurred in infants receiving E-Ferol dosages of greater than 20 U/kg/d. Case infants who had higher daily doses of E-Ferol had a shorter latency. No new cases were reported after use of E-Ferol was stopped. Results of these investigations led to a nationwide recall of intravenous E-Ferol.

Erosion of nails following thallium poisoning: a case report.

This case report describes a patient with thallium poisoning caused by repeated exposure to low doses of thallium. Alopecia and nail changes were the most prominent features of this case. There was dystrophy of nails in the form of whitish lunular stripes. This is the first report of complete erosion of proximal parts of nails following thallium poisoning. This case is the first report of thallium poisoning from India occurring from repeated low dose exposure.

Road traffic accident fatalities in Port Moresby: a ten-year survey.

A retrospective analysis for a 10-year period (1976-1985) of Road Traffic Accident (RTA) fatalities was carried out in Port Moresby, the capital of Papua New Guinea. The majority of the victims were males and under the age of 45. Passengers formed the largest number, followed by pedestrians and drivers. Most fatal accidents occurred during the weekend. Analysis of injuries reveal head injury to be the dominant and possible cause of death in all three categories of victims. Multiple injuries involving many organs were more common in pedestrians and passengers than drivers. Factors contributing to the high rate of RTAs are discussed and measures to minimise the rate of such accidents have been suggested.

Binding pattern of eight different lectins in healthy subjects and patients with dysplastic and malignant lesions of the oral cavity.

The present investigation was undertaken to assess the binding characteristics of eight different lectins to normal oral mucosa (11 cases), leukoplakia with varying degrees of dysplasia (five cases), and oral mucosal squamous cell carcinoma (12 cases) by the use of biotinylated lectins and avidin biotin peroxidase complexes. The lectins employed were soybean (SBA), peanut (PNA), Dolichos biflorus (DBA), concanavalin A (Con A), wheat germ (WGA), Ulex europaeus (UEA), Ricinus communis (RCA), and Lotus tetragonolobus (LTA). It was observed that SBA, DBA, WGA, UEA, RCA, and LTA showed very strong to strong binding in healthy oral mucosa but no or very weak binding in squamous cell carcinoma. On the contrary, PNA showed weak binding to normal mucosal epithelial cells but showed strong binding to malignant cells. The dysplastic mucosa had an intermediate binding pattern. The lectin Con A was not bound at all or seen in very low concentration in the malignant cells and dysplastic epithelium, but it showed weak binding in the normal mucosa. Hence, we conclude that lectins may be utilized as probes to determine the dysplastic and malignant status of the oral mucosal epithelium.

Peristaltic transport of a physiological fluid. Part-I. Flow in non-uniform geometry.

The problem of peristaltic transport of a fluid of variable viscosity in a non-uniform tube and channel has been investigated under zero Reynolds number, and long wavelength approximation. It is found that, the pressure rise decreases as the fluid viscosity decreases at zero flow rate, is independent of viscosity variation at a certain value of flow rate, and increases if flow rate exceeds further. The difference between two corresponding values (for constant and variable viscosity) of pressure rise, under a given set of conditions increases with increasing amplitude ratio at zero flow rate. Further, for a given zero pressure rise, the flow rate increases as viscosity of fluid decreases. The pressure rise, in the case of non-uniform geometry is found to be much smaller than the corresponding value in the case of uniform geometry. In Part II (a companion paper), results for uniform tube and channel are obtained and comparison with other theories are made in detail. Finally, the models developed in Part I and Part II are applied and compared with observed flow rates in vas deferens of rhesus monkeys, the small intestine, and the ductus deferens of the male reproductive tract in the other companion paper, Part III.

Peristaltic transport of a physiological fluid. Part - II. Flow in uniform geometry.

Using the model of peristaltic flow in non-uniform geometry, developed in the companion paper (Part I), results for uniform tube and channel are obtained in closed form. Comparison of analysis with other theories and the effect of viscosity variation are discussed in detail. Finally, quantitative comparison are made between theory and experiments of Weinberg et al. and Latham.

Peristaltic transport of a physiological fluid. Part - III. applications.

The models of peristaltic flow in non-uniform and uniform tube and channel, developed in the companion papers, Part I and Part II, are applied and compared with the observed flow rates in vas deferens of rhesus monkeys, the small intestine, and the ductus deferens of the male reproductive tract.

Mesh plug repair for paraumbilical hernia.

BACKGROUND: The standard method of repair of paraumbilical hernia (PUH) is by the Mayo technique, using a double-breasted flap of the rectus sheath. The reproducibility of this technique in the hands of others is highly variable. The present study describes and evaluates the application of a Prolene mesh plug in the repair of PUH. The use of a mesh plug in hernia repair is not a new concept with previous investigators yielding consistently excellent results in the repair of femoral and inguinal hernias. METHODS: The study is a retrospective analysis of hospital records and telephone interviews of 34 patients having undergone PUH repair using the mesh plug technique in the period March 1998- May 2002. There were 20 males and 14 females with a median age of 53 years (range 34-86 years). Seventy-six percent (26) of the patient sample was obese (median BMI 33). Whenever possible local anaesthetic was used. Principal outcome measures studied were post-operative complications, recurrences, length of stay in hospital, post-operative analgesia, duration of drain, return to normal activities and patient satisfaction. RESULTS: Post-operative complications encountered included one case of seroma and a single wound infection with recurrence. Ninety-seven percent (32) of patients were satisfied with the procedure. CONCLUSION: Mesh plug repair can be performed with minimal postoperative complications, low recurrence rate, minimal post-operative pain and achieving excellent patient satisfaction. Prosthetic mesh plug repair under local anaesthetic could become the standard treatment for PUH in adults.

Do leg ulcer clinics improve patients' quality of life?

The aim of this prospective study was to measure quality of life in patients with chronic leg ulcers. All eligible, consenting patients who attended the leg ulcer clinic at the Repatriation General Hospital (Tasmania, Australia) during the 16-month study period were included. Patients completed questionnaires on their first visit and at follow-up which occurred, on average, eight weeks later. This study found an improvement in three quality-of-life indicators--pain, sleep and mobility--over an average of eight weeks' treatment involving one to three visits to the clinic and home visits by primary care nurses. Of the 57 patients, 53 (93%) indicated that their wound had improved following attendance at the clinic. The cost-effectiveness of providing treatment in a dedicated leg ulcer clinic has been the focus of many previous studies. This study emphasises the additional benefits a dedicated clinic may have in improving quality of life in patients with chronic leg ulcers. Such benefits ought to be considered when allocating resources to leg ulcer services.

Ipsilateral absence of tonsil and microtia with ectopic salivary gland. A case report.

This case of congenital unilateral absence of the faucial tonsil and microtia, with atresia of the external auditory canal, and an ectopic salivary gland has not been reported previously; it differs from other congenital abnormalities reported earlier.

Induction of carboxymethylcellulase in Macrophomina phaseolina.

Macrophomina phaseolina, the well-known jute pathogenic fungus produces very low levels of both extra- and intracellular carboxymethylcellulase even in the absence of any cellulose as carbon source in the medium. However, the production of these enzymes is greatly induced by soluble carboxymethylcellulose. The carboxymethylcellulase in M. phaseolina is repressed by glucose.

Morbidity pattern in relation to birth interval and birth order in children.

PIP: An oral questionnaire method was used with parents to determine the effect of birth interval and birth order on the morbidity pattern of children below age 5. 3 localities in India were selected -- Sir Syed Nagar, Zohra Bagh, and Jeevan Garh as all the families residing in these localities are registered under the Urban Health Training Center of the Department of Preventive and Social Medicine. All children (280 from 160 families) between 0-5 years were included. 256 children belonging to 150 families were studied longitudinally for 1 year (January-December 1978), with follow-ups at 3-week intervals. Only 8.6% of the children were from social class 1; the majority (67.4%) belonged to lower social classes 4 and 5. 68.5% of the fathers and 88.8% of the mothers were illiterate; both parents were illiterate for 64% of the 256 children. Only 8.6% of the children had no illness during the study period; the remaining 91.4% suffered from 1 or another illness. The disease incidence rate was 3.4 per child and 3.7 per sick child whereas the spell rate was 5.5 per sick child. An inverse relationship was observed between birth interval and prevalence of malnutrition, anemia, worm infestation, respiratory infection, and gastroenteritis. When the birth interval was more than 4 years, the risk of malnutrition tended to be reduced by about 7 times, which was statistically significant. The incidence of respiratory infection, gastroenteritis, anemia, worm infestation, and vitamin deficiency declined from 63.6, 72.7, 45.5, 36.4, and 46.5% to 50, 43.5, 36.0, 18.7, and 31.2%, respectively, with an increase in birth interval from 1 year to 5 years. The decline in the incidence was more pronounced in anemia, worm infestation, and gastroenteritis. The incidence of all the major illnesses increased with an increase in birth order. The increase is more significant beyond the 3rd birth order.^ieng

Family planning and tuberculosis.

PIP: The mutual impact of India's family planning program and tuberculosis control program on each other was examined, and the conclusion reached that close cooperation between the 2 programs would have mutually beneficial results. The impact of the diagnosis of pulmonary tuberculosis on the family planning practices of 367 male and 290 female patients at a treatment clinic in Aligarh District was assessed. Prior to diagnosis only 10% of the patients practiced contraception, after diagnosis 19% practiced contraception, and after disease stabilization 29.5% practiced contraception. Among those patients who began practicing contraception after diagnosis, about 1/2 were motivated to practice by their physicians, and the remaining patients were motivated to practice either for economic reasons or because they feared spreading the infectious disease to an infant. About 2/3 of the tuberculosis patients had 3 or more children, and about 90% belonged to the lower socioeconomic class. Among female patients, disease onset occurred for 49.7% within 1 year of childbirth, and for 29.3%, it occurred during pregnancy. These findings suggested that an increase in the acceptance of family planning among members of the lower class and among high parity women would contribute toward decreasing the incidence of tuberculosis in the country. Clients who practiced contraception were also more likely to attend the tuberculosis treatment clinic on a more regular basis than non-practicing clients.^ieng

Susceptibility status of Culex quinquefasciatus in Patna to insecticides.

To obtain the base line data, a study conducted in district Patna, Bihar to note the susceptibility status of adult Culex quinquefasciatus against organochlorine, organophosphorous and synthetic pyrethroids. It was found that adult of Cx.quinquefasciatus developed double resistance to DDT and dieldrin but susceptible to O.P. compounds and pyrethroids. Cx.quinquefasciatus larvae are also found susceptible to O.P compounds like malathion, temophos, fenthion and fenitrothion.

Hepatocellular carcinoma--an update.

Primary hepatocellular carcinoma (HCC) is one of the commonest malignant diseases in the world. In this study the association of HBsAg and HCC, together with the role of other aetiological agents, is reviewed. Alfa-foeto-protein continues to be the best marker for early diagnosis of HCC. Surgical resection provides the only chance of cure, but the proportion of patients with resectable tumour is small. The hope for prevention of HCC lies in the use of a vaccine against hepatitis B virus.