Primary cutaneous zygomycosis from a tertiary care centre in north-west India.

Background & objectives: Zygomycosis is highly invasive fungal infection, with high mortality rate. In most of patients, diabetes mellitus is an underlying factor but in primary cutaneous zygomycosis, presentation may be different. Here we present the description of clinical presentation, fungi isolated and management of cases with cutaneous zygomycosis seen in a tertiary care hospital in north India during 2001-2007. Methods: All patients diagnosed with primary cutaneous zygomycosis between November 2001 and September 2007 presenting with clinical diagnosis of necrotizing fasciitis were included. Detailed history of each patient was taken, clinical presentation, site of involvement, underlying illness and risk factor, if any were noted. The diagnosis was established by direct microscopic evidence of broad, aseptate or sparsely septate ribbon-like hyphae with right angle branching in KOH wet mount and histopathological examination of stained sections. Cultures were put up for fungal isolation and species identification. Outcome of the therapy was analysed. Results: Of the nine patients reviewed, only one had diabetes mellitus. Commonest risk factor was injection abscess (33.3%). Apophysomyces elegans was isolated in four cases, Saksenaea vasiformis and Absidia corymbifera in one each. The fungal culture was sterile in three cases. Mortality rate was high with only four patients responded well to surgical and/or medical therapy. Interpretation & conclusion: Primary cutaneous zygomycosis appears to be on rise in India that calls for high index of clinical suspicion and an early biopsy of the affected area for timely diagnosis. The standard treatment is a combination of amphotericin B therapy, surgical debridement, and reversal of the underlying disease or immunosuppression.

Spectrum of microbial flora in diabetic foot ulcers.

A prospective study was carried out on patients with diabetic foot lesions to determine their clinical characteristics, the spectrum of aerobic microbial flora and to assess their comparative in vitro susceptibility to the commonly used antibiotics. A total of 157 organisms (143 bacteria and 14 fungi) were isolated and an average of 1.52 isolates per case was reported. Polymicrobial infection was found in 35% of the patients. In this study, Pseudomonas aeruginosa among the gram-negative (22%) and Staphylococcus aureus among the gram-positive (19%) were the predominantly isolated organisms, while Candida was the most predominantly isolated fungus. Antimicrobial sensitivity pattern of the isolates is discussed in detail. There was a linear increase in the prevalence of organisms with increase in Wagner's grade. Neuropathy (76%) and peripheral vascular disease (57.28%) was a common feature among the patients. Poor glycemic control was found in 67% of the patients. Awareness about lower limb complications of diabetes was very low (23%) among the patients.

A comparative study of serum lipid profile and gallstone disease.

The diseased gallbladder is one of the commonest specimens submitted to the surgical pathology laboratory in North India. Obesity is associated with a linear increase in gallstone formation. It has been observed that the plasma lipoprotein profile of patients with gallstones differs markedly from that of healthy subjects. Serum lipid profile was done by enzyme kit method. All the gallstones received were categorized morphologically and examined biochemically. The age range of 200 cases was 13 to 77 years with a mean of43.75 +/- 13.39 years. There were 171 females (85.5%) and 29 males (14.5%) with male to female ratio of 1: 5.8. The stones containing both cholesterol and bile pigments were the most common (129 cases, 84.87%); while pure cholesterol stones were seen in 23 cases (11.50%) and pigment stones were infrequent (1 case, 0.65%). On lipidogram of patients in the study group, mean serum total cholesterol was 155.50 +/- 43.03 mg/dL, mean serum triglycerides was 100.49 +/- 45.23 mg/dL, mean HDL cholesterol was 46.71 +/- 15.20 mg/dL, mean LDL cholesterol was 87.94 +/- 36.85 mg/dL and mean VLDL cholesterol was 20.84 +/- 11.97 mg/dL. Serum total cholesterol values were significantly higher in patients older than 39 years as compared to patients < or =39 years (161.44 +/- 42.32 mg/dL vs. 145.79 +/- 32.96 mg/dL, p < 0.05). But the observed mean values in both of these subgroups were within the normal range i.e. <200 mg/dL. No significant difference was observed in the mean serum triglyceride values between male and female patients. The findings of this study did not indicate any role of serum lipid profile in the formation of gallstones. However the higher mean values of serum total cholesterol and serum triglycerides in patients older than 39 years of age may be explained by increasing age.

Herniation of colon following transhiatal esophagectomy.

We report a 38-year-old man with intestinal obstruction following transhiatal esophagectomy for carcinoma esophagus; it occurred secondary to herniation of the transverse colon through the esophageal hiatus into the mediastinum. The patient is asymptomatic after reduction of the hernia and repair of the disphragmatic hernia.

Mechanical bowel obstruction: the Chandigarh experience.

Intestinal obstruction is a fairly common surgical emergency in India, but there is little data available regarding the spectrum of intestinal obstruction in India, or its related complications. This paper represents a retrospective review of 97 patients who underwent surgery for intestinal obstruction at Government Medical College and Hospital, Chandigarh, India, over four years (1997-2000). The case files of all these patients were reviewed and analysed for patient particulars, pre-operative clinical examination and investigations, intraoperative findings, final diagnosis, post-operative morbidity, and mortality. The mean age of our patients was 39.46 years, with an overall male to female ratio of 2.46:1. Most of the patients were in the age group of 17 to 60 years (62.89%). A total of 107 causes for the obstruction could be identified at surgery, with intra-abdominal adhesions and bands (27.10%) being the commonest followed by obstructed herniae (22.43%). Strangulation was present in 21 patients at the time of surgery. This group of patients had a significantly higher post-operative morbidity than patients with simple obstruction, although no statistically significant difference was seen in between the mortality rates in these two groups.

Osteosarcoma of the bladder--a case report.

A 25-year old man with hematuria had a polypoid tumor of the urinary bladder which was diagnosed as transitional cell carcinoma (TCC) on transurethral resection with partial cystectomy. One year following post-operative radiotherapy, he had to undergo surgery for intestinal perforation. On laparotomy the recurrent tumor had involved pelvic organs and sigmoid colon. It now showed predominantly osteogenic sarcoma on histopathologic examination. The case is reported in view of rarity of primary osteogenic sarcoma in the urinary bladder.

Conversion of loop colostomy to end colostomy: is dismantling necessary?

Twelve patients who had previously undergone preliminary pelvic loop colostomy were treated by conversion of loop colostomy to end colostomy by alternative technique ie without dismantling of loop and conversion to end stoma. The results of this technique were compared with those of conventional procedure which was performed in ten patients. The new technique results in a 'mature' end colostomy in situ with little pain at the stoma site, no risk of retraction and lower risk of peristomal infection. We therefore recommend this procedure for all patients needing such conversion.

A possible role of caesium radiations in the control of propagation of hookworm.

Faeces charcoal mixtures containing eggs of sheep hookworm, Haemonchus contortus were exposed to caesium radiations (23 r to 1656 r) from 1st to 7th day of incubation. Each plate was exposed only once. A dose related inhibition of transformation of eggs to infective larvae was observed. The maximum effect was observed on 2nd day of incubation. The radiation has maximum effect on the 1st stage larvae followed by 2nd stage. The 3rd stage or ineffective larvae are relatively resistant to the effect of radiation.

Central hyperthermic effect of arsenic in rabbits.

Hyperthermic effect of arsenic was investigated in rabbits. Injections of arsenic trioxide (0.0001 to 0.1 micrograms) into a lateral cerebral ventricle of the rabbit evoked a dose-dependent hyperthermia, respiratory stimulation and peripheral vasodilatation. Heat loss through respiratory stimulation and peripheral vasodilatation appeared responsible for the long latent period and the slight hypothermia sometimes obtained during this period as these effects followed the same time course. These effects were centrally mediated as demonstrated by the lack of efficacy of the same doses by the intravenous route. The hyperthermic effect of arsenic was antagonized by the sulphydryl donator, dimercaprol, the a-adrenoceptor blocking agent-phenoxybenzamine and the PG-synthesis inhibitor-aspirin. Multiple sites, for antagonistic effects of these substances can be explained by the action of arsenic in inactivating sulphydryl containing enzymes which are many and catalyze diverse biochemical reactions.