Somatosensory and Motor Evoked Potential Monitoring in a Patient of a Spinal Tumour at Lumbar Level under Total Intravenous Anaesthesia- A Case Report..

A 40-year-old, ASA1 patient was posted for intradural extramedullary tumour at the level of L2-L3 spine. Patient was operated for the same and the tumour was resected. Postoperatively after 36 hours, patient complained of loss of bladder sensation associated with urinary retention. Surgical, urological and radiological findings were suggestive of mass effect (remnant tumour or clot) at the site of the previous surgery. A decision was taken to perform a re-exploration at the site with the use of electrophysiological monitoring including somatosensory and motor evoked potential. The surgery was performed completely under total intravenous sedation with the use of midazolam, fentanyl and propofol. The remnant mass was resected and the patient regained sensory functions in the post-operative period. Hence this case report highlights the use of total intravenous sedation for somatosensory and motor evoked potential monitoring in major neurosurgeries

Carbonic anhydrase IX immunohistochemistry has potential to predict renal cell carcinoma outcomes: A systematic review and meta-analyses

@#Introduction: Tissue biomarker carbonic anhydrase IX (CAIX) is purported to have prognostic value for renal cell carcinoma (RCC) but contradicting findings from previous studies have also been documented. This study aims to perform a systematic review and meta-analysis on the role of CAIX in RCC disease progression. Materials and Methods: Following the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, online searches of multiple databases were performed to retrieve articles from their inception until December 2017. Inclusion criteria included all English-based original articles of immunohistochemistry (IHC) studies investigating CAIX expression in human RCC tissue. Four articles were finally selected for meta-analysis with a total of 1964 patients. Standard meta-analysis methods were applied to evaluate the role of CAIX in RCC prognosis. The relative risk (RR) and its 95% confidence interval (CI) were recorded for the association between biomarker and prognosis, and data were analysed using MedCalc statistical software. Results: The meta-analysis showed that high CAIX expression was associated with low tumour stage (RR 0.90%, 95% CI 0.849-0.969, p= 0.004), low tumour grade (RR 0.835%, 95% CI 0.732-0.983, p= 0.028), absence of nodal involvement (RR 0.814%, 95% CI 0.712-0.931, p= 0.003) and better ECOS-PS index (RR 0.888%, 95% CI 0.818-0.969, p= 0.007). The high tissue CAIX expression in RCC is hence an indication of an early malignancy with a potential to predict favourable disease progression and outcome. Conclusion: The measurement of this marker may be beneficial to determine the course of the illness. It is hoped that CAIX can be developed as a specific tissue biomarker for RCC in the near future

RECURRENT PREGNANCY LOSS AND ASSOCIATION OF MTHFR, PAI-1 AND ACE GENE POLYMORPHISMS IN WOMEN

Recurrent pregnancy loss (RPL) is a significant clinical problem that may occur before the 20th week of gestation. There is no general consensus on how many consecutive abortions are considered as RPL. The goal of this study is to investigate the correlation between recurrent miscarriage (RM) and common polymorphisms in angiotensin-converting enzyme (ACE), plasminogen activator inhibitor 1 (PAI-1) and Methylenetetrahydrofolate Reductase (MTHFR) genes among women experiencing RM. The literature existing in different population was searched and based on these finding we conclude that polymorphism in either one of these genes may increase chances of miscarriage.

An approach for conjugation of 177Lu- DOTA-SCN- Rituximab (BioSim) & its evaluation for radioimmunotherapy of relapsed & refractory B-cell non Hodgkins lymphoma patients.

Background & objectives: The prerequisite of radioimmunotherapy is stable binding of a radionuclide to monoclonal antibodies, which are specific to the tumour-associated antigen. Most B-cell lymphomas express CD20 antigen on the surface of the tumour cells, making it a suitable target for therapeutic radioactive monoclonal antibodies. In the present study, the immunoconjugate of biosimilar Rituximab (Reditux™) and macrocyclic chelator, p-SCN-Bz-DOTA, was prepared and radiolabelled with Lutetium-177 followed by quality control procedures. Methods: Rituximab(BioSim) was desalted with sodium bicarbonate (0.1M, pH 9.0) and incubated with DOTA-SCN (1:50). The effectiveness of the conjugation was evaluated by determining the number of chelators per antibody molecule. This conjugate was radiolabelled with Lutetium-177 and purified using PD10 column. The quality control parameters like pH, clarity, radiochemical purity, in vitro stability and sterility were studied. Immunoreactivity of 177Lu-DOTA-Rituximab (BioSim) was assessed using RAMOS cells. The radioimmunoconjugate (RIC) after stringent quality assurance was injected in three patients and the biodistribution profile was analysed. Results: An average of 4.25 ± 1.04 p-SCN-Bz-DOTA molecules could be randomly conjugated to a single molecule of Rituximab (BioSim).The radiochemical purity of the labelled antibody was >95 per cent with preserved affinity for CD20 antigen. The final preparation was stable up to about 120 h when tested under different conditions. A favourable biodistribution profile was observed with liver showing the maximum uptake of the RIC. Interpretation & conclusions: A favourable radiochemical purity, stability and biodistribution of the radiolabelled immunoconjugate indicate that clinical trials for evaluation of toxicity and efficacy of 177Lu-DOTA-antiCD20 antibody-Rituximab (BioSim) in patients of relapsed and refractory non Hodgkin’s lymphoma can be considered.

Orthodontic and surgical management of cleidocranial dysplasia / 대한치과교정학회지

Cleidocranial dysplasia (CCD), an autosomal dominant disorder with a prevalence of 1 in 1,000,000 individuals, is mainly caused by mutations in Runx2, a gene required for osteoblastic differentiation. It is generally characterized by hypoplastic clavicles, narrow thorax, and delayed or absent fontanel closure. Importantly, its orofacial manifestations, including midfacial hypoplasia, retained primary teeth, and impacted permanent and supernumerary teeth, severely impede the well-being of affected individuals. Successful treatment of the orofacial problems requires the combined efforts of dental specialists. However, only a few successfully treated cases have been reported because of the rarity of CCD and complexity of the treatment. This article presents the University of California, San Francisco (UCSF) treatment protocol for the dentofacial manifestations of CCD based on two treated and 17 diagnosed cases. The records of two patients with CCD who had been treated at the UCSF School of Dentistry and the treatment options reported in the literature were reviewed. The UCSF treatment protocol produced a successful case and a partially successful one (inadequate oral hygiene in the retention stage resulted in decay and loss of teeth). It provides general guidelines for successfully treating the orofacial manifestations of CCD.

Caudodontia of mandibular 2nd molar with bilateral maxillary canine – premolar transposition - a case report.

Transposition of teeth is a developmental anomaly manifested by a positional interchange of two permanent teeth. It is often associated with hypodontia, peg lateral crowding, severe rotation and malformation like dilaceration and missing teeth, retained teeth and even with impaction which are clinically important for diagnosis as well as treatment plan. However, this case is a deviation from the afore mentioned group of associated anomalies. Surprisingly, in this case bilateral maxillary canine – premolar transposition is associated with idiopathic resorption of the crown of the second mandibular molar. The persistence of only the caudal part of the tooth in such a case merits denoting it as ‘Caudodontia’ by us.