Primary hyperparathyroidism presenting as severe hypercalcemia with acute pancreatitis in pregnancy.

Primary hyperparathyroidism presenting first time with severe hypercalcemia is rare in pregnancy. We report a case of primary hyperparathyroidism due to a cystic parathyroid adenoma presenting as severe hypercalcemia with acute pancreatitis in second trimester of pregnancy. Acute pancreatitis was managed by conservative treatment. Hypercalcemia failed to respond to medical management and ultimately responded to ultrasound-guided ethanol ablation of parathyroid adenoma. The delivery was uneventful and patient continues to remain normocalcemic during follow up. As such, ethanol ablation of parathyroid adenoma may be considered during pregnancy in case of failure of response to medical management and when surgical removal of parathyroid adenoma is not safe.

Evaluation of line-probe assay for molecular analysis and drug susceptibility of extra-pulmonary tuberculosis.

SETTING: Most epidemiological studies on Mycobacterium tuberculosis focus on pulmonary tuberculosis (TB), whereas extra-pulmonary TB (EPTB) remains poorly explored. OBJECTIVE: To study the rate of resistant EPTB cases among individuals with suspected EPTB using a commercial line-probe assay (LPA), polymerase chain reaction (PCR) and reverse hybridisation test. We also examined the molecular profile of the EPTB isolates obtained at the Himalayan Institute of Medical Sciences, Dehradun, India. DESIGN: EPTB samples were collected from 249 patients with clinical and radiological suspicion of EPTB and subjected to automated liquid culture, PCR and GenoType MDRTBplus according to the manufacturers' instructions. RESULTS: A diagnostic yield of 15% was observed among individuals with suspected EPTB using MGIT™ (Mycobacterium Growth Indicator Tubes), which increased to 38% on LPA and PCR. LPA results had 100% concordance with MGIT, with all culture-positive samples also being positive on LPA. However, 70.2% of LPA-positive samples did not grow Mycobacterium tuberculosis in liquid culture. Two (2.1%) of the culture-negative EPTB PCR-positive samples were multidrug-resistant, 20 (21.2%) were rifampicin-monoresistant and 12 (12.7%) isoniazid-monoresistant on LPA. CONCLUSION: Given the paucibacillary nature of EPTB, we demonstrated that PCR and LPA can have a vital role in establishing TB diagnosis in extra-pulmonary tissues.

Coccydynia - could age, trauma and body mass index be independent prognostic factors for outcomes of intervention?

Introduction The aetiology of coccydynia can be multifactorial, with several associated factors such as obesity, female gender and low mood. The long-term results of operative interventions, such as manipulation under anaesthesia and coccygectomy are variable, ranging from 63-90%. Materials and methods Our aim was to identify whether age, trauma and body mass index (BMI) were independent prognostic factors in coccydynia treatment. All patients who presented to the Royal Derby Hospital with a primary diagnosis of coccydynia between January 2011 and January 2015 who had injections, manipulation under anaesthesia or coccygectomy were included. We used patient-reported satisfaction score as the primary outcome measure. We hypothesised that patients with preceding history of trauma and with high BMI (> 25) would be less satisfied. We divided patient BMI into four groups, following World Health Organization guidelines: group A (18.5-24.9), group B (25-29.9), group C (30-39.9) and group D (> 40). Results A total of 748 patients were diagnosed with coccydynia. Of these, 201 patients had 381 injections, 40 had 98 manipulations under anaesthesia and 9 had coccygectomy. Mean age was 46.4 years; 26% of patients had trauma to the coccyx. The mean time to follow-up was 7.3 months. We found a statistically significant difference (P = 0.03) between satisfaction scores in groups B and D. Patients who had trauma improved significantly (P = 0.04). The odds ratio calculation of coccygectomy and BMI revealed a higher risk of coccygectomy in Group A. Discussion This is the first study to establish BMI and trauma as independent prognostic factors for coccydynia treatment. Our hypothesis that patients with higher BMI would have lower satisfaction levels has been proven true.

Reduced thalamic volume in men with antisocial personality disorder or schizophrenia and a history of serious violence and childhood abuse.

OBJECTIVE: Violent behaviour has been associated with presence of certain mental disorders, most notably antisocial personality disorder (ASPD) and schizophrenia, childhood abuse, and multiple brain abnormalities. This study examined for the first time, to the authors' knowledge, the role of psychosocial deprivation (PSD), including childhood physical and sexual abuse, in structural brain volumes of violent individuals with ASPD or schizophrenia. METHODS: Fifty-six men (26 with ASPD or schizophrenia and a history of serious violence, 30 non-violent) underwent magnetic resonance imaging and were assessed on PSD. Stereological volumetric brain ratings were examined for group differences and their association with PSD ratings. PSD-brain associations were examined further using voxel-based-morphometry. RESULTS: The findings revealed: reduced thalamic volume in psychosocially-deprived violent individuals, relative to non-deprived violent individuals and healthy controls; negative association between thalamic volume and abuse ratings (physical and sexual) in violent individuals; and trend-level negative associations between PSD and hippocampal and prefrontal volumes in non-violent individuals. The voxel-based-morphometry analysis detected a negative association between PSD and localised grey matter volumes in the left inferior frontal region across all individuals, and additionally in the left middle frontal and precentral gyri in non-violent individuals. CONCLUSIONS: Violent mentally-disordered individuals with PSD, relative to those with no or minimal PSD, suffer from an additional brain deficit, i.e., reduced thalamic volume; this may affect sensory information processing, and have implications for management, of these individuals. PSD may have a stronger relationship with volumetric loss of stress-linked regions, namely the frontal cortex, in non-violent individuals.

Experiencia preliminar con solo micro-disectomía cervical anterior (SMCA), en un Instituto de Cuidado Terciario en el norte de la India / Only preliminary experience with micro-discectomy anterior cervical (SMCA) in a tertiary care institute in North India

OBJETIVO: La fusión intercorporal seguida de disectomía cervical anterior para la enfermeda degenerativa del disco (EDD) es una enseñanza tradicional y convencional. El diseño de este estudio prospectivo fue para evaluar los resultados clínicos a largo plazo en los pacientes operados de hernia cervical del disco con solo micro-disectomía cervical anterior (SMCA). MÉTODOS: Se incluyeron en el estudio, desde enero del 2004 a marzo del 2007, pacientes con evidencia radiológica de enfermedad cervical discal de uno o dos niveles y fueron seguidos por un mínimo de 6 meses y un máximo de 46 meses. A todos los pacientes se les realizo solo microdisectomía cervical anterior, por un solo cirujano, usando un microscopio Leica. Se evaluaron a los pacientes en la mejoría de los síntomas y signos clínicos, estatus laboral usando la graduación de Nurick y los criterios de Odom. RESULTADOS: De los 33 pacientes operados durante el período de estudio; 28 eran varones y su edad vario entre 28 a 65 años con una media de 45.72 años. La hernia de disco C5-6 fue el nivel más comúnmente afectado. Cinco pacientes tuvieron dos niveles de hernia del disco y fueron operados de dos niveles en la misma cirugía. La presentación más común fue radiculomielopatia seguida por dolor y mielopatia. Dolor radicular fue el síntoma más temprano que desapareció después de la cirugía seguido por los síntomas mielopaticos. CONCLUSIÓN: Esta técnica es un tratamiento quirúrgico adecuado para la mayoría de casos de disco cervical prolapsado; no requiere fusión y evita problemas específicos y complicaciones asociados a la instrumentación y fusión. Nosotros, aun continuamos el estudio de seguimiento de estos pacientes, pero hasta la fecha ningún problema tardío considerable ha llegado a ser evidente. Pensamos que la mejor respuesta a esta pregunta se puede obtener solamente con un estudio prospectivo multicentrico doble ciego randomizado.

Aggressive angiomyxoma in men.

Aggressive angiomyxoma is an uncommon neoplasm that preferentially involves the pelvic and perianal regions of reproductive age females. These tumors are rare in men and merit a wider recognition in male urologic pathology. We report a case of a 65 year old male who presented with a swelling in the left perineal region since 2 years which gradually increased in size to 10 x 10 x 8 cms. CT scan revealed a well defined lobulated heterogenous minimally enhancing mass in the left ischiorectal fossa extending upto the subcutaneous plane. Microscopically stellate to spindle shaped cells arranged in a loose myxoid stroma with numerous thin to thick walled vessels were seen. There was no evidence of pleomorphism, hyperchromatism or mitotic activity. This case is reported because of its rarity in males. It is a benign tumor and requires a wide excisional surgery.

Goldenhar-Gorlin's syndrome: A case report.

Goldenhar syndrome, a term synonymously used with "oculo-auriculo-vertebral" [1] spectrum is a rare disorder that is apparent at birth. Described as early as 1950's it was initially comprised of malformation of ears and ocular abnormalities it was only in 1963 that vertebral abnormalities were included as signs of this syndrome. This work reports a case 12 year old male who presented in department of GMC with dysmorphic ears and on evaluation was found to have the classical signs of this syndrome. This case did not have the classical ocular findings. Also included is the current protocol for treatment of this syndrome.

Bronchial foreign body: A case report.

Exogenous foreign bodies in the tracheo bronchial tree, are not uncommon particularly in children. Children who are not given proper individual attention at an early age are more liable to ingest or inhale foreign body. Complications are related to site, size, shape, nature and duration of foreign body. Foreign body aspiration is associated with significant morbidity. Awareness of these possible complications and a high index of suspicion is the key to successful management. We report a case of bronchial foreign body in a 12 year old boy who had accidentally aspirated a metallic whistle. The foreign body was removed successfullv without any complications.

Isolation and molecular characterization of the COP1 gene homolog from rice, Oryza sativa L. subsp. Indica var. Pusa Basmati 1.

The COP1 (CONSTITUTIVE PHOTOMORPHOGENIC 1) gene has been identified earlier from dicot species namely Arabidopsis, tomato and pea. The protein encoded by this gene acts as a molecular switch that negatively regulates the transition from the skotomorphogenic to the photomorphogenic mode of plant development. We have isolated and characterized the COP1 homolog from a monocot species, i.e. rice (var. Pusa Basmati 1). All the functional domains (Zn-binding RING finger motif, coiled-coil region, WD-40 repeats, cytoplasmic/nuclear localization sequences and protein-protein interaction domains) that are known in the COP1 proteins from dicots are conserved in COP1 from rice as well. The transcript levels of COP1 vary in various tissues of the rice plant. These variations were found to be development-dependent and do not solely depend on the light conditions.

Alpha-fetoprotein production by rhabdomyosarcoma of the urinary bladder.

Alpha-fetoprotein has emerged as a useful diagnostic tool for hepatic tumour and tumours of germ cell origin. However, isolated case reports of association of this tumour marker with tumours of the lung and non-germ cell tumours of the ovary are reported. We present a case of a Rhabdomyosarcoma, a generally non-secretory tumour that showed raised levels of AFP in serum and reacted positively for the same in a PAP technique for AFP. Cross striations were visible in many cells on II & E stained sections.

Gamma-rays and EMS induced pentaphyllous mutant in black gram (Vigna mungo).

Pentaphyllous mutants in black gram were isolated in M2 generation of a segregating family, irradiated at 20 kR. The genetic nature of mutants was tested by hybridizing with controls, and chi-square tests applied to the F2 population, proved it to be a monogenic recessive. The pentaphyllous mutant had a greater number of pods and leaves per plant and larger and more root nodules. It also showed improved nutritional value with increased seed protein percentage and no increase in TIA (trypsin inhibitor activity).

Genotype dependent radiosensitivity of autotetraploids in Trigonella foenum-graecum L.

Different diploids of Trigonella foenum-graecum L. and their corresponding autotetraploids were seed-treated with 40 krad of γ-rays, and parameters such as germination, survival, growth reduction, pollen fertility, pod setting, etc. were recorded. A stimulation of seed germination due to the irradiation could be observed. Contrary to the general rule that polyploids are more radioresistant than their corresponding diploids, one 4x strain was completely killed while the 2x version survived comparatively well. Apparently gene reduplication is not the overall protective mechanism as was once earlier believed. The importance of genotypic influence on radiosensitivity was demonstrated at both the 2x and 4x level. The limitation of interphase chromosome volume and degree of ploidy in predicting radiosensitivity is discussed.