Mucosal Melanoma of Palate: A Case Report with Review of Literature.

The World Health Organisation defines mucosal malignant melanoma as a malignant tumour of melanocytes or of melanocyte progenitors. Due to the lack of symptoms and unknown etiology, mucosal malignant melanoma may go undiagnosed. The surgeon can find it challenging to come up with a definitive treatment strategy because of its rarity and rapid spread. In this case study, a 57-year-old female patient with hyperpigmented gingiva and palate diagnosed pathologically and immunohistochemically as malignant melanoma underwent surgical excision and a modified radical neck dissection.

Iron deficiency in proteinuric children with nephrotic syndrome: A cross-sectional pilot study.

Massive proteinuria in nephrotic syndrome causes depletion of various proteins. Iron deficiency can occur due to urinary loss of iron, transferrin, and soluble transferrin receptors. We conducted this cross-sectional study of 52 children with proteinuric nephrotic syndrome, aged 1-12 years (mean 7.1±2.7 years). Hemoglobin (Hb), RBC indices (MCV, MCH, MCHC), percentage of hypochromic RBCs (Hypo-He), reticulocyte hemoglobin content (Ret-He), and serum ferritin were examined. Seven (13%) patients had iron deficiency anemia and another 10 (19%) exhibited iron deficiency. A higher proportion of children with steroid-resistant disease had anemia than did steroid-sensitive children (P=0.076). Thus, children with nephrotic syndrome may have iron deficiency (32.7%), which needs to be screened.

Multi-walled carbon nanotube-based nanobiosensor for the detection of cadmium in water.

Industrial and agricultural processes have led to the prevalence of cadmium in the ecosystem. A successive build-up of cadmium in food and drinking water can result in inadvertent consumption of hazardous concentrations. Such environmental contamination of cadmium can pose a substantial threat to human and animal life. In humans, it is known to cause hypertension, cardiovascular diseases, DNA lesions, inhibition of DNA repair protein or disturb the functioning of lung, liver, prostate and kidney. The development of a reliable method for Cd (II) ions detection would reduce the exposure and complement existing conventional methods. In this study, a DNA based electrochemical method is employed for the detection of Cd (II) ions using ethyl green (EG) and multi-walled carbon nanotube (MWCNT). Glassy carbon electrode (GCE)/MWCNT forms the working electrode for differential pulse voltammetry (DPV) analysis for the detection of Cd (II) ions. The dsDNA is immobilized onto the working electrode. The indicator dye EG, preferably binds to ssDNA and its reduction peak current is noticeably less in the presence of dsDNA. The Cd (II) ions after interacting with dsDNA, unwinds the dsDNA to ssDNA, upon which the EG molecules bind to ssDNAs, giving a higher reduction peak current. The difference in the reduction peak currents in the presence and absence of Cd (II) ions is proportional to its concentration. The linear detection range achieved in this method is 2 nM-10.0 nM with a sensitivity of around 5 nA nM-1 and the limit of detection is 2 nM, which is less than the permissible limit of WHO for human exposure. This study considerably broadens the possible application of multi-walled carbon nanotube modified electrodes as biosensors and holds prospects for the detection of other heavy metals in environmental samples.

Desmoid-Type Fibromatosis-Clinical Study of an Uncommon Disease.

Desmoid-type fibromatosis is an uncommon disease which mimics sarcoma but is more locally aggressive but with less metastatic potential than sarcoma. Diagnosis is difficult and treatment protocols have changed to include more non-surgical options as compared with sarcoma. This is a retrospective study of the clinical presentation, imaging findings, treatment given, and outcomes of pathologically proven desmoid-type fibromatosis patients who presented to government medical college Kozhikode.

Clinicopathological Factors of Cervical Nodal Metastasis and the Concept of Selective Lateral Neck Dissection in the Surgical Management of Carcinoma Larynx and Hypopharynx and Its Outcome.

To study the clinicopathological and molecular factors which correlate with nodal metastasis in laryngeal and hypopharyngeal carcinoma, a retrospective analysis of 170 patients who underwent surgery for laryngeal and hypopharyngeal carcinoma at RCC, Trivandrum from 2006 to 2010 was done. The pathological nodal stage and levels of involvement were correlated with the clinicopathologic features of the primary disease. Neck node positivity was significantly more for lesions of pyriform sinus lesion (61%), with thyroid cartilage erosion (56%) and with base tongue involvement (88%). Other clinicopathological factors have no impact on the disease-free survival and overall survival for patients with pathologically N0 status. Elective lateral neck dissection is advisable in cases with laryngeal cartilage erosion, pyriform sinus, supraglottis and base tongue involvement.

Cytotoxicity and cellular uptake of ZnS:Mn nanocrystals biofunctionalized with chitosan and aminoacids.

Highly luminescent, manganese doped, zinc sulphide (ZnS:Mn) nanocrystals biofunctionalized with chitosan and various aminoacids such as L-citrulline, L-lysine, L-arginine, L-serine, L-histidine and glycine were synthesized by chemical capping co-precipitation method at room temperature, which is a simple and cost effective technique. The synthesized nanocrystals were structurally characterized by TEM, XRD, EDXS and FT-IR spectroscopy techniques. They possess high colloidal stability with strong orange red photoluminescence emission at 598 nm. The intensity of orange red emission has been observed to be maximum in L-citrulline capped ZnS:Mn nanocrystals in which the emission at 420 nm is effectively quenched by surface passivation due to capping. Taking into consideration the prospects of these highly luminescent, bio-compatible ZnS:Mn nanocrystals in bio-imaging applications, cytotoxicity studies were conducted to identify the capping combination which would accomplish minimum toxic effects. ZnS:Mn nanocrystals biofunctionalized with chitosan, L-citrulline, glycine, L-artginine, L-serine and L-histidine showed least toxicity up to 10 nM concentrations in mouse fibroblast L929 cells, which further confirms their cytocompatibility. Also the ZnS:Mn nanocrystals biofunctionalized with l-arginine showed maximum uptake in in vitro studies carried out in human embryonic kidney cells, HEK-293T, which shows the significant role of this particular amino acid in fetoplacental nutrition. The present study highlights the suitability of aminoacid conjugated ZnS:Mn nanocrystals, as promising candidates for biomedical applications.

Prevalence of Psychiatric Disorders among the Rural Geriatric Population: A Pilot Study in Karnataka, India.

BACKGROUND: Increasing life expectancy around the world, an outstanding achievement of our century, has brought with it new public health challenges. India is the second most populous country in the world, with over 72 million inhabitants above 60 years of age as of 2001. The life expectancy in India increased from 32 years in 1947 to over 66 years in 2010, with 8.0% of the population now reaching over 60 years of age. Few studies in India target the health, especially mental health, of this geriatric population. This study aims to estimate the current prevalence of psychiatric disorders in the geriatric population of the rural area of Singanodi,Karnataka, India. METHODS: This cross sectional, epidemiological, community-based study was conducted in a rural health training area of Singanodi, Raichur District, Karnataka, India.The General Health Questionnaire-12, Mini Mental State Examination, and Geriatric Depression Scale were administered to 366 participants. Chi square tests with Yates correction were utilized for statistical analysis using SPSS 19.0 software. RESULTS: We found that 33.9% of the geriatric population in the selected province were above the threshold for mental illness based on the GHQ-12 questionnaire. Females had a higher prevalence of mental disorder at 77.6% (152 out of 196) as compared to males who had a prevalence of 42.4% (72 out of 170). The most common psychiatric disorder was depression (21.9%), and generalized anxiety was present in 10.7% of the study population. Prevalence of cognitive impairment was 16.3%, with a significantly higher percentage of affected individuals in 80+ age group. CONCLUSION: Mental disorders are common among elderly people, but they are not well documented in rural India. The assessment of psychiatric disorder prevalence will help strengthen psycho-geriatric services and thus improve the quality of life of the elderly. A system that ensures comprehensive health care will have to be developed for this purpose as part of our future efforts.

Thyroid type papillary carcinoma arising in a mature teratoma.

Struma ovary is a monodermal ovarian teratoma which contains mature thyroid tissue. We present an unusual case of papillary carcinoma arising in struma ovarii. A 52 year old post menopausal lady presented with a large right adnexal mass preoperatively diagnosed as a dermoid cyst. She underwent staging laparotomy and the histopatholgy report showed follicular variant of papillary carcinoma thyroid arising in a mature teratoma. She subsequently underwent total thyroidectomy to enable follow up with serum thyroglobulin and iodine scan. On follow up there is no evidence of disease recurrence.

Laparoscopic cholecystectomy for acute cholecystitis: does timing matter?

Acute cholecystitis is a common cause of acute abdominal pain and the definitive treatment is laparoscopic cholecystectomy. When to perform surgery remains controversial. To find out whether laparoscopic cholecystectomy can be performed for acute cholecystitis irrespective of the time since onset of acute symptoms. A total of 200 laparoscopic cholecystectomies performed for acute cholecystitis were evaluated for duration of surgery, conversion rates, biliary and other organ injury, and postoperative stay. Kruskal-Wallis tests, Mann-Whitney tests, and paired t-tests using SPSS software. Thirty patients underwent laparoscopic cholecystectomy within 48 h of onset of symptoms (group 1), 60 patients underwent surgery between 48 h and 6 weeks of onset of symptoms (group 2), and 110 patients underwent surgery after 6 weeks of onset of symptoms (group 3). While the duration of surgery was significantly shorter in group 3 compared to groups 1 and 2 (57.5 min vs. 53.5 min vs. 34.2 min), there were no conversions or major biliary or other organ injury in any of the three groups. Postoperative stay was also comparable between the three groups (3 days vs. 3.1 days vs. 3.08 days). Laparoscopic cholecystectomy can safely be performed at any time after the onset of acute cholecystitis.

Valve repair in rheumatic heart disease in pediatric age group.

Valve repair in children is technically demanding but more desirable than valve replacement. From April 2004 to September 2005, 1 boy and 8 girls with rheumatic heart disease, aged 2-13 years (median, 9 years), underwent valve repair for isolated mitral regurgitation in 5, combined mitral and aortic regurgitation in 2, mitral stenosis in 1, and mitral regurgitation associated with atrial septal defect in 1. Chordal shortening in 7, annular plication in 6, commissurotomy in 1, reconstruction of commissural leaflets in 7 were performed for mitral valve disease. Plication and reattachment of the aortic cusps was carried out in 2 patients. Annuloplasty rings were not used. All patients survived the operation, 8 had trivial or mild residual mitral regurgitation, and 1 had trivial aortic regurgitation. Mean left atrial pressure decreased from 14 to 7 mm Hg postoperatively. During follow-up of 3-18 months, all children were asymptomatic and enjoyed normal activity. None required reoperation. In addition to chordal shortening and annular plication, reconstruction of the commissural leaflets is considered the most important aspect of valve repair. It can be achieved without annuloplasty rings, giving good early and midterm results.

Neonatal Blalock-Taussig shunt: technical aspects and postoperative management.

A systemic-pulmonary artery shunt in neonates with decreased pulmonary blood flow is technically demanding. We describe our surgical technique, postoperative management, and results in 19 neonates who underwent a modified Blalock-Taussig shunt between April 2003 and March 2006. Prostaglandin infusion was required in 8 patients who were critically cyanosed, and 5 were on inotropic support preoperatively. A 3.5 or 4.0-mm polytetrafluoroethylene graft was anastomosed with 8/0 polypropylene suture. Postoperatively, systemic pressure was kept slightly higher than normal, and heparin was started early. One patient required revision of the shunt, and one was reexplored for bleeding. There were 2 hospital deaths (mortality, 11%) in patients with preoperative hemodynamic instability. The mean follow-up period was 12 months, with no late postoperative shunt blockage or death. Meticulous surgical technique and judicious use of heparin and inotropic agents improved the outcome and reduced the incidence of shunt blockage and reexploration for bleeding.

Percutaneous closure of iatrogenic femoral arteriovenous fistula using endovascular covered stent.

Local complications after femoral arterial catheterization, such as hematomas, pseudoaneurysms, arteriovenous fistulas (AV fistulas), and arterial occlusions, are becoming more common, with the growing number of complex invasive procedures being undertaken, especially in older and sicker patients. Newer percutaneous techniques are being developed to treat these. Covered stents are an effective, safe, and less invasive way to deal with pseudoaneurysms and AV fistulas. This case report highlights the application of this technique to treat an iatrogenic femoral AV fistula in a 69 years male.

Erdheim-Chester disease. Case report with autopsy findings.

Erdheim-Chester disease is a rare pathologic entity characterized by symmetrical radiodensities in the metaphyseal and the diaphyseal portions of the long bones. Fibrosis, osteoblastic cortical bone deposition, and fibroxanthomatous granulomas with lipid-laden macrophages and multinucleated giant cells, which have a particular tropism for connective and adipose tissues, are the pathologic hallmarks. To our knowledge, 27 cases have been reported in the literature since the entity was first described in 1930. Protean clinical features range from a focal and asymptomatic process to a multisystemic infiltrative disease. We describe the clinical course of a new case and review the extensive pathologic findings at autopsy, including those demonstrated by light and electron microscopy and cytochemical and immunocytochemical studies.

Ileal hemorrhage caused by a parasitic uterine leiomyoma.

Parasitic uterine leiomyomas occur rarely and may present with a wide variety of symptoms. This report describes a uterine leiomyoma that became adherent to the distal ileum and caused massive lower gastrointestinal hemorrhage. The diagnosis was made preoperatively with a selective superior mesenteric arteriogram. The patient underwent an exploratory laparotomy, hysterectomy, and bowel resection, with subsequent resolution of symptoms. Pathologic evaluation revealed fibrous adhesions of the leiomyoma to the ileum, with bleeding from a dilated blood vessel in the submucosa of the bowel.

Use of polyglycolic acid mesh to confine particulate hydroxylapatite for augmentation of bone in the rat.

A preliminary report of the use of polyglycolic acid (PGA) mesh to contain particulate nonresorbable hydroxylapatite (HA) used for augmentation of bone in rats is presented. PGA mesh tubes, approximately 2 mm in diameter and 5 mm in length, were fabricated, filled with HA, and placed in surgically created subperiosteal pockets against the medial cortex of the tibia in rats. Specimens were obtained at two, six, 12, and 18 weeks. The results showed that when the HA was contained within the PGA mesh, severe displacement of particles was prevented and greater HA augmentation was possible. Absorption of the mesh took place between six and 12 weeks, after which the histologic features were the same as those seen when HA was implanted alone. Grossly, the implants appeared to hold firmly to bone even two weeks after implantation. A new, more efficacious delivery system is proposed for the augmentation of atrophic alveolar ridges using HA contained within PGA mesh tubes.

Anterior mediastinal endodermal sinus (yolk sac) tumor in a female infant.

The first known case of primary anterior mediastinal endodermal sinus (yolk sac) tumor in a female patient, occurring in a 20-month-old infant, is reported. The child presented with cough, fever, and listlessness. Chest x-ray revealed a right anterior mediastinal mass. At thoracotomy a large anterior mediastinal tumor extending from the neck to the diaphragm was found, and was almost totally resected. Microscopically, the tumor displayed many of the histologic patterns observed in EST. Other neoplastic germ cell elements were not identified. The ultrastructural and immunohistochemical findings further confirmed the diagnosis. Serum alpha-fetoprotein (AFP) level, determined during surgery, was elevated to 65,200 ng/ml, whereas serum beta-human chorionic gonadotropin level was normal. Postoperatively, combination chemotherapy consisting of vinblastine, bleomycin, cisplatin, dactinomycin, cyclophosphamide, and doxorubicin was administered with a maintenance program. After 18 weeks on this regimen all the findings were normal, including serum AFP level. The child is well and disease-free 25 months after diagnosis.

Coexistence of IgA myeloma and Gaucher's disease.

An elderly woman of Ashkenazic Jewish descent, who had had adult Gaucher's disease diagnosed seven years previously, was found to have IgA myeloma. The diagnosis of IgA myeloma was confirmed by the presence of lytic lesions in the skull and long bones, atypical plasma cells in bone marrow, and monoclonal elevation of IgA, kappa-type. In addition, the marrow contained Gaucher's cells. A causal relationship between these two pathologic entities remains speculative.