Cerebro-spinal and renal ochronosis: A rare case report.

Alkaptonuria, a rare inborn error of tyrosine metabolism, characterized by the absence of homogentisic acid oxidase results in the accumulation of homogentisic acid in the body. Associated renal failure and cerebral infarction is rare and usually occurs in the later stages of the disease. We report a 55-year-old male who presented, initially with features of stroke and degenerative arthritis. He had pigmentation of sclerae, darkening of urine on long standing, abnormal renal profile, degenerative arthritis and cerebral infarction. Alkaptonuria was suspected and biochemical tests confirmed mild renal impairment, homogentisic acid in urine and homogentisic acid crystal was detected cytologically in urine sediment. Such a case of Alkaptonuric ochronosis with cerebrovascular and renal complications have been rarely reported in the previous literature.

Significance of free radical injury in laryngeal and hypopharyngeal cancers.

BACKGROUND AND OBJECTIVES: Laryngeal and hypopharyngeal cancer is a multifactorial disease caused by various carcinogens such as tobacco, alcohol and viruses. Likewise, oxidative stress is known to cause aberrations in the cell membrane and DNA, leading to cancer. We conducted this prospective study in order to evaluate the level of oxidative stress in laryngeal and hypopharyngeal cancer patients. METHODS: Fifty patients with laryngeal and hypopharyngeal cancer and 40 control subjects were selected. Serum malondialdehyde concentrations and ferric reducing antioxidant power were assessed, in order to evaluate oxidative stress. Results were analysed by Student's t-test. RESULTS: Malondialdehyde levels were significantly higher and ferric reducing antioxidant power lower in the cancer patients, compared with the controls, indicating higher oxidative stress in the former. There was no statistically significant difference in malondialdehyde concentration or ferric reducing antioxidant power, comparing patients with versus without neck secondaries, and patients with early stage versus late stage tumours. CONCLUSION: Oxidative stress may have a role to play in the initiation of laryngeal and hypopharyngeal cancers, especially in patients with other risk factors such as tobacco and alcohol use.

Total antioxidant capacity--a novel early bio-chemical marker of oxidative stress in HIV infected individuals.

BACKGROUND: Oxidative stress induced by the production of reactive oxygen species may play a critical role in the stimulation of HIV replication and the development of immunodeficiency. This study was conducted as there are limited and inconclusive studies on the significance of a novel early marker of oxidative stress which can reflect the total antioxidant capacity in HIV patients, METHODS: Total antioxidant capacity (TAC) and lipid peroxidation were evaluated in 50 HIV-1 seropositive patients (including HIV-1 symptomatics and asymptomatics). Controls included 50 age and sex matched and apparently healthy HIV-1 seronegative subjects. Serum malondialdehyde (MDA), Total antioxidant capacity [TAC] (by ferric reducing antioxidant power assay), vitamin E, vitamin C and superoxide dismutase (SOD) enzyme activity were estimated among controls and cases. Statistical comparisons and correlations at 5% level of significance were determined. RESULTS AND DISCUSSION: The mean MDA concentrations were significantly elevated in both HIV-1 asymptomatic (CD4+ count > 500 cells/microliter) and HIV-1 symptomatic (CD4+ count <500 cells/microliter) groups (Mean +/- S.D values were 2.2 +/- 0.7 nmol/ml and 2.8 +/- 0.8 nmol/ml respectively) when compared with the control group (mean +/- S.D value was 0.9 +/- 0.2 nmol/ml) (p < 0.01). The mean TAC of HIV-1 asymptomatic and HIV-1 symptomatic (Mean +/- S.D values were 754.6 +/- 135.6 micromol/L and 676.6 +/- 154.1 micromol/L respectively) patients were significantly reduced compared with the control group (Mean +/- S.D value was 1018.7 +/- 125.6 micromol/L) (p < 0.01). Also, there were significantly decreased levels of vitamin E, vitamin C and SOD among HIV-1 seropositive patients(controls > asymptomatic > symptomatic) compared to controls (p < 0.01). TAC showed significant negative correlation with MDA among HIV-1 infected patients (p < 0.01). CONCLUSION: Our results clearly show that severe oxidative stress occurs in the HIV-1 seropositive patients in comparison with controls, and increases significantly with the progression of disease, i.e. HIV-1 symptomatics > asymptomatics > controls. TAC can be used as a novel early bio-chemical marker of oxidative stress in HIV-1 infected patients which may result in reduced tissue damage by free radicals and help to monitor and optimize antioxidant therapy in such patients.

Acalculous gallbladder distension in a young child due to HAV infection: Diagnostic dilemma.

Gall bladder distension with acute viral acalculous cholecystitis is a rare event in pediatric cases with a high incidence of perforation, gallbladder necrosis and mortality. We report a two and a half year old female child presenting with fever, vomiting, pain abdomen, mild hepatosplenomegaly and tenderness in right hypochondrium. Laboratory investigations revealed hyperbilirubinemia and elevated alkaline phosphatase, but there was no evidence of bacterial or parasitic infection. Serology for viral hepatitis suggested acute Hepatitis A infection. Ultrasonographically, distended inflamed gallbladder without calculous was observed. Finally acute acalculous cholecystitis due to Hepatitis A virus was diagnosed and the child responded to the conservative management.

Plasma lactate as prognostic marker of septic shock with acute respiratory distress syndrome.

The present study was conducted to study the significance of lactate as a prognostic marker in patients of septic shock with acute respiratory distress syndrome. This study was conducted on 50 critically ill patients of septic shock with acute respiratory distress syndrome between the age group of 20-60 years and 50 controls. Plasma lactate and serum electrolytes were determined among controls and patients. Arterial blood gas analysis for pO(2), pCO(2) and pH was carried out among patients. Arterial base excess and anion gap were calculated and lactate was correlated with base excess, anion gap and pCO(2) at 5% level of significance. Higher lactate, negative arterial base excess, high anion gap, low pO(2) and high pCO(2) were observed among patients. Lactate was positively correlated pCO(2) and anion gap and negatively with pO(2) and base excess among patients. Hyperlactatemia increasing with progression of septic shock with acute respiratory distress syndrome may suggest that lactate may be used as noninvasive prognostic marker or guide to resuscitation.

Primary mucinous adenocarcinoma in an ileostomy with adjacent skin invasion: a late complication of surgery for ulcerative colitis.

INTRODUCTION: Adenocarcinoma of the ileostomy after colectomy performed for non-neoplastic condition are relatively uncommon. Mucinous adenocarcinoma at an ileostomy site represents a late complication of total colectomy performed for ulcerative colitis. CASE REPORT: We here report a case of mucinous adenocarcinoma of the mucocutaneous junction at the ileostomy site with adjacent skin invasion occurring 35 years after total colectomy for ulcerative colitis. Wide excision with refashioning of the ileostomy was performed.