Study of Different Adjuvant Treatment Regimens as a Complement to Surgery in Patients with Carcinoma Anorectum.

Background: In the present study we have done a retrospective as well as prospective studies of patients with carcinoma anorectum undergoing abdominoperineal resection with special emphasis on the role of adjuvant treatment regimens as a complement to surgery. Methods: 75 patients operated for APR were studied retrospectively and 25 patients operated for the same were studied prospectively. Results: It was observed that colorectal cancer is the most common malignancy of the gastrointestinal tract. Rectum remains the most common site affected by it. Carcinoma anal canal is about one tenth as common as rectal cancer. Adjuvant treatment after surgery was studied with respect to the indications, the schedules followed and the subsequent complications. Conclusion: It was concluded that adjuvant treatment, in the form of Radiotherapy and Chemotherapy, has a definitive role in, both locally advanced Carcinoma Anorectum and for Dukes' C stage but it has its own complications which need to be addressed. Nigro's chemoradiation regimen has become the first choice for carcinoma anal canal, ahead of APR.

Accessory Sulci of Liver in the Population of Haryana.

Aims and objectives: Research on segmental anatomy of liver has been extensively done but very little work is done on Accessory Sulcus (AS). Participants: Present study was carried on 36 cadaveric livers with mean age ranging between 30-60 years. Main outcome measures: Although, variation in surface of liver are reported but very few studies are there which reports their presence on inferior surface, on caudate lobe, in gall bladder fossa and right lateral surface of liver. Result:We found AS in 13 livers (36.1%) out of 40 livers. These Sulci were transverse, vertical as well as curved in shape. Out of these in nine liver a single sulcus was present (25%) while in five livers the sulci were multiple (13.88%). Conclusion: This study highlights the occurrence of variations on the liver surface. The finding of this studymay be utilized by imaging specialists & surgeons respectively to avoid errors in interpretations & subsequent misdiagnosis.

Sickle Children Vs Normal Children: A Transcranial and Extracranial Doppler Study.

A prospective hospital based study was carried out to evaluate the role of transcranial Doppler in sickle cell anemia for period of 2 yrs (July 2009- August 2011). A total of 100 children, 50 normal individuals in control group and 50 diagnosed sickle cell disease patients in sickle group were evaluated in the age group .Children were from Newborn to15 years of age, of which 62% were males and 38% were females. Common Carotid Artery (CCA), External Carotid Artery (ECA), Internal Carotid Artery (ICA), Vertebral Artery,Middle Carotid Artery (MCA), Anterior Carotid Artery (ACA), Posterior Carotid Artery (PCA) was evaluated by Transcranial and Extracranial Doppler on both sides in sickle cell patient. The mean velocities in all the vessels were higher in sickle group patient as compared to normal group patients. Evaluation of Extracranial carotid vessels has not been done in previous published studies. Our study can act as benchmark in extracranial Doppler studies of sickle cell patients. We have not followed the patients of sickle cell disease till stroke, but we can say with certainty that increased values of velocity >200 cm/sec is an absolute indication for blood transfusion to prevent stroke, which was observed in 10% of sickle cell patient in our study where velocities reduced by 20-25 cm/sec after blood transfusion.

A Rare Case of Prolapsed Omphalomesenteric duct with ruptured Umbilical Hernia.

Strangulated ileal intussusceptions into the Meckel’s diverticulum (which is caused by an incomplete obliteration of omphalomesentric duct) and coming out through ruptured umbilical hernia is an extremely rare presentation. A 3- months- old male child presented with low grade fever, refusal to feed and episodes of discomfort often alternating with long period of sleepiness and lethargy. On abdominal examination loops of intestine were seen at the site of ruptured umbilical hernia. The abdomen was opened under general anaesthesia by transverse incision. Proximal ileal intussusception into the Meckel’s diverticulum, which was gangrenous, was noted. A resection with end to end ileo-ileal anastomosis was undertaken. The prolapsed bowel was replaced back and double breasting of umbilical defect was done with vicryl 2-0. The patient was completely asymptomatic and healthy.

Pharmacognostical studies of important arid zone plants / Estudos farmacognósticos de plantas importantes de zonas áridas

Arid zone of Rajasthan, India, has its own importance, great diversity and specific characteristic with respect to endemic and large number of plants of economic importance and medicinal use. Out of these, three arid zone plants Gisekia pharnaceoides L., Gisekiaceae, Sericostoma pauciflorum Stocks ex Wight, Boraginaceae, and Trianthema decandra L., Aizoaceae, which are traditionally used for different ailments (hepatitis, asthma, jaundice, skin-infections etc.) have been selected for the study. In the present paper, detailed pharmacognostical evaluation of these plant species using microscopy, standard physicochemical determinations and authentic phytochemical parameters has been carried out. Later, these morphological characteristics could be used for rapid identification of the drugs, particularly in case of powdered materials, and may possibly help to differentiate the drug from its other species.

A zona árida de Rajasthan, Índia, é importante pela grande diversidade e especificidade de plantas endêmicas de importância econômica e medicinal. Destas, três plantas de zonas áridas, Gisekia pharnaceoides L., Gisekiaceae, Sericostoma pauciflorum Stocks ex Wight, Boraginaceae, e Trianthema decandra L., Aizoaceae, que são tradicionalmente utilizados para diversas doenças (hepatite, asma, icterícia, infecções da pele etc.), foram selecionados para o estudo. Neste trabalho trabalho, a avaliação farmacognóstica detalhada destas espécies, através de estudo morfoanatômico, determinações físico-químicas e parâmetros fitoquímicos, foram realizados. As características morfológicas podem ser utilizados para rápida identificação das drogas, particularmente no caso de materiais em pó, e possivelmente ajudar a diferenciar a droga de outras espécies.

Surgical outcome of cortical dysplasias presenting with chronic intractable epilepsy: A 10-year experience.

Background: There has been sparse description of cortical dysplasias (CDs) causing intractable epilepsy from India. Aim: Clinical retrospective study of CDs causing intractable epilepsy that underwent surgery. Materials and Methods: Fifty-seven cases of CDs reviewed (1995 till July 2006) are presented. All patients had intractable epilepsy, and underwent a complete epilepsy surgery workup (inter ictal electroencephalography (EEG), video EEG, MRI as per epilepsy protocol, SPECT {interictal, ictal with subtraction and co-registration when required}, and PET when necessary). Surgical treatment included a wide exposure of the pathology with a detailed electrocorticography under optimal anesthetic conditions. Mapping of the sensori-motor area was performed where indicated. Procedures included resection either alone or combined with multiple subpial transactions when extending into the eloquent areas. Results: Our study had 28 (49.12%) cases of isolated focal CDs, and 29 (50.67%) with dual pathology. Average age at the time of onset of seizures in our series was 7.04 years (three months to 24 years), and average age at the time of surgery was 10.97 years (eight months to 45 years). Among coexistent pathologies, one had associated MTS, 16 had coexistent gangliogliomas and 12 (dysembryonic neuroepithelial tumor) DNTs. At an average follow-up of 3.035 years (range 5-10 years), three patients were lost to follow-up. Fifty-one per cent (29/57) patients had a good outcome (Engel Grade I) and 26%(15/57) had a Grade II outcome. Conclusion: Cortical dysplasias have a good outcome if evaluated and managed with concordant electrical and imaging modalities.

Neuropathological spectrum of lesions associated with intractable epilepsies: a 10-year experience with a series of 153 resections.

BACKGROUND: Surgical management of intractable epilepsies is currently an established mode of therapy in various clinical settings. AIMS: To retrospectively evaluate the neuropathological findings in both temporal and extratemporal lobe resections in such patients. MATERIALS AND METHODS: The study included resected specimens from patients with intractable epilepsy managed at a tertiary care hospital of India, during a 10-year period (1995-2004). RESULTS: A total of 153 patients, with mean age of 19.4 years and male predominance (73.2%) were included in the study. Overall, there was a predilection for the temporal lobe (73.2%), while 41cases were extratemporal in location. On histopathology, mesial temporal sclerosis (MTS) (24.8%) was the commonest lesion, followed by tumors (19.6%) and isolated focal cortical dysplasia (FCD - 15.11%). Other less common findings included Rasmussen encephalitis, non-specific gliosis and vascular malformations. In addition, 20.9% (32 cases) had dual lesions, majority of which included FCD with ganglioglioma (15 cases) or with dysembryoplastic neuroepithelial tumor (12 cases). In the temporal lobe, neoplasms and dual lesions formed the majority (apart from MTS), unlike dual lesions followed by neoplasms and FCD, in the extratemporal location. CONCLUSION: This series demonstrates that most patients with chronic intractable epilepsy have significant histopathological findings and highlights the neuropathological spectrum of such lesions, in the Indian context. This was similar to that reported from the West, but different from the single Indian series available in the literature. Further, the overall profile of temporal lobe lesions was not different from the extratemporal ones.

Neuropathological spectrum of Rasmussen encephalitis.

BACKGROUND: Rasmussen encephalitis (RE) is a chronic epileptic disorder of unknown etiology, and is clinically characterized by progressive neurological deterioration, focal seizures often progressing to intractable epilepsy, cognitive decline and hemispheric atrophy. AIMS: We report the spectrum of neuropathological changes seen in RE, and discuss the evolutionary mechanisms of this disease. MATERIALS AND METHODS: Surgically obtained specimens from RE patients diagnosed during 2002-2004 at this institute were evaluated for the presence and extent of different histopathological features of RE. The H&E and immunohistochemistry stained slides were also evaluated for the type and distribution pattern of inflammatory infiltrates, along with a semiquantitative evaluation for the severity of inflammation. RESULTS: Four cases of RE were admitted during the study period, all of which presented with partial seizures with successive deterioration to intractable epilepsy. The age at onset varied between 5 and 10 years (mean 7.8 years), with three male and one female patients. Subsequently, all four patients underwent hemispherotomy. Histopathological features of perivascular lymphocytic infiltrate, neuronal loss, microglial nodules, and reactive astrocytosis, with or without evidence of neuronophagia confirmed a diagnosis of RE. These cases also had varying degrees of T-cell-rich (CD3-positive) inflammatory infiltrates and CD68-immunopositive microglial proliferation. It was observed that the severity of inflammation had a trend to inversely correlate with the duration of symptoms. CONCLUSION: It is proposed that an accurate evaluation and histopathological grading of these lesions may possibly have a role in patient prognostication.