Sensitivity and specificity of frozen section diagnosis in orbital and adnexal malignancies

Purpose: To analyze the diagnostic accuracy of frozen section in orbital and adnexal malignancies. Methods: A total of 55 cases between January 2006 and December 2011 for which intraoperative frozen section was performed for various orbital and adnexal lesions were included in the study. The frozen section diagnosis was compared with the permanent section diagnosis. Margin clearance was also compared between the two. Data were analysed using SPSS version 14. Odds ratio and cross-tabulation was used to perform the analysis. Results: The mean age at presentation was 51.46 � 20 years. Eyelid was the most common site of involvement. Out of 55 cases, diagnosis was deferred in four cases (7.27%) on frozen section. Among 51 cases, 44 (86%) cases were concordant, whereas 7 (13%) cases were discordant. The sensitivity and specificity of frozen section compared to permanent section for diagnosis of malignancy was found to be 87.2% and 87.5%, respectively. The sensitivity and specificity of frozen section for diagnoses of basal cell carcinoma was found to be 100%, while it was 83.3% and 100% respectively for sebaceous gland carcinoma and 87.5% and 94.9% respectively for squamous cell carcinoma. Conclusion: Frozen section had high sensitivity and specificity when compared with permanent section for all three parameters studied. It is an important intraoperative tool that is increasingly being used in histopathological examination of ophthalmic lesions. However, it should not be used as a substitute for the permanent section and critical decisions based on it are best avoided.

Necrotizing fungal infection due to Saksenaea erythrospora: A case report and review of literature

Mucormycosis caused by Saksenaea erythrospora is an emerging infection seen with soil contamination, burns and/or nosocomial infections. PCR amplification and internal transcribed spacer sequencing is gold standard for its identification. Here, we report a case of necrotizing fungal orbital infection by S. erythrospora in an immunocompetent child.

Combined approach to management of periocular arteriovenous malformation by interventional radiology and surgical excision

Periorbital arteriovenous malformations (AVMs) are congenital lesions that may cause significant morbidity such as amblyopia, cosmetic disfigurement, or chronic pain. Due to the rarity of these lesions, they are frequently misdiagnosed and treated inappropriately. We managed a 6-year-old girl with preseptal AVM by endovascular embolization followed by complete surgical excision after 2 days. She was previously diagnosed as capillary hemangioma and was being treated with intralesional steroid injections and oral propranolol. Neuroimaging revealed an AVM fed by the branches of both external and internal carotid arteries and drained by the superior ophthalmic vein. Endovascular embolization with glue followed by complete surgical excision of the lesion was done. The resultant cosmetic and functional outcome was gratifying. Diagnosis and management of periorbital AVM remain a challenge requiring a multidisciplinary approach involving interventional radiologist and trained oculoplastic surgeons. Combined endovascular embolization followed by surgical excision proved safe and effective.

Bacteriology and Antibiotic Resistance Pattern in Community Acquired Urinary Tract Infection.

Extensive use of antibiotics have resulted in development of resistance among most commonly used drugs in community acquired urinary tract infection (UTI). This study was conducted to identify the resistance pattern in community acquired UTI .We collected urine for routine examination and culture from suprapubic urine in all the cases to avoid any contamination. E. Coli was the most common organism identified. Among oral antibiotics, there was high degree of resistance to penicillin group and cephalosporin groups. Among parentral antibiotics, all the cephalosporins were variably resistant except cephaperazonesalbactum.

Plankton diversity and dynamics in a polluted eutrophic lake, Ranchi.

The species diversity of a cultural eutrophic lake at Ranchi was studied in relation to external variables (forcing functions) and internal or state variables. The lake receives daily detergent inputs in the form of washings of a variety of objects. A model was constructed for the estimation of detergent inputs from the increase in the phosphate concentration, and from changes in the concentration of inorganic carbon. Nutrients such as inorganic carbon, nitrates, phosphates, sulphates were found to be high in contrast to natural unpolluted systems. The DOM, COD and BOD were also found to be high suggesting organic pollution of the system with an organic carbon load of 5.4 m moles l-1. The growth and development of the plankton constituents was studied in this regime. The natural planktonic rhythm was found to be modified by the polluted condition existing in the lake. The phytoplankton exhibited four peaks in March, May, August, and November while, the zooplankton showed three peaks in February, July and October. The abundance of zooplankton during the annual cycle oscillated with that of the phytoplankton. There was much more evenness in the zooplankton population in comparison to the phytoplankton. Analysis of both, the zooplankton as well as the phytoplankton population was done using the Bray-Curtis dissimilarity index, importance value index and Shannon-Weaver diversity index. The importance value index was found to provide a better evaluation of the plankton community than the diversity index. The phytoplankton population showed no correlation with nutrient availability as indicated by the correlation-regression analysis and the planktonic rhythm was not in tune with normal unpolluted conditions. The lake was classified as meso-polysaprobic using biological and chemical indices (Pantle and Buck index:3.5, BOD:60; DOM:9.3 and COD:130).

Nutrient cycling in a simulated pond ecosystem.

Mathematical modeling of ecosystems requires a considerable amount of knowledge about the subsystems functioning within the broad framework and the various rate processes and transfer coefficients that control the dynamic aspects. A detailed analysis of the transfer rates and budget of inorganic carbon and nutrients in a simulated pond was conducted for assessment and comparison with aquatic bodies that undergo cultural eutrophication. In these systems the processes are complicated by a variety of inputs. Such inputs interfere with the assessment of lake background conditions and water quality. We used the compartmental model of biogeochemical cycling to calculate transfer rate of inorganic carbon and nutrients through various processes. The major external variables or forcing functions considered were light and temperature, while the state variables included the biotic and the abiotic compartments. The major processes studied were: photosynthesis, respiration and decomposition that play an important part in balancing the nutrient content of the system and maintain a dynamic equilibrium. The study illustrates how computational modeling studies are useful for analysis and management of systems for control and optimization of processes. The system shows a perfect cycling of carbon and the rate of withdrawal is equal to the return keeping the system in balance. About 0.284 m moles l-1 is withdrawn from the reservoir for primary production each day and returned back through respiration and decomposition. The concentration of nitrates and phosphates resonate in tune with the utilization of carbon and productivity.

Serological aspects of Dengue fever and its correlation with clinical features in a recent febrile outbreak.

The study was done to assess correlation between serology and clinical features of Dengue fever at Burdwan Medical College, where after clinical examination, blood samples were processed by E.I.A. Of 139 cases, mostly between 1 to 20 years, Male-Female ratio was 80:59. Bleeding manifestation was observed only in 3 cases, and Lymphadenopathy, Myocarditis were uncommon features. Few patients have biphasic temperature. Fever and severity of symptoms did not have correlation. Patients' blood was examined for Dengue viruses, with only 44.6% positivity. Correlation exists between illness duration and antibody titer. [r = 0.41; (P < 0.01)]. Fever other, than Dengue also exhibited similar symptoms, but optical density in EIA test was less. As high fever with similar symptoms may be due to causes other than Dengue, thorough search for other viral infection namely Chikungunya should be done in endemic areas also.

Historical introduction of acupuncture in India.

Acupuncture, though originated in oriental countries in the ancient times but, its philosophical understanding is amazingly wide open to the modern medical science. Historically, records are there regarding its Indian origin. However, acupuncture practised today in Indian sub-continent mainly shows Chinese origin and its introduction to India was pioneered by Dr. B.K. Basu, the first Indian who learned Chinese acupuncture from mainland China during 1959. It is interesting enough to note that though acupuncture is successfully practised in India in a rejuvenated form for the last few decades but due to lack of proper Governmental support this thereby suffers from under utilization and under development. While WHO suggested for its wider application and development through concerted Governmental efforts.