Inverted papilloma of the urinary bladder: Rigorous surveillance needed: An Indian experience.

Aims: Inverted papilloma (IP) is an uncommon benign neoplasm of the urinary tract. Its multiplicity, recurrence, and association with transitional cell carcinoma (TCC) leads to conflicting clinical conclusions regarding its biological behavior, and hence, the need for rigorous follow-up protocols. In this study, we review all cases of urinary bladder IP in our institution and determine the need for strict follow-up. Materials and Methods :0 We included consecutive patients from August 2004 to August 2008 with IP of the urinary bladder in this study who did not have prior or concurrent urothelial carcinoma. A single pathologist performed the histologic review. The patients had undergone strict a follow-up schedule every 6 months. Results: In our study of the 24 patients, the mean age at presentation was 53.5 (range 22-81) years. The mean follow-up period was 25.8 months (range 6-58 months). Of the 24 patients, 21 were men and 3 were women. No patient had a synchronous or previous bladder tumor. The most common presenting symptoms were macroscopic hematuria and dysuria. All were solitary tumors except one, most commonly found at the bladder neck and trigone. The average follow-up period was 2.5 years without any evidence of recurrence. Conclusions: We conclude that when diagnosed by strictly defined criteria, IP as benign urothelial neoplasm was with extremely low incidence of recurrence and good prognosis. It does not seem to be a risk factor for TCC, especially if located in the bladder. Therefore, a good transurethral resection is adequate therapy and follow-up protocol as rigorous as those for TCC may not be necessary.

Descending thoracic aortic aneurysm presenting as left sided hemorrhagic pleural effusion.

Aneurysm of descending thoracic aorta, in majority of cases is diagnosed either by chance in routine chest imaging for some other reasons or rarely due to it's symptomatic presentation like chest pain and other mediastinal compression symptoms. In this case report we present a case of 69 year old smoker who presented with cough, hemoptysis and left sided massive painless hemorrhagic pleural effusion. Further investigation revealed a large aneurysm of descending thoracic aorta which infiltrated the left lung. We suggest descending thoracic aneurysm be included in the differential diagnosis of this sort of clinical presentation which otherwise imperative with the clinical scenario of bronchogenic carcinoma.

Systemic lupus erythematosus presenting with recurrent pleural effusion without any systemic manifestation.

Pleural effusion can be the sole presenting manifestation in about 5 percent of cases with SLE. We are reporting a case of SLE which presented with recurrent pelural effusion without other systemic manifestation.

Myocardial metabolism: pharmacological manipulation in myocardial ischaemia.

Acute myocardial ischemia may result in diverse outcomes ranging from asymptomatic episodes to frank myocardial infarction. Reperfusion therapy becomes the mainstay of treatment of patients with evolving MI and provide practical approach for salvage of ischemic myocardium. Favorable modulations of metabolic events during and after ischemia results in increased myocardial salvage in reperfused myocardium. The use of GIK showed great advantage in enhancing myocardial salvage in patients with AMI. Use of other metabolic agents show great promise in experimental studies and merits further evaluation in human trials. Metabolic modulation of ischemic myocardium continues to be a unique and untapped approach to favorably effect ischemic myocardium. Metabolic adjuncts can be employed to lessen ischemic injury and thereby enhance the salutary effects of reperfusion. The use of metabolic manipulations which enhance glycolytic pathways and inhibit potentially noxious fatty acid intermediates may also offer a noble approach for the protection of transiently ischemic myocardium in patients with coronary artery disease. And one thing is certain, that is -- agents that modify myocardial metabolism in disease states have definitely enhanced the therapeutic armamentarium to fight the problem and improve the well being of the patients.

High sensitive C-reactive protein: a novel biochemical markers and its role in coronary artery disease.

A series of prospective studies provide consistent data documenting that mild elevation of baseline levels of hs-CRP among apparently healthy individuals is associated with higher long-term risk for future cardiovascular events. This predictive capacity of hs-CRP is independent of traditional cardiovascular risk factors and offers a prognostic advantage over measurement of lipid alone. PHS and CARE trial suggest that the increased risk associated with systemic inflammation may be modified with certain preventive therapies and that inflammatory marker specifically hs-CRP may help to identify those who would benefit most from these pharmacological intervention. hs-CRP is the novel and evolving biomarker which provides a most useful predictive indicator for subsequent cardiovascular events. Based on various studies, increased hs-CRP levels in patients with high risk cardiovascular disease without documented CAD warrant treatment with statin even if LDL-C levels are within target range. Patients with documented CAD and high hs-CRP levels should be followed, and there risk factors should be managed aggressively.

Serum phospholipid fractions measured by two dimensional thin layer chromatography in normal pregnancy.

Serum phospholipid fractions were quantitated by two dimensional thin layer chromatography in 85 apparently normal pregnant women at different gestational period. Fifteen healthy non-pregnant women matched for age served as controls. Normal chromatogram showed eight spots of serum phospholipid viz., phosphatidic acid (PA, 3.9 +/- 0.5%), cardiolipin (C, 7.2 +/- 0.4%), phosphatidylethanolamine (PE, 10.6 +/- 1.1%), phosphatidylglycerol (PG, 3.2 +/- 0.6%), lecithin (L, 34.5 +/- 1.8%), sphingomyelin (S, 31.0 +/- 1.4%), lysolecithin (LL, 8.6 +/- 1.2%) and phosphalidylionositol (PI, 1.0 +/- 0.2%). Serum total phospholipid which increased with gestational age, being lowest at 6 wk (220.2 +/- 4.8 mg/dl) and highest at 38 wk (290.3 +/- 4.5 mg/dl), started declining at term (275.8 +/- 5.8 mg/dl) and returned to levels in normal nonpregnant women (214.1 +/- 4.7 mg/dl) at 4 wk after delivery (217.2 +/- 3.3 mg/dl). PG was absent in both the first and second trimester and first appeared between 31-32 wk, i.e., in the third trimester of pregnancy when the mean per cent of PG was 0.7 +/- 0.4 per cent. During the first trimester when the L/S ratio was less than 1.2 the PI level was low (0.8 +/- 0.2%). Parallel to the increase in the L/S ratio to 2.0, the content of PI increased to 2.6 +/- 0.4 per cent. PG first appeared (0.7 +/- 0.4%) and PI concomitantly decreased (2.1 +/- 0.3%) when the L/S ratio exceeded 2.0 at 31-32 wk. Sequential analysis of maternal serum phospholipid fractions may be used as an additional tool in predicting gestational age of normal growing pregnancy.