Comparing The Efficacy Of Dishwash Solution, Diluted Lemon Water, Coconut Oil And Xylene As Deparaffinizing Agents For Hematoxylin And Eosin Staining Procedure

Aim: To compare the efficacy of dish wash solution, diluted lemon water, coconut oil and xylene as deparaffinizingagents for hematoxylin and eosin staining procedure.Objective: The objective is to find eco-friendly deparaffinizing agents like dish wash solution, diluted lemonwater and coconut oil as substitute to xylene and comparing the staining characteristics of each individualdeparaffinizing agent with Xylene.Materials and Methods: The study comprised of paraffin embedded 45 blocks of various tissues. Each block offour sections of 5 microns thickness was prepared. They were considered in four different groups like A, B, C andD. Tissue sections in Group A were stained with H & E method where xylene was used as deparaffinizing agent. Theother three sections were stained with H & E where dish wash solution, diluted lemon water and coconut oil wereused as deparaffinising agent’s alternative to Xylene. Staining characteristics were compared with xylene andscoring was given. The total score of 3–5 was regarded as satisfactory for diagnosis and less than that isinsufficient for diagnosis.Statitistical Analysis: Chi square test was used.Results: Adequacy of staining characteristics such as nuclear, cytoplasm, uniformity, clarity and crispiness ofstaining for diagnosis was greater with dish wash solution followed by diluted lemon water, coconut oil andxylene.Conclusion: The Eco-Friendly deparaffinizing agents such as dish wash solution, diluted lemon water, and coconutoil can be used as alternatives to xylene

Evaluation And Comparison Of Various Methods Of Lip Prints In Gender Determination And Its Stability Over A Period Of Time

Context: Gender identification is one of the most important aspects in the forensic science. It is based onscientific principles involving dental records, fingerprints and DNA comparisons. Sometimes, it becomes necessaryto apply easy techniques like cheiloscopy. The wrinkles and grooves on the labial mucosa form a characteristicpattern called lip prints, the study of which is referred to as cheiloscopy.Aim: The present study was done to evaluate the accuracy of various methods of lip prints in gender determinationand its stability over a period of time.Subjects and Methods: It consists of 80 healthy individuals (40 males and 40 females) in the age group of 18 to25 years. Lip prints were taken by lipstick, latent and digital photography methods. Data was collected by twoobservers at 0 month and 6months to assess their stability in gender determination.Statistical Analysis Used: Chi-square test was used.Results: The results obtained showed an accuracy of 0% and 57.5% by observer I, 30% and 67.5% by observer IIat 0 and 6th month in gender determination. The measurement of agreement in stability of lip prints was found tobe 27.8% by observer II.It was found that digital photography being the accurate method followed by lipstick andlatent methods.Conclusion: This study revealed that lip prints can be used for determining the gender of an individual.

Gender Determination Using Peripheral Blood Smear

Background: Sex chromatin is a chromatin mass of 1 micron size usually seen at the periphery of nucleus infemales. The term sex chromatin comprises of two superficially dissimilar structures known as Barr body inepithelial cells, other tissue cells and as Drumstick appearance in polymorphonuclear leucocytes. Aim of thestudy is gender determination by drumstick appearance of neutrophils using Leishman’s stain and Field stain.Materials and Methods: The present study included 60 individuals ranging from 20-50 age group of both thesexes to observe the morphology of sex chromatin in neutrophil by using Leishman’s and Field stain for thegender determination and comparison between the 2 staining procedure, using research microscope.Results: Presence of drumsticks, sessile nodule and non specific appendages like racket, tag, hook, minor lobe,small club, were found in neutrophils. In males 37% of drumstick, 7% of sessile nodule, 20% of racket structure,3% small club, 13% minor lobe, 7% hook, 3% tag, was seen and in females 10% of drumstick, 60% of sessilenodule, 17% of racket structure, 7% small club, 1% minor lobe, 0% hook, 3% tag, was seen and field’s stainshowed better results in appreciating the morphology of neutrophil.Conclusion: Observation on morphology and comparison between 2 different stain presented a moderate agreementin gender determination.

Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives

Cholesteatoma is a cystic non tumorous lesion of the temporal bone that has the ability to destroy nearby structures by its power to cause bone resorption and as a result, fatal complications prevail. We aimed to conduct a comprehensive review for pathogenesis of acquired cholesteatoma, bone resorption mechanisms, and offer a future vision of this serious disease. We have reviewed different theories for pathogenesis of acquired cholesteatoma including the most relevant and updated ones with special emphasis on the mechanisms of bone resorption through Medline/PubMed research using the keywords ‘aetiopathogenesis, bone resorption, acquired cholesteatoma, temporal bone, and cytokines.’ In order to strengthen our study, we searched the reference lists of identified reviews. Cholesteatoma is a subject of debate among otolaryngologists since it was prescribed firstly. Over many decades, several theories were postulated for aetiopathogenesis of cholesteatoma with a tendency to follow more than one theory to explain the proper nature of that disease. Until now, the mechanism of bone resorption has yet to be more clarified. In the last century, a leap has occurred in the field of biomolecular cholesteatoma research which improved our knowledge about its pathophysiology and bone destructive mechanism. However, surgery is still the only available treatment. We conclude that discovery of new therapeutic choices for cholesteatoma other than surgery by the use of anti-growth, anti-proliferative, apoptotic agents as well as medications that antagonize osteoclastogenesis should be the main concern in the future clinical and experimental research work. Also, searching for predictors of the aggressiveness of cholesteatoma can affect the timing of intervention and prevent occurrence of complications.

Crystal violet stain as a selective stain for the assessment of mitotic figures in oral epithelial dysplasia and oral squamous cell carcinoma.

Background: Assessment of mitotic figures (MFs) is routinely practiced as prognostic indicator in oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC), but identification of MFs poses a problem in terms of staining characteristics. Aim: To evaluate effectiveness of crystal violet stain for staining of MFs and its comparison with hematoxylin and eosin (H and E) stain. Materials and Methods: Study sample includes archival tissues embedded in paraffin blocks diagnosed as OED (n = 30) and OSCC (n = 30). The control group comprised of tissue specimen from oral mucosa of healthy volunteers (n = 30). Two serial sections of each tissue specimen were stained separately with H and E stain and 1% crystal violet stain. The stained sections were observed under microscope for identification and counting of MFs. Data obtained was statistically analyzed by using the Man-Whitney U test. Results: A significant increase in number of MFs was observed in OED and OSCC in comparison with normal oral mucosa. There was a highly significant increase in number of MFs in crystal violet stained tissue sections when compared with H and E stain. Metaphase is the most commonly observed phase of mitosis in crystal violet stain when compared with H and E stain for all three groups. Conclusion: Crystal violet stain can be considered as selective stain for mitotic figures.

Risk factors of perinatal and neonatal mortality in Alexandria, Egypt

Background: Egypt has already achieved the goal of reducing the under-five mortality rate [U5MR] by two-thirds. However, one of the challenges that Egypt currently faces is how to reduce the perinatal and neonatal mortality [PM, NM]. This study aimed to identify the social and biomedical risk factors contributing toward PM and NM in Alexandria, Egypt

Participants and methods: A case-control design was used. Cases were 150 mothers whose index pregnancy terminated in perinatal [from the 28th week of pregnancy to less than 7 days after birth] and neonatal deaths [from the seventh day to less than the 28th day after birth]. They were selected from the antenatal clinic and neonatal care unit of ElShatby University hospital for Obstetrics and gynecology. Controls were 150 mothers with live births ranging in age from 28 days up to 2 months selected from the outpatient clinics of ElShatby University Hospital for Pediatrics

Results: Stepwise logistic regression analysis indicated a higher risk of PM/NM among very young or very old mothers [OR=4.1 and 6.46, respectively], those who had previous PM/NM [odds ratio [OR]=12.7; 95% confidence interval [CI]: 5.04-29.54], grand multiparous [OR=2.23; 95% CI: 1.50-5.42], those with infrequent antenatal visits [OR=3.88; 95% CI: 2.26-6.65], and mothers with complications during the index pregnancy [OR=9.21; 95% CI: 3.40-24.95]

Conclusion: This study confirms the evidence of a positive association between PM/NM and maternal age, obstetric history, and utilization of healthcare services. Appropriate age at marriage and pregnancy, spacing of and limiting the number of births, and improving antenatal, natal, and postnatal care are priority actions that can reduce PM/NM in Alexandria

Outcome of major liver resection in gastroenterology and hepatology teaching hospital review of nine cases

Major hepatectomies consider one of the most challenging procedure and did not become commonplace until the dramatic improvement in periopertive care in the 1980s. Review the outcome of liver resection performed recently in Gastroenterology and Hepatology Teaching Hospital. From June 2008 to March 2011, nine major anatomic hepatic resection was performed. Enucleation, Non-anatomic or wedge resection was excluded from this study. There were 4 men, 4 women and one child. Age range between 5-43 years median age 40 years. Nine major resection was done this include; extended right hepatectomy 1 patient, right hepatectomy 2 patients, left hepatectomy 3patients, left lateral lobectomy 2 patients, right anterior sectionectomy one patient. The inflow pedicle was controlled either by extrahepatic approach in 6 patients or intrahepatic pedicle ligation by vascular stapler in 3 patients. Post-operative hospitalization was 3-16 days, median 8 days. There were no mortality. Two patients developed bile leak in form of biloma which was treated by percutaneous drainage under ultrasound for 2weeks. Two patients develop intra-operative hypothermia that led to stop the operation for one hour until warming of the patient. Major liver resection can be performed in our hospital with acceptable morbidity rate

Glandular odontogenic cyst: Report of an unusual bilateral occurrence.

Glandular odontogenic cyst (GOC) is a recently recognized rare developmental odontogenic cyst having an aggressive behavior and accounting for 0.012% to 1.3% of all jaw cysts. GOC usually presents as a painless, slow-growing swelling that tends to affect the anterior part of the jaws. It chiefly occurs in the fourth and fifth decades of life and presents as an expansion of jaws with or without pain or paresthesia. Aggressive nature of the lesion has been reported, as supported by the fact that 25 to 55% of cases recur following curettage. So far only just over 113 cases of GOC have been reported in the literature. Here, we report a case of bilateral GOC in the posterior region of the maxilla, in a 29-year-old male patient, which is unique, being the first case of bilateral GOC to be reported in the literature.

Self-limiting caries therapy on an artificial caries model [an artificial dentin caries model in vitro]

Objective: The aim of this study was to quantify the action of the enzyme pepsin on demineralized dentine collagen

Materials and Methods: Slices of dentin were demineralized with acetic and lactic acids. Subsequently, the demineralized surfaces were treated with the enzyme pepsin. To obtain information on the morphology of the demineralized dentine before and after pepsin treatment, high resolution FE-SEM was used. Chemical analysis of the demineralizing solutions was done to identify demineralized and denaturated collagen

Results: As shown in the SEM pictures, surface precipitates accumulated on the demineralized surfaces. The biochemical analysis revealed that no hydroxyproline could be detected in the acetic acid after 7 days of demineralization. Hydroxyproline was found in lactic acid after 3, 7 and 14 days. The enzyme pepsin was effective in removing the degraded organic matrix

Conclusions: The results of the present study indicated a different effect of acetic and lactic acids on collagen degradation; both denaturated and demineralized dentine were produced when lactic acid was used. The application of the enzyme pepsin was capable of removing the denaturated collagen

Modulatory effects of rosemary leaves aqueous extract on doxorubicin-induced histological lesions, apoptosis and oxidative stress in mice

Doxorubicin is used in treatment of many solid malignancies and lymphomas with poorly understood mechanism underlying tissue injury. Rosemary leaves or extracts were found to contain high antioxidant activity almost equivalent to BHA [Butylated Hydroxy Anesole] and BHT [Butylated Hydroxy Toluene]. Thus, the possibility of aqueous rosemary leaves extract [RE] to ameliorate doxorubicininduced histological lesions, apoptosis and oxidative stress in male mice tissues was tested. Four doses [25, 125, 250 and 375 mg/kg b. wt.] of RE have used orally two times/ week for 15 days prior to the administration of an intraperitoneal single dose of doxorubicin [25 mg/kg b. wt.]. Biochemical, histological and immunohistochemical methods were performed on liver, kidney and heart tissue sections. The positive control group [DXR alone] showed severe histological lesions in the liver, kidneys and heart, including degeneration and inflammatory response accompanied with significant increase in the apoptotic index [Bax/ Bcl-2] and oxidative stress. Rosemary extract was proved to significantly attenuate the doxorubicin-related toxic effects via more than one mechanism such as: the powerful inhibition of lipid per-oxidation, the stimulation of the synthesis of cellular antioxidants, the decrease of the inflammatory response and the reduction of the apoptotic index. The efficacy of the tested doses of RE in improving doxorubicindeteriorated effects was organ specific. The most potent dose of RE to abate the lesions in all examined tissues, was 125mg/ kg b. wt and the less effective was 375 mg/ kg b. wt

Effect of a 6-week rehabilitation program on gait parameters after total knee arthroplasty

To investigate early changes in gait parameters following total knee arthroplasty [TKA]. Fifteen patients scheduled to undergo unilateral TKA at King Faisal Specialist Hospital and Research Centre [KFSHRC], Riyadh, Saudi Arabia, between March 2009 and February 2010, were included in the study. This study was a prospective pretest-posttest experimental design; all patients underwent unilateral TKA, and were subjected to a 6-week standard postoperative rehabilitation program. Pain intensity and gait variables were evaluated before surgery and 6-weeks postoperatively using the Visual Analogue Scale and simple footprint method. Statistical analysis showed improvement in pain intensity and reduction in gait velocity, cadence, and stride length following the 6-week postoperative exercise intervention compared with preoperatively. A 6-week postoperative exercise program is not a long enough time-period to restore walking abilities to their pre-surgery values in patients undergoing TKA. A longer period of rehabilitation is needed to improve the quality of the patient's gait

Adiponectin and infarction size in subject with and without cerebrovascular disease

To investigate whether hypo-adiponectinemia is present in ischemic stroke patients. This comparative study was carried out in the Biochemistry Department, Ziauddin University, Karachi, Pakistan in 2008. In this study, plasma adiponectin concentration was measured by an enzyme-linked immunosorbent assay in subjects with and without ischemic cerebrovascular disease [CVD]. A total of 80 subjects were studied [40 patients with CVD, and 40 without CVD as controls]. The mean plasma level of adiponectin of the 40 patients with ischemic CVD was significantly lower than that of the 40 subjects without CVD [4.36 +/- 0.21 ug/mL versus 6.97 +/- 0.241 ug/mL; p=0.000]. Decreasing concentrations of adiponectin were negatively correlated with infarction size in ischemic CVD patients. These data show that there are significantly lower levels of plasma adiponectin in patients with ischemic CVD. Moreover, adiponectin is negatively correlated with infarction size in these patients suggesting the possible role of adiponectin in cerebrovascular disease

Histological, histochemical and biochemical changes in the liver, kidney, lung and spleen under the effect of repetitive hyperthermia in rat neonates

Artificial hyperthermia in association with radiotherapy or chemotherapy has become a promising method for cancer treatment. Thus, this study was designed to assess the impact of repetitive hyperthermia [41degree C +/- 0.5 degree C] on some normal histological, histochemical, and biochemical variables in newborn rats. After parturition, the neonates were randomly chosen and assigned to two groups [each being comprised of ten animals]: one group was exposed to hyperthermia [41 degree +/- 0.5 degree C] and the other one was exposed to normothermia [25 degree +/- 0.5 degree C]. Both groups were treated daily for 2 hours from the day of labor until the age of 21 days. Histological and histochemical examination of the tissue sections of hypothermic rat neonates exhibited numerous cirrhotic changes in liver with deposition of collagen fibers extending from the central veins or portal tracts forming thick or thin fibrotic septa and even pseudolobule formations. The kidneys showed areas of necrosis, edema, glomerular hyperplasia or infiltration of inflammatory cells, marked amounts of collagen surrounding some Malpigian corpuscles and in between the renal tubules in a focal or diffuse fashion. The lungs revealed alveolar haemorrhage, focal fibrosis, emphysema of the alveoli with rupture of some alveolar walls and hyperplasia of the cells lining alveoli with collagen distribution in the peribronchiolar area as well as in the tunica adventitia of the peribronchiolar dilated blood vessels, and in the interalveolar and perialveolar areas. The spleen suffered from severe hyperemia in the red pulps and sinusoids with distorted lymphoid nodules and atrophy of others. The quantitative measurement of the degree of fibrosis proved a significant [p < 0. 01] accumulation of collagen fibers in all the examined tissues except for spleen. Additionally, hyperthermia caused a significant increase in most measured serum biochemical variables [ALT, AST, GGT, LDH, total bilirubin, total protein, albumin, creatinine and urea] except for the globulin content whose concentration showed a significant decrease. As high preferential absorption ability of tumour tissue components to heat over normal tissues rely, in part, upon their higher collagen and protein content, attention should be paid to the repetitive effect of high temperature on the architecture of normal tissues, total collagen and protein contents in addition to its upshots on certain biochemical indices to appraise the impact of the method on patients particularly newborns and those with multi-recurrences carcinoma

Suppression of doxorubicin apoptotic, histopathologic, mutagenic and oxidative stress effects in male mice bone marrow and testis tissues by aqueous rosemary leaves extract

In the present set of investigations, the anti-mutagenic and anti-cytotoxic effects of aqueous rosemary leaves extract [RE] beside the dose dependency of these effects on male mice bone marrow and germ cells have been evaluated using in vivo cytogenetic, histopathologic and apoptotic assays, as well as biochemical analysis. Doxorubicin [DXR], a well-known mutagen and cytotoxic agent, was given at a single dose of 25 mg/kg b. wt. intraperitoneally at the fifteenth day. 25, 125, 250 and 375 mg/kg b. wt. of RE were given through oral intubation once a day/three days for 15 days prior to DXR administration. The animals of the positive control group [DXR alone] showed significant increase in the mutagenic effect in bone marrow cells, histological damage, incidence of apoptotic cells [TUNEL-positive cells], level of lipid peroxidation and activity of superoxide dismutase in testis. Though, the activities of the other antioxidant enzymes such as glutathione peroxidase, catalase and glutathione reduced form beside the serum level of testosterone and the rate of primary spermatocytes' transformation to spermatids were significantly declined [P < 0.001]. The ratio of dismutase to glutathione peroxidase and/or catalase was significantly elevated. Pretreatment with each dose of RE showed significant reduction in these frequency of chromosomal aberrations and mitotic index of bone marrow cells and the level of peroxidation, the ratio of SOD/ GPX or CAT, the histological damage and the incidence of apoptotic cells in testes. Also, it caused increase in the levels of some antioxidant enzymes [GSH, CAT and GPX], the level of testosterone and returned the semineferous tubular cell populations' ratio to the control distribution.The protective efficacy of the RE was much pronounced following pretreatment with 125 mg/kg b. wt

effect of hysterectomy on psychiatric morbidity [anxiety and depression]

To evaluate the psychiatric morbidity [anxiety and depression] in women underwent an abdominal and vaginal hysterectomy of a benign indication. This is a prospective observational study which was done in the Obstetric and Gynecology and Neuropsychiatry Departments, Sohag University Hospital. One hundred and two women were scheduled for undergoing hysterectomy after fulfilling the inclusion criteria. All women underwent a thorough history taking, clinical examination and complete psychiatric history. General health questionnaire [GHQ-28] was used to assess women with psychiatric co-morbidity before and after the operation. All women with psychiatric co-morbidity were re-evaluated by Beck depression inventory [BDI] and Hamilton anxiety scale [HAMA] before and after hysterectomy. On screening for psychiatric co-morbidity using the GHQ-28 for the 96 women who completed the follow up protocol of the study 35 [36.46%] scored >/= 4 [Group I] with psychiatric co-morbidity, and 61 [63.54%] scored <4 [Group II] without psychiatric co-morbidity. GHQ-28 was reapplied to all women in group II [post-operatively] where 48 [78.69%] scored >/= 4 [group IIa] and 13 [21.31%] scored <4 [group IIb. Severe anxiety and depressive symptomes were the most common presentation after the operation and represented 8 [40%] and 8 [53.3%], of patients of group I, respectively. In patient, of group II [without psychiatric morbidity] after hysterectomy, depressive and anxiety symptoms was the most common presentation in nulliparous women and was found in 7 [63.64%] and 3 [27.27%], respectively. However, the least depressive and anxiety symptoms was observed in women with parity >/= 5 and was found in 12 [38.7%] and 9 [29.03%], respectively. It is not worthy that the majority of women free from psychiatric co-morbidity was observed in women with parity >/= 5 and represented 10 [32.5%] of patients. It was clear that there was a definite significant relation between hysterectomized women and psychiatric morbidity of a depressive and anxiety nature. So we recommend that before hysterectomy in benign conditions, gynecologists should exhaust great effort of using the available recent less invasive modalities of treatment as first option

Chronic gastric volvulus caused by epigastric hernia: case report

Gastric volvulus is a twisting of the stomach on itself more than 180 degree, which is either an organo-axial or mesentero-axial volvulus. This case report presents a rare and probably the first reported chronic secondary organo-axial gastric volvulus caused by a large epigastric hernia. Gastric volvulus is worth to be added to the index of differential diagnosis in the presentation of chronic gastric symptoms of epigastric hernia

comparative study between serological and molecular identification of cytomegalovirus infection

Cytomegalovirus [CMV] is a common virus that infects most people worldwide. Aim of this study is to compare between serological identification and molecular detection of CMV by PCR technique. The samples consisted of 120 pregnant women [complaining from repeated abortion], prospectively screened for CMV by serology. The women were presenting for routine antenatal care. CMV IgG and IgM were detected in patient serum by using a commercial microparticle enzyme immunoassay, and determination of the presence of CMV genome by PCR. All neonates were diagnosed after one month of birth by serological and clinical signs. The age range of the pregnant women was 18 to 46 years, with no significant difference seen between the mean age of seropositive and seronegative women. The CMV seropositivity rate for the pregnant women showed that, overall, 76.8% women were CMV IgG positive at pregnancy. Pregnant women were considered in high risk due to [i] documented seroconversion to positively for CMV [ii] presence of CMV immunoglobulin M [IgM] [iii] intrauterine growth retardation as detected by ultrasound or CMV symptoms [increase in liver enzyme levels and/or fever]. No. of all of them was 30. After birth it was found that 6 neonates [+ve] by serological tests and clinical signs of them. But, it was found that also one case false +ve from PCR group, and one case false -ve from the rest. So, determination of the presence of CMV genome by PCR can be considered as a rapid and accurate tool for detection of CMV infection but negative results cannot rule out of infection, so that diagnosis of this infection should be based on correlation between serological and PCR Identification

Serum antioxidant and pro-oxidant trace elements: relationship with oxidative stress in children with chronic renal failure on regular hemodialysis

There is a good evidence indicating that uremia, in general, is associated with enhanced oxidative stress and treatment of uremic patients with hemodialysis [HD] or peritoneal dialysis [PD] has been suggested to particularly contribute to oxidative stress and reduced antioxidant levels in those patients. Also uremic patients have abnormalities in trace elements which maybe caused by the uremia itself and/or enhanced or modified by the dialysis procedures. The aim of this study was to evaluate the oxidative stress imbalance and its relationship to the trace elements in children with chronic renal failure [CRF] on regular HD. This study was conducted on 36 children with CRF on regular HD and in 25 age and sex matched normal control children. Thiobarbituric acid [TBARS], total antioxidant [TAO], and hydrogen peroxide [H[2] O[2]] were measured by colorimetric assays. Trace elements [selenium [Se[+2]], zinc[zn[+2]], copper [Cu[+2]], manganese [Mn[+2]], lead [Pb[+2]] and cadmium [Cd[+2]] were measured by atom absorption/flame emission spectrophotometry. The results showed that the serum concentrations of TBARS, H[2]O[2], Cd and Pb were significantly higher in the studied cases [2.498 +/- 0.29, 2.967 +/- 0.414, 21.74 +/- 2.37 and 38.01 +/- 4.18 respectively] than in the controls [1.649 +/- 0.093, 0.311 +/- 0.032, 5.83 +/- 0.68 and 12.67 +/- 0.85 respectively] P<0.05 and P<0.001 for the others. The serum concentration of TAO, selenium, zinc and copper were significantly lower in the studied cases [1.379 +/- 0.017, 2.411 +/- 0.138, 91.07 +/- 2.979 and 84.89 +/- 3.145 respectively] than in the controls [2.049 +/- 0.014, 4.012 +/- 0.203, 128.7 +/- 4.924 and 128.7 +/- 3.904 respectively] [P<0.001 for each]. A significantly positive correlations were found between serum levels of cadmium and TBARS and between serum levels of selenium and TAO [r=0.359 P<0.05, and r=0.398, P<0.05 respectively]. Also a significant negative correlation was found between serum levels of zinc and serum level of TBARS [r=-0.392 P<0.05]. Our data suggest an enhanced oxidative stress and significant changes in trace elements in end stage renal disease [ESRD] patients undergoing HD. Also there is a significant relationship between the oxygen stress imbalance and the changes in the trace elements in these patients

Presentation of gallbladder carcinoma and its surgical management

To study the mode of presentation, age and sex distribution, socio-economic status and evaluation of various surgical methods adopted for treatment of localized and advanced gallbladder carcinoma. It was a prospective type of study. This study was conducted in the Department of Surgery Nishtar Hospital, Multan from January 2004 to June 2005. Patients and methods: Twenty five patients of all ages and both sex were taken from all surgical units. On the basis of history, examination and laboratory investigations they were suspected of having gallbladder cancer. All the patients were operated and were divided into three groups on the basis of operative findings and stage of disease. There were 4 males and 21 female with a male to female ratio of 1:5. Presenting feature in decreasing order of frequency were; pain in right hypochondrium in 88%, nausea and vomiting in 60%, weight loss in 40%, jaundice in 28%, anorexia in 28%, mass in right hypochondriu m in 24%, pruritis in 20%, fever in 12% and ascites in 4% patients. Preoperative diagnosis of carcinoma of gallbladder was possible in 12 [48%] patients with the help of ultrasound and CT scan but all were of advanced age of disease. Gall stone were the most important etiological factor in 20 [80%] patients, obesity was found in 7 [28%] and chronic typhoid infection in 2 [8%] patients. All patients were operated. Simple cholecystecytomy was done in 4 patients of stage I and II. Extended cholecystectomy done in 6 patients of stage III. Laparotomy and biopsy of the mass and/or palliative surgery for drainage of bile was done in 15 cases of stage IV and V disease. Adenocarcinoma was the most common histological type found in 22 [88%] cases. Gallstone are the most important etiological factor in gall bladder carcinoma