Clinicopathological study of benign and malignant ovarian tumours and the role of HER2/neu and ER expression in these tumours

Background: Ovarian cancers represent the 6th most common cancer among females and are the most common cause of death from gynaecological cancers in the world. The aim is to do clinicopathologic study of ovarian tumours along with evaluation of the expression of estrogen receptor (ER) and human epidermal growth factor receptor (HER2/neu).Methods: A total of 85 cases of ovarian tumors were studied and immunohistochemistry was performed with specific antibodies against ER and HER2/neu as per standard protocol.Results: In present study, surface epithelial tumours were the commonest type comprising 64 cases (75.2%), followed by Germ cell tumours, 17cases (20%) and sex cord stromal tumours, 04 cases (4.8%).Among the surface epithelial tumours , ER‑positive cases were higher in malignant (71.4%) tumours as compared to borderline tumours (33.3%) and benign tumours (7.7%) while Her2/neu positive cases were higher in borderline (66.7%) tumours as compared to malignant tumours (42.9%) and benign tumours (15.3%).Among the germ cell tumours, ER expression was positive in 62.5% cases of mature teratoma while HER2/neu expression was positive in only 12.5% cases of mature teratoma. None of the sex cord stromal tumours showed positive expression of ER and HER2/neu.Conclusions: Positive expression of estrogen receptors is seen predominantly in surface epithelial malignancies and in mature teratoma. It proves the mitogenic role of estrogen in ovarian tumours. Her-2 neu was expressed mainly in malignant tumours. This suggests their carcinogenic role. This also helps in differentiating borderline and malignant tumours.

Comparison of Oral Ivabradine, Oral Metoprolol and Placebo to Attenuate the Stress Response in Nasal and Laryngeal Surgeries: A Prospective, Randomized, Double Blind Study

Introduction: Nasal surgeries like septoplasty, polypectomyand laryngeal surgeries for removal of vocal nodule, cysts etcare commonly performed. Changes in haemodynamics due tolaryngoscopy and endotracheal intubation are likely to persistduring these procedures. These surgeries also require bloodless field. The present study was conducted to evaluate andcompare the efficacy of oral metoprolol tartrate versus oralivabradine versus placebo in attenuation of haemodynamicresponses during laryngoscopy, tracheal intubation andthroughout nasal and laryngeal surgeries.Methods: This was a prospective, randomized, comparative,double blind study. . Patients were randomly allocated bysimple randomization into 3 groups having 30 patients in each.Neither the patient nor the investigator was aware, whichpatient is allocated into which group and were unaware of thedrug being administered as it was given to the patient by aperson not involved in the study. Data collections were carriedout by investigator in a double blind manner. All the patientswere explained about the anesthesia technique and writteninformed consent was taken. Group 1: Oral Ivabradine 5mgtablet was given orally 2 hours before induction of anaesthesia.Group 2: Oral Metoprolol tartrate 50mg tablet was given orally2 hours before induction of anaesthesia. Group 3: Oral placebowas given 2 hours before induction of anaesthesia.Results and Conclusion: We concluded that both the drugscan be used as an effective premedication, to attenuate thesympathetic response to laryngoscopy, endotrachealintubation, extubation and throughout nasal and laryngealsurgeries. However Metopolol was found to have better controlthan Ivabradine in maintaining the vitals at all points andproviding a good hypotensive effect than ivabradine.

In Vitro Evaluation of Carbachol and Endothelin on Contractility of Colonic Smooth Muscle in Hirschsprung’s Disease.

Background: The hypomotility of colon observed in Hirschsprung’s disease (HD) has been attributed to congenital aganglionosis only. So far, it is not clear whether the contractility of colonic smooth muscle in this condition is altered or not. Therefore, the present study attempted to understand the contractile status of colonic segments of HD patients by examining carbachol and endothelin (ET-1) evoked colonic smooth muscle contractions in vitro. Methods: Contractile responses were recorded from strips of colonic segments obtained from HD patients, using organ bath preparations. Cholinergic agonist carbachol and ET-1 along with their antagonists were used to evoke contractile responses. Thereafter, the samples were histopathologically confirmed for HD. Results: Colonic strips of HD did not show any spontaneous contractions but responded to carbachol and ET-1 to a lesser extent. In HD, response of carbachol was blocked by atropine and hexamethonium by nearly 73% and 50% respectively. ET-1 induced contractile responses were blocked by ET-A and ET-B antagonist up to 40%, signifying the possible role of ET-A and ET-B receptors in HD colon contractility. Conclusion: As evidenced by lack of spontaneous contractions and impaired carbachol and ET-1-induced contractile responses, it is concluded that, in addition to aganglionosis, decreased contractility of colonic smooth muscle may contribute to hypomotility observed in patients with HD.

Neonatal surgery: a ten year audit from a university hospital.

Neonatal surgery is the flagship and most challenging component of pediatric surgery, which is the youngest subspeciality of surgery. Neonatal surgery carried a survival rate of only 30% three decades ago. In the last decade there has been a significant change in the scenario. Earlier recognition and referral of these anomalies, availability of neonatal intensive care, better preoperative planning, decision, and techniques have lead to the change in the management. This is an audit into the outcome of neonatal surgery from one of the largest units in India over a ten year period. This audit reveals an across the board survival of 65-70% newborns after surgery on nearly two thousand case over a ten year period. It has an important message that while pediatric surgery units expand, risk stratification of surgical newborns and their treatment in suitable units is mandatory to maintain and improve these figures to match international standards over the next decade.

Obstructed Morgagni's hernia.

Morgagni's Hernia is the direct herniation of the intra-abdominal organs through the anterior retrocostoxiphoid diaphragmatic defect. We are presenting a case of obstructed Morgagni's hernia in a five-year-old child. Who presented with colicky abdominal pain, distention of upper abdomen, vomiting with constipation of three days duration.. Morgagni hernia is a rare disease even rarer in pediatric age group, and is usually diagnosed incidentally; presentation of this disease with obstruction had been reported in adult but not in children.

Conservative treatment for round worm intestinal obstruction.

OBJECTIVE: The ascariasis is one of the most cosmopolitan intestinal parasite infections and it can be in inhospitable regions inhabited by human being, but its biggest prevalence is observed in the tropical and subtropical areas. Intestinal obstruction has been estimated to occur in 2 per 1000 ascaris-infected children per year. We are presenting a study emphasizing the conservative treatment for complete intestinal obstruction due to roundworms without sign and symptom of peritonitis and perforation. METHODS: A total of 22 patients of roundworm obstruction partial or complete without signs of and symptoms of peritonitis were admitted in the Department of Pediatric Surgery IMS, BHU Varanasi India in the period form 2003-2005. Patients were put nil by mouth, intravenous fluid, antibiotics, piperazine salt through nasogastric tube and glycerine + liquid paraffin emulsion enemas and were evaluated for duration of hospital stay, rate of conversion to surgical treatment and complications. RESULTS: 19 (86%) patients were treated successfully with conservative line of management. Only 3 patients required surgical intervention. No mortality, complication and mean hospital stay was 4.1 days (range 4-5 days). CONCLUSION: Round worm intestinal obstruction can be effectively treated by conservative line of management.

Spontaneous regression of patent omphalo-mesenteric duct.

We report a one-month-old male child with a patent omphalo-mesenteric duct that regressed spontaneously in the neonatal period and resulted in a Meckel's diverticulum.

Septic induced abortion claiming life of a Nepalese woman.

This is a case report of septic induced abortion done at 16 weeks of gestation outside Kathmandu valley who presented to the emergency department of Tribhuvan University Teaching Hospital (TUTH) with peritonitis and septic shock. The case underwent emergency laparotomy and was treated surgically for perforated ileum and uterus by resection and end to end anastomosis of bowel and subtotal hysterectomy. The patient died after 16 hours of operation due to multiple organ failure (MOF) as a sequelae of septic shock. Unsafe abortion remains one of the major causes of maternal mortality in Nepal. Increasing public awareness about hazards of septic abortion and the provisions of law and decentralizing the trained manpower throughout the country would play a pivotal role in decreasing the incidence of septic induced abortion.

Ivemark syndrome in association with congenital septum transversum defect and pancreatic divisum.

A four-month-old female baby presented with cyanosis and respiratory distress. A provisional diagnosis of congenital posterolateral diaphragmatic hernia was made but on exploration there was a defect in the septum transversum along with features of Ivemark syndrome - asplenia with visceroatrial heterotaxia, malrotation and pancreatic divisum - an association not yet reported in literature. The child did well after operative correction of the hernia. Echocardiography showed situs inversus with dextrocardia with double outlet right ventricle, atrial septal defect, ventricular septal defect, patent ductus arteriosus and pulmonary stenosis.

Maharishi Amrit Kalash, an ayurvedic medicinal preparation, enhances cholinergic enzymes in aged guinea pig brain.

The effect of orally fed Maharishi Amrit Kalash was examined on the activities of cholinergic enzymes in the guinea pig brain. The activity of the cholinergic enzymes viz. choline-acetyltransferase and acetylcholinesterase enzymes was found to be reduced significantly (P<0.05) in the various regions of CNS of the aged guinea pigs. Oral administration of MAK(500 mg/kg body weight daily) for 2 months significantly increased (P<0.05) the activity of choline acetyltransferase and acetylcholinesterase in the older animals. The present study indicates that this food supplement can be helpful in alleviating the cholinergic deficits in the old age.

Age-dependent variations in mitochondrial and cytosolic antioxidant enzymes and lipid peroxidation in different regions of central nervous system of guinea pigs.

The age-related changes in the activities of antioxidant enzymes of mitochondrial and cytosolic fractions were measured in different regions of the central nervous system (CNS) in 10 and 32 months old guinea pigs. In old animals, the activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx) were reduced (p < 0.05) in all the regions of CNS studied but catalase (CAT) declined significantly only in the cerebral cortex, hypothalamus and cerebellum. Glutathione reductase (GRd) activity declined in cerebral cortex and hypothalamus in the cytosolic fractions and only in cerebellum in the mitochondrial fraction. It is concluded that age-related decline in the activities of antioxidant enzymes is both region and enzyme specific. The endogenous lipid peroxide was found to be significantly higher (p < 0.05) in the 32 month old animals whereas, lipid peroxidation after incubating the tissue homogenate in air was found to be lower (p < 0.05). The in vitro mitochondrial lipid peroxidation decreased with age. The results indicate that accumulation of lipid peroxides takes place with ageing but the susceptibility of lipid peroxidation decreases in the older animals.

Effect of Maharishi Amrit Kalash an ayurvedic herbal mixture on lipid peroxidation and neuronal lipofuscin accumulation in ageing guinea pig brain.

The effects of ayurvedic herbal mixture Maharishi Amrit Kalash(MAK) were studied on brain lipid peroxidation, oxygen consumption, and lipofuscin accumulation in 10 months and 32 months old guinea pigs. Brain regions studied were cerebral cortex, hypothalamus, cerebellum and spinal cord. Parameters assessed were lipid peroxidation, oxygen consumption, and lipofuscin accumulation. The endogenous lipid peroxide was found to be increased significantly (P < 0.05) in the 32-month-old animals. Neuronal lipofuscin accumulation in the neurons of cerebral motor cortex, cerebellum and cervical spinal cord was increased (P < 0.05) in the older animals. Oxygen consumption was found to be decreased significantly(P < 0.05) in the 32-month old guinea pigs. Treatment with MAK at a dose of 500 mg/kg body weight daily for two months reduced the lipid peroxidation and lipofuscin pigment accumulation significantly in brain regions and it also helped in restoring the normal oxygen consumption in the older animals. This indicates antioxidant properties of MAK.

Aspiration vs nonaspiration technique of cytodiagnosis--a critical evaluation in 160 cases.

The two sampling techniques were studied in 160 randomly selected cases of superficial swellings in various sites of the body. They were sampled by fine needle aspiration (FNA) and by non-aspiration (NA) (a needle without application of aspiration pressure). Cell samples were cytologically assessed and critically evaluated using five objective parameters. Contamination with blood was more in lymphnode, thyroid and liver lesions in aspiration smears than NA smears and values were statistically significant. Similarly when compared for the degree of cellular trauma and cellular degeneration statistically significant better results were obtained by nonaspiration technique for lymphnode lesions. Regarding amount of cellular material obtained by FNA, statistical significant better results were found for breast lesions only. Statistically significant better maintenance of architecture was observed only for thyroid lesions by NA technique. Better average scores were observed by NA technique for lymphnode and thyroid only. Categorizing all the smears obtained by FNA & NA on the basis of their scores according to predetermined criteria, greater number of diagnostically adequate specimens were obtained by FNA than by NA but the number of diagnostically superior specimens obtained by NA technique was found to be more than that by FNA. The difference was found to be statistically significant. However the number of inadequate smears was also more by NA technique than by FNA technique.

Local steroid therapy in cutaneous hemangiomas.

OBJECTIVES: To evaluate the efficacy of intralesional triamcinolone in enhancing regression in various type of hemangiomas. SETTING: Outpatients department of a teaching hospital Subjects: One hundred and five patients with rapidly growing surface hemangioma. The age ranged from 1 month to 15 months (mean 7 months). INTERVENTION: Intralesional triamcinolone administered at monthly intervals, ranging from single injection to 7 injections (mean 3.6 injections). MAIN OUTCOME MEASURE: Regression of the hemangioma. RESULTS: The overall response rate was 88.6% (excellent 51.4%, and good 37.2%). Maximum response was observed in children below 1 year of age (> 90%), lesions over the face (92.8%) and strawberry hemangiomas (99.9%). CONCLUSION: Intralesional administration of triamcinolone devoid of systemic side effects and an effective initial modality for rapidly growing hermangiomas.

Estimation of tissue DNA content in Wilm's tumour.

DNA genome, is affected by malignant processes. Estimation of DNA content was carried out biochemically using Gile's and Myer's technique to assess its prognostic value in 21 cases of Wilm's tumour. The DNA content of tumour tissue and normal adjoining renal tissue was estimated in each case. The DNA content was significantly higher in Wilm's tumour tissue as compared to normal renal tissue (p < 0.05). As the disease advanced, the DNA content of the tumour further increased. The tumours having unfavourable histology had significantly higher DNA content as compared to favourable histology cases (p < 0.001). Similarly, the patients who died because of the disease, had a very high DNA content as compared to those who survived. Further, it was seen that two fold increase in DNA content indicated advanced stage (III & IV), whereas a three fold or more increase indicated grave prognosis as it was usually seen in advanced stage with unfavourable histology and such cases died early. Thus, the DNA content estimation has a prognostic significance in Wilm's tumour.