Hematological abnormalities in patients of alcoholic chronic liver disease – A cross-sectional study in a tertiary care hospital in Eastern Zone of India

Background: Alcohol abuse is on increasing trend in world as well as in India, especially in young population. Long-term alcohol intake may leads to alcoholic chronic liver disease which may turns in to end stage liver diseases. Alcoholic chronic liver disease is associated with some hematological abnormalities which if detected at early stage may provide clear therapeutic implications in managing these patients and reducing the adverse events. Aims and Objectives: Our aim of the study was to identify various hematological abnormalities in patients of alcoholic chronic liver disease. Materials and Methods: This hospital-based cross-sectional study includes 100 randomly selected patients with alcoholic chronic liver disease attending Out-Patient Department and admitted in General Medicine ward of Burdwan Medical College satisfying the inclusion and exclusion criteria. Data were analyzed for hemoglobin (Hb), red blood cell (RBC), total leukocyte count (TLC), platelet count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), MCH concentration, and prothrombin time-international normalized ratio. The mean and standard deviation, percentages, and ratio were calculated and presented in the form of tables with the help of SPSS (IBM) ver-23. P < 0.05 was considered statistically significant. Results: Hematological abnormalities were found more with increased duration of alcohol consumption. Prolonged bleeding time was observed in 23% cases and prolonged clotting time was observed in 21% cases. Maximum patients belonged to Child–Pugh grade C. Hematological abnormalities were more in patients belonging to Child–Pugh grade C. Hb, RBC, platelet, and packed cell volume were significantly lower in patients belonging to Child–Pugh class C, whereas TLC, MCV, and MCH were significantly higher in class C. Conclusion: It can be concluded that related hematological changes, which are common in alcoholic chronic liver disease endanger the lives of these patients. They should be detected and corrected at earliest to minimize morbidity and mortality.

Analysis of brain tumors in Kashmir Valley - A 10 year study.

Background: Geographically Kashmir valley is isolated from the rest of the country. It has a different climate with people having different social and dietary habits. Gastric cancer, esophageal, and skin (Kangri) cancer have a higher prevalence but there is little data available on the cancers of brain. Objectives & Methodology: Aim was to study brain tumors prospectively and retrospectively, to analyse brain tumors geographically and to analyse the age and sex ratio of brain tumors in Kashmir valley. In this Retrospective and Prospective study, retrospectively (initial seven years) all patients were analyzed for their clinical symptoms, age, sex, residence, histopathologic characteristics of tumors. Prospectively (later three years) after get-ting the radiological diagnosis pathological diagnosis was arrived by procedures like open, stereotactic, and endoscopic procedures. All patients were then analysed for age, sex, residence, signs and symptoms and histopathological characteristics. Follow up was done for gliomas. Mortality and morbidity was analysed for gliomas in these 3 years. Patients who lost the follow up were considered dead. Out of 1730 patients included in our study, there were 1031 males and 699 females. The most common age group was between 41-50 years. Results: The most common tumor was gliomas followed by meningiomas. Gliomas were most common in men and meningiomas in females. Out of all the histological grades in gliomas, the glioblastoma multiforme (GBM) was the most common, and frontal lobe was the commonest anatomical site involved. The most common symptom in our study was headache followed by vomiting.

Assessment of cosmetic outcome of oncoplastic breast conservation surgery in women with early breast cancer: A prospective cohort study.

BACKGROUND: The aim of this study was to assess the cosmetic outcome of patients undergoing oncoplastic breast conserving surgery in Indian population. MATERIALS AND METHODS: A prospective cohort of 35 patients who were eligible for breast conservation surgery was included in the study from year 2007 to 2009. Patients with central quadrant tumors were excluded from the study. A double ‑ blind cosmetic assessment was done by a plastic surgeon and a senior nurse not involved in the management of patients. Moreover, self‑assessment was carried out by the patient regarding the satisfaction of surgery, comfort with brasserie, social and sexual life after oncoplastic surgery. RESULTS: In this study, 35 patients underwent oncoplastic breast conservation surgery by various techniques. The cosmetic outcome scores of the surgeon and nurse were analyzed for inter rater agreement using inter‑class Correlation Coefficients. There was a good association between them. The risk factors for poor cosmetic outcome was studied by univariate analysis and significant correlation was obtained with age, volume of breast tissue excised and estimated percentage of breast volume excised (P < 0.05). Moreover, 96% of patients were moderately to extremely satisfied with the surgery. Patients were offered an option for cosmetic correction of contralateral breast by mastopexy or reduction mammoplasty however, none of them agreed for another procedure. CONCLUSIONS: Oncoplastic breast surgery helps to resect larger volume of tissue with wider margins around the tumor. It helps to achieve better cosmesis and extends the indications for breast conservation. Most of the patients were satisfied with mere preservation of the breast mound rather than a symmetrical contralateral breast.

Scrofulous swelling of the bosom masquerading as cancer.

Tuberculosis of breast is very rare with an incidence of 0.1-0.5%. It can be primary or secondary. Except in patients presenting with sinuses, it is a challenge to diagnose it. A 40 year old premenopausal lady presented with breast lump increasing in size for 3 months. Mammogram showed a lesion suspicious of malignancy and trucut biopsy showed necrotic material only. Intraoperatively there was caseous necrosis and the tract from breast was extending to rib. It is a rare case with few case reports been reported where a rib tuberculosis presents as a breast lump rather than retromammary abscess.

Cytomixis impairs meiosis and influences reproductive success in Chlorophytum comosum (Thunb) Jacq. - an additional strategy and possible implications.

Spontaneous intercellular chromatin migration/cytomixis was observed to occur in the pollen mother cells (PMCs) of the Chlorophytum comosum for the first time. The migration through cytomictic channels was more pronounced in meiosis-I and very rare in meiosis-II. The process was associated with erratic meiosis, which was characterized by defects in chromosome organization and segregation. Cytomixis was more intense in the month of April than in July and consequently the frequency of meiotic irregularities was much more pronounced during the month of April. As a consequence of abnormal meiosis, fertility was drastically reduced resulting in meager seed efficiency of 17% only. Recombination system also does not guarantee the release of sufficient variability. We view the phenomenon of cytomixis as genetically controlled mechanism involving meiotic genes and operating through signal transduction pathway triggered by the environmental stimuli. The evolutionary significance and tenable hypothesis in the backdrop of existing literature is also proposed.

Second echelon node predicts metastatic involvement of additional axillary nodes following sentinel node biopsy in early breast cancer.

BACKGROUND: In many patients with early breast cancer, the sentinel lymph node (SLN) is the sole site of regional nodal metastasis. This subgroup of patients may not benefit from completion axillary lymph node dissection (CALND). AIMS: This pilot study evaluates the status of 2nd echelon (station) lymph nodes in the axilla as a predictor of additional positive nodes in the axilla in the presence of sentinel node metastasis. SETTINGS AND DESIGN: Cross-sectional study of 40 breast cancer patients. MATERIALS AND METHODS: Forty patients with invasive breast cancer underwent SLN biopsy followed by 2nd echelon lymph node biopsy in the same sitting. SLN mapping was performed using a combined technique of isosulfan blue and 99 mTc-sulfur colloid. SLNs (Station I) were defined as blue and/or hot nodes. These nodes were then injected with 0.1 ml of blue dye using a fine needle and their efferent lymphatic was traced to identify the Station II nodes. Then a complete ALND was performed. All the specimens were sent separately for histopathological evaluation. RESULTS: SLNs (Station I nodes) were successfully identified in 98% (39/40) patients. Of the 17 patients with a positive SLN, 8 (47%) patients had no further positive nodes in the axilla, 9 (53%) patients had additional metastasis in nonsentinel lymph nodes upon CALND. Station II nodes were identified in 76% (13/17) patients with a positive SLN. Station II nodes accurately predicted the status of the remaining axilla in 92% patients (12/13). STATISTICAL ANALYSIS: We calculated the Sensitivity, Negative predictive value, Positive predictive value, False negative rate and Identification rate. CONCLUSION: Station II nodes may predict metastatic involvement of additional nodes in the axilla.

Comparison of cardiac output in OPCAB: bolus thermodilution technique versus pulse contour analysis.

The study was designed to evaluate the clinical agreement between intermittent bolus thermodilution technique and pulse contour analysis technique. Sixty patients with normal left ventricular function undergoing elective off-pump coronary bypass surgery were included in this prospective study. In addition to routine monitoring, a 7.5F pulmonary artery thermodilution catheter via right internal jugular vein and a 4F arterial thermodilution catheter into femoral artery were also placed. Cardiac output measurements were compared before induction, after induction, after sternotomy, during the various anastomoses, post-protamine and post-sternal closure. Statistical analysis was performed using analysis of agreement to assure bias distribution of differences between the two methods by using Bland and Altman analysis. The cardiac output values obtained at preinduction, post-induction, and post-sternal closure time points showed good agreement, whereas the values obtained during the various anastomoses showed significant differences (p <0.05). Therefore it was concluded that pulse contour analysis cannot be relied upon completely whenever there is a change in the position of heart or alteration in systemic vascular resistance. But the trends in cardiac output were in complete agreement during the entire procedure.

Endometrioid carcinoma of uterus and ovary.

A thirty-two-year-old married woman presented with pain abdomen and polymenorrhoea. Her uterus was bulky and one of the fornices was full. USG of abdomen revealed unilateral ovarian tumour associated with a mass in the uterus. Histopathological report revealed synchronous endometrioid carcinoma of the uterus and the ovary with morphological evidences in favour of independent primary carcinomas. With these perspectives the present case is reported where endometrioid carcinomas of uterus and ovary are two separate primary tumours.

Randomized trial of a quadruple-drug regimen and a triple-drug regimen for eradication of Helicobacter pylori: long-term follow-up study.

BACKGROUND: In developing countries, H. pylori eradication rates are suboptimal. A quadruple-drug regimen may improve on the eradication rate achieved with triple-drug regimen. METHODS: 64 consecutive patients with active duodenal ulcer associated with H. pylori infection were randomized to receive either a one-week triple-drug regimen (lansoprazole, clarithromycin, secnidazole) or a one-week quadruple-drug regimen (lansoprazole, amoxycillin, colloidal bismuth subcitrate, secnidazole). H. pylori eradication and ulcer healing were assessed 4 weeks after completion of therapy. Patients were followed up at 24 weeks and 52 weeks for H. pylori recurrence. RESULTS: Both the regimens eradicated H. pylori in 75% (95% CI 0.6-0.9) of patients. The ulcer-healing rate with the triple-drug regimen was 97% (95% CI 0.91-1.0) and 91% (95% CI 0.91-1.0) with the quadruple-drug regimen. No ulcer or H. pylori recurrence occurred in patients eradicated with the triple-drug regimen, whereas 8.3% of patients eradicated with the quadruple-drug regimen had ulcer as well as H. pylori recurrence during the 52-week follow up. CONCLUSION: Triple-drug regimen achieves similar eradication rates as quadruple-drug regimen in H. pylori infection.

Purification and characterization of an invertase produced by Aspergillus ochraceus TS.

Purification and characterization of an extracellular invertase produced by Aspergillus ochraceus TS are reported. The enzyme was purified (42-fold) from culture filtrate by salt precipitation, ion-exchange and gel filtration. Sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) of the purified enzyme showed a single band of molecular mass 66 kDa. The molecular mass of the native enzyme was found to be 130 kDa by gel filtration. The purity of the protein was also checked against its antiserum raised in rabbits by two-dimensional immunodiffusion in agarose gel and Western blot that showed a single band. It is a glycoprotein with mannose as its carbohydrate residue. The enzyme showed high affinity for sucrose with a Km of 3.5 mM. The amino acid analysis revealed a high proportion of acidic residues but it had a low content of cysteine, histidine and arginine comparable to other fungal invertases.

Ultrasonographic assessment of gall bladder kinetics in the elderly.

BACKGROUND: The incidence of gallstones increases with age but the factors that influence gallstone formation in the elderly are poorly understood. Proposed factors include changes in bile composition and hypomotility of the gall bladder. Studies on gall bladder motility in the elderly have provided conflicting results, and none has been reported from India. AIM: To determine gall bladder contractility in healthy elderly subjects and compare it with that in young healthy volunteers. METHODS: Thirty healthy elderly (above the age of 60 years) and 30 young volunteers with no abdominal complaints were studied. Using real-time ultrasonography and the ellipsoid method, gall bladder volume was measured after overnight fast and at 10, 20, 30, 40, 50 and 60 minutes after a standard fatty meal. Residual volume, delta volume and ejection fraction were calculated. RESULTS: Mean fasting gall bladder volume in elderly subjects was higher than that in young subjects (13.5 [5.8] mL vs 10.9 [3.6] mL; p < 0.05). However, there was no difference in the 60-min postprandial residual gall bladder volumes in the two groups. Change in gall bladder volume and ejection fraction were also similar in the two groups. CONCLUSION: There was no difference in gall bladder emptying between elderly and young subjects though the fasting gall bladder volume was higher in the elderly.

Haemodynamic effects of leg raising in patients undergoing coronary artery bypass grafting.

Twenty patients undergoing elective coronary artery bypass grafting were studied prospectively to evaluate the haemodynamic effects of passive leg raising. The patients were divided into two groups: those having good left ventricular function with ejection fraction of 0.50 or more (group I, n = 10) and those having poor left ventricular function with ejection fraction of upto 0.35 (group II, n = 10). Morphine-based anaesthetic technique was used and standard haemodynamic measurements were obtained at following stages: (1) control--20 to 30 min after induction of anaesthesia; (2) one minute, and (3) five min after raising both the legs; (4) one min, and (5) five min after the legs were repositioned. In group I, heart rate decreased from 71 +/- 9 to 66 +/- 8 beats/min (p < 0.001) at stage 1 and persisted throughout the study period. This was accompanied by a decrease in cardiac index, although, the statistical significance was achieved at stage 3 and 4 only. The haemodynamic changes observed in group II were of more severe magnitude. The heart rate decreased from 90 +/- 13 to 84 +/- 13 beats/min at stage 1 (p < 0.05) and persisted throughout the study with maximum decrease of 14 percent occurring at stage 3. The cardiac index decreased significantly from 2.4 +/- 0.3 to 2.0 +/- 0.5 L/min/m2 (p < 0.05) at stage 1. This persisted throughout the study except that it recovered at stage 4. The maximum decrease in cardiac index (20%) occurred at stage 2. In addition, systemic vascular resistance increased significantly from 1458 +/- 255 to 1830 +/- 420 dyne.sec.cm-5 (p < 0.05) at stage 1 and persisted throughout the study period. We conclude that passive leg raising should be undertaken with caution in patients with coronary artery disease especially in those who have poor left ventricular function.

Benign cystic peritoneal mesothelioma in a man.

Benign cystic mesothelioma of the peritoneum is uncommon and usually occurs in women. We report this condition in a man, who was treated successfully by surgical excision of the tumor.

Antibodies to Cag A protein are not predictive of serious gastroduodenal disease in Indian patients.

OBJECTIVE: The present study was aimed at assessing the predictive utility of anti-Cag A antibodies in differentiating patients of duodenal ulcer (DU) and non ulcer dyspepsia (NUD) from asymptomatic controls in a developing country. METHODS: Sera from 120 subjects were tested for antibodies to Cag A using the immunodominant portion of a recombinant 37.5 kDa fusion protein by ELISA, in endoscopically proven cases of DU and NUD and healthy controls. RESULTS: The observed optical density (OD) in DU and NUD patients was 1,947 and 1,960 respectively, which was higher than that observed in controls (p < 0.01), but there was no difference in the anti-Cag A antibody titers between DU and NUD patients. CONCLUSION: Anti-Cag A antibodies do not seem to discriminate duodenal ulcer patients from non ulcer dyspepsia in the Indian population.

Clinical evaluation of the leukogard-6 arterial line filter.

To assess the leucocyte depleting characteristics of the Pall leukogard-6 arterial line leucocyte depleting filter, it was incorporated in the extracorporeal circuit of 30 patients with normal left ventricular function scheduled for elective coronary artery bypass grafting. The Intersept Medtronic 40 micro arterial line filter which is normally used at our centre was used in 29 similar patients. Blood samples were drawn for estimation of total and differential leucocyte and platelet counts, blood gas analysis, superoxide dismutase levels and renal function tests at various time points. Ventilation time, length of ICU stay and incidence of infection were recorded. No significant difference was observed between the two groups regarding total leucocyte count, percentage of neutrophils and lymphocytes, platelet count, arterial oxygen and carbon dioxide tensions, pulmonary vascular resistance, ventilation time and postoperative infection. A significant difference was observed between the prebypass levels of superoxide dismutase 89.63 +/- 49.69 SOD units/ml, and 24 hours post bypass levels 66.62 +/- 36.23 SOD units/ml, (p<0.01), in the control group. In the leukogard filter group, the difference between pre bypass levels of superoxide dismutase 82.47 +/- 50.58 SOD units/ml and 24 hours post bypass 73.44 +/- 41.10 SOD units/ml, (p>0.05), was not significant. This indicated less free radical activity in the leukogard filter group, but this beneficial effect of the leukogard-6 filter did not correlate with any clinical parameter. In this study, the leukoard-6 filter did not exhibit leucocyte depleting characteristics following cardiopulmonary bypass and is unlikely to be of significant advantage when incorporated in the extracorporeal circuit for coronary artery bypass grafting, in patients with normal ejection fraction.

Bifid pancreas: a case report.

Bifid pancreas is a rare anatomical anomaly in which the main pancreatic duct is bifurcated along its length. Although the pancreatographic appearance has been described in the literature, there is no mention of the computerised tomographic appearance of this condition. We report a case of bifid pancreas with the ERCP and CT appearances, who also had alcohol induced changes of chronic pancreatitis.