Metastasis from cervical carcinoma presenting with acute intestinal obstruction – a case report.

Abstract : A 55 yr. old woman attended emergency with acute intestinal obstruction ..The patient underwent emergency surgical procedure of intestinal resection after straight X-ray,few haematological and biochemical investigations. On gross examination ileal stricture due to mass in ileocaecal region with mesenteric lymph nodes found which on histological examination came out to be a squamous cell carcinoma with metastatic deposit in lymph node.The patient had a hysterectomy done 3&1/2 years back for Stage IIB squamous cell carcinoma of cervix for which she received chemoradiation.The intestinal obstruction very likely to be a metastatic presentation.

Advances in management of meconium aspiration syndrome.

Meconium Aspiration Syndrome (MAS) is a leading cause of respiratory distress in the newborn. Antenatal diagnosis of meconium stained amniotic fluid and fetal distress is important to reduce morbidity and mortality in the neonates. Amnioinfusion of saline and tracheal suctioning of meconium are preventive interventions. Babies with MAS who continue to have respiratory distress need to be put on conventional ventilators. Increasing hypoxia, hypercarbia and barotrauma warrants changing to high frequency oscillatory ventilation. Pulmonary hypertension is an important complication which should be promptly recognized. Nitric oxide therapy used with high frequency ventilation has improved the outcome of babies with severe MAS and pulmonary hypertension. Some of these babies who continue to worsen clinically need to be put on ECMO circuit. Surfactant infusion in babies with MAS has been shown to improve gas exchange, resolve pulmonary hypertension and decrease oxygenation index. Total and partial liquid ventilation with perflurocarbon improves oxygenation, increases lung expansion and increases pulmonary blood flow in model studies of animals with MAS. Surfactant infusion and liquid ventilation are newer promising modes of therapeutic interventions in babies with severe MAS.

Bacteria in surface infections of neonates.

A bacteriological work on surface infections was done among live births (study group I) and neonates admitted in hospital (study group II). Out of 134 cases of conjunctivitis in group I Gram-negative bacilli predominated (48.5%) with Escherichia coli accounting for 29 (14.9%) cases, Klebsiella species 15 (11.2%) cases, Citrobacter freundii 3 (2.2%) cases, Pseudomons aeruginosa 18 (13.4%) cases and Aeromonas hydrophila 3 (2.2%) amongst pure isolates (73.9%). Gonococcus was noted in 2 (1.5%) cases. In group II, 41.7% were Staphylococcus aureus in pure growth (75%), compared to only 9.0% in group I. Skin infections were caused by both Staphylococcus aureus and Staphylococcus epidermidis. Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa were the principal insolates from umbilical sepsis. Pseudomonas aeruginosa was isolated as pure growth from local site of noma neonatorum. Anaerobic cultures were negative in all except in 2 cases of umbilical sepsis with tetanus neonatorum revealing Clostridium tetani which however proved to be non-toxigenic. Blood cultures were positive in 4 out of 14 cases bearing 50% correlation with bacteria from surface infections. A source study established partial correlation with the cases of pseudomonas conjunctivitis. Phage typing of Staphylococcus aureus and biochemical typing failed to detect any definite marker of clinical entities, except that the skin infections were caused by group III phages predominantly (65.0%).

Plasma lipids and blood glucose in infants of toxemic mothers.

Maternal and cord blood of 34 toxemic and 27 non-toxemic mothers and their infants were studied for lipids and glucose. All the lipid fractions in cord blood were significantly lower (P less than .001) than that of the mother in all groups due to relative impermeability of the placenta. AFD infants of toxemic mothers had significantly higher (P less than .001) value of FFA and triglyceride as compared with AFD infants of non-toxemic mothers. However SFD infants of toxemic mothers had higher FFA only when compared with that of non-toxemic mother. This is possibly due to sympathetic stimulation related to placental insufficiency with hypoxia and hypoglycemia that lead to mobilisation of adipose tissue into FFA and glycerol in fetus. Plasma phospholipid, cholesterol, HDLC, LDLC of infants of toxemic mothers were significantly lower (P less than .001), more so in SFD infants, possibly due to impaired liver function. 53% of infants of toxemic mothers also had hyperbilirubinemia. Cord blood glucose in toxemic group was significantly lower (P less than .05) than AFD infants of non-toxemic group.