Squamous Cell carcinoma (Moderately Differentiated) of Conjunctiva – A Rare Case in a Five Year Retrospective Study.

Worldwide squamous cell carcinoma (SCC) of the conjunctiva is a rare malignancy; however, it is reported to be the most common malignant tumour of the ocular surface. Its incidence varies between 0.02 and 3.5/100.000. We report a case of squamous cell carcinoma of conjunctiva presented with triangular pedunculated mass of left eye of 75 years old female. It is diagnosed on FNAC and confirmed on histopathological examination after excision. On analyzing the data of FNA done (19150) and biopsies received (23158) in 5 years in the department of pathology, we found only five cases of eye region came for FNA while 25 biopsies of eye region received and diagnosed rightly. Out of all these cases, this is the only case of squamous cell carcinoma of conjunctiva in this study. Incidence of SCC of conjunctiva in our retrospective study of data of total pathological biopsies received found to be 4.3/100000.

Current management of pancreatic trauma.

Background: Although pancreatic trauma is uncommon, it poses a diagnostic and therapeutic challenge. Any delay in diagnosis raises morbidity and mortality. This study highlights the current management and outcome in patients of pancreatic trauma at a single tertiary care center. Methods: This is a retrospective analysis of prospectively collected data of 24 patients diagnosed to have pancreatic trauma. Collected data was analyzed for age, gender, mechanism of injury, hemodynamic status at presentation, initial serum amylase levels, CECT abdomen findings, AAST-OIS grade of pancreatic injury, injury to other organs, management, complications and outcome. Results: The mean age of these 24 patients was 25 years; 19 were male and 5 females. The mechanisms of pancreatic trauma included blunt abdominal trauma in 21 (87.5%) cases and penetrating injury in 3 (12.5%). Seven (29.16%) patients were managed by non-operative management and 17 (70.83%) underwent surgery. Complications were more frequent in the operative group as compared to the non-operative group. Neither endocrine deficiency nor any mortality was noted in the non-operative management group; while there were 2 cases of endocrine deficiency and 3 mortalities in the operative group. Conclusions: Pancreatic trauma is more common in young male patients and more commonly inflicted by motor vehicles accidents. Low grade blunt pancreatic injury in hemodynamically stable patients and selected patients with high grade blunt pancreatic injury can be managed successfully by non-operative management with no increase in morbidity or mortality and most patients with high grade blunt pancreatic injury and those having penetrating injuries need surgical intervention.

Normalized embryoid cDNA library of oil palm (Elaeis guineensis) / Biblioteca ADNc normalizada de embrioides en aceite de palma (Elaeis guineensis)

A normalized embryoid cDNA library (EON) was constructed based on reassociation kinetics reaction. Results from dot blot hybridization and sequencing of EON cDNA clones clearly indicated that the normalization process reduced the frequency of high abundance transcripts and increased the frequency of low abundance gene transcripts. A total of 553 non-redundant expressed sequence tags (ESTs) were identified, 325 of these were not observed in the standard oil palm cDNA libraries sequenced previously. A total of 10 EON cDNA clones were chosen for expression profiling across samples from different stages of the tissue culture process. Two of the genes exhibited promising expression patterns for predicting the embryogenic potential in callus. Some of these genes were also differentially expressed in the various tissues of oil palm. This study showed that normalization of the existing embryoid library improved the chances of identifying transcripts not captured in the standard libraries, some of which could be associated with embryogenesis. This collection of ESTs is particularly well suited for use as candidate genes for development of an oil palm DNA chip, which can be used to obtain a more comprehensive view of the molecular mechanism associated with oil palm tissue culture.

Dignostic Yield of Fiberoptic Bronchoscopy in a Teaching Hospital.

Fiberoptic bronchoscopy is minimally invasive procedure which can be performed on outpatient basis.The study is a reterospective review of the data at a tertiary center and compares the diganostic yield of the patients (n=720), who underwent FB at our pulmonary unit with the data from international centers. The diagnostic yield of the FB was high(70%) with good selection of the patients and growth was the most common finding followed by infections.FB was normal in 218(30%) patients. Flexible fiberoptic bronchoscopy is a useful diagnostic tool with a low rate of complications. The diagnostic yield in our institution is alsmost similar to that reported in other series.

Global Youth Tobacco Survey: A Report from Jammu and Kashmir.

Global Youth Tobacco question based survey Survey (GYTS) in the state of Jammu and Kashmir in the age group of 13-15 years of age, using study design, method of sampling technique and the actual survey administration followed by standardized, uniform methodologyof GYTS was done to find out prevlance and awareness about harms of smoking..The study showed high prevlance of tabacco use in the school going children.The perent study streses upon the importance of such surveys regionally so that helath care agencies can plan startergies to combat such increasing use of tobacco in young population

Clinical Spectrum of Pulmonary and Extrapulmonary Tuberculosis in End Stage Renal Disease in Jammu.

One hundred patients of End Stage Renal Disease (ESRD) (mean age 50.5 years, S.D. 14.0341) during a period of one year from April 1, 2004 to March 31, 2005 were studied. Detailed clinical history, physical examination and laboratory investigations were recorded. Chi-square and Fischer-exact tests were used for statistical analysis. Sixteen cases of tuberculosis were detected in 100 ESRD patients. Fifteen of them were pulmonary and one extrapulmonary. Increased association of tuberculosis was seen in – diabetics as underlying cause for ESRD (37.5%), lower socioeconomic status (62%), male patients (68.75%), and patients > 35 years of age (87.5%). Anorexia was most common symptom (100%), followed by fever (87.5%) and cough (68.7%). Keeping in view of high incidence and prevalence of tuberculosis, patients of ESRD should always be screened for tuberculosis, requiring a high index of suspicion.

Morphological and functional outcome after pancreatic necrosectomy and lesser sac lavage for necrotizing pancreatitis.

BACKGROUND: Immediate outcomes after pancreatic necrosectomy have improved in recent years. This study reviews our short-term to medium-term experience of structural and functional changes in the pancreas after necrosectomy. METHODS: Ten patients (8 males, median age 35 years), discharged after pancreatic necrosectomy for acute necrotizing pancreatitis between 1996 and 1998 were reviewed after a median period of 22 months. Clinical evidence of pancreatic dysfunction was documented at follow-up interview. Patients underwent computed tomography of the abdomen, endoscopic retrograde pancreatography, oral glucose tolerance test, fecal fat estimation and fasting serum C-peptide estimation (CPE). RESULTS: No patient had repeat episodes of pancreatitis during the follow-up period. Three patients developed de-novo diabetes after discharge. No patient had symptoms of steatorrhea. Five patients showed severe changes on CECT. ERCP showed marked changes in six patients, the commonest being an abrupt cut-off of the main pancreatic duct. Glucose tolerance was abnormal in three patients and impaired in two patients while fecal fat excretion was abnormal in 8 patients. CONCLUSIONS: Severe acute pancreatitis and necrosectomy are associated with significant structural and functional changes on medium-term follow-up.

Pleurocutaneous flap: how useful it is in management of chronic empyema.

BACKGROUND: Definitive surgical treatment of chronic empyema is associated with considerable morbidity and mortality. Methods. Retrospective study of 50 patients with chronic empyema who underwent pleurocutaneous flap procedure during the period 1994 to 2003. RESULTS: Their age ranged from 14 to 70 years; there were 32 males. Thirty-seven (74%) patients were on intercostal tube drainage; nine (18%) presented with bronchopleural fistula; and four (8%) had past-pneumonectomy empyema. Following pleurocutaneous flap procedure, 28 (56%) responded with re-expansion of the lung; 15 (30%) had persistence of pus discharge and air-leak suggestive of bronchopleural fistula. Definitive surgery could be undertaken in nine of the 15 patients. CONCLUSIONS: Pleurocutaneous flap procedure renders the patient ambulatory, facilitates re-expansion of the lung and helps as a tide-over procedure before definitive surgery in patients with chronic empyema.

Thin layer chromatographic analysis of some commonly used poisonous seeds.

Forensic scientists are often confronted with cases where seeds of poisonous plants are used in the commission of crime. Identification of these poisonous seeds is always a tough job because literature does not provide any significant reference work regarding this important aspect. In the present work, five seed samples of four different poisonous plant species were selected and Thin Layer Chromatography (TLC) was employed for the separation of their constituents. While advanced instrumental techniques are available, TLC is an economical and simple method that can be used in any laboratory. Various solvent systems were tried for analysis, and led to the discovery of an effective solvent system. This study is hoped to help forensic toxicologists in answering some queries related to TLC analysis of plant poisons.

Evaluation of the role of prophylactic antibiotics in elective laparoscopic cholecystectomy: a prospective randomized trial.

At present the use of prophylactic antibiotics in elective laparoscopic cholecystectomy is controversial. This prospective study was carried out to define the role of prophylactic antibiotics in elective laparoscopic cholecystectomy to prevent postoperative infection. Ninety three patients were randomly placed in two groups. Group A comprised of 40 while group B consisted of 53 patients. Patients in Group A received 1.5 grams of second generation cephalosporin (cefuroxime sodium) diluted in 100ml of normal saline, at the time of induction of anesthesia. Group B patients received an equal volume of normal saline only. A sample of gall bladder bile was collected by direct gall bladder puncture intra-operatively for aerobic and anaerobic culture. Age, sex, weight of the patient, American Society of Anesthesiologists classification grade, presence of diabetes mellitus, episodes of colic 30 days preceding surgery, intra-operative gall bladder rupture, stone and / or bile spillage, results of bile culture, gall bladder histology, length of hospital stay, and number of septic complications were recorded and analyzed. In group A, one patient (2.5%) had post operative wound infection and in group B, two patients (3.8%) had post operative infection which was statistically similar (p>0.1). There was no difference between the two groups in terms of demographic, intra operative and post operative denominators. Therefore the study concluded that prophylactic antibiotics did not have a significant role to play in prevention of postoperative wound infection in elective laparoscopic cholecystectomy.

External duodenal fistula following closure of duodenal perforation.

AIM: Retrospective analysis of experience with management of external duodenal fistula (EDF) without using total parenteral nutrition (TPN). METHOD: Medical records of 31 patients with EDF following closure of duodenal ulcer perforation, treated over a 7-year period (1994-2001), were studied. Twenty-one patients (68%) had evidence of sepsis at presentation or during the course of treatment. None could afford TPN for optimum time. All patients received hospital-based enteral nutrition through nasojejunal tube, besides supportive medical treatment and/or surgery. Peritonitis or failure to insert nasojejunal tube for enteric alimentation led to early surgery. RESULTS: Two patients died of septicemia and multi-organ failure within 48 hours of admission. Fourteen patients (48.3%) initially received conservative treatment (Group I); six of them later required surgery. Fifteen patients (51.7%) underwent early surgery due to peritonitis (n=9) or failure to establish enteral feeding (n=6) (Group II); wound infection, intra-abdominal abscess and septicemia were more common in these patients than those in Group I. Survival rate was higher in Group I than in Group II (86% versus 40%; p< 0.05). Septicemia and gastrectomy were the independent factors associated with high mortality. CONCLUSIONS: EDF can be satisfactorily managed without TPN. Successful placement of enteral feeding line, supportive treatment and delayed surgery can achieve survival in 85% of patients. Minimum intervention is recommended when early surgery is performed in peritonitis or to establish enteral feeding line.

Pulmonary Resections - Jammu Experience

Ten year registry of patients who underwent pulmonary resections at CTVS section of Govt Medical College Jammu is being presented. The cohort consisted of 94 patients operated between1994-2004. Males outnumbered females in this series Most number (30/94) of patients presented in the 4th decade. Etiology wise, Infective lung diseases were the leading causes leading to pulmonary resections, this included bronchiectasts with 32/94, chronic empyema in6/94 and middle lobe syndrome in one patient. Lung tumors were the causative factors in 20 and post tuberculosis destroyed lung in 17 cases. Two patients presented with intralobar lung sequestrations and one each with pulmonary blastoma and teratoma. The spectrum of resections included right pneumonectomy in19/94 followed by right and left lower lobectomies in 18 each. Thirteen patients underwent left pneumonectomy, 7 bilobectomy and 4 lingulectomy respectively. The mortality in our series was 6/94,20 patients had wound infection, 9 had bronchopleural fistula and 3 postoperative space infections.3 patients were reexplored because of hemorrhage in immediate postoperative period. Diagnostic video assisted thoracoscopy has been started and was employed in 6 patients.

Postoperative pulmonary function in laparoscopic versus open cholecystectomy: prospective, comparative study.

BACKGROUND: Pulmonary complications remain a leading cause of morbidity after major abdominal operations. OBJECTIVE: To compare pulmonary function and the frequency of pulmonary complications after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC). METHODS: Fifty-five patients with symptomatic gallstone disease undergoing elective cholecystectomy (LC 40, OC 15) under general anesthesia were evaluated using pulmonary function tests (forced vital capacity [FVC], forced expiratory volume at 1 second [FEV1], and forced expiratory flow at 25% to 75% [FEF25% -75%], chest X-ray and pulse oximetry before and after surgery. RESULTS: FVC, FEV1 and FEF25% -75% decreased by 21.5%, 21.2% and 30.3%, respectively, on postoperative day 1 following LC, and by 44.3%, 46.2% and 58.3%, respectively, after OC. Chest X-ray showed atelectasis in 15% of patients undergoing LC and 45% of those with OC. CONCLUSION: Impairment in pulmonary function after LC was less marked than after OC.

Multiple squamous cell carcinomas of esophagus.

Multiple tumors of the esophagus are reported only rarely. We describe three patients with double carcinoma of esophagus. They developed a second squamous cell carcinoma of esophagus more than 4 1/2 years after external radiation for a primary squamous cell carcinoma at a different site in the esophagus.

True epiphrenic diverticulum of esophagus secondary to tubercular adenitis.

Ephiphrenic esophageal diverticulum is rare and usually is a pulsion-type pseudodiverticulum that occurs in association with motility disorders of the esophagus. We report a 35-year-old man with tubercular lymphadenitis causing true traction type of epiphrenic diverticulum. Esophageal diverticulectomy and esophagomyotomy was done; he is doing well on antitubercular drugs.

The indocyanine green findings in idiopathic uveal effusion syndrome.

We report two cases clinically diagnosed as idiopathic uveal effusion syndrome, where indocyanine green angiogram suggest non-specific choroidal inflammation as the underlying cause. Treatment with non-steroidal anti-inflammatory drugs was beneficial.

Angle closure glaucoma following pupillary block in an aphakic perfluoropropane gas-filled eye.

We report the case of a 35-year-old aphakic patient who developed an intractable secondary glaucoma due to angle closure after pupillary block following the use of perfluoropropane (C3F8) gas at a nonexpansile concentration of 14%.

Biliary mishaps in laparoscopic cholecystectomy.

AIM: To determine the incidence and types of biliary complications following laparoscopic cholecystectomy in our patients. METHODS: The clinical records of one hundred and fifty-five patients undergoing laparoscopic cholecystectomy were reviewed. RESULTS: Five patients developed biliary mishaps. The overall incidence of biliary complications was 3.2% (5/155). The incidence of major complications was 1.9% (3/155) and the incidence of minor biliary complications was 1.2% (2/155). In 3 out of 5 patients the mishap was attributed to developmental anomalies. Dense pericholecystic adhesions and cystic duct blow out were responsible for biliary complications in one patient each. Bilioenteric anastomosis was performed in two patients and restoration of continuity of the common hepatic duct over a T-tube was done in one patient. Side hole in an accessory duct was repaired over a T-tube and cystic duct blow out was managed with endoscopic biliary drainage alone. CONCLUSIONS: A high index of suspicion of developmental anomalies, cautions approach in difficult cases and readiness to consider conversion to open cholecystectomy are recommended to reduce the incidence of biliary complications in laparoscopic cholecystectomy.