Medullary carcinoma of jejunum presenting as perforation peritonitis: A case report

Small intestinal medullary carcinoma (MC) is a newly recognized subclass of small intestinal carcinomas and is an exceptional entity for this site. A search of the literature for similar cases arising in the small intestine revealed only six previously reported cases. Here we present a case of MC arising in the jejunum of a 65-year-old male. The patient presented to the emergency with features of perforation peritonitis with liver metastasis and no known predisposing factors like inflammatory bowel disease and celiac disease. Studies conducted on this tumor's colonic counterpart have shown microsatellite instability (MSI) and B-type Raf kinase (BRAF) mutations; however, few exceptions are known. Also, this subtype of carcinoma is known to have a better prognosis than its other histological subtypes.

Application of pulsed field gel electrophoresis for molecular characterization of vancomycin resistant Staphylococcus aureus isolates from hospitals

Aim: The present study was conducted to characterize VRSA isolates on the basis of pulsed field gel electrophoresis (PFGE) and the presence of spa gene, recovered from different Doon Valley Hospitals.Methodology: Six VRSA isolates were analyzed using PFGE and spa typing. spa gene coded Protein A was used as a genetic marker for the characterization of Staphylococcus aureus isolates. Dendrogram were constructed on the basis of unweighted pair group method with arithmetic means (UPGMA method) for clusters analyses.Results: Dendrogram finally showed two major banding patterns at about 85% similarity designated as PFGE type A and PFGE type B exhibiting differences of 4-6 bands. The length of spa gene varied from 1200 to 1500 bp, showing variation in length. The most prevalent length was 1200bp.

Validity of heart rate based nomogram fors estimation of maximum oxygen uptake in Indian population.

Maximal oxygen uptake (VO2max) during a graded maximal exercise test is the objective method to assess cardiorespiratory fitness. Maximal oxygen uptake testing is limited to only a few laboratories as it requires trained personnel and strenuous effort by the subject. At the population level, submaximal tests have been developed to derive VO2max indirectly based on heart rate based nomograms or it can be calculated using anthropometric measures. These heart rate based predicted standards have been developed for western population and are used routinely to predict VO2max in Indian population. In the present study VO2max was directly measured by maximal exercise test using a bicycle ergometer and was compared with VO2max derived by recovery heart rate in Queen’s College step test (QCST) (PVO2max I) and with VO2max derived from Wasserman equation based on anthropometric parameters and age (PVO2max II) in a well defined age group of healthy male adults from New Delhi. The values of directly measured VO2max showed no significant correlation either with the estimated VO2max with QCST or with VO2max predicted by Wasserman equation. Bland and Altman method of approach for limit of agreement between VO2max and PVO2max I or PVO2max II revealed that the limits of agreement between directly measured VO2max and PVO2max I or PVO2max II was large indicating inapplicability of prediction equations of western population in the population under study. Thus it is evident that there is an urgent need to develop nomogram for Indian population, may be even for different ethnic sub-population in the country.

Effect of body posture on dynamic lung functions in young non-obese Indian subjects.

Flow volume loop and its various indices can be used to diagnose UAO. Change in posture from sitting to horizontal position per se causes a decrease in effort dependent inspiratory and expiratory flow rates but no significant change in upper airway obstruction indices. Thus, measurement of FVL in supine posture may be used to detect UAO as it may be missed if spirometry is performed in sitting posture.

Effect of glutamic acid and ketamine on morphine-induced analgesic response in rats.

Rats were treated with intraperitoneal injections of morphine (10 mg/kg) followed by glutamic acid (20 mg/kg.) and ketamine. (5 mg/kg). Pain thresholds were recorded as tail flick latencies for a period of 23 days and the mean area under curves calculated. Glutamic acid and ketamine, partially blocked the analgesic effects of morphine. Two types of effects were observed. In 4 animals, there was a partial blockade of the response, and in 2 animals there was a complete blockade followed by reversal in both the groups. It is suggested that two different mechanisms one excitatory and one inhibitory may be operating for the interaction of NMDA receptors with the opioid analgesic systems for modulating nociceptive responses.

Cardiovascular responses to phenylephrine during acute experimental anaemia in anaesthetized cats.

Experiments were performed on anaesthetized artificially ventilated cats to study the effects of phenylephrine (PE) on cardiovascular responsiveness, before and after induction of experimental anaemia. Acute anaemia was induced by replacement of blood by dextran in three steps of 20% each of total estimated blood volume. The effect of PE (20 micrograms/kg) was investigated at four stages: control and after 1st, 2nd and 3rd exchanges of blood. Induction of anaemia produced a significant increase in heart rate (HR) and cardiac output (CO) and a decrease in right atrial pressure (RAP). No significant change in mean arterial pressure (MAP), LV dP/dt max and blood gas tension was observed. Administration of bolus dose of PE produced a rapid rise in MAP, LVdP/dt max, and a decrease in HR without a change in the RAP. The pattern of response to PE was similar after induction of acute anaemia, however the magnitude of the response was significantly reduced. The attenuation in the response to PE was related to the fall in the haematocrit (HCT) level. This shows that induction of experimental anaemia, produced an increase in CO due to an increase in HR and SV and the effect of PE on cardiovascular responsiveness was significantly attenuated. The reduced sensitivity to PE during acute anaemia could be due to many factors such as inadequate O2 supply, effect of local vasodilating agents or some other cardiotonic agents which are known to contribute to vascular responsiveness.

Effect of carbachol injection in the medial preoptic area on sleep-wakefulness and body temperature in free moving rats.

The aim of the present study was to find out the changes in sleep-wakefulness and body temperature brought about by application of cholinergic agonist, carbachol, in the medial preoptic area (mPOA). Carbachol, when injected bilaterally into the mPOA of male rats, through chronically implanted cannulae, produced a fall in rectal temperature and long lasting arousal. There was temporal dissociation in the duration of changes produced in the two parameters. It is suggested that the cholinergic system at the medial preoptic area brings about arousal response and fall in body temperature through different circuits.