Role of parecoxib in pre-emptive analgesia: comparison of the efficacy and safety of pre- and postoperative parecoxib in patients undergoing general surgery.

Management of acute postoperative pain remains sub-optimal despite the availability of multiple analgesics and improved pain management strategies (with nearly 80 % of patients reporting moderate to extreme pain following surgery). To evaluate the role of parecoxib as a pre-emptive analgesic in patients undergoing general surgery, the present study was undertaken. Eighty patients of either sex, aged 18 to 70 years, requiring elective ambulatory general surgery like hernioplasty, appendicectomy, cholecystectomy, etc, were enrolled in this prospective, randomised, assessor-blind, parallel-group, comparative trial. Eligible patients were randomised to receive a single dose of 40 mg of parecoxib IM/IV either 30-45 minutes prior to induction of anesthesia (pre-emptive analgesia) or in the postoperative period when one reported pain or when the effects of anesthesia were worn off (whichever was earlier). The primary measures of efficacy were pain intensity scores measured on a visual analog scale (VAS) and pain relief before and after therapy. Adverse event monitoring, physical examination and changes in laboratory tests, chest x-ray and ECG were used to evaluate safety. A comparison of the pain intensity scores between the two groups revealed that patients treated with parecoxib preoperatively did not complain of pain in the entire postoperative period up to 12 hours. Mild pain (1.05+/-1.36) was reported by patients in this group only at the 24 hours assessment. On the other hand, patients treated with parecoxib in the postoperative period, experienced severe pain at baseline, which declined gradually up to 12 hours. The difference in the pain intensity scores between the two groups was statistically significant at all the time intervals from 0 hour to 24 hours. All the 40 patients (100%) in the pre-operatively treated group reported total pain relief at 12 hours compared to only 22 patients (55%) in the postoperative period. At 24 hours total pain relief was reported by 70% of the patients in the pre-operatively treated group, compared to only 20% (8) patients in the postoperatively treated group. The difference between the two groups was statistically significant in favour of the pre-operatively treated group (p<0.05). Present results suggested that pre-operative administration of parecoxib was more effective than a postoperative use in providing pain relief in postoperative period in patients undergoing elective general surgical procedures. Both the regimens were well tolerated. Based on the above data, it appears that pre-operative dose of parecoxib 40 mg IV/IM is a useful optionfor pre-emptive analgesia in general surgical practice.

Giant cell tumour of talus with osteosarcomatous transformation in a young male: a case report.

A case of osteosarcomatous transformation in a benign giant cell tumour is described. Spontaneous malignant transformation is rare in a giant cell tumour with only 17 cases reported in the literature till date. In addition, a giant cell tumour arising in the bones of the hands and feet is in itself a rarity. In this instance the lesion presented in the talus of the left ankle in a 13 year old male.

Glial choristoma.

Glial choristoma is a developmental malformation of heterotopic central nervous tissue with limited growth potential. It is considered to be one of the very rare choristomatous lesions involving the oral cavity. This report details the morphological characteristics of glial choristoma arising from the palate in a newborn. Bulk of the tissue comprised of mature neuroglial tissue with astrocytes representing developing brain, cystic spaces lined by cuboidal epithelium indicating ependymal layer. Clinical features, associated malformations and histomorphology of this lesion is discussed.

Metaplastic carcinomas of the breast (light microscopic and immunohistochemical features).

Metaplastic carcinomas of the breast are uncommon tumors that contain other cellular components besides the glandular component. These carcinomas have a poor prognosis as compared to breast carcinomas without metaplasia. It is, therefore, important to recognise the metaplastic components. The study was conducted over a three year period. All breast carcinomas received during this period in the department of pathology were analysed for areas of metaplastic carcinomas. The light microscopic features, special stains as well as the immunohistochemical markers of metaplastic carcinomas are highlighted in this paper.

Leiomyosarcoma arising from tunica vaginalis testis: a case report.

Benign and malignant soft tissue tumors of the paratesticular region i.e. those arising from the testicular tunics, epididymis and spermatic cord are uncommon. Of these, leiomyosarcoma arising from the tunica vaginalis is extremely rare. On extensive computerised search, a single case has been reported till date in the literature. We hereby report one such case because of its rarity.

Lipoleiomyoma of broad ligament: a case report.

Lipoleiomyoma is a very uncommon tumor, and broad ligament of uterus is one of the rare sites. No case has been reported in last five years. This case is presented because of its rarity and its uncommon site of occurrence.

Leiomyosarcoma of the mesocolon--a case report.

Retroperitoneal leiomyosarcomas including those arising from the mesentery are rare. These account for 5.8% of all soft tissue sarcomas. Most of these tumors present in late life with female preponderance. Diagnosing these tumors at an early stage is difficult due to their location. Hence, most of them attain large sizes with metastases to distant sites at the time of diagnosis. We report a case of leiomyosarcoma arising from the sigmoid mesocolon due to it's rarity and unusual clinical presentation.

Collagenous spherulosis of breast: diagnosis by FNAB with review of literature.

Collagenous Spherulosis (CS) of breast is an innocuous but interesting uncommon morphological feature observed with a variety of benign and malignant breast lesions. We report a case of collagenous shperulosis associated with nodular sclerosing adenosis (Adenosis tumor) on fine needle aspiration (FNA) smears confirmed later by biopsy. The differential diagnosis of collagenous spherulosis is discussed.

Coat's disease: an uncommon lesion of eye--a case report.

Coat's Disease, first reported in 1908, is a rare disease which is usually seen in young males presenting with complaints of unilateral vision loss. Microscopically, retinal telangiectasis and exudative retinal detachment is seen. Attempts should be made for differentiating and early detection of this disease to avoid enucleation of eye ball. Here we discuss a case report of a child manifesting as coat's disease in which a clinical diagnosis of Retinoblastoma was given and eye was enucleated.

Multiple primary visceral malignancy--a review with report of two cases.

Multiple primary cancers are being reported with increasing frequency in recent years, the frequency varying from 0.3 to 4.3% in different studies. A combination of primary cancer of larynx and lung is the most common followed by malignant neoplasm involving lip-larynx, skin-larynx, skin-lung, breast-ovary and breast-endometrium. Two interesting cases of rare combinations of primary cancers are being presented. In the first case primary adenocarcinoma of the gall bladder was associated with appendiceal adenocarcinoma. In the second case primary malignant papillary serous cystadenocarcinoma of right ovary and squamous cell carcinoma of cervix uteri were found.

Congenital diaphragmatic hernia: a retrospective autopsy study.

Congenital diaphragmatic hernia is one of the acute pediatric surgical emergencies and an important cause of perinatal mortality. Its incidence varies from 1 in 2000 to 1 in 5000 live-births, with a greater incidence in stillbirths and abortions. Non-operative mortality is generally reported as 100% and early diagnosis is imperative. A retrospective study of all infant and neonatal autopsies done during last 30 years (1960 to 1989) was conducted. Ten cases of congenital diaphragmatic hernia were encountered among 588 autopsies and its incidence was 1.7% of all infant and neonatal autopsies, dying due to varying causes. The male:female ratio was 7:3, while maternal factors showed no consistent relationship. All cases had left-sided posterolateral diaphragmatic defects. Dyspnea, cyanosis and dextrocardia was the classical triad present in more than 50% cases. The commonest herniated contents were the small intestinal loops and the left lobe of liver. Associated congenital multiple anomalies related to neural axis, skull, vertebral column and cardiovascular system were noted in 30% cases and were major contributory factors for perinatal mortality.

Hormonal regulation of macromolecular synthesis in testes and accessory reproductive glands of Spodoptera litura during post-embryonic and adult development.

In S. litura testicular growth during the last larval instar and early pupal stage is associated with significant increase in DNA, RNA and protein contents. DNA synthesis is stimulated by 20-hydroxyecdysone (20-HE) in the penultimate instar testes. 20-HE injection in ligated late last instars increases the testicular weight and protein content. Accessory reproductive gland (ARG) development takes place during the mid and late pupal stages. Protein synthesis in the pharate adult ARG is stimulated by 20-HE. Juvenile hormone has no effect on ARG protein synthesis.