Role of oxidative stress & transient receptor potential in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) affect millions of people worldwide and is known to be one of the leading causes of death. The highly sensitive airways protect themselves from irritants by cough and sneeze which propel endogenous and exogenous substances to minimize airway noxious effects. One noxious effect of these substances is activation of peripheral sensory nerve endings of nociceptor neurons innervating these airways lining thus transmitting dangerous signals from the environment to the central nervous system (CNS). Nociceptor neurons include transient receptor potential (TRP) ion channels, especially the vanilloid and ankyrin subfamilies, TRPV1/A1 which can be activated by noxious chemical challenges in models of airways disease. As oxidative stress may activate airways sensory neurons and contribute to COPD exacerbations we sought to review the role that TRP channel activation by oxidative signals may have on airway responses. it would be prudent to target the TRP channels with antagonists and lower systemic oxidative stress with agents that can modulate TRP expression and boost the endogenous levels of antioxidants for treatment and management of COPD.

CD14 C-159T polymorphism and its association with chronic lung diseases: A pilot study on isocyanate exposed population of Central India.

CONTEXT: CD14 functions as a multifunctional receptor for bacterial cell wall components including endotoxin and lipopolysaccharide and is likely to influence the cytokine profile and subsequent immunoglobulin E production in response to antigen/allergen contact in allergic phenotypes. AIMS: The present study was to investigate genetic polymorphism in CD14 gene - 159C/T, which may be one of the risk factor for increased prevalence of Chronic Lung Diseases in the Central India. SETTINGS AND DESIGN: Survivors of Methyl isocyanates toxicity in Bhopal still suffering from various respiratory ailments were examined. MATERIALS AND METHODS: Polymerase chain reaction-restriction fragment length polymorphism was performed to determine the polymorphism of C-159T. RESULTS: The genotype and allelic frequencies were in Hardy-Weinberg’s equilibrium. Prevalence of CC, CT, and TT were 5.5%, 22.2% and 9.25% respectively in asthmatics; 16.6%, 20.3% and 5.5% respectively in chronic obstructive pulmonary disease (COPD) patients and 5.5%, 14.8% and 1.85 respectively among interstitial lung disorder (ILD) patients; whereas the control cohort with no methyl isocyanate exposure displayed (CC, CT, and TT) cytosine, thymine as 2%, 1.6% and 2% respectively. Increased risk of Asthma among those carrying TT genotype and T allele (odds ratio [OR] =2.61 and 2.02 respectively). CONCLUSION: COPD risk significantly found among those with CC genotype and C allele (OR = 2.81 and 1.50 respectively), whereas ILD risk found significantly among CT genotype and C allele (OR = 1.75 and 1.40 respectively). Therefore, single nucleotide polymorphism (SNP) C-159T polymorphism in CD14 gene might be a risk factor for development of CLD in this population.

Congenital urethral fistula.

A 3-year-old male child was presented with the history of passage of urine coming from the undersurface of penis and its tip since birth. An opening was present on the ventral aspect of midshaft of penis through which a catheter could be passed. It was diagnosed as urethral fistula which was managed surgically.

Evaluation of surgical options in difficult gall bladder stone disease.

Mirizzi syndrome (17%), shrunken gall bladder (32%) and frozen Calot's triangle (51%) were encountered in 41 cases of cholelithiasis. Difficult gall bladder stone disease was recognised at operation. Peroperative cholangiogram was done in 70% of the cases, CT scan in 27% cases and percutaneous transhepatic cholangiography (PTC) in 17% cases were done to rule out cancer. Operative procedures included removal of stones and cholecystostomy (5%), partial cholecystectomy (12%), subtotal cholecystectomy (52%), choledochoduodenostomy (22%), choledochoplasty (7%) and cholecystocholedochoduodenostomy (2%). Cholecystectomy (5%) was done in 2nd stage. There was no operative mortality. Postoperative complications included biliary leak (5%), septicaemia (2%) wound dehiscence (5%) and pulmonary infection (2%). It is concluded that subtotal cholecystectomy is an ideal, safe and simple procedure for difficult gall bladder stone disease.

Experience in elective hepatic resection.

A study was conducted on 35 elective hepatic resections performed by one surgical team over a period of 5 years with 14% postoperative mortality. The indications for hepatic resection were primary hepatocellular carcinoma in 20 cases (57%) and metastatic tumours from colorectal cancer in 12 cases (34%). Underlying cirrhosis of liver was found co-existent in 35% of patients of hepatocellular carcinoma. The 3-year actuarial survival rate after resection for HCC and metastatic tumour was 30% and 42% respectively.

Gastric cancer: a critical analysis of surgical treatment and long term survival.

Results of consecutive study of 120 cases of carcinoma stomach treated by one surgical team over a period of 10 years (1980-89) are presented. Maximum cases were in the sixth and seventh decades with male to female sex ratio of 2.5:1. The lesion in most cases were in the gastric antrum. Distal tumours were more of poorly differentiated histology compared to proximal tumours. Eighty-three out of 120 (69%) patients underwent surgical resection. In 50 patients it was in the form of a subtotal and distal gastrectomy. Only 5 patients underwent a total gastrectomy. In 70 cases the resection which involved en bloc removal of involved part of stomach including adequate proximal and distal free margins, omenta and perigastric lymph nodes and considered absolutely curative in 8 cases being no disease. The overall 5-year-survival figure was 18%. However, taking only the resected cases into account, the 5-year survival rate was 27%. The low survival figure can be attributed to a very small number of early cases encountered.