Pulmonary artery sarcoma mimicking a pulmonary embolism.

Sarcomas involving the lung are a rare occurrence, often a result of metastatic disease from primary malignancies involving the skin, liver, breast or heart. Primary pulmonary artery sarcomas are rarer still, with limited cases reported world-wide and consequently data regarding treatment modalities are sparse and largely experimental. These tumors are often mistaken for a pulmonary embolism and seemingly supported by radiological findings. Patients will often present without symptom resolution despite therapeutic anticoagulation. The following case illustrates how a soft tissue sarcoma of the pulmonary artery can mimic a pulmonary embolism, thus, resulting in both a diagnostic and therapeutic dilemma. A positron emission tomography scan was an invaluable tool in this case, showing increased radiotracer uptake and placing neoplasm at the top of the differential diagnosis. This ultimately led to a biopsy that was vimentin positive, cytokeratin negative and CD117 negative, thus consistent with soft tissue sarcoma.

Index for measuring child feeding practices.

OBJECTIVE: The present investigation was undertaken with the objective of creating an Infant and Child Feeding Index (ICFI) from a set of complementary feeding (CF) practices and to determine its association with growth of infants and young children (6-23 months). METHODS: A semi-structured interview schedule was used to collect information for 204 children from one large slum (n=104) and two private pediatric clinics (n=100) of urban Vadodara. RESULTS: Results revealed that about half (50.5%) of the children were stunted Ht for Age Z score (HAZ<-2SD), nearly one-fourth (25.5%) were underweight Wt for Age Z score (WAZ<-2SD), but wasting (WHZ Wt for Ht Z score<-2SD) was low (3%). Significant associations were revealed between almost all positive CF practices and nutritional status of the children as measured by HAZ and WAZ (p<0.01), but not with WHZ. Good associations were revealed between ICFI and HAZ and WAZ, but not with WHZ. On multivariate analysis of factors affecting the HAZ, WAZ and WHZ scores, ICFI was not found to be significant whereas maternal education was the most significant factor, which was also found to be associated significantly with ICFI. CONCLUSION: It is concluded that the composite index in its present form can reflect the CF practices more holistically than just one or few behaviors studied separately. More research is needed in the direction of constituting a composite index which can then be used for research, monitoring, evaluation and much needed advocacy for complementary feeding.

Infant and child feeding index.

Traditional indicators of child feeding practices are widely used and appear to be useful, although the validity and reliability of those related to complementary feeding have not been established. Composite child feeding indices have the potential to address some of the methodological constraints related to the quantitative measurement of child feeding practices. They can address the multi-dimensionality of child feeding practices i.e. the need to consider the type, quality, texture, nutrient density of food, frequency of feeding and diversity of the diet; the age-specificity of child feeding practices; and the fact that feeding practices tend to cluster. The main advantage of creating a composite index is that it allows construction of one variable representing various dimensions of feeding or care practices. This variable, in turn, can be used to illustrate graphically the importance of child feeding or care for child outcomes or to model their determinants. This can be invaluable for advocacy, apart from being an indispensable tool for the purposes of research, monitoring and evaluation. Experience with creation of composite child feeding indices with the studies in Accra and DHS data sets from Latin America and Ethiopia has been encouraging and suggests that this is a promising area for future development and program applications.

Primary gastrointestinal lymphoma--disease spectrum and management: a 15-year review from north India.

OBJECTIVE: To analyze retrospectively the disease spectrum and outcome of primary gastrointestinal lymphoma (PGIL) in a tertiary referral center in north India. MATERIAL: Seventy five patients presenting with PGIL between January 1971 and December 1985 were evaluated. RESULTS: The 49 males and 26 females were aged 3.5-69 years (mean 34) at presentation. Abdominal pain, weight loss and vomiting were cardinal symptoms at presentation; the stomach was the most common site of involvement. Histologically, a majority of patients were classified as having diffuse poorly-differentiated lymphocytic lymphoma (46.7%) and diffuse histiocytic type (30.7%). Twenty seven (36%) patients had stage I disease, 31 (40%) stage II, 11 (14.7%) stage III, and 6 (8%) stage IV. At laparotomy, primary resection and anastomosis was carried out in 66 patients, while only biopsies were taken in nine. Forty eight patients received adjuvant radiation with or without chemotherapy. The mean follow-up was 3.9 years (range 1-14). The 5-year actuarial survival was 34%, 25% and 16% for stages I, II, and higher-stage disease, respectively. The survival was significantly better (p < 0.01) for gastric location (44%) compared to other sites (24%). CONCLUSION: PGIL was more common in the 3rd and 4th decades of life, with the stomach being the predominant site of involvement. Survival was better among patients with stages I and II disease, and gastric location of lesion.

Results of treatment in endometrial carcinoma: ten years experience.

From 1980 to 1989, 145 patients of histologically proven adenocarcinoma of the endometrium were seen and treated at the Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, Majority of the patients (84/145) presented with FIGO stage I disease. Relationship of myometrial invasion to grade was highly significant (p < 0.001). One hundred and seven patients were treated by surgery in combination with pre-operative or post-operative radiotherapy. The importance of various prognostic factors was assessed and grade of the tumour had statistically highly significant effect on survival (p < 0.005). Postoperative radiotherapy is recommended in patients with poor prognostic factors.

Growth of term infants during neonatal period.

One hundred and seventy two healthy term (T) appropriate-for-dates (AFD) singleton neonates were prospectively studied from birth until 28 days of age for changes in weight, occipitofrontal circumference (OFC), chest circumference (CC), midarm circumference (MAC), thigh circumference (TC) and crownheel length (CHL). Male babies had statistically significant (p < 0.05) higher values than females for weight, OFC, CC and CHL at birth and for all the six parameters at 28 days. The mean loss of weight during the first 72 hours was 120 g and 140 g and the mean gain in weight at 28 days was 640 g and 520 g for males and females, respectively. After an initial decrease, OFC, CC and TC showed a mean growth of 1.9 cm and 1.9 cm, 1.4 cm and 1.1 cm and 0.9 cm and 0.7 cm in males and females, respectively by 28 days. By that age CHL showed a mean growth of 3.2 cm in males and 3.0 cm in females. Although both groups after an initial decrease in MAC, had started showing growth by 2nd week, female babies fell short by 0.1 cm of mean birth values by 28 days while males had a mean growth of 0.1 cm.

Carcinoma of the esophagus presenting with esophagocutaneous fistula--a case report.

An interesting manifestation of carcinoma of the esophagus, hitherto undescribed is reported. The patient at the time of diagnosis had presented with an esophagocutaneous fistula. He was treated by feeding jejunostomy and local palliative radiotherapy and showed good clinical improvement. The extreme rarity of such a presentation is highlighted.

Occult carcinoma esophagus metastatic to spine producing paraplegia--a case report and review of literature.

An extremely rare case of asymptomatic squamous cell carcinoma of the esophagus metastatic to the spine leading to paraplegia is reported. The rarity of such an event signifies the relationship between hypercalcaemia and carcinoma of the esophagus. Its occurrence as a second silent primary neoplasm and its association with a negative esophagogram is highlighted.