A report of orbital metastasis from a urinary bladder adenocarcinoma

A 60-year-old man presented with sudden-onset proptosis of the left eye and intermittent diplopia of 2 months duration. Ophthalmic examination revealed bilateral eyelid retraction, left eye proptosis and a firm, non-tender mass (2 cm × 1.5 cm) in left supero-medial orbit with restricted extraocular movements. Contrast-enhanced computed tomography showed a well-defined, enhancing antero-medial orbital mass which was removed via anterior orbitotomy approach. The histopathology/immunohistochemistry showed adenocarcinoma; metastasis of urothelial origin. The oncology consultation and metastatic workup revealed a urinary bladder carcinoma with distant metastasis. Our patient expired within 6 months of diagnosis. The ophthalmic symptoms due to orbital metastasis may be the first presentation of some cancer patients.

Nasal endoscopic features and outcomes of nasal endoscopy guided bicanalicular intubation for complex persistent congenital nasolacrimal duct obstructions

Purpose: To study the clinical presentation, nasal endoscopic features, and outcomes of nasal endoscopy guided (NEG) bicanalicular intubation (BCI) in children with complex persistent congenital nasolacrimal duct obstruction (pCNLDO). Methods: A prospective, interventional study including eligible children (age ? 12 years) having complex pCNLDO. The demographics, number of previous probings, nasal endoscopy findings, and outcomes; were noted in all children who underwent NEG-BCI with Crawford's stents. Matting of eyelashes (MoE, upper, and lower eyelid), tear-film height (TFH), and fluorescein dye disappearance test (FDDT) was assessed pre and postoperatively. The minimum stent in-situ period was 12 weeks, and the minimum follow-up was 6 months (after stent removal). Results: Total 32 children (36 eyes) including 18 females (56.25%) were studied. At a mean age of 4.9 years, all children had epiphora and discharge with MoE (both upper and lower), raised TFH and positive FDDT. Previously, all children underwent conventional probing (s)- once in 12 (33.3%), twice in 18 (50%) and thrice in 6 (16.7%) eyes. The general ophthalmologists performed the majority (n = 21, 58.33%) of those. The BCI was performed under GA in all eyes, and at a mean follow-up of 8.5 months, the “complete” success was noted in 29 eyes (80.5%), 'partial' success in 4 (11.1%) and failure in 3 (8.3%). The stent prolapse was seen in three. Conclusion: NEG-BCI may provide a satisfactory resolution to complex pCNLDO after single or multiple failed probings. NEG provides confident and efficient management of coexistent intranasal complexities related to the inferior turbinate and meatus.

Holocord Syrinx, Tethered Cord and Diastematomyelia: Case Report and Review of Literature.

Syringomyelia refers to the presence of cavities within the spinal cord or a dilatation of the central spinal cord canal. In 90% of cases, syringomyelia is associated with a Chiari I malformation. The association of syringomyelia with tethered cord is well known but syrinxes associated with these defects are usually below vertebral level T6. Holocord syrinx associated with tethered cord is rare and is almost always associated with Chiari 1 malformation. To the best of our knowledge, only a single case report of holocord syrinx with tethered cord has been reported, but this patient had multiple overt lumbosacral defects (tethered cord, meningocele and diastematomyelia). We are reporting a three year old child with holocord syrinx with tethered cord and diastematomyelia and no evidence of Chiari malformation, meningocele or any overt spinal malformation and minimal neurological abnormalities.

Esophageal Foreign Body in a Neonate: An Unusual Age of Presentation.

Ingestion of foreign bodies in neonates is very rare and can be life threatening. We describe a 20 days old neonate presented with vomiting, drooling of saliva and poor feeding tolerance. Chest radiograph showed a metallic foreign body in superior mediastinum. Foreign body was removed by rigid oesophagoscopy. The case describes the unusual age of presentation of foreign body and options available to remove these foreign bodies in neonates.

Peripherally inserted central venous lines versus central lines in surgical newborns - A comparison.

Objective. To compare the insertion characteristics, utilization profile, life span and the complication rates of Central lines (CL) and Peripherally inserted central lines (PICL). Methods. A prospective study of all CL or PICL insertions during January 2007 to September 2007 in the Neonatal Surgical Intensive Care Unit of a tertiary care center was done. The number of attempts, procedure time, duration of catheter stay, number of dressing done, complication during insertion and maintenance and cause of removal were noted and the differences analyzed statistically using Pearson chi square / t test. P value . 0.05 was considered significant. Results. Ninety two neonates were included in the present study of whom 60 were PICL insertions and 32 CL insertions. The two groups were comparable in terms of age, weight and the use of total perental nutrition (TPN) through the catheters. On comparing the PICL and CL groups, the number of attempts for successful insertion (p=0.003), the time taken (p=0.005), the number of dressing changes required during the indwelling period (p=0.005) and the overall complication rates (p=0.002) were significantly less in the PICL group. The PICL could be maintained for longer periods of time (p= 0.005) and only in 11.5% of the patients it had to be removed before completion of therapy as compared to 37.5% early removals for CL (p=0.02) Conclusion. PICL is a safe, effective and reliable method of providing prolonged IV access in newborns. It also has the least incidence of complications during insertion and maintenance over prolonged period of time when compared to CL and should be recommended for routine use in neonatal surgical patients.

Study of Prevalence, Awareness,and control of Hypertension in a Suburban Area of Kathmandu, Nepal.

BACKGROUND, In the context of rapidly raising occurrence of cardiovascular diseases in the developing countries, it becomes imperative to study the scenario in its various aspects. The present study in Nepal deals with the hypertension as it is one of the major risk factors of cardiovascular diseases. METHODS AND RESULTS, A house-to-house survey was conducted in a suburban area of Kathmandu valley from February to June 2005 in adult population (age >/=18 years) to estimate the prevalence, awareness, treatment, and control rates of hypertension. Blood pressure was measured twice using standardized mercury sphygmomanometer, and an average of the two readings was taken. Total number of subjects were 1114 (men:541; women: 573; mean age: 37.8 -/+ 16.3 years). Overall prevalence of hypertension was 19.7% (22.2% in men and 17.3% in women, p < 0.05).Prevalence of hypertension in age group of >/=40 years was 36%.Awareness, treatment, and control rates were 41.1%, 26%, and 6%, respectively. CONCLUSION, Our study indicates that prevalence of hypertension is significant in Nepal and is comparable with other developing countries of this region. Awareness, treatment, and control rates are poor.

Evaluation of immune responses directed against 30kDa secretory protein of Mycobacterium tuberculosis H37Ra complexed in different adjuvants.

Ability of different adjuvants to promote cell mediated immune responses towards 30 kDa secretory protein of Mycobacterium tuberculosis H37Ra was monitored by assessing the lymphocyte proliferation and IgG1/IgG2a subclass profile in mouse model. Six formulations, viz. poly lactide-co-glycolide (PLG) microspheres, dimethyldioctadecyl ammoniumbromide (DDA), liposomes, liposomes containing monophosphoryl lipid A and coated with alum (L-LIPA-AL) or without alum (L-LIPA) were evaluated in comparison to standard Freund's incomplete adjuvant (FIA). Two adjuvant formulations of 30kDa-L-LIPA-AL and 30kDa-PLG showed maximum reactivity on VIIIth week post immunization (p.im) in terms of lymphoproliferation w.r.t. other adjuvant formulations. Both the vaccine formulations also exhibited a Th1 shift in terms of higher IgG2a response over IgGI. Flowcytometric analysis in the mesenteric lymph nodes (MLNs) of immunized animals revealed the capacity of 30kDa-PLG and 30kDa-L-LIPA-AL to activate T cell subsets like CD4 and CD8 T cells. The upregulation of B7 costimulatory molecules (B7-1 & B7-2) after immunization further proved the ability of the two vaccine formulations to activate antigen presenting cells. The immunostimulatory nature of the two formulations was also reflected in their capacity to reduce the bacilli load from the lungs of the experimentally infected mice. This study demonstrates PLG and L-LIPA-AL as potent adjuvants and their bioacceptibility and nontoxic nature make them suitable candidates for future subunit vaccine development against tuberculosis.

Immunoreactivity of mycobacterial 70 kDa protein in different physico-chemical forms.

The immunoreactivity of 70 kDa culture filtrate protein of Mycobacterium tuberculosis H37 Ra has been examined as such and by increasing its hydrophobicity through its conjugation to stearic acid ester (70 kDa-FAester). The cell mediated immune responses produced by 70 kDa-FAester encapsulated in phosphatidylcholine (PC) liposomes were significantly higher particularly at the 3rd week post immunization (wk p. im.) than that produced by the 70 kDa protein in PC liposomes, whereas humoral immune responses were non-significant. Further, these immune responses were comparable to that elicited by 70 kDa protein complexed with Freund's incomplete adjuvant (70 kDa-FIA). Results of this study suggest that changes in physicochemical nature of 70 kDa protein influences both the humoral and cellular immunoreactivity.

Natural regulation of white grub (Holotrichia sp: Scarabidae) by birds in agroecosystem.

The white grub (Holotrichia sp: Scarabidae) is an important subterranean pest damaging root systems of several crops. Experiments conducted during I985 and I986 showed that at least I4 species of birds picked up the grubs exposed during ploughing operation. The important bird predators were mynas Acridotheres tristis (Linnaeus) and Acridotheres ginginianus (Latham), crows Corvus splendens (Vieillot), Corvus macrorhynchos (Sykes), drongo Dicrurus adsimilis (Hodgson) and cattle egret Bubulcus ibis. The birds were found to reduce 45 to 65% grub population during 3 subsequent ploughings. The plant stand of second crop raised in bird exposed field was higher in experimental plot compared to the control. The number of birds attracted to the plough was not consistent with the density of grubs exposed but oh many extraneous factors. Factors affecting the extent of bird predation were presence of insectivorous birds in the surroundings, proximity to their breeding sites and timing of ploughing. White grub control by birds is economically cheaper and environmentally safe compared to the chemical control.

Effect of some natural pesticides on entomogenous muscardine fungi.

Five commercial preparations of natural pesticides were tested for in vitro compatibility with muscardine fungi, Beauveria brongniartii and Metarhizium anisopliae. Neemark (azadirachtin) was found compatible with both the fungi. Phytoallexin, the natural fungicide, significantly inhibited the growth of both the fungi, while other natural pesticides showed moderate to severe inhibition.