CARCINOMA COLON SIGNET-RING CELL TYPE: A RARE CASE REPORT

Carcinoma colon ranks third among the commonest cancer in the world, while seen less common in the Asian countries however lately an increasing trend has been observed. Majorly the elderly population is at an increased risk of colon cancer however early onset of the disease has also been observed in past few years. Various histologic subtypes with different prognoses are present, but the most common histological type is Adenocarcinoma (1). Signet-ring cell carcinoma (SRCC) is a known rare subtype of colorectal carcinoma (< 1%) officially recognized by the WHO, mucinous types are aggressive with poor outcomes and are most commonly diagnosed around the fourth to fifth decade of life comprising only 1% of colorectal cancers. So we report a case of a 40-year-old male with adenocarcinoma colon of signet ring cell type. The patient presented with localized abdominal discomfort with only generalized weakness and fatigue which was later evaluated to be a near-obstructing right-sided colonic mass. Patient was taken up for surgery and was found to have diffuse carcinomatosis

LYMPHOEPITHELIOMA LIKE CARCINOMA OF URINARY BLADDER: A RARE CASE REPORT

Urinary bladder neoplasm is the 10 most common cancer in the world, predominantly affecting males. Nowadays incidence of urinary bladder carcinoma in female has increased. It is a uncommon type carcinoma of urinary bladder. It resembles to non-keratinizing carcinoma of nasopharynx. This study report a case of 65 years old male presented with painless gross hematuria for 3 weeks. Patient was a known case of Meckel's diverticulum. Ultrasonography and cystoscopy showed a mass on lateral wall of urinary bladder measuring 3x3 cm . A radical cystectomy of the urinary bladder tumor was done. He was diagnosed as case of lymphoepithelioma like carcinoma of urinary bladder along with benign prostate hyperplasia and Meckel's diverticulum was made with stage 2. According to the WHO classification criteria, Lymphoepithelioma like carcinoma is a subtype of undifferentiated carcinomas. Immunohistochemical stains are helpful to differentiate Lymphoepithelioma from primary lymphoma of the bladder. Differentiation of LELCB from urothelial carcinoma is important, since it has better prognosis compared to pure urothelial carcinoma. It is important to diagnose this neoplasm for therapeutic as well as prognostic purpose.

PARATHYROID ADENOMA: A RARE TUMOUR CASE REPORT

Parathyroid adenoma is a rare tumour and are generally small size (< 2 cm) and <1gm weight. Giant adenomas are infrequent, are mostly elucidated as > 3.5 gm weight, along with few reports weights up to 110 gm. Parathyroid adenoma are usually found with primary hyperparathyroidism syndrome which is common, seen as third most common endocrine disorder. In this study a case of 52-year-old lady was refereed with complain of neck swelling, lethargy and generalized drowsiness. The results obtained from laboratory revealed increased serum calcium and increased parathyroid hormone. There is no significant history of renal stone, renal dysfunction or any family history of endocrinal tumours. Ultrasonography revealed a composite nodule with cystic and solid elements. Focused surgical neck exploration was performed with removal of 4 gm adenoma . Microscopic examination showed, encapsulated lesion formed of chief cells of parathyroid organized within network of capillaries. The most exact mechanism for localizing a Parathyroid Adenoma is altogether MIBI scan along with neck ultrasonography. Surgical excision with monitoring of parathyroid hormone screening during operation is the recommended conductance. Need for the intraoperative Parathyroid hormone monitoring is debatable in Parathyroid adenoma due to accuracy of preoperative imaging.

PYLORIC GLAND ADENOMA OF STOMACH: A RARE CASE

Pyloric gland adenoma is an uncommon precancerous polypoidal growth. Pyloric gland adenoma of stomach accounts for 2.7% of all gastric polyp. Mostly Pyloric gland adenoma are found in stomach but can be found in other anatomical sites. Pyloric gland adenoma of stomach occur in elderly population and having female predominance. Pyloric gland adenoma of stomach is commonly seen in chronic gastritis patients, autoimmune gastritis but can also occur in some genetic disease like familial adenomatous polyposis and Lynch syndrome. Early identification and therapeutic polypectomy by endoscopically and histopathological evaluation and confirmation of pyloric gland adenoma may reduce the chances of transformation of invasive adenocarcinoma

The Effect Of Upanaha Sweda And Vatari Guggulu In The Management Of Janusandhigata Vata (knee Osteoarthritis): A Comparative Study

Every man derives the happiness and benefit of his life through locomotion i.e., using his joints. For the minute if he loses this power of locomotion he not only feels himself a miserable creature but also becomes a burden both of his family and society. The loss or reduction in his locomotive power is due to dysfunction of the joints causing an impediment to his movements. If not treated in time, the disease makes man disable. Sandhigata Vata is most common articular disorder. It is a type of Vata Vyadhi which mainly occurs in Vriddhavastha, due to Dhatukshaya. Sandhigata Vata can be correlated with osteoarthritis (OA) which is one such chronic, degenerative, inflammatory disease and has a great impact on the quality of the life of an individual. Different modalities of treatment have been explained in the classics to tackle the condition effectively. The present study was aimed to assess clinically the effect of Upanaha Sweda and Vatari Guggulu in the management of Janusandhigata Vata. In this study total 42 patients were divided in 2 groups. In Group A, patients were treated with only Upanaha Sweda and other group patients were treated with Upanaha Sweda and Vatari Guggulu. Results obtained were analyzed for statistical significance which shows group B in which Vatari Guggulu and Upanaha Sweda were given, was more effective in bringing relief in signs and symptoms of Janusandhigata Vata.

Clinical speech impairment in Parkinson's disease, progressive supranuclear palsy, and multiple system atrophy.

Context: Speech abnormalities are common to the three Parkinsonian syndromes, namely Parkinson's disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), the nature and severity of which is of clinical interest and diagnostic value. Aim: To evaluate the clinical pattern of speech impairment in patients with PD, PSP and MSA and to identify significant differences on quantitative speech parameters when compared to controls. Design and Setting: Cross-sectional study conducted in a tertiary medical teaching institute. Materials and Methods: Twenty-two patients with PD, 18 patients with PSP and 20 patients with MSA and 10 age-matched healthy controls were recruited over a period of 1.5 years. The patients were clinically evaluated for the presence and characteristics of dysarthria. This was followed by quantitative assessment of three parameters: maximum phonation time (MPT), semantic fluency and reading speed. The outcome measures were compared between the patient groups and with controls. Results: Patients with PD had hypophonic monotonous speech with occasional rushes of speech while patients with MSA and PSP had mixed dysarthria with ataxic and spastic elements respectively. All quantitative parameters were affected when compared to controls ( P values < 0.001, 0.012 and 0.008 respectively). Maximum phonation time was significantly less in PSP when compared to MSA and PD ( P =0.015). Reading speed also showed a similar trend which was not statistically significant. Semantic fluency was comparable in all three groups. Conclusion: Dysarthria in PD, PSP and MSA have many overlapping but certain distinctive features as well which could serve as a diagnostic clue. Patients with PSP had profound speech impairment probably indicative of the more severe frontostriatial pathology.

Hyperacute thrombolysis with IV rtPA of acute ischemic stroke: efficacy and safety profile of 54 patients at a tertiary referral center in a developing country.

BACKGROUND: Given the constraints of resources, thrombolysis for acute ischemic stroke (AIS) is under evaluation in developing countries. Prothrombin time (PT), platelet count and activated partial thromboplastin time (aPTT) may not be feasible within the time window. AIM: To evaluate the safety and efficacy of thrombolysis in selected patients without the coagulation profile. DESIGN: Open, nonrandomized, observational study. MATERIALS AND METHODS: Fifty-four stroke patients were classified using TOAST criteria (large artery atherosclerotic = 13; cardioembolic = 12; small vessel occlusion = 22; other determined etiology =three; undetermined etiology = four). The mean time to reach emergency was 2.4h (1.15-3.4), the mean door to CT, 24 min (10-47) and the door to recombinant tissue plasminogen activator (r-tPA) injection, 26.8 min (25-67). The NIHSS scores ranged from 11 to 22 (mean = 15.5 +/- 2.7). Patients with history of liver or renal disease or those on anticoagulants were excluded. The PT, aPTT and platelet count were not done. Recombinant tissue plasminogen activator was administered at a dosage of 0.9 mg/Kg. RESULTS: Thirty-five patients (65%) significantly improved on NIHSS at 48 h (> or =4 points) (mean change = 10; range= 4-17). At one month, 43 (79%) improved on Barthel Index (mean change = 45%). One each developed small frontal lobe hemorrhage and recurrent stroke; one died of aspiration; and eight showed no improvement. CONCLUSIONS: Hyperacute thrombolysis was found useful and safe in selected patients with AIS even without the coagulation studies.

The lateralizing significance of version of head and dystonic limb posturing in epileptic seizures.

Several clinical signs have been described for lateralization and localization of seizure focus in complex partial seizures; however, the specificity of each of these has been widely debated upon. The present study was done to evaluate 'dystonic unilateral limb posturing' and 'versive head movements' for lateralization and localization of epileptic foci in patients with intractable partial complex seizures, being investigated with long term Video-EEG monitoring. Fifteen patients with 46 seizures, studied with long term Video EEG, had either one or both of these signs. The video recordings of the clinical behaviour were noted and later compared with the corresponding EEG. Unilateral dystonic limb posturing and versive head movements had good lateralising value in complex partial seizures, suggestive of temporal lobe origin, contralateral to the seizure focus, with a specificity of 87.5% and 86% respectively. In addition, turning of the whole body to one side was associated with a contralateral seizure focus in 100% cases. Appendicular automatisms were found to be of no lateralising significance, as they occurred on either side with equal frequency. These motor phenomena should, therefore, be enquired about in detail, during history taking for lateralization or localization of seizure focus.

Aerodigestive foreign bodies.

Accidents with foreign bodies (FBs) are most common within the first two years of life. The airway FBs present a diagnostic dilemma as both the history and the investigations can be misleading. The persistent hypoxia presents a threat to life as does extraction. Moreover, the chemical pneumonitis induced by vegetative FB makes the situation even more worse. The FB of digestive tract are comparatively benign unless long standing. It is neither necessary for the airway FB to present with respiratory symptoms and signs nor for the FB of digestive tract to complain of dysphagia/throat pain. Oesophagoscopy may have to be done if an esophageal FB is causing only recurrent respiratory infections without dysphagia. The situation in dealing with FB varies from site to site in the aerodigestive tract. This article stresses the various dubious factors including the history, examination and investigation which can lead to misdiagnosis and also those problems which are encountered during planned extraction as well as post-operatively.

Aural foreign bodies.

At KGMC Lucknow, 168 pediatric cases with aural foreign bodies (FB) were reviewed. Most of the FB were self-inflicted and seen in children under 5 years of age (69.64%), within 24 hours (91.66%) of impaction. 86.30% of FB were seen to impact in external auditory canal (EAC) and their nature revealed predominance of nonvegetative inanimate FBs (43.45%). The TM perforation was encountered in only 6.54% of cases. If the FB is a living insect, it should be drowned before being manipulated. Syringing is the method of choice for a nonimpacted relatively small FB, even if it is vegetative. It is to be avoided in the 'potential' cases of external otitis or in cases with severely impacted wax. For a tightly wedged smooth rounded FB the hook and forceps are preferred in superficially and deep lying FBs respectively. A dissociate anaesthesia (ketamine) appears to be a better choice than general anaesthesia. An end-aural incision should be preferred over post-aural one and canalplasty for access of FB should be carried out wherever necessary. The presence of otorrhoea in cases of penetrating FB or aural myasis should be dealt on the lines of otitis media after removing the FB concerned.

Attitude of Indian urban adults towards mental illnesses.

In an urban area of Jhansi 238 adults were interviewed to asses their views regarding mental illnesses. Mental illness was not perceived as a serious disease. Cancer was perceived as the most serious disease. Worries, faulty upbringing, overwork were perceived as a cause of mental illness by majority. Early identification sings of mental illness described by them were difficulty in sleeping, changes in facial expression and feeling of impending mental imbalance. Marital alliance with them was not favoured. However, a sympathetic attitude towards mental patients was favoured. Avoiding tension, adapting oneself to circumstances, a consulting elders were considered as preventive measures against mental illness by majority.

Prevention of malaria-induced foetal abnormalities following immunization of mice with Plasmodium berghei merozoite antigen.

Pre-pregnancy immunization of Swiss albino mice with merozoite antigen of P. berghei entrapped in multilamellar phosphatidyl choline liposomes resulted in (i) increased prepatent period, (ii) either no or low parasitaemic levels, (iii) reduced mortality, and (iv) normal foetal and placental development, upon challenge with P. berghei on 13th gestational day. The unimmunized animals which received either phosphate buffered saline or empty multilamellar phosphatidyl choline liposomes before pregnancy developed high parasitaemic and 30-40 per cent animals died before parturition while 60-70 per cent unimmunized animals revealed foetal abnormalities such as low body weight and larger spleen size. Placentae of unprotected animals had hyperplasia of trophoblastic membrane and plugging of placental sinusoids with parasitized erythrocytes and malarial pigments. The data suggest that prior immunization of animals with merozoite antigen entrapped in multilamellar phosphatidyl choline liposomes could abrogate the ill effects induced by malaria infection under the stress of pregnancy.