Role of measurement of antioxidant enzymes in evaluation of antioxidant therapy in tobacco abusers with oral leukoplakia.

Antioxidants are widely used in chemoprevention of malignancy. Numerous studies in medical literature have reported the evaluation of this treatment protocol by indirect methodology-epidemiology, invitro studies, pharmacology and animal models etc. However, there is a paucity of literature on the measurement of antioxidant enzymes as a parameter for assessing the outcome of antioxidant therapy. This study explores the efficacy and outcome of antioxidant enzyme assay in relation to antioxidant therapy in tobacco abusers, hitherto unreported in medical literature. A prospective cohort study with control in 50 patients carried out at a tertiary care teaching Institution (Institute of Medical Sciences, Banaras Hindu University, Varanasi, India). Out of these patients, 10 patients acted as control, rest 40 patients-all tobacco users in some form, were divided into three groups on the basis of histopathological grading of dysplasia-no dysplasia, mild or moderate dysplasia. The levels of Lipid peroxidase (LPO), Superoxide dismutase (SOD) and Catalase (CAT) in mucosa and serum were assayed in each group, and re-evaluated at the end of 3 months after intervention with antioxidant treatment. To detect any alteration in degree of dysplasia a repeat biopsy was also done at the end of 3 months. The results were statistically analysed using paired t test. A statistically significant decrease in level of LPO and SOD, and an increase in CAT levels were recorded both in mucosa and serum. However, no change in dysplasia and no new case of dysplasia were observed. Further, antioxidant treatment was continued for a year and the final out come of the lesion was assessed by "Carter's criteria". A final success rate of 74.19% was recorded in terms of partial or complete regression of the lesion. This study confirms the therapeutic efficacy of antioxidants in oral leukoplakia, and cites the importance of LPO, SOD and CAT in evaluating the efficacy of antioxidant treatment. However, the study failed to elucidate any relationship between enzyme measurement and the final outcome of the lesion.

Chondroid lipoma in a child.

Chondroid lipoma (CL), a rare lipoma variant, has not been described well for patients younger than 14 years of age. We herein report an extremely unusual instance of CL in a 7-year-old child. The cut surface of the tumor showed peculiar tan-brown and yellow-white areas. Histopathological sections showed the presence of eosinophilic variably vacuolated round- to oval-spindle cells in a myxo-hyaline background. The findings were consistent with CL. The case is reported because of its extreme rarity.

Incorporation and biodegradation of hydroxyapatite-tricalcium phosphate implanted in large metaphyseal defects--an animal study.

Incorporation and biodegradation of hydroxyapatite(HA)-tricalcium phosphate(TCP) granules implanted in 5 x 5 x 5 mm distal femoral metaphyseal defects created in 18 adult rabbits were studied. In two rabbits, the defects were left to heal spontaneously without any implant. Roentgenographic and histological study by light microscopy was done on silver nitrate stained undecalcified sections as well as haematoxylin-eosin stained decalcified sections. The synthetic HA-TCP was biocompatible and produced no adverse reactions. The implant was osteoconductive and allowed good new bone formation to occur, mainly from periphery to center, but mature trabeculae could be delineated only at 4-6 months. The HA-TCP biomaterial had very low biodegradability with marked amount of intact implant still present at final follow up. Bonding between implant and bone, though a close biological bond, was not uniformly strong. Rate of bone ingrowth was very slow and large areas of implant at center did not show new bone formation at 12 months.

Leiomyosarcoma of kidney: a case report with long term result after radiotherapy and chemotherapy.

Leiomyosarcoma of the kidney is a rare entity with poor prognosis. Among renal sarcomas, it is the most common histologic subtype amounting to 50-60% of all cases. The tumors usually arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall. We describe a case of renal leiomyosarcoma that presented with history of left flank pain. Physical examination was normal. Abdominal ultrasound showed a solid lesion of 38 x 36 mm arising from the left kidney. Intravenous urography showed cut off of both major and minor calyces of the left kidney from its pelvis with a normal right kidney. Exploratory laparotomy revealed a well-encapsulated mass confined to the renal parenchyma for which radical nephrectomy was performed. Histopathology showed a Grade I leiomyosarcoma arising from the renal capsule. Adjuvant chemotherapy and sandwich radiotherapy was given and he is disease free after six and half years of follow up. The rarity of this disease, its severity and poor prognosis, uncommon form of presentation, resulting delay in diagnosis and difficulty in management is highlighted and reported.

A comparative study of intratumoral chemotherapy in advanced childhood common solid tumors.

BACKGROUND: Advanced and inoperable solid tumors in children are great killer despite aggressive multimodality treatment. Intravenous chemotherapy, due to high dose of drug given systemically, at times leads to abandonment of therapy due to systemic toxicities. To overcome this problem lots of studies are going on to explore alternative modes of giving anticancer drugs so as to decrease the systemic toxicities of the drugs and increase their therapeutic index at the same time. AIM: The study was conducted to know the results of anterior intratumoral chemotherapy and its comparison to anterior intravenous chemotherapy. MATERIALS AND METHODS: Forty patients of advanced inoperable solid tumors in children (Wilms' tumor and neuroblastoma) between 2000-2004 were randomly allocated to two groups. Group A (20 patients) was given intratumoral chemotherapy while Group B (20 patients) was given intravenous chemotherapy. Both the groups were compared in terms of reduction in size and volume, resectability of tumor, histopathological changes and side-effects of chemotherapeutic drugs. The Institute's ethics committee approved this study. RESULTS: Males were predominant in both type of cases (Wilms' tumor and neuroblastoma) in both the groups (Group A and Group B). Mean age in the study was 3.27 years. All cases in Group A had Stage III disease except three cases which had Stage IV disease (one case of Wilms' tumor and two cases of neuroblastoma) while in Group B only two cases had Stage IV disease (one case of Wilms' tumor and one case of neuroblastoma). Intratumoral chemotherapy was found to be superior over intravenous chemotherapy in terms of reduction of size and volume (63% in Group A vs. 22% in Group B). The resectability was 70% in the intratumoral group in comparison to 40% in the intravenous group. The overall good histopathological response was 71% in Group A as opposed to 0% in Group B. Moreover, the incidence and severity of side-effects of chemotherapy and morbidity was less in intratumoral chemotherapy. Mortality was also low in Group A (5%) in comparison to Group B (20%). CONCLUSION: In this study intratumoral chemotherapy was found to be superior over intravenous chemotherapy in terms of better and early tumor regression, minimal side-effects, better tumor resectability and well response on histopathological criteria. This study is still going on at our center where different drug combinations, different drug doses, their toxicities, their mechanisms of action, their serum levels and long-term results of intratumoral mode of chemotherapy are to be evaluated thoroughly in future.

Effect of Bacopa monniera and Azadirachta indica on gastric ulceration and healing in experimental NIDDM rats.

Gastric ulcers were induced in normal/NIDDM rats by various physical (2 hr cold restraint stress and 4 hr pylorus ligation) and chemical agents (ethanol, 1 ml/200 g, oral, 1 hr before; aspirin, 200 mg/kg, oral, 4 hr) and duodenal ulcers were induced by cysteamine (40 mg/200 g). Ulcer healing activity was studied in gastric ulcers induced by acetic acid (50%) and HCI (0.6 M). The result indicated that in both, normal and NIDDM rats, B. monniera extract (BME, 20-100 mg/kg) did not show any significant effect on blood glucose level, while A. indica (AIE, 250-1000 mg/kg) significantly decreased it. However, both BME (50 mg/kg) and AIE (500 mg/kg) showed significant anti-ulcer and ulcer-healing activities in normal and NIDDM rats. Further, the present results also indicated that the ulcer protective effects of BME was more pronounced in non-diabetic, while that of AIE was more in NIDDM rats. The anti-ulcer and ulcer-healing activities of BME and AIE may be due to their effects on various mucosal offensive and defensive factors, and correction of blood sugar level by AIE may help to have more ulcer protective effect in NIDDM rats.

Primary squamous cell carcinoma of gallbladder presenting as acute cholecystitis.

Primary squamous cell carcinoma of gallbladder accounts for only 0-12.7% of all cases of gallbladder cancer. We here report a case of primary squamous cell carcinoma of gallbladder presenting as acute cholecystitis. A 50 year old man was admitted with the complaints of pain in right hypochondrium and fever of 2 days duration. Abdominal examination revealed tenderness along with guarding and rigidity in right hypochondrium with positive Murphy's sign. The patient was conservatively treated as a case of acute cholecystitis. After 12 hrs of unrewarding treatment patient was operated upon and cholecystectomy done. The specimen revealed thick walled gallbladder with multiple calculi. Histopathology revealed squamous cell carcinoma grade II.

Gastroduodenal ulcer protective activity of Asparagus racemosus: an experimental, biochemical and histological study.

Asparagus racemosus is an Ayurvedic rasayana, which finds mention in ancient Indian texts for treatment of gastric ulcers. The ulcer protective effect of methanolic extract of fresh roots of A. racemosus (ARM), 25-100 mg/kg given orally, twice daily for 5 days, was studied on different gastroduodenal ulcer models. ARM 50 mg/kg, twice daily, orally (total saponins 0.9%) showed significant protection against acute gastric ulcers induced by cold restraint stress (CRS), pyloric ligation, aspirin plus pyloric ligation, and duodenal ulcers induced by cysteamine. ARM in the above dose also significantly healed chronic gastric ulcers induced by acetic acid after 10 days treatment. However, ARM was ineffective against aspirin- and ethanol-induced gastric ulcers. Further, gastric juice and mucosal studies showed that ARM significantly increased the mucosal defensive factors like mucus secretion, cellular mucus, life span of cells and also possessed significant anti-oxidant effect, but had little or no effect on offensive factors like acid and pepsin.

Cystic atypical mesoblastic nephroma.

Cystic variants of atypical mesoblastic nephromas are very rare. The present communication deals with two such cases encountered in 3- and 6-month-old patients. The literature is briefly reviewed. The need for proper diagnosis of this tumor to distinguish it from cystic nephroma and Wilms' tumor is highlighted.

Carcinoma of the gallbladder: a retrospective review of 99 cases.

Since the first description of the carcinoma of the gallbladder, about two centuries ago, this disease has evaded all attempts at early detection and a potential cure. There are only a few studies involving the Indian population, which has a high incidence of gallbladder cancer. Indians are ethnically and culturally different from their Western counterparts, for whom the incidence of this disease is comparatively low. The present study was conducted prospectively on 99 consecutive cases of carcinoma of the gallbladder of 736 patients with biliary diseases admitted to one surgical unit at the University Hospital. The staging, histological type, and grade were correlated with the clinical outcome. Abdominal pain (82.8%) and abdominal mass (73.7%) were the main presenting features. The diagnosis was obtained by ultrasonography (USG) in 93 of 99 cases and confirmed by fine-needle aspiration cytology (FNAC) in 70 patients. Ultrasonography, however, was found to be inadequate for accurate staging of the disease. Based on the TNM classification, 3 (3.0%), 12 (12.1%), 14 (14.1%), 12 (12.1%), and 58 (58.6%) patients had stage 0, I, II, III, and IV disease, with a corresponding mean survival of 28.3, 13.8, 7.5, 5.2, and 3.7 months, respectively. Carcinoma of the gallbladder is difficult to diagnose early due to its vague symptomatology. A high index of suspicion and health education seem to be the only answers available for early detection and improvement of survival.

Carcinoma of the gallbladder: role of sonography in diagnosis and staging.

PURPOSE: In an attempt to define the sonographic characteristics of gallbladder cancer, we retrospectively analyzed the sonographic findings in 203 cases of gallbladder cancer confirmed by cytology or histopathology. Patients and Methods Patients with proven gallbladder cancer presenting to a single surgical unit between 1991 and 1995 were identified through a records search. All patients underwent sonographic examination followed by fine-needle aspiration (FNA), biopsy, or laparotomy for establishing the diagnosis. RESULTS: A mass in the gallbladder and gallbladder wall thickening (> 12 mm) were cardinal sonographic findings of carcinoma. Liver infiltration was correctly identified in all patients who had it. Sonography was highly accurate for detecting mass lesions, gallstones, liver infiltration, metastasis, and ascites. However, visualization of lymph nodes, common bile duct infiltration, and peritoneal dissemination was poor. CONCLUSIONS: Sonography was found to be a good diagnostic tool for carcinoma of the gallbladder; however, its sensitivity was poor for staging nodal spread of the disease.

Pulmonary oedema produced by scorpion venom augments a phenyldiguanide-induced reflex response in anaesthetized rats.

1. The involvement of pulmonary oedema produced by scorpion venom in augmenting a phenyldiguanide (PDG)-induced reflex response was evaluated in urethane-anaesthetized rats. 2. PDG-induced bradycardiac, hypotensive and apnoeic responses, expressed as time-response area, exhibited similarities before or after venom treatment. Hence, the time-response area of bradycardia was taken as a reflex parameter. Pulmonary oedema was determined by physical evaporation and histological methods. 3. Exposure to Indian red scorpion (Buthus tamulus, BT; i.v.) venom for 30 min increased the pulmonary water content (P < 0.05; Student's t test) and augmented the PDG-induced bradycardiac reflex response by more than 2 times (P < 0.001). The increase of pulmonary water content was maximal with 100 microg kg-1 of venom and the augmentation was maximal with 10 microg kg-1. In a separate series of experiments, the venom (100 microg kg-1)-induced pulmonary oedema was confirmed by histological and physical methods. In this group also, the venom augmented the reflex to the same magnitude. 4. Pulmonary oedema (physical and histological) and augmentation of the bradycardiac reflex response after BT venom (100 microg kg-1; i.v.) were absent in animals pretreated with aprotinin, a kallikrein-kinin inhibitor (6000 KIU; i. v.). 5. Ondansetron (10 microg kg-1; i.v.), a 5-HT3 receptor antagonist, failed to block the venom-induced pulmonary oedema (physical and histological) but blocked the venom-induced augmentation of the reflex. 6. The results of this study indicate that the venom-induced augmentation of the PDG reflex is associated with pulmonary oedema involving kinins utilizing 5-HT3 receptors.

Malignant fibrous histiocytoma of the rectum.

Malignant fibrous histiocytoma (MFH) of the gastrointestinal tract is a rare occurrence. We report a case of MFH of the rectum in a 55-year-old man. Ultrasound examination revealed thickening of the rectal wall and the biopsy study indicated MFH. The patient underwent abdominoperineal resection and chemoradiation and is doing well after 46 months. A high index of suspicion for colorectal MFH should be taken into account in order to avoid histological misdiagnosis.

Immunohistopathological reactions for liver-specific membrane lipo-protein in experimental autoimmune hepatitis.

Antibody to the hepatocyte membrane protein, was induced in inbred strain C57BL/6 and C3H mice by immunisation with 100,000 g supernatant of syngeneic liver homogenate in CFA. Three weekly intraperitoneal injection of 200 ul of liver homogenate with CFA for continuous 4 weeks gave the best possible result. Histopathological changes were characterised mainly by perivascular inflammatory infiltrates and hepatocyte necrosis which mimicked human autoimmune hepatitis. In one of the immunological parameters, antibody to hepatocyte membrane protein (LSP) has been demonstrate by ouchterlony method in the test serum of those animals, who had received weekly doses of liver antigen. Thus in experimental autoimmune liver disease, semi-purified syngeneic liver fluid (S-100) leads to hepatic destruction and to an inflammatory process with several features in common with human chronic aggressive hepatitis. The presence of antibody against syngeneic liver antigen (S-100) in the test sera emphasizes that hepatocyte membrane protein does have an important role in liver tissue pathogenesis and disease process in experimental model. In this study we tried to prove that hepatocyte membrane protein may act as a target antigen in developing experimental autoimmune hepatitis.

Carcinoma of the gallbladder presenting as scalp tumour.

Carcinoma of the gallbladder is characterized by rapid tumour growth associated with lymphatic and local tumour invasion. The peritoneum, GIT and lungs are common sites of seeding. Distant metastasis to bone rarely occurs. Here we document a case of silent gallbladder carcinoma presenting as scalp tumour with improved survival.

Metallothionein expression in carcinoma of the gallbladder.

AIMS: Metallothioneins (MT) are sulphur-rich, low molecular-weight, intracellular metal-binding proteins with a possible role in carcinogenesis of some human tumours. Metallothionein expression in gallbladder cancer has not been studied previously. METHODS AND RESULTS: Immunohistochemical expression of metallothionein was studied in 42 gallbladders (27 cases of carcinoma of the gallbladder, eight chronic cholecystitis and seven cases of normal gallbladder). Metallothionein expression was significantly higher in cases with carcinoma of the gallbladder (70.37%) as compared to chronic cholecystitis (25%) and normal gallbladders (0%). There was a trend suggestive of increasing MT expression with increasing histological dedifferentiation of carcinoma of the gallbladder. CONCLUSIONS: The increased expression of MT in cases of carcinoma of the gallbladder may represent an increased exposure to heavy metals, which are known carcinogens, and may have a role in gallbladder carcinogenesis. Metallothionein over-expression in carcinoma of the gallbladder may be relevant to the poor prognosis and chemoresistance seen in these cases.

Ultrasound-guided fine needle aspiration cytology of malignant gallbladder masses.

OBJECTIVE: To determine the accuracy and reliability of ultrasound (US)-guided fine needle aspiration cytology (FNAC) over blind aspiration in gallbladder masses. STUDY DESIGN: We performed FNAC in 107 cases of carcinoma of the gallbladder; blind aspiration was done in 71 patients (66.36%) and US-guided aspiration in 36 (33.64%). In cases where FNAC after the first aspiration showed the aspirate to be inflammatory, acellular (inconclusive) or suspicious for malignancy, FNAC was repeated under US guidance. Diagnosis was later confirmed by histopathology in all cases. RESULTS: After the first aspiration, gallbladder malignancy was confirmed in 77 (71.96%) cases. Of these 77 cases, 34 underwent US-guided aspiration, and the remaining 43 underwent blind aspiration. Cases with inflammatory or acellular (inconclusive) aspirates or that were suspicious for malignancy after the first aspiration underwent a second aspiration under ultrasonic guidance. On the second aspiration of 30 cases, 16 (53.33%) proved to be of adenocarcinoma, 7 (23.33%) were suspicious for malignancy, 5 (16.66%) were inflammatory, and 2 (6.66%) were acellular. Diagnosis was later confirmed by histopathology in all cases. US-guided FNAC had diagnostic accuracy of 95% as compared to 60% on blind aspiration. There was no major complication or needle tract recurrence of the disease. CONCLUSION: US-guided FNAC is safe, rapid, reliable, cost-effective and accurate in diagnosing gallbladder carcinoma.