A non-parametric statistical analysis in the measurement of outdoor gamma exposure to the residents around Trombay.

During this study, non-parametric statistical methods were used to validate the measured gamma dose rate with the calculated one, around Trombay. Portable dose rate digital gamma spectrometry system (target fieldSPEC) was used for in situ measurement of external gamma (gamma) dose rate (measured) with the range of 1 nSv/h-10 Sv/h. The activity concentration of U-238, Th-232, K-40 and Cs-137 in the soil and their respective external dose-conversion factor (nSv/h/Bq/kg) was used to evaluate the gamma dose rate (calculated). Non-parametric statistical tool like Box- and -Whisker Plot, Spearman's (rho) rank Correlation coefficient, the Wilcoxon/Mann-Whitney test and chi(2) distribution test have been applied for validation. The randomness or discrete behaviour of measured and calculated dose rate was obvious from the Box- and -Whisker Plot as mean and median of the two are not equal. The inter quartile range (Q3-Q1), which explains about the dispersion of measured and calculated dose rate were also evaluated and found to be 10 and 16 microSv/y, respectively. The linear association between the order of ranks of the two dose rates was established by using Spearman's (rho) rank correlation that showed a coefficient of R = +0.90 with the intercept +1.9, whereas Pearson's correlation was observed with a coefficient of R = +0.93 with the intercept -25.6. Wilcoxon/Mann-Whitney test shows that, medians of the calculated and the measured dose rate as significantly different under the assumption of null hypothesis and measured dose rate was made to the normal distribution by applying Z-statistics. Value of chi(2) was calculated and found to be 284.95, which was very much greater than the critical value of chi(2)(0.05) = 43.77 at a degree of freedom 30, concluding that there is a highly significant difference between the measured and calculated dose rate at 5% significance level.

Internal iliac artery ligation for arresting postpartum haemorrhage.

OBJECTIVE: To study the role of internal iliac artery ligation (IIAL) in arresting and preventing postpartum haemorrhage (PPH). DESIGN: Retrospective chart review of women undergoing therapeutic IIAL for PPH or prophylactic IIAL for risk of PPH. SETTING: Tertiary care hospital in Pune, India. SAMPLE: Women admitted to King Edward Memorial (KEM) Hospital, Pune, India, who underwent IIAL to control or prevent PPH. METHODS: Bilateral IIAL was performed in all women. MAIN OUTCOME MEASURES: Need for re-laparotomy or hysterectomy to control haemorrhage, complications of the procedure. RESULTS: Out of 110 women who underwent IIAL, 88 had therapeutic IIAL for PPH from atony (36), genital tract injury (23), placenta praevia (21), placental abruption (4), uterine inversion (3) or coagulopathy (1). Hysterectomy was performed after IIAL failed to arrest haemorrhage in 33 (39.3%) of 84 women (excluding 4 with vaginal lacerations). Hysterectomy was more likely with uterine rupture (79%) than with nontraumatic PPH (up to 27%). Failure to control haemorrhage by IIAL was evident immediately, and bleeding arrested by IIAL did not recur to require later laparotomy in any woman. Out of 22 women at high risk for PPH undergoing prophylactic IIAL at caesarean section, none had subsequent haemorrhage. One woman had an iliac vein injury that was repaired with no further morbidity. There were no ischaemic complications either during inpatient stay or up to 6 weeks. CONCLUSIONS: IIAL is useful in the treatment and prevention of PPH from any cause. Early resort to IIAL effectively prevents hysterectomy in women with atonic PPH. In traumatic PPH, IIAL facilitates hysterectomy or repair as indicated and prevents reactionary haemorrhage.

Inflammatory myofibroblastic tumor involving the pterygopalatine fossa.

SUMMARY: Inflammatory myofibroblastic tumors (IMT) comprise a rare group of lesions characterized histologically by acute and chronic inflammatory cells with a variable degree of fibrous stroma. Occurrence in the extracranial head and neck in children is unusual, and involvement in the pterygopalatine fossa has not, to our knowledge, been reported as occurring in this age group. We present the CT findings of an IMT of the pterygopalatine fossa in a 6-year-old female patient with a 2-week history of fever and a painless swelling of the left cheek. The diagnosis of IMT should be included in the differential diagnosis of a child presenting with an aggressive mass associated with systemic features such as fever, elevated sedimentation rate, and leukocytosis.

Cervical nodal metastases in squamous cell carcinoma of the head and neck: what to expect.

The treatment and management of malignancies of the head and neck is directly altered by the presence of metastatic cervical adenopathy. The treatment of nodal metastases in squamous cell carcinoma of the head and neck (HNSCCA) is determined by the lymphatic drainage of the upper aerodigestive tract. The lymphatic drainage is site-specific and occurs in a predictable manner. The purpose of this text is to provide an overview of the normal routes of lymphatic drainage in the head and neck and correlate this with the current nodal classification system. The specific aims of this manuscript are to 1) illustrate the expected lymphatic drainage patterns of HNSCCA arising in the different subsites (nasopharynx, oropharynx, oral cavity, larynx, and hypopharynx) and 2) review the expected frequency of metastases within nodal groups for HNSCCA that arise in these locations. An understanding of the topographical distribution and incidence of cervical lymph node metastases plays an integral role in the physical examination and radiological evaluation of patients with HNSCCA. For the neuroradiologist, this information may increases the ability to identify those nodal groups at risk for metastatic involvement.

Intercostal lung herniation--depiction on spiral CT.

Computed tomography (CT) is the imaging modality of choice for the demonstration of intercostal lung herniation. The use of forced expiration and Valsalva's manouevre during CT scanning has been recommended in selected cases. We report a case of intercostal lung herniation, demonstrated only on coughing on spiral CT.

Exercise performance following repair of hypoplastic left heart syndrome: A comparison with other types of Fontan patients.

Reports of exercise performance after Fontan surgery for hypoplastic left heart syndrome (HLHS) are lacking. We compared the exercise performance of total cavopulmonary connection type (TCPC) of Fontan subjects with HLHS (group 1, n = 7) to those not requiring a Norwood procedure having a systemic right ventricle (group 2, n = 6) or a systemic left ventricle (group 3, n = 8). The subjects underwent assessment of resting pulmonary mechanics followed by maximal exercise testing with a bicycle or treadmill protocol. ECG, oxygen consumption, and carbon dioxide production were measured continuously. There was not a significant difference seen between HLHS and the comparison groups for the following parameters: maximum heart rate, maximum oxygen consumption, respiratory exchange ratio, breathing reserve, and arterial oxygen saturation at rest or exercise. Exercise performance in the TCPC type of Fontan patients was comparable regardless of ventricular morphology or surgical approach.

Enhanced resting left ventricular filling in patients with successful coarctation repair and exercise-induced hypertension.

M-mode and Doppler echocardiographic analyses of left ventricular (LV) shortening and filling were performed in 50 patients who underwent coarctectomy (median follow-up 9.5 years) and in 16 athletes in a control group before an exercise stress test with upright bicycle ergometry was performed. Thirty-two of 50 patients and 18 of 50 patients had a normotensive and hypertensive response to exercise, respectively. Preexercise echocardiographic data were compared among the control, normotensive, and hypertensive patient groups. LV peak filling rates (dD/dt, diastole) were increased in the hypertensive group (18.3 +/- 3.5) compared with those in the normotensive group (14.4 +/- 3.2; p < 0.001) and the control group (13.6 +/- 2.8; p < 0.001). LV shortening was enhanced in the coarctectomy group compared with that in the control group. A higher aortic isthmus Doppler gradient at peak exercise was not found in the hypertensive group compared with that in the normotensive group. Therefore patients with successful coarctectomy in childhood have enhanced LV shortening and relaxation at rest. Demonstration of enhanced LV peak filling rates may help identify patients at risk for exercise-induced hypertension.

A new technique of uterine suspension to pectineal ligaments in the management of uterovaginal prolapse.

The incidence of uterovaginal prolapse in young women is high in developing countries. Preservation of the uterus is of prime importance in the surgical management of these patients. A new technique of uterine suspension to the pectineal ligaments is presented as an alternative to traditional procedures. Through a Cherney incision, the uterus is suspended to the pectineal ligaments on both sides with mersilene tape. A simultaneous Burch colposuspension can be useful in selected cases. The operation has been done in 20 women, who averaged 27.5 years of age. There was no early or late morbidity during the follow-up period of 6-30 months. Of nine women desiring further childbearing, seven conceived within 6 months of surgery and thus far five have had an uneventful vaginal delivery at term; the other two have continuing normal gestations. There was no recurrence of prolapse at 6 weeks postpartum in any of the women.

The relationship between obesity, plasma immunoreactive insulin concentration and blood pressure in newly diagnosed Indian type 2 diabetic patients.

The association of blood pressure with clinical and biochemical measures was studied in 185 newly diagnosed Type 2 diabetic patients, 74 impaired-glucose-tolerant (IGT) and 128 non-diabetic control subjects. Hyperglycaemic subjects were older than control subjects (controls 40 (24-59) years, IGT 48 (29-64) years, diabetic 43 (29-60) years, median (5th-95th centile) both p < 0.05). They were also more obese (body mass index (BMI) controls 23.5 kg m-2 (17.2-29.9), IGT 26.0 kg m-2 (19.8-33.9), diabetic 24.2 kg m-2 (19.3-32.2)) and with a greater waist-hip ratio (controls 0.83 (0.70-0.98), IGT 0.88 (0.75-0.98), diabetic 0.89 (0.75-1.00)). Blood pressure was significantly higher in both IGT (systolic 127 mmHg (108-162), diastolic 84 mmHg (66-99)) and diabetic patients (systolic 130 mmHg (104-160), diastolic 84 mmHg (66-102)) compared to non-diabetic controls (systolic 120 mmHg (100-151), diastolic 80 mmHg (60-94)). Univariate analysis showed that in diabetic patients systolic blood pressure was related to age (r = 0.17, p < 0.05), BMI (r = 0.23, p < 0.01) and plasma immunoreactive insulin (fasting and post glucose, r = approximately 0.25, p < 0.01) but not to C-peptide concentrations; diastolic blood pressure to BMI (r = 0.35, p < 0.001), waist-hip ratio (r = 0.23, p < 0.01) and plasma immunoreactive insulin (fasting r = 0.30, p < 0.001, post glucose r = approximately 0.20, p < 0.05) but not to C-peptide concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of calcium in cholinergic stimulation of lacrimal gland protein secretion.

To characterize the role of Ca2+ in cholinergic stimulation of lacrimal gland protein secretion, the effects of inhibitors of cellular Ca2+ handling on protein secretion were investigated. Protein secretion was measured from rat exorbital glands using either pieces of gland in perifusion or acini isolated by collagenase digestion. Peroxidase was used as a measure of protein secretion. An inhibitor of Ca2+ influx via voltage sensitive Ca2+ channels (verapamil) at 10(-5) and 5 X 10(-5) M did not alter protein secretion stimulated by the cholinergic agonist carbachol at 10(-5) M. Inhibition of Ca2+ efflux via Na+/Ca2+ exchange by removal of extracellular Na+ or by inhibition of Na+-K+-ATPase activity using ouabain (10(-3) M) or extracellular K+ removal did not stimulate protein secretion. In contrast, inhibition of Ca2+ release from intracellular stores with TMB-8 at 100 micron completely blocked protein secretion stimulated by carbachol at 10(-5) M. Similarly, the Ca2+/calmodulin (CaM) antagonists W-13 and W-12 decreased carbachol-induced protein secretion with potencies similar to those which inhibit Ca2+/CaM dependent processes. We conclude that cholinergic agonists stimulate lacrimal gland protein secretion primarily by mobilizing Ca2+ from intracellular stores and that one mechanism by which this Ca2+ could activate secretion is in conjunction with calmodulin.

Quantitative electromyography using automatic analysis--diagnostic utility of turns per unit amplitude.

Quantitative electromyographic (QEMG) data from 3 muscles recorded with a 50-micronV threshold for the turns and amplitude measurements are presented. Using turns per unit amplitude as the index, consistent and comparable readings were recorded from abductor digiti minimi, biceps brachii and vastus medialis in normal subjects, namely 1.132 +/- 0.08 (31 subjects), 1.059 +/- 0.122 (31 subjects) and 1.007 +/- 0.088 (11 subjects), respectively. It is shown here that the diagnostic yield increases when all 3 values, namely, turns/s, average amplitude and turns/unit amplitude are considered in conjunction rather than considering the first 2 alone.

Quantitative electromyography using automatic analysis. A comparative study with a fixed fraction of a subject's maximum effort and two levels of thresholds for analysis.

Quantitative electromyographic (QEMG) data recorded with two levels of threshold for the apparatus are compared. Using a fixed fraction of a subject's maximum effort the data are shown to be independent of sex, age and the strength of the muscles. The diagnostic yield of such a method is shown to be better with 50 muV threshold for analysis than with 100 muV, in cases of muscle disorders such as Duchenne muscular dystrophy and polymyositis. However, in cases of neurogenic lesions due to anterior horn cell disease the diagnostic yield remains the same with both thresholds.