Clinicopathological Profile and Survival Outcomes in Patients with Localised Extremity Synovial Sarcomas.

AIMS: Synovial sarcoma is a rare but aggressive variant of soft-tissue sarcoma. Literature is sparse and reported mostly from the West. We analysed the clinical profiles and prognostic factors of extremity synovial sarcoma patients in order to study their clinical journey. MATERIALS AND METHODS: This was a retrospective analysis. All patients with extremity synovial sarcoma treated between 1992 and 2020 were included. Patients with metastases at presentation were excluded. A descriptive analysis of demographic and clinicopathological features of patients undergoing limb salvage surgery (LSS) or amputation was carried out. Overall survival and disease-free survival were calculated for the entire cohort as well as for the LSS and amputation groups. Factors prognostic for survival were identified. RESULTS: In total, 157 patients had localised extremity synovial sarcoma. Predominantly, young adults (median 31 years) and males (61%) were affected. Over 70% of patients presented after recurrence or unplanned surgeries. Sixty-seven per cent of tumours were >5 cm, 69% were deep and 23% involved bone. The limb salvage rate was 64%. In the LSS group, adjuvant radiotherapy and chemotherapy were given to 72% and 68% of patients, respectively. In the amputation group, 72% of patients received adjuvant chemotherapy. In a median follow-up of 59 months, 39.4% of patients had recurrences, the majority (61.2%) were systemic. Five-year overall survival and disease-free survival were 53.4% and 49.8%, respectively. Overall survival was 63.9% and 29.7% in the LSS and amputation groups, respectively. On multivariate analysis, tumour size, depth, omission of radiotherapy and bone invasion were found to be the adverse prognostic factors. CONCLUSION: This is one of the largest studies on extremity synovial sarcoma. Mostly males and young adults were affected. The limb salvage rate was 64%, despite most being referred after unplanned surgery. Almost 70% of patients received radiotherapy and chemotherapy. Overall survival was inferior in the amputation group. Tumour size >5 cm, depth and bone invasion were negative, whereas adjuvant radiotherapy was a positive prognostic factor for survival. Chemotherapy had no impact on survival.

Learning Curve of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy - an Analysis of Critical Perioperative and Surgical Outcomes among 155 Peritoneal Surface Malignancy Patients Treated at a Tertiary Care Cancer Centre.

AIMS: Various factors can influence the learning curve of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Initiating CRS and HIPEC programmes in low- and middle-income countries is challenging due to resource constraints and limited availability of expertise. We present our experience of CRS and HIPEC from a learning curve perspective among a cohort 155 peritoneal surface malignancy patients. MATERIALS AND METHODS: Patients undergoing CRS and HIPEC between May 2015 and February 2019 were included in the study. Patients were divided into two consecutive cohorts: the first 73 cases comprised the learning phase, group 1; the subsequent cohort of 82 patients were considered as the implementation phase, group 2. A comparative analysis of clinical and surgical outcome parameters was carried out between the two groups. RESULTS: The clinical spectrum was comparable among group 1/group 2. Most were ovarian (56.8%), colorectal (13.5%) and appendiceal (11.0%) malignancies. Group 2 had a higher number of moderate to high peritoneal cancer index patients (34.1% versus 19.1%), total peritonectomies (48.8% versus 45.2%), multi-visceral resections (colonic 41.5% versus 27.4%, small bowel 25.6% versus 19.1%, diaphragmatic 8.5% versus 6.5% and hepatic resections 8.5% versus 2.7%) and completeness of cytoreduction 0/1 rates (97.6% versus 93.1%). A lower incidence of intraoperative urological injuries (2.6% versus 12.3%) was noticed in group 2 (P = 0.007). Non-significant improvements seen in group 2 included surgery duration (6.0 ± 1.3 h versus 6.4 ± 1.7 h), intensive care unit stay (1.3 ± 1.1 days versus 1.8 ± 1.5 days), overall hospital stay (8.1 ± 0.9 days versus 8.8 ± 1.4 days) and reduction in Clavien-Dindo grade 3-4 complications (25.4% versus 36.9%). CONCLUSIONS: The results of the current study indicate that by implementing standard protocols and mentoring by an experienced team, a learning curve of CRS and HIPEC can be achieved in fewer than 75 cases. The baseline expertise of the treating team can also influence the learning curve.

Characterization of fertility associated sperm proteins in Aseel and Rhode Island Red chicken breeds.

This study focused on characterization of fertility associated proteins in Aseel and RIR roosters and was conducted on two generations of birds. Roosters were divided into high (>50%) and low fertility groups (<50%) based on sperm function tests and fertility rate in both the generations. Polyclonal antibodies were raised in rabbits against sperm proteins of first generation highly fertile roosters and tested for characterization of fertility associated sperm proteins in the second generation of same roosters. IgG-fraction against proteins (Anti-SP-IgG) was reacted with sperm proteins of both high and low fertile roosters of second generation on immunoblots. Sperm proteins present in highly fertile roosters were further characterized by Mass Spectrometry (MS). Use of SDS-PAGE for evaluation of sperm extracts of Aseel and RIR breeds resulted in resolution of 16 and 10 proteins on 12% acrylamide gels. Anti-SP-IgG reacted with eight and ten sperm proteins of Aseel and RIR roosters on immunoblots. The SDS-PAGE and immunoblotting analysis also indicated a variation in sperm proteins among two breeds and high/low fertile roosters. The MS analysis indicated matching of 20, 30, and 20, 25 kDa proteins (associated with high fertility rate) of Aseel and RIR roosters with immunoglobulin kappa chain variable, phospholipase A2 (PLA2), hypothetical N332-08551 partial and cystatin like partial proteins with a top score of 41, 46, 52 and 43, respectively. Considering the function and importance of matching proteins in male reproduction, these proteins may be further explored as potential markers for fertility evaluation of Aseel and RIR roosters.

Bacterial isolation of milk samples submitted from clinical mastitis buffaloes during 2007 to 2016.

The present study determined trends in the isolation of bacterial pathogens in milk samples submitted from clinical mastitis buffaloes at the University mastitis laboratory during 2007 to 2016. Culture results (n = 3945) were classified into six categories (Staphylococcus spp., 28.7%; Streptococcus spp., 1%; Corynebacterium spp., 1.1%; gram-negative organisms, 3.2%; others including mixed growths, 3.3%; and no growth, 62.7%). Overall, culture results were significantly associated with year (χ2 = 112.28; df = 10; P < 0.001) and season (χ2 = 136.03; df = 20; P < 0.001). From 2007-2009 to 2013-2016, the isolation of Staphylococcus spp. increased from 28.2 to 48.4%, while isolation of Streptococcus spp. (50 to 20%) and Corynebacterium spp. (65.1 to 16.3%) decreased. The proportion of samples characterized as no growth increased from 26.4% (2007-2009) to 46.3% (2013-2016). Further, the proportion of clinical mastitis cases increased over the study years (goodness-of-fit χ2 = 59; df = 2; P < 0.001). With respect to season, the proportion of Staphylococcus spp. (30.6%; 346/1132), Corynebacterium spp. (48.8%; 21/43), and gram-negative bacteria (55.9%; 71/127) were more associated with the monsoon, and that of Streptococcus spp. (47.5%; 19/40) with the winter. Seasonal effects were also observed on the occurrence of clinical mastitis cases; comparatively, more clinical mastitis cases (35.6%; 523/1473) were observed during the monsoon season (goodness-of-fit χ2 = 276.7; df = 4; P < 0.001) as compared with other seasons. The present study concludes that Staphylococcus spp. are the major cause of intramammary infections in buffaloes with clinical mastitis, demanding more studies regarding its epidemiology and pathogenicity. Also, more efforts are needed in the prevention and control of clinical mastitis in buffaloes, especially, during the monsoon season.

Relationship between teat morphological traits and subclinical mastitis in Frieswal dairy cows.

The present study was aimed to investigate the relationship between selected morphological traits of teat and subclinical mastitis (SCM) in Frieswal crossbred dairy cows. A total of 1040 quarters from 261 lactating cows were evaluated for teat shape (bottle/fleshy/collapsed/conical/normal/pencil and short), teat-end shape (dished/flat/funnel/pocketed/pointed and rounded), teat orientation (aligned/misaligned) and teat position (front and rear; left-sided and right-sided). Each udder quarter was screened with California Mastitis Test (CMT) for the purpose of defining quarter health status. Data were analysed using Chi-square test and multivariable logistic regression procedure. An overall prevalence of SCM (CMT positive) at quarter level was 30.6%. Most of the teats had normal or cylindrical shapes (48%), dished teat-ends (40.7%), and aligned (central or squared) in orientation (65%). At bivariable level, significant association of SCM with teat shape, teat position, teat orientation, parity, and stage of lactation was observed (P < 0.05 to P < 0.001). Teat-end shapes showed some association with SCM (P = 0.07). Results of multivariable analysis showed that pencil-shaped teats were least associated with SCM (P < 0.05) as compared to other teat shapes. Prevalence of SCM was also higher in rear teats (P = 0.015), misaligned teats (P = 0.01), and cows in second or higher parities (P < 0.01) and late stage of lactation (P < 0.001). The results of the present study indicate that selected morphological traits of teat are associated with SCM in Frieswal crossbred cows; therefore, selection towards desirable morphological traits could help reduce mastitis in this breed.

Acute phase response in lame crossbred dairy cattle.

AIM: The study was undertaken to study acute phase response based on acute phase proteins (APPs) such as C-reactive protein (CRP), haptoglobin (Hp), serum amyloid A (SAA), and fibrinogen in lame crossbred dairy cattle. MATERIALS AND METHODS: Lame animals (n=30) were selected within 3-7 days of being noticed as lame by the farm veterinarian, from a local dairy farm in southeast Ludhiana over a period of 6 months, stratified proportionately with respect to stage of lactation with non-lame healthy cows (n=10). All the cows were otherwise healthy and did not have any other inflammatory problems such as pneumonia, enteritis, mastitis, or any kind of acute uterine inflammation. Blood samples were collected from all the animals; serum and plasma samples were separated and stored at -20°C. The levels of CRP, Hp, and SAA were estimated using Sandwich ELISA, whereas fibrinogen was estimated by heat precipitation method. RESULTS: SAA levels in lame cows were significantly higher (22.19±0.85 µg/ml), approximately 3 times as compared to non-lame cows (8.89±0.72 µg/ml), whereas serum Hp concentration was approximately 20 times higher in the lame cattle (21.71±3.32 mg/dl) as compared to non-lame cows (1.17±0.07 mg/dl). Fibrinogen also increased in the lame cattle (3.97±0.22 g/L) as compared to non-lame group (1.40±0.17 g/L). Serum CRP levels analyzed in the lame cattle for the first time in the present study, and significant high concentration was appreciated in lame cattle (4.41±0.33 mg/L) as compared to non-lame cattle (0.61±0.14 mg/L). Lame cattle were having more of sole hemorrhages, sole ulcers, and white line lesions as compared to non-lame cattle. CONCLUSION: It can be concluded that lame cattle exhibit high levels of APPs including CRP, Hp, SAA, and fibrinogen as compared to non-lame cattle.

Laparoscopic TEP repair of inguinal hernia does not alter testicular perfusion.

PURPOSE: The effect of laparoscopic TEP repair on testicular perfusion is unclear. The procedure entails dissection of testicular blood vessels off the hernial sac and incorporation of a prosthetic mesh. This carries at minimum, a theoretical risk of compromise in testicular blood supply, which in turn may affect fertility. Our study aims to establish if any alteration in testicular perfusion occurs in very early (24 h), early (1 week) or late postoperative period (3 months) after laparoscopic TEP repair in the Indian population. METHODS: In our prospective trial, 20 patients underwent unilateral and 8 underwent bilateral laparoscopic TEP hernia repairs using standard technique by experienced surgeons. Flow parameters of testicular, capsular and intratesticular artery were noted using color Doppler ultrasound preoperatively and postoperatively and the postoperative resistive indexes of operated side (n = 36) were compared with preoperative values. Additionally, for unilateral repairs, flow parameters on operated side were compared with the non-operated side. RESULTS: No statistically significant difference was noticed in the resistive index of the arteries upon comparing these postoperative with preoperative values. For unilateral repairs, the flow parameters of the operated side were comparable with that of non-operated side (i.e. p > 0.05). CONCLUSION: Laparoscopic TEP performed by experienced surgeons does not alter testicular flow dynamics in early or late postoperative period.

Comparative antibiogram of coagulase-negative Staphylococci (CNS) associated with subclinical and clinical mastitis in dairy cows.

AIM: The present study was planned to determine the in vitro antibiotic susceptibility of coagulase-negative Staphylococci (CNS) strains isolated from clinical and subclinical cases of mastitis in dairy cows. Antibiotic sensitivity profile will be helpful to recommend early therapy at the field level prior to availability of CST results. MATERIALS AND METHODS: The milk samples from cases of clinical mastitis received in Mastitis Laboratory, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana and those of subclinical mastitis collected during routine screening of state dairy farms, were subjected to microbial culture. Identification of CNS organisms was done by standard biochemical tests. Antibiotic sensitivity testing, based on 30 antibiotics belonging to 12 groups, was done on 58 randomly selected CNS isolates (clinical isolates: 41, subclinical isolates: 17). RESULTS: Isolates were highly susceptible to chloramphenicol (98.3%), gentamicin (93.1%), streptomycin (91.4%), linezolid (91.4%), ceftixozime (87.9%), cloxacillin (86.2%), clotrimazole (86.2%), bacitracin (86.2%), enrofloxacin (84.5%) and ceftrioxone + tazobactum (70.7%), while resistance was observed against amoxicillin (77.6%), penicillin (75.9%), ampicillin (74.1%) and cefoperazone (51.7%). Overall, isolates from clinical cases of mastitis had a higher resistance than subclinical isolates. CONCLUSION: CNS isolates were susceptible to chloramphenicol, gentamicin and streptomycin, while higher resistance was recorded against routinely used penicillin group.

Para-clinico-pathological observations of insidious incidence of canine hepatozoonosis from a mongrel dog: a case report.

A rare case of canine hepatozoonosis in a mongrel dog with para-clinico-pathological observations has been reported. The study included detailed haemato-biochemical changes at two stages, i.e. before treatment and after treatment with adopted therapy. Before therapy, blood picture revealed normocytic hypochromic anaemia and neutrophilic leucocytosis with variable counts of platelets. Thirty-seven percent of neutrophils were found infected with gametocytes of Hepatozoon canis. Following treatment, further decrease in haemoglobin value with a relative increase in lymphocyte count was seen. Biochemically, increase in alkaline phosphatase, blood urea nitrogen and creatinine levels along with hyperproteinemia was seen. The 14 days chemotherapy did not bring a respite for the dog and the level of parasitaemia was 33% after the treatment. The alkaline phosphatase and creatinine level further rose up following therapy with sulphadiazine and clindamycin. Continual study is required to explain the best possible therapeutic combination to deal H. canis.

Concomitant percutaneous nephrolithotomy and transperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction complicated by stones.

INTRODUCTION: Ureteropelvic junction (UPJ) obstruction and stones can co exist. Therapeutic controversy exists regarding their ideal management. We present our experience of combining Percutaneous nephrolithotomy (PNL) with laparoscopic pyeloplasty (LP),in patients with UPJ obstruction with multiple secondary, in the same session or staged manner. PATIENTS AND METHOD: From November 2006 till April 2008 ten patients underwent PNL with LP at our institution. Two of these patients had recurrent obstruction and stones after PNL and endopyelotomy. All patients had multiple calyceal and pelvic calculi (>10) with sizes ranging from 3 to 24 mm. Mean age of patients was 33 years (17-55). PNL was done in standard manner and was followed by laparoscopic pyeloplasty. RESULT: Complete stone clearance could be achieved in all by PNL. Procedure was staged in 2 due to the presence of infected hydronephrosis. 9 patients underwent dismembered pyeloplasty and in 1 Fengerplasty was done. Reduction of baggy pelvis was required in 3 cases. Mean operative time was 3. 9 hours (3-5). Postoperatively the nephrostomy was kept for an average of 2 days (1-3). Drain was removed after an average of 3. 5 days (3-5). Mean hospital stay was 5. 2 days (5-7). None of the patients required blood transfusion. Stent was removed after 4 weeks. At 6 months patients are stone free on ultrasound and show good drainage on renal scan. One year follow-up is available for 5 patients which shows a stone free status and good drainage across UPJ. CONCLUSION: Concomitant PNL and laparoscopic pyeloplasty are feasible and safe for patients with UPJ obstruction complicated by multiple calculi. We did not encounter any intraoperative difficulty during pyeloplasty following PNL.

High prevalence of type 2 diabetes mellitus in affluent urban Indians.

The highest prevalence of type 2 diabetes mellitus in developing countries occurs in the upper socio-economic group, but this has not been well documented in Indians. The age and sex standardized prevalence of diabetes in 1112 affluent adult Indian subjects was 21.1%. This is the highest prevalence of diabetes reported from India.

Prevalence & risk factors of pre-hypertension & hypertension in an affluent north Indian population.

BACKGROUND & OBJECTIVES: Urban Indians have a high prevalence of insulin resistance, hypertension and cardiovascular disease. We studied the prevalence of pre-hypertension and hypertension, as well their association with cardiovascular risk factors, in a north Indian upper socio-economic population. METHODS: A total of 1746 adults (age >or=30 yr) residing in an urban colony of high-income group residents in the city of Lucknow, north India, were invited to be enrolled for the study. The response rate was 64 per cent (n=1112). Blood pressure, anthropometry, plasma glucose in response to oral glucose tolerance test and lipids were measured. The variables contributing significantly to pre-hypertension and hypertension were analyzed by multiple logistic regression analysis. RESULTS: The age and sex adjusted prevalence of hypertension was 32.2 per cent and pre-hypertension was 32.3 per cent. In contrast to hypertension, which was highest in the age group 60-69 yr (64%), prehypertension was highest (36%) in the group 30-39 yr. There was a high prevalence of cardiovascular risk factors in the general population [central obesity (86.7%), elevated LDL cholesterol (22.8%), abnormal glucose tolerance (41.6%) and smoking (20.3% of males)]. Two or more of the cardiovascular risk factors were present in a higher proportion of hypertensive [66%, odds ratio (OR) 3.0, P<0.0001] and pre-hypertensive, (56%, OR 2.0, P<0.0001) compared to normotensive subjects (39%). Subjects with pre-hypertension had body mass index, waist-hip ratio and frequency of glucose intolerance, which was intermediate between normotensive and hypertensive subjects. In multiple logistic regression analysis, increasing age, body mass index, waist hip ratio and impaired glucose tolerance/diabetes were independent risk factors for both hypertension and pre-hypertension. INTERPRETATION & CONCLUSION: A high prevalence of pre-hypertension and hypertension were noted in affluent urban north Indians. Increasing age, body mass index, central obesity and impaired glucose tolerance/diabetes were significantly associated with both hypertension and pre-hypertension. Pre-hypertension was associated with an increased prevalence of cardiovascular risk factors.

Pharmacokinetic profile of erythromycin after intramammary administration in lactating dairy cows with specific mastitis.

The pharmacokinetics of erythromycin was studied in five lactating dairy cows following single intramammary infusion of 300 mg erythromycin in each of two quarters per cow with specific mastitis. Levels of erythromycin in plasma and quarter milk samples were measured by agar plate diffusion assay using Micrococcus luteus (ATCC 9341) as the test organism. Erythromycin level in plasma reached a peak concentration value (C(max)) of 0.07 +/- 0.01 microg/ml at 30 min; thereafter, levels declined gradually to reach 0.05 +/- 0.00 microg/ml 12 h post drug administration. The pharmacokinetic profile of the drug revealed mean absorption half life (t(1/2 ka)) as 0.26 +/- 0.05 h. The drug was eliminated slowly with elimination half-life (t(1/2 beta)) of 13.75 +/- 0.35 h and elimination rate constant (k(el)) of 0.04 +/- 0.00 h(-1). The volume of distribution based on the zero-time plasma concentration intercept of the least-squares regression line of the elimination phase (V(d(B))) was 0.032 L/kg. The drug crossed to untreated quarters also; mean drug levels of 0.20 +/- 0.07, 0.23 +/- 0.07, 0.17 +/- 0.04, and 0.17 +/- 0.04 microg/ml were found at 3, 6, 8 and 12 h, respectively. The mean drug concentration for treated quarters was measured as 22.97 +/- 2.31 microg/ml milk at first milking (12 h) following drug infusion. No apparent adverse reaction was seen in cows administered erythromycin. It is concluded that following intramammary infusion erythromycin diffuses readily and extensively in various body fluids and tissues and adequate concentration is maintained in udder tissues for at least 12 h post intramammary administration. Thus, erythromycin may be recommended for local therapy of acute mastitis caused by Gram-positive bacteria in lactating dairy cows.

A neurocomputational model for prostate carcinoma detection.

BACKGROUND: Current guidelines for prostate carcinoma screening rely primarily on the digital rectal examination (DRE) and prostate specific antigen (PSA). Well described patient risk factors for prostate carcinoma also include age, ethnicity, family history, and complexed PSA. However, due to the nonlinear relation of each of these variables with prostate carcinoma, it is difficult to predict reliably each patient's risk based on linear univariate analysis. The authors investigated a neural network to model the risk of prostate carcinoma by seven readily available clinical features. METHODS: The database for the current study comprised 3268 men recently evaluated for the early detection of prostate carcinoma. The seven clinical features evaluated included age, race, family history, International Prostate Symptom Score (IPSS), DRE, and total and complexed PSA. Three hundred forty-eight subjects in the dataset included men with determined prostate biopsy outcomes and for whom at least 6 of 7 features were available. The dataset was divided randomly into a training set (60%) and a test set (40%), with n1/n2 cross-validation used to evaluate model accuracy, and was modeled with linear and quadratic discriminant function analysis and a neural computational system. After a model with acceptable goodness of fit was achieved, reverse regression analysis using Wilks's generalized likelihood ratio test was performed to evaluate the statistical significance of each input variable. RESULTS: The receiving operating characteristic (ROC) area for the neural computational system in the test set was 0.825, whereas total PSA and complexed PSA alone had ROC areas of 0.678 and 0.697, respectively. The ROC area of logistic regression in the test set was 0.510, linear discriminant function analysis was 0.674, and quadratic discriminant function analysis was 0.011. All were significantly less than the ROC area of the neural computational model (all Ps < 0.002). Reverse regression based on Wilks's generalized likelihood ratio test demonstrated each input feature to be highly significant to the model (all Ps << 0.000001). CONCLUSIONS: The authors modeled a combination of well described patient risk factors for prostate carcinoma using a neural computational system with acceptable goodness of fit. They demonstrated that each of the seven variates on which the model was based was critically significant to model performance. The authors presented this model for clinical use and suggested that clinicians use it in deciding to perform prostate biopsy.

Symptomatic small non-obstructing lower ureteric calculi: comparison of ureteroscopy and extra corporeal shock wave lithotripsy.

OBJECTIVE: To compare the success, efficacy and complications of ureteroscopy (URS) and extra corporeal shock wave lithotripsy (ESWL) for the treatment of symptomatic small non obstructing lower ureteric calculi. SUBJECTS AND METHODS: This prospective non-randomised study was conducted simultaneously at two urological referral centres, included 280 patients with symptomatic small (4-10 mm) lower ureteric calculi (situated below the sacroiliac joint), with good renal function on intravenous urography. Patients were offered both the treatment options. One hundred and sixty patients chose ureteroscopy, whereas 120 patients were treated by ESWL. Standard techniques of ureteroscopy and ESWL were employed. Patients were followed-up to assess the success rates and complications of the two procedures. RESULTS: Ureteroscopy achieved complete stone clearance in one session in 95% of patients. In six patients ureteroscopy had failed initially and was later accomplished in second session improving the success rate to 98.7%. Two patients had a proximal migration of calculus that needed ESWL. Of the 120 patients treated by ESWL, 90% achieved stone free status at three months. Ureteroscopy was needed for twelve patients (10%) where ESWL failed to achieve stone clearance. There were no significant ESWL related complications. ESWL was administered on outpatient basis, while patients needed hospitalisation and anaesthesia for ureteroscopy. CONCLUSION: ESWL can be the primary mode of treatment for symptomatic small non-obstructing lower ureteric calculi as it is minimally invasive and safe. Ureteroscopy can be offered to patients who demand immediate relief or when ESWL fails.

Hypertension and cerebrovascular disease.

Cerebrovascular disease (CVD) is the third leading cause of death in United States and hypertension is a leading cause of both stroke and heart disease. It may cause headache, acute hypertensive encephalopathy, dementia and various types of strokes e.g., thrombotic, haemorrhagic, lacunar infarcts and transient ischaemic attacks. It remains the singlemost important treatable risk factor for stroke in all age groups and modern antihypertensive therapy has its documented prevention of stroke. Hypertension in acute phase of ischaemic stroke should not be treated. Hypertension in acute stroke should be treated. In advanced centres with specialised stroke units, the favoured drugs are short acting vasodilators e.g., sodium nitroprusside and labetalol. Nifedipine is the most popular drug followed by captopril, both sublingually and orally.

Subcutaneous emphysema as an uncommon presentation of child abuse.

A case of subcutaneous emphysema and pneumomediastinum as a result of child abuse is presented to add to the spectrum of findings associated with child maltreatment. This case is a reminder that although most cases of subcutaneous emphysema resolve uneventfully, there still needs to be an aggressive search for a cause. In addition, in the pediatric age group, the history given should be carefully verified as being plausible because of the possibility that child abuse may be the true etiology.

Rapid accretion and early differentiation of Mars indicated by 142Nd/144Nd in SNC meteorites.

Small differences in the ratio of neodymium-142 to neodymium-144 in early formed mantle reservoirs in planetary bodies are the result of in situ decay of the extinct radionuclide samarium-146 and can be used to constrain early planetary differentiation and therefore the time scale of planetary accretion. The martian meteorite Nakhla (approximately 1.3 billion years old), the type sample of the nakhlite subgroup of the Shergottite-Nakhlite-Chassigny (SNC) meteorites, exhibits a 59 +/- 13 parts per million excess in the ratio of neodymium-142 to neodymium-144 relative to normal neodymium. This anomaly records differentiation in the martian mantle before 4539 million years ago and implies that Mars experienced no giant impacts at any time later than 27 million years after the origin of the solar system.