Biosorption of Heavy Metal (Mn2+) by Thermophilic Bacterial Strains Isolated from Surya Kund Hot Spring, Yamunotri, Uttarakhand.

This investigation aimed to identify the bioremediation potential of Mn2+-resistant bacterial strains cultured from the Surya Kund hot spring, Yamunotri, Uttarakhand. In this study, eight heavy metal-resistant isolates belonging to two phyla, i.e., Firmicutes and Proteobacteria, were investigated for their Mn2+ biosorption potential. The metal tolerance potential of all the thermophilic bacterial strains was determined by MIC. Bioremediation assay of these metal-resistant strains was performed for Mn2+ through the live and dead biomass of the bacterial cell. The evaluation of the bioremediation rate of metal ions through bacteria was done by AAS. All the selected bacterial strains were evaluated with effective biosorption rates for Mn2+. Acinetobacter sp. LSN-10 (YII-1) has been showing the highest potential for the removal of Mn2+ in both live (41.202%) and dead biomass (64.721%) conditions. The bioremediation rate of dead biomass was observed quite higher in comparison to bioremediation through live bacterial cells in the maximum number of isolates. This study may provide a new eco-friendly and cost-effective approach to dealing with metal toxicity. However, further investigation is needed to identify the most effective applications and potential limitations of this method.

Menstrual characteristics and prevalence of dysmenorrhea in college going girls.

BACKGROUND: Dysmenorrhea is a common gynecological condition with painful menstrual cramps of uterine origin. Prevalence of primary dysmenorrhea is not yet clearly studied in central India. OBJECTIVE: To study prevalence of primary dysmenorrhea in young girls and to evaluate associated clinical markers of dysmenorrhea. MATERIALS AND METHODS: In a cross-sectional study, data was collected among 310 girls (18-25 years) on age at menarche, presence and absence of dysmenorrhea, dysmenorrhea duration, pre-menstrual symptoms (PMS), family history, menses irregularities, menstrual history, severity grading using visual analogue scale (VAS) using a semi-structured questionnaire. RESULTS: Dysmenorrhea was reported in 84.2% (261) girls and 15.8% (49) reported no dysmenorrhea. Using VAS, 34.2% of girls experienced severe pain, 36.6% moderate and 29.2% had mild pain. Bleeding duration was found to be significantly associated with dysmenorrhea (χ(2) = 10.5; P < 0.05), girls with bleeding duration more than 5 days had 1.9 times more chance of getting dysmenorrhea (OR: 1.9; 95% CI: 1.7-3). Moreover, girls with the presence of clots had 2.07 times higher chance of having dysmenorrhea (OR: 2.07; 95% CI: 1.04-4.1) (P < 0.05). Almost 53.7% girls who had some family history of dysmenorrhea, 90.9% experience the condition themselves (χ(2) = 11.5; P < 0.001). Girls with family history of dysmenorrhea had three times greater chance of having the same problem (OR: 3.0; 95% CI: 1.5-5.8; P = 0.001). CONCLUSION: Dysmenorrhea is found to be highly prevalent among college going girls. Family history, bleeding duration and presence of clots were significant risk factors for dysmenorrhea.

Preservation of autonomic nerves in laparoscopic total radical hysterectomy.

OBJECTIVES: The aim of this study was to evaluate the feasibility, complications, margin status, and functional outcome (on urinary and sexual functions) of nerve-sparing radical hysterectomy (NSRH) performed laparoscopically. METHODS: Patients with cervical carcinoma of stage Ia2 and Ib1 underwent laparoscopic NSRH along with pelvic lymphadenectomy. We performed the technique in simple comprehensible steps with anatomic delineation of the autonomic nerves and selective cutting of the uterine and cervical branches. RESULTS: Laparoscopic NSRH was feasible in 85.7% of patients. Mean operative time was 160 minutes and all 7 patients had clear surgical margins. There were no complications and no blood transfusions were required. The median hospital stay was 3 days. The median return time for normal bladder function was 2 days and none of them required catheterization beyond 2 weeks. The mean residual urine volume was <50 mL. Urodynamic studies performed at 3 weeks after the operation showed no impairment of maximum flow rate (maximal flow rate: 20 ± 2 mL). The postoperative results of sexual dysfunction were inconclusive. CONCLUSION: Understanding this technique and the knowledge of laparoscopic anatomy of pelvic autonomic nerves is important in both benign and malignant pelvic surgeries. These preliminary results indicate that nerve sparing is easier done laparoscopically and its results are comparable to that of conventional laparoscopic radical hysterectomy in terms of lateral margin status and lymph node yield. Whether quality of life can be benefited by L-NRSH technique and its long-term oncological sequelae need further evaluation.

Indications and outcomes of deep anterior lamellar keratoplasty in children.

PURPOSE: To report our experience of deep anterior lamellar keratoplasty (DALK) in children. DESIGN: Retrospective case note review. PARTICIPANTS: Nine patients (13 eyes) aged from 13 weeks to 14 years, 11 months at the Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom. METHODS: A study of all pediatric patients undergoing DALK from February 2002 to October 2008 was undertaken. Deep anterior lamellar keratoplasty was attempted in 9 children (13 eyes); the procedure was successful in 11 eyes, and 2 eyes progressed to penetrating keratoplasty (PKP). One eye underwent repeat DALK. Preoperative examination included electrophysiology, ultrasound biomicroscopy (UBM), and slit-lamp biomicroscopy. MAIN OUTCOME MEASURES: Complications and visual acuity at last follow-up. RESULTS: Five patients had mucopolysaccharidoses (MPS), 3 patients had scarring presumed to be infectious, and 1 patient had keratoconus. Because of the failure of follow-up and loose sutures, 1 child with MPS had an epithelial rejection and the operation was repeated successfully. All grafts showed good graft clarity 10 to 80 months after grafting with visual acuities ranging from 0.28 to 1.0 logarithm of the minimum angle of resolution. Two children with nonspecific causes of scarring showed good visual acuities 24 to 51 months post-DALK. Two children who had conversion to PKP were lost to follow-up because they had moved abroad. In 4 of the 5 children with MPS, established techniques of DALK could not be performed because of excessive glycosaminoglycans (GAGs) in the stroma. Ultrasound biomicroscopy was used to guide trephination depth in the first instance. In 1 child with MPS, viscodissection was successfully used. All clinically diagnosed scars were histologically confirmed, and electron microscopy of corneal buttons confirmed the diagnosis in patients with MPS. CONCLUSIONS: Deep anterior lamellar keratoplasty should be considered in children with MPS and partial-thickness scars. In MPS, viscodissection and the "big bubble" technique may not be useful if there are excessive GAGs in the stroma. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Laparoscopic hyperthermic intraperitoneal chemotherapy as adjuvant modality following radical surgery for advanced rectal cancer a new look to an old problem.

BACKGROUND/AIMS: The benefits of adjuvant chemotherapy for colorectal cancer has been well accepted over the last decade. Published data so far has been focused in the direction of giving the right chemotherapy dose, schedule, and combinations, in order to increase the efficacy and decrease the toxicity. METHODOLOGY: Eighty-seven patients with histological proved stage III rectal carcinoma were subjected to a combined adjuvant modality using laparoscopic heperthermic endoperitoneal chemotherapy (HIPEC) and systemic chemotherapy twenty days following the initial surgery. RESULTS: Seventy patients who completed a one year follow-up had a disease free survival. Among forty patients who completed the two year follow-up, two patients developed local recurrence. CONCLUSIONS: Cytoreduction followed by HIPEC improves survival in patients with rectal carcinoma and lymphnode positive and neurovascular involvement.

Thoracolaparoscopy in the lateral position for esophageal cancer: the experience of a single institution with 112 consecutive patients.

BACKGROUND: Esophagectomy has been performed using a thoracoabdominal, transhiatal, or transthoracic approach. All these methods have an acknowledged high intra- and postoperative morbidity. The principle of minimally invasive esophagectomy is to perform the operation the same as by the open approach but through a smaller incision, thus reducing the operative trauma without compromising the principles of the operation. The authors report their experience with thoracoscopic esophagectomy performed for 112 patients in left lateral position. METHODS: Patients with resectable thoracic or gastroesophageal junction cancer and medically fit for a three-stage esophagectomy underwent thoracoscopic esophagectomy in left lateral position. The procedure was converted to open surgery for 2 (1.79%) of the 112 patients. RESULTS: Since June 2005, 112 patients have undergone thoracoscopic esophagectomy in left lateral position. Of these patients, 80 patients had middle-third esophageal cancer. The pathology of 100 patients showed squamous cell carcinoma. The average thoracoscopic operating time was 85 min (range, 40-120 min). The average blood loss was 200 ml, and the average number of harvested mediastinal nodes was 20. Postoperative morbidity occurred for 16 patients, with 8 patients (7.27%) experiencing respiratory complications. Postoperative mortality was experienced by three patients. The median follow-up period was 18 months. CONCLUSIONS: Thoracoscopic esophagectomy is surgically safe and oncologically adequate. Thoracoscopy for patients in the left lateral position does not require prolonged single-lung ventilation. The anatomic orientation in the left lateral position is the same as that for open surgery, reducing the learning curve for thoracic surgeons. The potential advantages and the morbidity trend of prone instead of left lateral thoracoscopic esophagectomy needs to be evaluated.

Laparoscopic total radical hysterectomy by the Pune technique: our experience of 248 cases.

STUDY OBJECTIVE: To describe our experience and technique of total laparoscopic radical hysterectomy with pelvic lymphadenectomy, which is the largest single- institution study. DESIGN: Retrospective, nonrandomized study (Canadian Task Force classification II-2). SETTING: Private hospital. PATIENTS: Two hundred forty-eight patients with International Federation of Gynecology and Obstetrics stage IA2 (n = 32) and IB1 (n = 216) of cancer of the cervix. INTERVENTION: Total laparoscopic type III radical hysterectomy with bilateral pelvic lymphadenectomy was done. Simple repetitive steps were used to perform this surgery and develop an easily replicable technique. Harmonic Shears, bipolar coagulation, and vascular clips were used. Resection of the cardinal and uterosacral ligaments was performed with LigaSure (LigaSure Vessel Sealing System; Valleylab, Tyco Healthcare, Boulder, CO) or the Harmonic Shears (Ethicon Endo-Surgery, Inc., Cincinnati, OH). Pelvic lymph node dissection was done. MEASUREMENTS AND MAIN RESULTS: Histopathologically, there were 183 (73%) cases of squamous carcinoma, 52 (20%) adenocarcinomas, and 13 (5%) adenosquamous carcinomas. Four patients needing anterior exenteration because of bladder involvement were excluded from data analyses. The operation was performed entirely by laparoscopy in all patients and by the same surgical team. The patients' median age was 61 years. The median operative time was 92 minutes (range 65-120 minutes). The median number of resected pelvic nodes was 18. The median blood loss was 165 mL. The median length of stay was 3 days. All 15 intraoperative complications were tackled laparoscopically. No patients were converted to the open technique. There were no deaths in our series. Seventeen patients had complications within 2 months of surgery. Seven patients had recurrences after a median follow-up of 36 months. CONCLUSION: Our technique of total laparoscopic radical hysterectomy, developed over 248 cases, can be performed safely. It is an easily replicable technique. This procedure reduces the morbidity associated with abdominal radical hysterectomy. All of the complications can also be tackled laparoscopically, which does not further add to the morbidity.

Endoscopic thyroidectomy: Our technique.

UNLABELLED: Minimally invasive surgery is widely employed for the treatment of thyroid diseases. Several minimal access approaches to the thyroid gland have been described. The commonly performed surgeries have been endoscopic lobectomies. We have performed endoscopic total thyroidectomy by the anterior chest wall approach. In this study, we have described our technique and evaluated the feasibility and efficacy of this procedure. MATERIALS AND METHODS: From June 2005 to August 2006, 15 cases of endoscopic thyroidectomy were done at our institute. Five patients were male and 10 were female. Mean age was 45 years. (Range 23 to 71 years). Four patients had multinodular goiter and underwent near-total thyroidectomy; four patients had follicular adenoma and underwent hemithyroidectomy. Out of the seven patients of papillary carcinoma, four were low-risk and so a hemithyroidectomy was performed while three patients in the high risk group underwent total thyroidectomy. A detailed description of the surgical technique is provided. RESULTS: The mean nodule size was 48 mm (range 20-80 mm) and the mean operating time was 85 min (range 60-120 min). In all cases, the recurrent laryngeal nerve was identified and preserved intact, the superior and inferior parathyroids were also identified in all patients. No patients required conversion to an open cervicotomy. All patients were discharged the day after surgery. All thyroidectomies were completed successfully. No recurrent laryngeal nerve palsies or postoperative tetany occurred. The postoperative course was significantly less painful and all patients were satisfied with the cosmetic results. CONCLUSIONS: It is possible to remove large nodules and perform as well as total thyroidectomies using our endoscopic approach. It is a safe and effective technique in the hands of an appropriately trained surgeon. The patients get a cosmetic benefit without any morbidity.