Lymphoma Maxilla mimicking orbital cellulitis; case report and review of Literature.

BACKGROUND: Sinonasal lymphomas are the commonest nonepithelial malignancies of the nasal cavity and paranasal sinuses. They may spread from their site of origin in nasal cavity and invade adjacent structures including orbits leading to varying presentation and a diagnostic dilemma. CASE: A-77- year old Nepalese male presented with swelling of left eye since 1 month and pain in the same eye since 2 days. OBSERVATION: Examination revealed axial proptosis, swelling of lids, restricted extraocular movement, diffuse conjunctival and ciliary congestion with chemosis. Visual acuity was grossly decreased. The case was diagnosed as left orbital cellulitis and treated with broad spectrum intravenous antibiotics and oral steriods. There was no response despite 3 days of antibiotics and steroids therefore a computed tomography was planned which showed features of Sinonasal malignancy invading the orbit. Repeated biopsy was suggestive of malignant small round cell tumour. In the view of unclear preoperative biopsy indicating further details on the histologic type of tumor and extensive erosion of maxilla with complete loss of vision in the eye the patient was planned for Total Maxillectomy with Orbital extenteration of the left orbit. Post-operative histopathological and Immunohistochemical report were suggestive of High grade Lymphoma. The patient was advised for Adjuvant Chemotherapy and Radiotherapy, which the patient refused due to financial constraints. He is on occasional follow up since the last 6 months. CONCLUSIONS: The diagnosis of maxillary sinus lymphoma needs to be borne in mind when a clinician encounters a case of Orbital Cellulitis. It may be difficult to diagnose clinically and require radio-pathological correlation.

Evaluation of intermittent pneumatic compression devices.

Venous blood flow rate in the lower extremity after applying different pneumatic compression devices was evaluated. Five healthy individuals, aged 21-35, were recruited for this study. The ability of six different pneumatic compression devices to increase femoral venous blood flow velocity was analyzed and compared to that of active and passive foot dorsiflexion. Baseline venous blood flow velocity was measured using an ATL Duplex Doppler before leg compression. Venous blood flow velocity was then monitored before, during, and after each compression cycle. Average peak venous velocity increased >200% on dorsiflexion of the ankle. Among the investigated devices, the increase in venous velocity varied significantly. Design of compression chambers enabling compression on the lateral and medial aspects of the calf produced an increase in venous velocity closest to active foot dorsiflexion. Foot compression devices produced the smallest increase in venous velocity. The relative effectiveness of pneumatic compression devices, particularly with respect to increasing venous blood flow in the lower extremity, may correlate well with how closely the device simulates the physiologic contraction of the calf muscles. Clinical trials are needed to further compare the effectiveness of these devices, as other less readily measured factors play a role in thromboprophylaxis.

Studies on some pharmacognostical profile of ficus racemosa linn (fam. Moraceae) leaves.

The Macroscopic character of the leaves ash values, extractive values, behaviors on treatment with different chemical reagents, fluorescence characters under ultra violet light after treatment with different chemical reagents of the powdered leaves of ficus racemosa Linn (fam. Moraceae) were studied to fix some pharmacognostical parameters. Preliminary phytochemical studies on different extractives of the leaves were also performed. These studies will help in future for identifying this plant for further research.

Clinical trial of captopril (Aceten) in Indian patients with essential hypertension.

ACE inhibitors are not available in India. Response to captopril in comparison with M-dopa was therefore seen in Indian hypertensive patients. A double blind randomized non-crossover study was carried out on 39 adult patients of either sex suffering from essential hypertension. Twenty-five patients included were resistant to earlier drug therapy. The remaining 14 were freshly detected hypertensive patients. Patients received either 150 mg/day captopril (Aceten) or 750 mg/day M-dopa in 3 equally divided doses every day for 30 days. The mean systolic and diastolic blood pressure in captopril (Aceten) group before starting drug therapy was 171 +/- 4.11 (mean +/- SE) and 111 +/- 0.22, respectively. At the end of therapy the systolic blood pressure was 132 +/- 1.86 and diastolic blood pressure was 84 +/- 1.36 mm of mercury. This fall in the blood pressure within the group was statistically highly significant (p less than 0.001). Similarly patients on M-dopa produced statistically highly significant fall in blood pressure (p less than 0.001) at the end of 4 weeks therapy. Initial systolic and diastolic blood pressure in both groups were comparable and, at the end of 2 and 4 weeks therapy, patients on captopril (Aceten) showed greater fall in both systolic (p less than 0.001) and diastolic (p less than 0.005) blood pressure than patients on M-dopa. None of the patients in the trial demonstrated clinically significant changes in the biochemical parameters. Six of nineteen patients on methyl dopa had side effects which are well known to this drug. None in the captopril showed any side effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Environmental considerations for the disposal of PBB-contaminated animals and wastes.

Accidental contamination of livestock feed in 1973 by polybrominated biphenyls (PBB) led to the destruction of over 30,000 animals in Michigan. Animal carcasses of mostly dairy cattle along with some beef cattle, hogs, sheep and rabbits destroyed under the Federal Food and Drug Administration guidelines were disposed on the land at an environmentally safe site in Kalkaska County, Michigan. The geology and hydrology of the disposal site on state-owned land is considered favorable for the disposal of contaminated carcasses and to prevent any migration of PBBs into ground and surface waters of the area. Materials underneath the site are predominantly sand with layers of silts and clays of glacial origin. The vertical isolation from the surface to the water table is over 90 ft, and the horizontal isolation to the privately owned properties and surface water bodies is well over 1.5 mile in all directions. The site design provides necessary safeguards for minimizing surface water infiltration into disposal trenches and maximizing the protection to the environment. A series of water wells in the direction of flow are established for monitoring groundwater quality for years to come. A 40-acre Gratiot County landfill located near St. Louis, Michigan, has received 269,000 lb of wastes containing 60 to 70% PBBs between 1971 and 1973. PBB wastes are intermixed with general refuse at various depths predominantly in the eastern half of the landfill. Phase I of the hydrogeological investigation shows that the landfill is situated immediately above the groundwater aquifer and a divide. Recently drilled test wells show traces of PBBs in the aquifer in all directions. Additional studies are planned in the near future for corrective measures and monitoring.