Pneumocephalus is a common occurrence after cranial surgery, with patients typically remaining asymptomatic from a moderate amount of intracranial air. Postsurgical pneumocephalus rarely causes focal neurological deficits; furthermore, cranial neuropathy from postsurgical pneumocephalus is exceedingly uncommon. Only 3 cases have been previously reported that describe direct cranial nerve compression from intracranial air resulting in an isolated single cranial nerve deficit. The authors present a patient who developed dysconjugate eye movements from bilateral oculomotor nerve palsy. Direct cranial nerve compression occurred as a result of postoperative pneumocephalus in the interpeduncular cistern. The isolated cranial neuropathy gradually recovered as the intracranial air was reabsorbed.
Cell surface biomarker CD44 plays an important role in breast cancer cell growth, differentiation, invasion, angiogenesis and tumour metastasis. Therefore, we aimed to investigate the role of CD44 gene polymorphisms in breast cancer risk and prognosis in North Indian population.
Materials & Methods
A total of 258 breast cancer patients and 241 healthy controls were included in the case-control study for risk prediction. According to RECIST, 114 patients who received neo-adjuvant chemotherapy were recruited for the evaluation of breast cancer prognosis. We examined the association of tagging SNP (rs353639) of Hapmap Gujrati Indians in Houston (GIH population) in CD44 gene along with a significant reported SNP (rs13347) in Chinese population by genotyping using Taqman allelic discrimination assays. Statistical analysis was done using SPSS software, version 17. In-silico analysis for prediction of functional effects was done using F-SNP and FAST-SNP.
No significant association of both the genetic variants of the CD44 gene polymorphisms was found with breast cancer risk. On performing univariate analysis with clinicopathological characteristics and treatment response, we found significant association of genotype (CT+TT) of rs13347 polymorphism with earlier age of onset (P = 0.029, OR = 0.037). However, significance was lost in multivariate analysis. For rs353639 polymorphism, significant association was seen with clinical tumour size, both at the genotypic (AC+CC) (P = 0.039, OR = 3.02) as well as the allelic (C) (P = 0.042, OR = 2.87) levels. On performing multivariate analysis, increased significance of variant genotype (P = 0.017, OR = 4.29) and allele (P = 0.025, OR = 3.34) of rs353639 was found with clinical tumour size. In-silico analysis using F-SNP, showed altered transcriptional regulation for rs353639 polymorphism.
These findings suggest that CD44 rs353639 genetic variants may have significant effect in breast cancer prognosis. However, both the polymorphisms- rs13347 and rs353639 had no effect on breast cancer susceptibility.
Traumatic abdominal wall hernia is a rare entity, and an uncommon type of abdominal wall hernia as far as the etiology is concerned. It is caused by blunt trauma and disrupts the fascial layers, but does not disrupt the elastic skin. In this study, we report the case of a 60-year-old female, diagnosed with traumatic abdominal wall hernia with delayed presentation. In this case, herniation of the bowels was present through the defect in the left iliac region. She was surgically well-managed. During the follow-up of 1 year, there was no recurrence. In the Western medical literature, only a few cases have been reported, especially with intra-abdominal injuries. Confusion still exists in the management of such a disease as to whether to treat the condition at an early or later stage.
Abdominal wall; Blunt trauma; Herniation; Multidetector computed tomography; Management
Mandibular fractures constitute a substantial proportion of cases of maxillofacial trauma. Demographic data related to mandibular fractures are difficult to evaluate because of many variables associated with the studies. The information is as diverse as the countries and the people who inhabit them.
This is a retrospective study designed to determine the site distribution, associated fracture and causes of mandibular fractures in patients presenting to the trauma centre of Veer Chandra Singh Garhwali Government Medical Science and Research Institute, Uttarakhand, India.
Materials and Methods:
Records of 121 patients with confirmed mandibular fractures presenting over a three year period (i.e., 1st January 2008 to 31st December 2010). Data obtained from record included age, sex, site of fracture and causes.
There were 48/121 (39.6%) males and 73/121 (60.3%) females. The most predominant age group of fracture was found to be 21-30 (53/121-43.8%) followed by 11-20 (25/121-20.6%). In this study history of fall was the most common cause of mandibular fracture (66/121-54.5%), followed by road traffic accidents (45/121-37.1%), fights and assault (08/121-6.6%) and industrial accidents (02/121-1.6%). In our study most of the patients suffered from fracture in the parasymphysis (35/139-25.1%) and angle region (32/139-23.0%) followed by body (30/139-21.5%), condyle (21/139-15.1%), symphysis (19/139-13.7%), and ramus (02/121-1.4%) area.
In this study mandibular fractures were more prevalent in females especially during the second and third decade of life. History of fall was the most predominant cause of mandibular fracture. The most frequently affected sites were parasymphysis and angle.
Fall; Mandible fractures; Road traffic accident
Pycnodysostosis (the Toulouse-Lautrec syndrome) is a rare autosomal-recessive disorder of osteoclast dysfunction. This disorder was first described by Maroteaux and Lamy in 1962. We describe anaesthetic management of a 35-year-old female having pyknodysostosis with fracture shaft left femur with anticipated difficult intubation. Therefore, spinal anesthesia was planned for her fracture fixation. The intra- and postoperative period remains uneventful.
Various colleges and universities worldwide develop and implement students’ orientation programs to acclimatize them to the campus environment, familiarize them with the teaching programs and its importance has been stressed in the document “Vision 2015” planned by the Medical Council of India (MCI).
To evaluate the feedback questionnaire after conclusion of two day :Foundation Program” for MBBS 2nd Professional students, conducted by the medical education unit at a tertiary care Medical Institute.
Material and Methods:
After the conclusion of two day “Foundation Program”, a pre-designed, anonymous questionnaire was received from all the students who participated in the program.
Of the 100 participants, 67% of the participants labeled the foundation program a very good exercise. Students’ view regarding the factors that facilitated their learning were good topics (covered important aspects pertaining to the clinical phases), good presentations, good and experienced speakers, and interactive faculty.
Such orientation programs lay a strong foundation for better understanding and learning of under-graduate courses, and should be a regular feature in the curriculum.
Foundation program; medical students; medical teaching
The benefits of hemicraniectomy for malignant middle cerebral artery (MCA) stroke may not be apparent in the 3- to 6-months in which final outcomes are assessed in research studies. We present the case of a 15-year-old who underwent hemicraniectomy for malignant MCA stroke and was significantly disabled 3 and 6 months after event. Over the long-term she was able to graduate from university, play tennis, and live an independent life. Although functional independence with only minor disability is relatively rare in adult hemicraniectomy patients, this outcome may be more easily achieved in children during a longer period of follow-up.
stroke; middle cerebral artery; hemicraniectomy
Coumarinic oral-anticoagulants (COAs) are commonly used for treatment of thromboembolic events. However, these medications have a narrow therapeutic range and there are large inter-individual variations in drug response. This is especially important in the initial phases of oral-anticoagulant therapy. Recent advancements in pharmacogenetics have established that clinical outcomes in oral-anticoagulant therapy are affected by genetic factors. The allelic variants of genes like cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase complex subunit 1 (VKORC1) are closely associated with maintenance dose of oral anti-coagulants. In addition, GGCX (Gamma-glutamyl carboxylase) polymorphism at position 12970 (rs11676382), CYP4F2 (rs2108622; V433M; 1347 C > T) and Apolipoprotein E (APOE) variants have been shown to explain a small but significant influence on dose requirements. There are large differences in the frequencies of these polymorphisms between different world populations which are also related to the requirements of oral anticoagulants. However, the final drug dosage in an individual is determined by complex sets of genetic and environmental factors and several dosing algorithms which combine clinical and genetic parameters to predict therapeutic COA doses have also been developed. The algorithm based dose prediction shows the importance of pharmacogenetic testing in patients undergoing oral anticoagulant therapies.
Coumarinic oral anticoagulants; Pharmacogenetics; Vitamin K cycle; Drug metabolism; Polymorphism; Dosing algorithm
Aorto-esophageal fistula (AEF) is a rare and life threatening condition, which can be rapidly fatal. More than half of such cases are secondary to aortic aneurysm rupture. There are only two previous reports describing AEF caused by penetrating atherosclerotic ulcer. We present multidetector computed tomography findings in a case of AEF secondary to penetrating atherosclerotic ulcer.
Aorto-esophageal; atherosclerotic; fistula; MDCT; penetrating; ulcer
Ophthalmic injuries commonly occur in patients with facial fractures. This study was set up to determine the incidence of ophthalmic injuries as assessed by an ophthalmologist, in patients who had sustained maxillofacial fractures.
To determine the incidence of ophthalmic injuries in maxillofacial fractures in Indian population.
Materials and Methods:
A study of 136 patients who had sustained facial trauma sufficient to lead to a facial bone fracture was undertaken and the patients received a comprehensive examination by an ophthalmologist and an orthoptist within one week of injury. All the patients sustaining confirmed maxillofacial fractures were examined by an ophthalmologist for any associated ocular injury. The ophthalmic injuries were classified into three categories—mild, moderate, severe.
Ninety-three patients (68.3%) examined sustained eye injuries of various types. Of these, 61.2% were temporary or minor, 29.03% were moderate, and 9.6% were serious. The highest incidence was found in association with mid face fractures, i.e., 95.7%. Fifty-seven patients sustained 176 minor ophthalmologic injuries; 27 patients suffered moderately; 33 had severe ophthalmic injuries. Nine patients sustained severe eye injuries.
It is suggested that all traumas to the face, particularly above the level of the mouth, require a careful eye examination, including an estimation of visual acuity of each type.
Mandibular fracture; maxillofacial trauma; mid face fracture; ophthalmic injuries
To develop a population specific pharmacogenetic acenocoumarol dosing algorithm for north Indian patients and show its efficiency in dosage prediction.
Multiple and linear stepwise regression analyses were used to include age, sex, height, weight, body surface area, smoking status, VKORC1 -1639 G>A, CYP4F2 1347 G>A, CYP2C9*2,*3 and GGCX 12970 C>G polymorphisms as variables to generate dosing algorithms. The new dosing models were compared with already reported algorithms and also with the clinical data for various performance measures. Odds ratios for association of genotypes with drug sensitive and resistant groups were calculated.
The pharmacogenetic dosing algorithm generated by multiple regression analysis explains 41.4% (p-value <0.001) of dosage variation. Validation of the new algorithm showed its predictive ability to be better than the already established algorithms based on similar variables. Its validity in our population is reflected by increased sensitivity, specificity, accuracy and decreased rates of over- and under- estimation in comparison to clinical data. The VKORC1-1639 G>A polymorphism was found to be strongly associated with acenocoumarol sensitivity according to recessive model.
We have proposed an efficient north India specific pharmacogenetic acenocoumarol dosing algorithm which might become a baseline for personalised medicine approach for treatment of patients in future.
Doppler ultrasound is the accepted gold standard for assessing direction of flow in the portal vein (PV). Moreover, it is non-invasive; therefore, it is well accepted by the patients and does not interfere with flow hemodynamics.
The present study was aimed to evaluate the association between color Doppler findings and the severity of portal hypertension in patients with cirrhosis.
Patients and Methods
The study group included 50 patients referred for ultrasound (US) evaluation over a period of six months from March to August, 2007. The patients were divided into three groups (Child’ A, B and C) based on Child Pugh classification. The direction of flow in the main portal vein (hepatopetal or nonhepatopetal) and peak venous velocity (PVV) in the main portal vein were measured and correlated with the presence or absence of ascites, splenomegaly, splenic and esophageal varices (assessed by Doppler US). These findings were correlated with clinical features and laboratory findings (using Child Pugh’s criteria).
There was significant association between the decrease of peak portal venous velocity (PVV) and the increase in Child Pugh score. Hepatofugal flow was seen only in patients with more advanced disease. There was also significant association between PVV and splenic varices and ascites, while PVV was not affected by the presence or absence of esophageal varices or splenomegaly. Presence of a recanalized umbilical vein (UV) was associated with increased PVV even in advanced disease.
Color Doppler is an excellent modality for detecting and characterizing the complex hemodynamics of portal hypertension in cirrhosis and they correlate with the clinical stage of disease.
Child; Liver Cirrhosis; Hypertension, Portal
Mutations in MYBPC3 encoding cardiac myosin binding protein C are common genetic cause of hereditary cardiac myopathies. An intronic 25-bp deletion in MYBPC3 at 3′ region is associated with dilated (DCM) and hypertrophic (HCM) cardiomyopathies in Southeast Asia. However, the frequency of MYBPC3 25 bp deletion and associated clinical presentation has not been established in an unrelated cohort of left ventricular dysfunction (LVD) secondary to coronary artery disease (CAD) patients.
We sought to determine the role of MYBPC3 25 bp polymorphism on LVD in two cohorts of CAD patients.
Methods and Results
The study included 265 consecutive patients with angiographically confirmed CAD and 220 controls. MYBPC3 25 bp polymorphism was determined by polymerase chain reaction. Our results showed that carrier status of MYBPC3 25 bp deletion was associated with significant compromised left ventricle ejection fraction (LVEF ≤45) in CAD patients (p value = <0.001; OR = 4.49). To validate our results, we performed a replication study in additional 140 cases with similar clinical characteristics and results again confirmed consistent findings (p = 0.029; OR = 3.3). Also, presence of the gene deletion did not have significant association in CAD patients with preserved ejection fraction (LVEF>45) (p value = 0.1; OR = 2.3).
The frequency of MYBPC3 DW genotype and D allele was associated with compromised LVEF implying that genetic variants of MYBPC3 encoding mutant structural sarcomere protein could increase susceptibility to left ventricular dysfunction. Therefore, 25 bp deletion in MYBPC3 may represent a genetic marker for cardiac failure in CAD patients from Southeast Asia.
A 40-year-old lady presented with severe endothelial cell loss in both eyes 14 years after angle-supported phakic intraocular lens (AS PIOL) implantation. The left eye had severe corneal edema with bullous keratopathy. The right eye had markedly reduced endothelial cell count (655 cells/mm2) although the cornea was clear. She underwent simultaneous bilensectomy (AS PIOL explantation and phacoemulsification) and Descemet's stripping and endothelial keratoplasty (DSEK) in the left eye. Explanted AS PIOL was identified as ZSAL-4 (Morcher, Stuttgart, Germany) model. Corneal edema cleared completely in 2 months with a best corrected visual acuity (-2.25 D sph) of 20/60. No intervention was done in the right eye. The present case illustrates that AS PIOL-induced endothelial decompensation can be effectively managed by simultaneous bilensectomy and endothelial keratoplasty.
Endothelial cell loss; endothelial keratoplasty; phakic phakic intraocular lens
Cysticercosis is endemic in India. Neurocysticercosis most commonly affects the brain parenchyma, which presents as focal lesions with the surrounding edema which later calcify. Rarely, it may affect the ventricular system and subarachnoid spaces and this form is known as racemose cysticercosis. We present magnetic resonance findings in a case of racemose cysticercosis.
Cysticercus; magnetic resonance; racemose
The dose requirements for oral anticoagulants in thromboembolic events are influenced by promoter polymorphism in the VKORC1 gene. However, limited data are available on the influence of the polymorphism in various Indian populations. The present study aimed at determining the relationship between the VKORC1-1639 G>A genotypes and maintenance doses of oral anticoagulants for therapeutically stable INR values in patients taking Acitrom after valve replacement surgery.
MATERIALS AND METHODS:
Fifty patients from the northern Indian region were genotyped for VKORC1-1639 G>A by polymerase chain reaction and restriction fragment length polymorphism. Means of the weight-normalized daily Acitrom dose were calculated for every patient.
RESULTS AND DISCUSSION:
The VKORC1 1639G>A minor allele frequency in the study population (n = 50) was found to be 22%. The patients with a wild type genotype required the maximum drug dose as suggested for full functionality of the enzyme. Heterozygous patients were found to have an intermediate drug dose and the patients with a variant homozygous genotype had the minimum maintenance drug dose requirement. These findings are in concurrence with the effect of the promoter polymorphism on vitamin K epoxide reductase activity.1639G>A minor allele frequency in the study population (n = 50) was found to be 22%. The patients with a wild type genotype required the maximum drug dose as suggested for full functionality of the enzyme. Heterozygous patients were found to have an intermediate drug dose and the patients with a variant homozygous genotype had the minimum maintenance drug dose requirement. These findings are in concurrence with the effect of the promoter polymorphism on vitamin K epoxide reductase activity.
The VKORC1-1639 G>A status can be indicative of establishing the therapeutic dose of oral anticoagulants in Indian patients.
Allele frequency; drug dose; genotype; polymorphism; VKORC1
Prostate cancer is common around the world, but rates of advanced disease differ substantially by race and geography. Although a major health issue, little is known about prostate cancer presentation in West Africa and India compared to the United States (US).
The aim of this study was to compare prostate tumor characteristics in four populations of men from the US, Senegal and India.
Materials and methods
We recruited prostate cancer patients from four hospital-based populations. The sample included 338 African-Americans, 1265 European-Americans, 222 Asian Indians, and 72 Senegalese. Questionnaire and medical record data were collected on each participant.
We found significant differences in age at diagnosis, BMl, and PSA levels across the groups. Senegalese and Indian men had a higher probability of high stage (T3/T4) disease compared to US men. Gleason grade was significantly higher in Asian Indians compared to other populations. African-Americans, Senegalese, and Asian Indians had a significantly higher probability of metastatic disease compared to European Americans. The odds ratios (OR) for metastasis were consistently higher in Asian Indians compared to American cases. As only 19/72 Senegalese were assessed for metastasis, OR could not be determined for metastasis.
These results suggest that there are significant geographical and ethnic differences in the presentation of prostate cancer. Men in developing countries lend to present with advanced disease compared to US men. Identifying risk factors for advanced disease may help to decrease the rate of poor prostate cancer outcomes and associated mortality worldwide.
ethnicity; prostate cancer; tumor characteristics; Senegal; India
Combined clinical presentation of hemifacial spasm and ipsilateral trigeminal neuralgia is also known as painful tic convulsif (PTC). It is a rare condition and the most common cause is vascular compression. Vertebrobasilar dolichoectasia (VBD) is characterized by dilated and tortuous vertebral and basilar arteries. VBD is an uncommon and rarely reported cause of PTC. Magnetic resonance imaging (MRI), due to its inherent excellent contrast resolution, is an excellent modality for demonstrating the nerve compression by dilated and tortuous vessels seen in this condition. For this purpose, 3D MRI sequences are especially useful like constructive interference in steady state (CISS) and MR angiography. Both of these have been reported to be helpful in the diagnosis of this condition. We report a case of PTC in which we were able to document facial and trigeminal nerve compression by VBD on MRI, using CISS and time-of-flight MR angiography.
Hemifacial spasm; magnetic resonance; painful tic convulsif; vertebrobasilar dolichoectasia
A 44-year-old man presented 28 days after cataract surgery (phacoemulsification) in right eye with multiple pinpoint infiltrates in posterior stroma at cataract surgery wound site. Visual acuity was 20/60. Corneal scraping from the floor of the corneal tunnel revealed fungus which was later identified to be Aspergillus flavus. The patient was started on oral voriconazole 200 mg twice daily and topical voriconazole 1% every hour. Two intracameral injections of voriconazole (50 micrograms/ 0.1 ml) were given 72 h apart, five days after starting initial therapy. Infiltrates increased in size and density in spite of 20 days of voriconazole therapy. Full-thickness patch graft was done to arrest progressive necrosis. Four months after surgery, patient had 20/60 best-corrected visual acuity. There was no recurrence in one-year follow-up. Present case illustrates the therapeutic challenge in fungal tunnel infections and possibility of voriconazole-resistant Aspergillus species.
Fungus; microbial keratitis; patch graft; phacoemulsification; tunnel infection; voriconazole
Tobacco consumption is the leading preventable cause of disease,
disability, and premature death but little is known about its
deleterious effect on the ocular health of workers handling
tobacco. The goal of this study was to identify probable effects
of occupational tobacco exposure among south Indian bidi-
industry workers. This study included 310 females (mean age,
34.8 ± 10.9 years) actively involved in bidi-rolling presenting with
eye symptoms to a tertiary eye care hospital. Results suggested
that a wide spectrum of ocular complications exist among these
workers. Common ocular symptoms were defective vision, dull-
aching headache and eye irritation. The main ocular findings
were papillary conjunctival hyperplasia, hyperpigmentation of
ocular surface, punctate epithelial erosion or superficial punctate
keratitis, cataract or pseudophakia and segmental optic atrophy.
Abstaining from work, supplementation of Vitamin B complex
rich in B 12 and appropriate surgical or medical management
reversed visual loss due to corneal disease or cataract but was not
effective in optic neuropathy.
Ocular manifestations of tobacco; tobacco industry workers; tobacco occupational exposure
The main adverse consequences of excess bodyweight are cardiovascular disease, type II diabetes, and several cancers, IL-1Ra serum concentration has been reported earlier to increase in human obesity and it is therefore assumed that the polymorphism of IL-1Ra may influence cytokine production. We designed this study to investigate whether the IL-1Ra polymorphism was associated with obesity. A total number of 103 individuals; 19 lean (BMI<25 Kg/m2), 51 overweight (BMI 25–29.9 Kg/m2) and 33 obese (BMI≥30.0 Kg/m2) were enrolled in this study. Genotyping was performed using a polymerase chain reaction PCR amplification of the intron-2 fragment harboring a variable number of tandem repeat (VNTR) nucleotide sequences 86 pb of tandem repeat. The PCR products were separated on 2% agarose gel. Statistical analysis was performed using SPSS software (version 11.5). We found no significant difference in genotype and allele frequencies between the three groups; lean vs. overweight and lean vs. obese (p=0.323; 0.202; 0.123 and 0.068 resp). However, an increased risk for obesity had a propensity to be higher in those having genotype II/II. This genotype has been reported to be a ‘high producer’ of IL-1Ra. Although no statistically significant relationship between IL-1Ra polymorphism and BMI was observed, however, a trend towards an increase of allele*II in overweight and obese group was observed. This may suggest that IL-1Ra appears to be induced by inflammatory stimuli as well as obesity-associated factors. This is relatively a pilot study: but nevertheless, may assist in identifying the pathophysiological cause for obesity.
IL-1 Ra Polymorphism; VNTR; Single nucleotide polymorphisms (SNP); Obesity
Microsatellite instability (MSI) characterized by alterations at simple repetitive genomic sequences is a distinct mechanism in tumorogenesis. Central nervous system (CNS) tumors have been reported to exhibit MSI, indicator of defective mismatch repair system with controversies. The present study was undertaken to examine sixteen primary brain and two spinal tumors for MSI at six mono: BAT-26, BAT-40, BAX, TGFßRII, IGFIIR and hMSH3 and four dinucleotide loci: D2S123, D9S1851, D9S283 and D18S58. Polymerase chain reaction (PCR) was done to amplify tumour and blood DNA, analyzed on 8% denaturing Polyacrylamide gel followed by autoradiography. Out of 18 CNS tumors examined, 39% exhibited MSI at BAT-26, BAT-40, D9S1851, D9S283 and D18S58 in tumoral DNA. However, no alteration was observed at BAX, TGFßRII, IGFIIR, hMSH3 and D2S123 loci. Low incidence of MS1-high hypothesizes role of MSI in evolution of CNS tumors but not in cancer initiation or progression.
Brain and spinal tumors; Tumor development; Mono-and dinucleotide microsatellite markers; Mismatch repair
Carcinoma of urinary bladder is one of the leading causes of death in India. Successful treatment of bladder cancer depends on the early detection & specific diagnostic approaches. In the present study, microsatellite instability (MSI) has been evaluated as a prognostic marker in patients with superficial urinary bladder cancer in lower urinary tract for determining risk of recurrence.
A total of 44 patients with bladder tumors diagnosed with Transitional Cell Carcinomas [TCC] from lower urinary tract were selected for the study. Tumors were staged and graded according to AJCC-UICC (1997) classification and patients were followed with cystoscopy as per the protocol. Polymerase chain reaction (PCR) was done to amplify microsatellite sequences at mononucleotide BAT – 26, BAT – 40, TGFβ RII, IGFIIR, hMSH3, BAX and dinucleotide D2S123, D9S283, D9S1851 and D18S58 loci in blood (control) and tumor DNA. PCR products were separated on 8% denaturing polyacrylamide gel and visualized by autoradiography.
MSI was observed in 72.7% of tumors at BAT – 26, BAT – 40, D2S123, D9S283, D9S1851 and D18S58 loci. Good association of MSI was seen with tumor stage and grade. MSI – High (instability at > 30% of loci) was frequently observed in high stage (40.6%) and high grade (59.4%) tumors. Of 24 tumors of Ta-T1 stage with different grades, 11 (9/18 high grade and 2/6 low grade tumors) recurred in the mean duration of 36 months. MSI positivity was significantly high in patients who had one or more recurrences (p = 0.02 for high grade and 0.04 for low grade tumors).
MSI may be an independent prognostic marker for assessing risk of recurrence in superficial tumors irrespective of the grade. Further studies on progression would help in stratifying the patients of T1G3 for early cystectomy vs bladder preservation protocol.
The present study was undertaken to investigate the relation of retinol with lipid profile of patients with cancers of breast, stomach, oesophagus, colon, gallbladder, pancreas, lung and cervix. Serum retinol was assayed in 120 patients and 40 healthy normal control by reverse phase HPLC using CLC-ODS C-18 columns and retinyl acetate as an internal standard.
Significant decease in serum cholesterol and LDL was observed in patients with cancers of esophagus, colon, stomach, pancreas and gallbladder respectively.
Retinol was reduced in all forms of cancers but pronounced decrease was observed in oesophagus, gallbladder, pancreas, stomach and colon. Serum Retinol in all patients was directly correlated with total cholesterol and LDL. These findings suggest that therapeutic modalities of this vitamin could be planned for these patients, as vitamin A is known to act as an antioxidant for prevention of certain cancers.
Retinol; lipid profile; cancer patients; antioxidant
Metabolic abnormalities were investigated in 44 stone patients with first time (group 1) and 56 with 2 times stone formation (group 2), and in 25 normal individuals. 24hr urine was analysed spectrophotometrically for oxalate, calcium, magnesium, citrate, uric acid, phosphate and creatinine. Hypocitraturia and hyperoxaluria were the common abnormalities in the stone formers. Stone patients had significantly higher urinary oxalate, calcium and uric acid and lower phosphate than normal individuals. Citrate/calcium and magnesium/calcium ratio were significantly high in normal individuals than stone formers. Patients in group 2 excreted significantly higher urinary calcium and lower citrate that patients in group 1. Citrate/calcium ratio was higher in group 1 than group 2. Hypocitraturia, hyperoxaluria, hypercalciuria and increased citrate/calcium and magnesium/calcium ratio seem to be an essential risk factor for stone formation. Patients with recurrent stone formation could be distinguished from patients with first time stone formation on the basis of urinary calcium and citrate.
Recurrent stone formation; metabolic abnormality; hypercalciuria; hypocitraturia; hyperoxaluria