Journal of Medical Science and Technology

124 - 129

Authors: Sandhya Panjeta Gulia, M.Lavanya, Madhusudan Chaudhury, SP Arun Kumar

Abnormal uterine bleeding is a common cause for women of all ages to consult their physicians. The specific diagnostic approach depends whether the patient is premenopausal, perimenopausal or postmenopausal. Hence hormonal therapy, endometrial biopsy, hysterectomy or imaging studies can be done accordingly. Retrospective analysis of endometrial biopsies to find out the spectrum of causes of abnormal uterine bleeding in different age groups. A total of 435 cases of endometrial biopsies were examined during a three year study period from Jan 2010 - Dec 2012 was examined. Serial sections, 3 – 5 μ were stained with Haematoxylin & Eosin (H&E) stain. 156 endometrial biopsies obtained by dilatation and curettage and 279 cases from hysterectomy specimens were reported. The majority of cases of AUB were noted in perimenopausal age group constituting 258(59.31%) of total cases, the rest being reproductive age 146(33.56%) and postmenopausal 31(7.13%) age group. The most common pattern was normal cyclic endometrium in 200(45.48%) cases, disordered proliferative endometrium in 56(12.88%), hormonal effect 16(3.68%), endometrial polyp 10( 2.30%), endometrial hyperplasia 73(16.78%), endometrial stromal tumor 1(0.23%), endometrial carcinoma 5(1.15%) , gestational endometrium 41(9.43%), vesicular mole5(1.15%), irregular ripening 3(0.69%), irregular shedding 1(0.23%), chronic endometritis 6(1.38%), atrophic endometrium 17(3.91%) , inadequate biopsy 1(0.23%). The study of endometrial biopsies helps to evaluate the cause of abnormal uterine bleeding, thus helps the clinician to guide for appropriate therapeutic intervention.

135 - 139

Authors: Pandit Vinodh Bandela, Durga Prasad K, Havilah P

To estimate spot urine microalbumin levels in metabolically healthy and metabolically unhealthy obese individuals in relation to metabolic syndrome risk factors of NCEP ATP III criteria. Total 50 (16 female; 34 male) obese subjects aged between age ranges between 29 to 62 years old were analyzed for metabolic syndrome parameters and spot urine microalbumin levels. 14 subjects who are having high urine micro albumin levels and urine samples which give positive (+) for dip stick were excluded from this study. Among the 36 obese subjects 25 subjects are having at least one other metabolic syndrome risk factor along with increased waist circumference considered as metabolically unhealthy (MUHO) and 11 subjects were considered as metabolically healthy (MHO). High 55.87±16.78) micro albumin levels noted in obese group. Very high levels of urine microalbumin noted among metabolically unhealthy obese (107.52±56.54). It was 13.98±5.34 among the metabolically healthy obese group. The mean urine microalbumin level among MHO individuals was towards the upper reference level but within the allowed reference level (< 25 mg/L) The correlation of urine microalbumin with number of metabolic syndrome risk factors was statistically significant (r=0.7020; p=0.0001). Among the risk factors blood pressure [systolic r=0.4149; p=0.0392 and diastolic r=0.6486; p=0.0005] and Fasting blood glucose (r=0.6938; p=0.0001) were highly correlated where as waist circumference was not correlated with urine micro albumin levels. Elevated spot urine microalbumin levels among the metabolically healthy obese individuals may predict the micro-vascular endothelial dysfunction.

146 - 149

Authors: V. Senthil Kumar, M. Ganesh, V. Duraisami, K. Jaiganesh

As uncontrolled stress leads to multiple complications, it has to be reduced by adopting life style modifications like yoga. Suryanamaskar, a form of yoga relieves anxiety by “mind body connection”. The purpose of the study was to compare the effect of Suryanamaskar with and without mantra chanting on anger among stressed men. Study included three groups each comprising of 10 men with elevated stress level. The experimental group I, which had undergone the Suryanamaskar practices without mantras, group II which had undergone Suryanamaskar practices with mantras and the control group which had not undergone any kind of interventions during the training programme of six weeks. Pre and post training session anger scores were measured using State and Trait Anger Inventory 1973. The data were statistically analyzed by Analysis of Co-variances (ANCOVA). Scheffe’s post hoc test was used to find out paired mean differences. There was a reduction in anger score after the training period in both the experimental groups when compared to the controls, of which there was a marked reduction in the group that practiced Suryanamaskar with mantra chanting.

158 - 172

Authors: Anthony Kodzo-Grey Venyo, Khalid Ahmed

Primary amyloidosis involving urinary tract is a rare. In this we reviewed the literature on primary amyloidosis of the urinary bladder, ureter, renal pelvis and urethra. Various internet search engines were used to identify reported cases and case series regarding primary amyloidosis of lining of the urinary tract. Amyloidosis of the urinary tract may either be primary or part of a systemic disease. Localized amyloidosis is of unknown aetiology but mostly of AL-type amyloid immunoglobulin light chains. Systemic amyloidosis can be either primary (AL-type amyloid), secondary (AA-type amyloid) or familial (ATTR-type amyloid). Systemic secondaryurinary bladder amyloidosis tends to be associated with autoimmune disease and chronic infection. Familial cases of systemic amyloidosis tend to be associated with mutations in the transthyretin gene. Primary amyloidosis of the urinary tract may present with haematuria; lower urinary tract symptoms; loin pain. Useful investigations in the diagnosis of urothelial amyloidosis include: urinalysis; urine cytology; ultrasound scan of renal tract; intravenous urography; computed tomography scan; urethrocystoscopy; retrograde ureteropyelogram and ureterorenoscopy; tumour specimen obtained by biopsy or resected lesion. In view of the benign biological behaviour of amyloidosis conservative treatment is the best modality of treatment however, radical surgical excisions have been undertaken when a definitive diagnosis had not been established and these surgical treatments have been carried out based upon a presumptive diagnosis of a malignant tumour. Surgical resection of the amyloid tumour is considered the first-line therapeutic method (TUR resection of bladder lesion; biopsy/resection or local segmental resection of a ureteric amyloid tumour; resection of urethral amyloid lesion). Pharmacotherapy can be used when the lesion is difficult to completely resect, or when a patient is unable tolerate surgery. Colchicine or dimethyl sulfoxide may be beneficial for the control of the progression or recurrence of amyloidosis. Because of reported recurrences, careful surveillance protocol is necessary. Diagnosis of amyloidosis is established by the characteristic eosinophilic amorphous material seen during microscopic examination of the biopsy specimen and positive Congo red staining and apple green birefringence. It can recur but this must be treated ideally by conservative surgery.

177 - 180

Authors: Vasantha N.Subbiah, Anoop Sreevalsan, Kavitha, Swayam Jothi S

Genito-urinary Tuberculosis is an entity that used to be very common in India in olden days. But we still come across it even now as the following case illustrates. A 25 year old Mrs. B presented to our OPD with secondary amenorrhoea following menarche at the age of 12 years. She gives h/o D&C in 2007 details were not available. She was worked up by blood investigations including hormonal & karyotyping which showed normal thyroid and FSH & LH and female karyotype. Ultrasound of the pelvis was normal. She did not respond to either a progesterone challenge or to a estrogen challenge test. She then had a hysterosalpingogram done which showed bilateral cornual block with intravasation of dye. A tentative D.D.of Asherman’s syndrome /tuberculous endometritis were made and she was then subjected to a hysterolaparoscopy. The hysteroscopy showed bland endometrium with both ostia visualized with no syneciae. The laparoscopy showed adhesions all over the abdomen with right tube hydrosalpinx & Left tubo-ovarian mass. Omental biopsy and endometrial biopsy taken which confirmed tuberculosis. She was then put on ATT & is at present on ATT. The case is presented as tuberculosis still is a cause for amenorrhoea and infertility in India.

184 - 186

Authors: Dr Ratnakar Vupputuri, Dr Alugolu Rajesh, Dr Ashish Kumar

Skull fractures with age old classification are categorised into linear, communited, depressed fractures. Depressed fractures have fracture fragments driven into the cranial cavity. There is a theoretical possibility of the fracture fragment to be elevated from the level of intact skull bone, but has sparingly been reported in the literature, with few hypothesis regarding the mechanism and transfer of force. Here we present a case with compound depressed fracture with elevated fracture fragments in a 24 yr old male sustaining head injury following RTA and try to dig deep into the various hypotheses mentioned in the literature. A pattern of antiquity with uniquity, these depressed fractures once become elevated may open a pandora’s box.

55 - 57

Authors: Manidip Pal, Satyasis Roy

Post void residual (PVR) urine volume is good indicator of voiding function. To find out the normal value of PVR in post menopausal women this study was undertaken. It was an OPD based prospective study. Post menopausal women without any pelvic organ prolapse, urological complain (e.g. stress incontinence, overactive bladder, voiding dysfunction etc.), renal diseases, neurologic disease (e.g. multiple sclerosis, spinal cord injury, or other neuropathies) were evaluated. Post void residual urine volume was measured by ultrasonography within 1 minute of voiding. Total 65 postmenopausal women had undergone PVR estimation. Women of less than 5 years menopause had median PVR 11 ml & mean PVR 16.8 ml. Women of 5 years or more menopause had median PVR 12 ml & mean PVR 21.1 ml. Knowledge of normal PVR in postmenopausal women will help in better managing voiding dysfunction in older women.

66 - 70

Authors: R.Sobana, K.Jaiganesh, P.Barathi

Pre-hypertension is the preliminary stage of hypertension with high normal blood pressure, which is a major risk factor for cardio vascular, renal and neurological complications. Music therapy is considered as an important complementary and alternative medicine (CAM) to treat pre-hypertension. The aim of this study was to find out the efficacy of music on blood pressure in pre-hypertensive adults. Sixty male pre-hypertensive subjects, who are not on any antihypertensive therapy, were divided randomly into 2 groups (the experimental and the control groups). The experimental group received 40 days of music therapy, while the control group did not receive music therapy. The systolic and diastolic blood pressures of the subjects were recorded before and after 40 days in both the groups and statistically analyzed. There was a significant reduction in the blood pressure in the experimental group when compared to the control group. We conclude that music plays an effective role as complementary therapy for treating the patients with pre-hypertension.

76 - 80

Authors: Srinivasarao. Yalakurthi, Thirupathirao. Vishnumukkala, Chandana Chaitnaya Siri, Bharath.CH.N.V , S. Swayam Jothi Dorai Raj, Bapuji.puttagunta, M Kannan

The cisterna chyli is the abdominal origin of the thoracic duct, and it receives the bilateral lumbar lymphatic trunks. Anatomically and surgically the cisterna chyli is an important structure but very fewer studies reported in literature,so that we undertake this study. In this study we observed the presence, position with respect to the vertebral bodies and the main lymphatic tributaries forming the cisterna chyli in 45 cadavers from 3 different medical colleges in costal Andhra, of these 15 were female and 13 were male cadavers. We found Cisterna chyli was present in 6(40%) out of 15 female bodies, and 14 (46.6%) out of 30 male bodies. To sum up cisterna chyli was present in 20 (44.4%) out 45 cadavers dissected (44.4%). The position of the cisterna chyli was at L1-T12vertebrae in 10 adult cadavers. The position of the cisterna chyli was at T12-T11 vertebrae in 6 adult cadavers. The position of the cisterna chyli was at L2-L1 vertebrae in 4 adult cadavers, the main lymphatic tributaries forming the cisterna chyli based on M.Loukas Types In 9 cadavers (20%) the thoracic duct arose from the confluence of the lumbar and intestinal trunk (Type I) . In 27 cadavers (60%) it was formed by the confluence of two ascending lumbar lymph trunks and intestinal trunk joined the thoracic duct (Type II). In 9 cadavers (20%) the thoracic duct ascended from a plexus formed by the lumbar and intestinal trunks (Type III). The reports documented in this study were different compare to the literature. The variations in the presence, positions and the main lymphatic tributaries forming the cisterna chyli are important for anatomists, surgeons and radiologists during their diagnosis and surgeries related to the cisterna chyli.

84 - 89

Authors: V Srihari, N Mallikarjuna Rao, B Vinusha, Muneera Bhanu, S V Prasad, M Prasad Naidu

In the present study Random Amplification of Polymorphic DNA(RAPD) have been described as powerful molecular typing methods for microorganisms. Isolated bacterial species (Escherichia sp) were Biochemically characterized by Indole, Methyl red , Citrate and catalase tests. Genomic DNA was isolated and purified by enzymatic digestion methods for polymorphic studies by RAPD-PCR and plasmid DNA was isolated by using alkaline Lysis method for RFLP analysis. Both Genomic and Plasmid DNA were separated by using 1% Agarose gels and Quantified by using UV Visible Spectrophotometry at OD260 nm/OD280nm.

99 - 108

Authors: Anthony Kodzo-Grey Venyo

Primary small cell carcinoma of the kidney is an extremely rare neoplasm. Less than 100 cases of primary small cell carcinoma of the kidney have so far been reported in the literature. In view of this most practitioners globally would not be accustomed to the biological behaviour of this neoplasm. There is therefore the need to review the literature on primary small cell carcinoma of the kidney. To review the literature on primary small cell carcinoma of the kidney, various internet search engines were used to form a foundation for the literature review including: Google; Google scholar; educus; Up To Date; Pub Med. The median age at diagnosis of small cell carcinoma of the kidney was 62 years and there was a female preponderance. Abdominal pain and haematuria are common symptoms of small cell carcinoma of the kidney.At the time of initial diagnosis slightly less than a third of the patients have distant metastasis. Surgery in the form of nephrectomy and systemic chemotherapy, have been the main forms of treatment modalities which include: nephrectomy alone; nephrectomy and chemotherapy; chemotherapy alone. The median survival in one series was about 8 months and this has ranged on the whole from between 1 month to 101 months. In another series the overall median survival was 9.9 months (range 6.9 to 31.6 months). Data on demographics, clinical symptoms, tumour staging and tumour characteristics recorded at the time of diagnosis was not found to be related to survival. The use of cisplatin-based chemotherapy was in some cases observed to be predictive of better overall survival. Small cell carcinoma of the kidney is an extremely rare neoplasm which mimics small cell carcinoma of the tracheobronchial tree and other extra-pulmonary sites, its aggressive biological behaviour and its high ability to result in the development of loco-regional and distant dissemination. The development of symptoms or clinical presentation tends to be usually late in the course of the disease. Utilization of platinum-based chemotherapeutic regimen has been found to be associated with tumour regression and prolonged survival. Small cell carcinomas of the genitourinary tract have been more commonly reported in the urinary bladder in comparison with primary small cell carcinoma of the kidney which is very rare.In view of the rarity of primary small cell carcinoma of the kidney its natural history, diagnosis and management is not well known. Despite the use of cisplatin-based chemotherapeutic regimen in the treatment of small cell carcinoma of the kidney there is not enough documentation of any treatment modality that would prolong life for a very long time. There is therefore the need for Urologists and oncologists throughout the world to come together in order to undertake a multicentre trial of chemotherapeutic modalities in the management of small cell carcinoma of the kidney in order to find ways of further improving the prognosis of such a rare carcinoma.

112 - 117

Authors: S Muneer Banu, M Prasad Naidu, N Mallikarjuna Rao,P Anusha, Madhu Sudan Reddy, S V Prasad

A simple, specific and accurate reverse phase high performance liquid chromatographic method was developed for the determination of assay of ascorbic acid tablet dosage forms. A reversed- phase C-18 column (4.6x250mm, 5µl, make :waters) column with mobile phase consisting of methanol and phosphate buffer 40:60 (v/v) was used. The flow rate was 1.0 ml/ min and effluents were monitored at 2249nm. The retention time of ascorbic acid is 2.5. The method was validated in terms of linearity, range, specificity,accuracy, precision, limit of detection (LOD) and limit of quantification (LOQ). By using this method, the retention time of the ascorbic acid in method development is reduced.

121 - 123

Authors: Dr Medabalmi Anitha

Leydig cell tumors belong to the small group of ovarian steroid tumors, which are hormone producing and derived from specific stromal cells. Morphologically, their endocrine like structure is characteristic, formed of large, polyhedral cells resembling luteal, adrenocortical and leydig cells. They contain crystalloids of Reinke in their cytoplasm which have diagnostic significance. The patients with these tumors present present with androgenic manifestations. We report a case of Leydig cell tumor in 35 years female who presented with infertility and hirsutism.