Journal of Medical Science and Technology

47 –50

Authors: Dr Asma Aref Idamat, Dr Najeh Yousef Alomari

Urinary tract infection (UTI) is known entity and a common problem in pediatric age group. Children at risk for (UTI) such as vesicoureteric reflux (VUR), pelvi-ureteric junction obstruction (PUJO) and other urinary tract anomalies commonly receive prophylactic antibiotics to prevent nephropathy such as renal scaring ,hypertension and renal failure. Prolonged use of prophylactic antibiotics is common for recurrent (UTI), but this has not been assessed in well-controlled prospective studies. Different antibiotics such as nitrofurantoin, trimethoprim/sulfamethoxazole and nalidixcic acid have been used as prophylactic antibiotics to prevent (UTI) in pediatric age group which proved to be safe in long term prophylactic therapy without major complications. Although it is not easy to perform prospective studies in children because both clinical course and prognosis may be affected by many factors. Infant and children with factors need prolonged use of antibiotic prophylaxis, until there is evidence that these patients are not at risk without prophylaxis. We reviewed thoroughly the up to date literatures and practice guidelines to make sure that we are implementing appropriate use of antibiotic prophylaxis in pediatric urology in our institution being the referral pediatric hospital dealing with the vast majority of pediatric urology/ nephrology cases in the kingdom. We focus on the evaluation and actual benefits of prophylactic antibiotics in vesicoureteric reflux (VUR) in pediatric age group to reach consensus and recommendations for in hospital protocol on the basis of current best evidence. Over the past 3 years we selected a group of patients (N=130), 50 males and 80 females , age 4-7 years ,median age 5, 2 years with grad I-III (VUR).All patients with abnormal voiding , neurogenic bladder and urinary tract anomalies were excluded from the study. All patients who had breakthrough (UTI) or deterioration in the renal function were excluded from the study and managed by surgery or endoscopic injection. All patients were treated by prophylactic antibiotics for 18 months (first trial) then stopped and followed up for another 18 months on no prophylaxis (second trial). At the end of both trials, 100 patients met the inclusion criteria and the results were analyzed. There was no significant break though infection in the second trial and no significant drop in the renal function. Multi resistant bacterial growth was encounter in the first trial, while less resistant bacterial growth was encountered in the second trial. In conclusion, routine use of prophylactic antibiotics for low grade I-III (VUR) in normal urinary tract is not indicated after the age of 4 years without any significant health compromise.

57 – 60

Authors: Maher khader, Ahmed AL- Issa, Fatin Al -Awaisha, Sameera Abuzeat RN, Asma Al Nesraween RN, Tagreed AL-kasassbah RN

Our aim is to determine whether the levels of blood electrolytes assessed using blood gas analyzer and central laboratory auto-analyzer are equivalent. This retrospective study was conducted over six month period (October 2012- March 2013). A total number of 60 paired blood samples were drawn from pediatric and adult patients either in the intensive care unit or in the ward with a variety of diagnoses .Analysis of blood sodium and potassium levels was carried out using a point-of-care blood gas analyzer and a central laboratory auto-analyzer. Statistical measures were employed using paired t –tests. The mean level (± standard deviation) of sodium measured by blood gas analyzer was significantly higher than in the auto-analyzer (141.4 ± 7.3 mmol/L and 137.7 ± 5.6 mmol/L respectively; P˂0.001). Regarding the potassium levels, there was also a significant difference between the mean level (± standard deviation) measured by blood gas analyzer and central laboratory auto-analyzer (3.2 ± 0.8 mmol/L and 4.2 ± 0.7 mmol/L respectively; p˂0.001). Our results showed that sodium and potassium levels measured by blood gas analyzer and auto-analyzer were significantly different.

67 –74

Authors: Mwenya Kwangu, Sandra Chileya, Pierre Yassa, Nason Lambwe, Gibson Sijumbila

The main objective was to investigate the role of glucose 6-phosphate dehydrogenase deficiency in aetiology of essential hypertension. An analytical cross-sectional design was applied to 89 essential hypertensive participants and 89 healthy normotensive participants, making a total of 178. All the participants were aged between 35 and 65 years. Blood was collected for G6PD activity and levels of blood nitric oxide, glucose, creatinine, urea and electrolytes. In addition, routine urinalysis was done. A logistic regression was used to investigate the association of age, sex, nitric oxide levels, and G6PD deficiency with essential hypertension as the dependant variable. The G6PD deficiency was found in 14 (16%) participants with essential hypertension and 9 (10%) control participants. The difference however, in the G6PD deficiency prevalence rate was not statistically significant (p= 0.13). Logistic regression analysis revealed that G6PD deficiency was significantly associated with increased risk for essential hypertension. The analysis further showed a significant association of age and essential hypertension with participants in age groups 46-55 and 56-65 being at higher risk of developing essential hypertension than those in age group 35-45. The study also revealed no association between gender and essential hypertension. The study showed that states that there is no difference in G6PD deficiency prevalence between the essential hypertensive and normotensive adults. The findings also demonstrated a possible role of G6PD deficiency in the pathophysiology of essential hypertension.

79 – 81

Authors: D Anil Kumar, V Shanmuga Priya, J Jaiprabhu, Krishnan Ramalingam

Alterations in plasma concentrations of several trace elements have been reported to occur in type 2 diabetes mellitus. These micronutrients are suspected to have a role in pathogenesis and progression of the disease. In a comparative analysis, the plasma concentration of copper and zinc was estimated in 50 patients with type 2 diabetes mellitus and 50 healthy non-diabetic subjects. Trace elements were estimated by using atomic absorption spectrophotometer. When compared to controls, cases (type 2 diabetic patients) showed significantly higher copper and lower zinc levels (P < 0.0001). Serum copper levels are significantly higher in type 2 diabetes mellitus patients, while serum zinc levels are significantly decreased when compared to controls.

87 – 90

Authors: Dr Jameel Ahmad

Medicines can be given to patients by different routes such as oral, topical, inhalation and parenteral. In the parenteral route of drug administration injections are among the most frequently used methods of drug delivery system and usually given for curative purposes and less than 5% cases for immunization. The correct vaccine administration is a very important component of a successful immunization. In India, 96% of all injections given by private practitioners include antibiotics, vitamins and analgesics and 66% of these injections are said to be unsafe. According to the WHO at least 16 billion injections are given every year in developing countries. The intramuscular (IM) and the subcutaneous (SC) injections are often referred as “basic skills”. The unsafe injection practices can give rise to the transmission of many blood borne diseases and complications such as abscess at the injection site, nerve injury and infections (Hepatitis B and C, and HIV etc). The reuse of syringes is another problem in some countries and it is also common in India. The injection practices are not always rational and research-based practices. So there is need to promote the research based injection practices for the safety of patients and the health care providers. The present article focuses on the issues related to the intramuscular and the subcutaneous routes of drug administration. This is particularly important for health care providers involved in the drug prescribing.

105 – 107

Authors: Anoop Sreevalsan, D Kavitha, Vasantha N Subbaiah

Ovarian pregnancy is a rare form of ectopic pregnancy. Although ectopic pregnancies have been reported to implant in the cervix, ovary, interstitial tubal segment, and at various intra-abdominal sites, majority of ectopic pregnancies are identified in the fallopian tube. Data regarding these unusual ectopic pregnancies come largely from case reports and anecdotal information. Management and treatment of these ectopic pregnancies includes various combinations of surgery and/or systemic and local chemotherapy. In this article we present a rare case of ovarian pregnancy which was diagnosed intraoperatively and managed successfully.

1 – 6.

Authors: Jolanta Walasz, Teresa Matthews-Brzozowska, Maja Matthews-Kozanecka, Dorota Cudziło

General muscle hypotonia, including hypotonia of the oro-facial muscle complex, is one of the characteristics of Down syndrome. To eliminate this disorder, oro-facial therapy with the use of a palatal plate is employed. The aim of this study is to assess the influence of the types and positioning of stimulation elements in palatal plates on the tongue position and mimetic muscles in children with Down syndrome. The study was conducted on 50 children with Down syndrome between the ages of 3 months and 2 years (22 boys, 28 girls) who were treated by means of palatal plate therapy in the Department of Maxillofacial Orthopaedics and Orthodontics at the Poznan University of Medical Sciences. The study analysed the responses received from the parents and the orthodontist to the questions included in a questionnaire developed for this study as well as the photographic documentation produced during every appointment over a period of two years. In total, 90 palatal plates were made for the children with stimulation elements in the form of a cylinder with a "roller" or a movable bead. The plates were replaced on average every 6 months in order not to inhibit the growth of the jaw. The study found that in 50 children who underwent palatal plate oro-facial therapy there was an improvement in the visual appearance of the mimetic muscles and tongue retraction, as well as improved lip closure. None of the children experienced deterioration in their condition. The stimulator in the form of a cylinder with a "roller" had a greater influence as regards improvements in the appearance of the mimetic muscles and lip closure, whereas a movable bead threaded on a wire and secured to the plate produced a greater improvement as regards tongue retraction. The positioning of the stimulation element closer to the alveolar ridges rendered better therapeutic results in the youngest children, whereas placing it in a central or posterior position produced better results in the older children.

10 – 12

Authors: Eyad Safadi, Aser Hrout, Zahi Majali, Nisreen Alkurdi, Sana'a Sulieman Al-Ali

Objective is to evaluate our clinical experience in dealing with recurrent respiratory papillomatosis (RRP) at Queen Rania Al-Abdullah Hospital for children. A total number of 9 patients (8 males, one female) were diagnosed by means of history; physical examination and flexible nasopharyngolaryngoscope .Patients age at time of presentation were 2-10 years. The presenting symptom was just hoarseness of voice in 5 patients (group 1). Hoarseness and dyspnoea on exertion in 3 patients (group 2) and respiratory distress in only one patient (group 3). All 9 patients had been treated by microdebrider excision using apnoic technique. In 3 of patients (group 2) we injected MMR vaccine intralesional and we injected sometimes MMR vaccine and sometimes Cidofovir intralesional in only the most severe case (group 3). In group 1 and 2 the post operative symptom free period was 6-8 months. In group 3 the symptom free period was 4-5 weeks when MMR was injected and 10-12 weeks when Cidofovir was injected. Recurrent Respiratory Papillomatosis (RRP) is a benign neoplasm caused by HPV, it affects mainly children, it has high recurrence rate with remissions. Best results are achieved using microdebrider and Cidofovir intralesional injection.

19 – 23.

Authors: Najeh Alomari, Asma Aref Idamat

Gastroesophageal reflux disease (GERD) is common in pediatric age group due to incomplete maturation of the antireflux mechanism. Vomiting and regurgitation are frequent manifestations in pediatric age group and are important for consideration when they adversely affect their nutritional status and recurrent chest infection due to aspiration. Medical treatment may not control (GERD), so surgical treatment is the remaining choice to control GERD and late complications. In this study, we present our experience in laparoscopic Nissen fundoplication for the management of (GERD) in children over 5 year period, acceptability, safety, efficacy and outcome. The data of all patients undergoing fundoplication for (GERD) at Queen Rania Hospital for Children / King Hussein Medical Center were retrospectively reviewed of prospectively collected data from April 2008 to 2013. Ages ranged from 3 months to 15 years. All laparoscopic fundoplications were performed by a single surgeon. Patients were evaluate for the indications for surgery, diagnostic modalities, duration of surgery, peroperative complications, pain management , hospital stay , post operative course, morbidity, mortality and the need for re operation. We used the Enseal vessel sealing device and hook diathermy through 5 and 3 mm ports for dissection and division of short gastric vessels and excision of the hernia sac. Over the last 5 years, 80 laparoscopic Nissen fundoplication for GERD were performed, 12 patients had GERD associated with thoracic stomach, 3 patients had esophageal achalasia underwent cardiomyotomy & fundoplication, 14 patients had neurological impairment. Weight ranged from 3, 5 to 82 kg. Mean age 5 years, range (3 months – 15 years), 50 males and 30 females. The indications for surgery were thoracic stomach and Barret esophagus due to (GERD), other indications were severe esophageal ulceration, stricture, recurrent bleeding, para-esophageal hernia and recurrent aspiration pneumonia. Five patients had previous repair of esophageal atresia. Mean operating time was 120 min (range 45 -240 minutes). The mean hospital stay was 2 days, range from 1 to 4 days. There were no intra-operative and post-operative complications. One conversion to open fundoplication was required due to technical fault of the CO2 insufflator. Six patients had laparoscopic gastrostomy insertion in addition to Nissen fundoplication. Blood transfusion was not required in any case and no mortality. There was no need for re do surgery. The vast majority of patients showed significant respiratory improvement as well as control of emesis and hematemesis. This study shows that laparoscopic Nissen fundoplication for GERD in children is rapidly becoming the procedure of choice for surgical correction because of the advantages of reduced discomfort and decreased hospitalization. It is feasible, effective and safe technique. Laparoscopic Nissen fundoplication operation times in children reduced by experience. The surgical skills are important to improved outcomes include adequate length of intraabdominal esophagus, minimal hiatal dissection and tension-free wrap. The results are superior to the traditional open fundoplication. Laparoscopic Nissen fundoplication should be considered the gold standard for anti reflux procedures. The length of hospital stay and convalescence is short and hence rapid return to normal activity is expected with less analgesia requirements. Follow-up examination verified perfect clinical, radiological and endoscopic findings. The cosmetic, endoscopic and functional results were excellent with very good patients and family satisfaction.

30 – 42

Authors: Anthony Kodzo-Grey Venyo

Primary angiosarcomas of the urinary bladder are very rare in view of this their clinical and pathological features have not been extensively described. Literature on primary angiosarcoma of the urinary bladder was reviewed performing an extensive search using various internet search engines for case reports, case series and review papers on primary angiosarcoma of the urinary bladder excluding metastatic angiosarcomas. Primary angiosarcomas of the bladder are rare tumours which are more commonly found in men and quite often present with haematuria, cystoscopy reveals raised lesions in the trigone / dome. Microscopic examination of the tumour tends to show anastomosing vascular channels lined by plump hyperchromatic cells as well as solid and epitheliod cytology. Typically the tumour is locally invasive invading the muscularis propria. The tumour stains positively with CD31, CD34 and can be focally positive especially in cases of epitheliod tumours. Few cases have so far been reported and on the whole previous reports have indicated poor prognosis. However, recent anecdotal reports have indicated that multi-modality treatment with radical cystectomy and adjuvant combination chemotherapy and radiotherapy may result in long term survival. Primary angiosarcomas of the urinary bladder tend to affect middle-aged and elderly men. Anecdotal reports have indicated longer term survival with multi-dal treatment strategy unlike previous reports which on the whole indicated poor prognosis. There is no consensus opinion regarding their treatment. There is therefore the need for a multi- centre trial to determine the best treatment options that would improve the prognosis for these tumours.

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.

1 - 2

Authors: Dr N Mallikarjuna Rao

An editorial article can be about anything and from any standpoint. Articles come in all shapes and sizes. They are in Medical Journals, Newspapers, Magazines, and Posted on the Internet. They cover any and every topic imaginable. As long as you have an opinion and can support it with facts, you have the makings of an interesting piece. We all have opinions, right? Yet not all of us are editorial writers and not all editorials are worth reading. Despite the wide variety, there are guidelines to write clinical oriented articles that can help you improve your articles' readability.

14 - 16

Authors: Robby Kumar and Pushkar Richharia

The programmed cell death, also known as Apoptosis is a complex mechanisms by which cell undergo its own destruction to control the process of cell proliferation or it can be due to in response of DNA damage. Apoptosis also plays an important role in tissue homoeostasis and development. The most striking feature of the cancer cells is that they do not undergo Apoptosis. This fact is due to the involvement of dynamic interplay between oncogenes and/or inactivated tumors suppressor genes. Both of them have a key role in generation of tumors. Certain drugs and agents have been identified which can restore the normal apoptotic pathways and thus, have the potential for the effective treatment of the cancers that depends on the alteration of the apoptotic pathway.