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Background: Hairdressers undergo extensive and prolonged exposure to a variety of chemical substances present in the air in their salons. Although in low concentrations, the various products used for hair care are harmful as most of these products generate chemical aerosols during different procedures. These aerosols which have irritant or sensitizing effects on respiratory mucosa have been found to enter into the airways. Aim: The aim of this study is to assess the impairment of lung function in hairdressers in Gangtok. Method: This is a cross-sectional, comparative study conducted on 50 hairdressers and 50 age- and sex-matched non-hairdresser comparison group. The sampling technique used was simple random sampling. Permission from Institutional Ethical Committee was obtained before beginning the study. A standard questionnaire was used to record the respiratory symptoms. The pulmonary function parameters of the subjects were measured using portable spirometer HELIOS 720. Results: All the parameters were decreased in hairdressers and almost all the differences were statistically significant. FEV1 (P = 0.023) and FEV1/FVC ratio (P < 0.05) were reduced significantly. FEF25-75% and PEFR were also significantly reduced (P < 0.05 in both parameters). FVC was also reduced in hairdressers, but it was not statistically significant (P = 0.342). Conclusion: Hairdressers undergo exposure to different chemicals in their workplace and carry the risk of decreased pulmonary function. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to assess the risk factors for adverse outcomes in pregnancy with obstructed labor. Methods: It was a prospective descriptive study conducted at BP Koirala Institute of Health sciences (BPKIHS).The patients with obstructed labour were managed and followed up until delivery and six weeks postpartum from Jan to Dec 2012. Results: There were 57 (0.6%) cases of obstructed labour out of 9500 deliveries. The main cause was cephalopelvic disproportion in 36 (63.2%). The majority of the cases were from rural areas, low socioeconomic status, non salaried and illiterate. Risk for maternal mortality, peripartum hysterectomy and perinatal mortality as adverse outcomes was significantly associated with low socioeconomic status (AOR 12.5, P=0.02) and literacy status (AOR 21.9, P=0.001). If only the risk of perinatal mortality is taken as an adverse outcome, it is significantly associated with booking status (AOR 7, P=0.001), low socioeconomic status (AOR 9.62, P=0.037) and literacy of the patient (AOR 15, P=0.001). Perinatal mortality rate was 100 per 1000 live births in women with obstructed labour. The case fatality rate was 1.2%. Conclusions: Individual socio-demographic and health system factors are strongly associated with obstructed labor. [ABSTRACT FROM AUTHOR]

Aims: To determine the prevalence of premenstrual syndrome and premenstrual dysphoric disorder and their association with psychiatric caseness and dysmenorrhea in students of Lumbini Medical College, Palpa, Nepal. Methods: This is a cross-sectional study where self-report questionnaires based on American College of Obstetrics and Gynecology and Diagnostic and Statistical Manual of Mental Disorders-V criteria for PMS and PMDD and the General Health Questionnaire-12 for psychiatric caseness were filled by the students. The results were calculated using SPSS 16.0 as frequencies, mean, standard deviation and chi square with a p-value of ⩽0.05 as significant. Results: There were 382 participants out of which 113 (61.1%) medical and 126 (64%) nursing students met the ACOG criteria for PMS. PMDD was diagnosed in 78 (39.6%) nursing students and 72(38.9%) medical students. The most common somatic symptom was headache 256(77%) and behavioral symptom was irritability 310(81.2%). A significant relation (p value <0.05) was seen between psychiatric caseness, dysmenorrhoea and PMS/PMDD. Conclusion: PMS and PMDD are common in young medical and nursing students. A significant relation was present between PMS and psychiatric caseness and dysmenorrhea therefore comprehensive efforts should be made by healthcare providers to screen and manage symptoms including dysmenorrhea efficiently, thereby improving daily functioning, academic performance and professional skills of the students. [ABSTRACT FROM AUTHOR]

Introduction: The primary goal of surgical intervention with an impalpable testis is to locate and reposition the gonad .There has been much debate in the management of impalpable undescended testes. Many centres still advocate the role of open inguinal exploration in impalpable testes. Materials and methods: This retrospective study included 35 male patients. The clinical notes were reviewed for details of age at operation, side, location and condition of testes intraoperatively and the type of operation performed. Standard approach of inguinal explorations was performed under general anaesthesia. Follow up in first week and after 3 months was done. Results: 25(71.42%) impalpable testes were in left side, 9(25.71%) were on right side and 1(2.85%) was bilateral. At exploration 17(47.22%) were intracanalicular, nine (25%) were intraabdominal with seven low and two high, 49(11.11%) were scrotal and six (16.66%) were absent, seven (41.17%) canalicular testes underwent orchidopexy and 10(58.22%) underwent gonadectomy for atrophied testes. Seven (77.77%) low abdominal testes were brought down to scrotum and two (22.22%) high abdominal were brought down to lower inguinal area as a first stage surgery. All 4(100%) scrotal testes were atrophied and gonadectomy performed. Six patients were diagnosed anorchia, 14 (87.5%) of impalpable testes that underwent orchidopexy were in a follow up with excellent results. One high first stage orchidopexy and another canalicular testes were found to have atrophied who did orchidectomy in follow-up. Conclusion: Inguinal exploration is a safe, reliable and successful surgical procedure for the management of impalpable testes including intraabdominal testes without procedure related complications. [ABSTRACT FROM AUTHOR]

The success of space-based forest defoliation monitoring beyond thematic classification hinges on the ability to link units of continuous foliar change with associated units of spectral or vegetation index change across different systems. To explore this, we used multi-temporal Landsat sensor data with respect to three defoliation metrics (shoot-based estimates (%), frass biomass (kg·ha−1), and proportion of foliar loss) across three different forest systems in the United States. While shoot-based defoliation was measured in the field, the later two defoliation metrics were estimated based on the insect phenology model, BioSIM. The systems include spruce budworm (SBW, Choristoneura fumiferana C). in heterogenous mixed forests, Minnesota, jack pine budworm (JPBW, Choristoneura pinus F). in homogenous pine forests, Wisconsin, and spongy moth (SGM, Lymantria dispar dispar L). in mixed broad-leaved forests, Maryland. Our generalized annual defoliation model for budworm was poor (R 2 adj = 0.35, RMSE = 23.70%) due to difficulty in detecting SBW defoliation in Minnesota. Thus, individual annual JPBW shoot-based defoliation models (R 2 adj = 0.27 to 0.75 and RMSE = 19.16% to 11.32%) outperformed the SBW models (R 2 adj = 0.08 to 0.27, RMSE = 23.18% to 34.13%). Cross-system differences between rates of change in ground-based metrics of defoliation with respect to observed change in spectral index values (dVI) were significant for shoot-based estimates of percent annual defoliation for SGM vs. JPBW (p -values <1.00 × 10−4) and SGM vs. SBW (p -values < 4.60 × 10−3). However, such comparison between SGM and JPBW were not significant when either frass biomass (kg·ha−1, p -value = 0.46) or proportion of foliage loss was used (p -value = 0.67). For a given unit of defoliation, the magnitude of vegetation index change, dVI, was significantly different between SGM and JPBW for each defoliation metric used (p -values <1.00 × 10−4), but not between SGM and SBW (p -value = 0.47) or between JPBW and SBW (p -value = 0.06) when shoot-based annual defoliation metrics were used. This study is first to report that, for a given quantity of defoliation, substantial differences in both the magnitude and direction of vegetation index change exists for different defoliator systems, which currently precludes the development of a viable, unified defoliation model. However, outcomes of this research provide an important step in our understanding of these defoliator systems that may enable specific scaling of continuous defoliation at landscape levels and across defoliator systems in the future. • Cross-system comparison of vegetation index associated with defoliation. • Ground-to-satellite disturbance models using three different metrics of defoliation. • Winter season is optimal for remote detection of defoliation in coniferous systems. • Vegetation index response for a given level of defoliation varies by insect system. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the treatment outcome and acceptance of LEEP in precancerous cervical lesions. Methods: ON is the pre-malignant cervical lesion that can be treated early and slow to progress to invasive disease. Among various treatment modalities for ON, LEEP has the advantage of treatment with tissue diagnosis. Results: Highest percentage of ON, 32.14% (9) was seen among 30-39 years age with 16 (57.14%) of parity three and more. 17 (60.71%) presented clinic with symptoms (lower abdominal, backpain, pervaginal discharge) while 11 (39.28%) were diagnosed from routine Pap test. Histopathology revealed four (14.28%) CIN 1, eight (28.57%) CIN2,11(39.28%) CIN 3, two adenocarcinoma in situ, one of invasive squamous cell carcinoma, chronic cervicitis and atrophic change with no dysplasia. Margins were negative (satisfactory) in 20 (71.42%) and positive in eight (28.57%) with endocervical involvement in two that required second LEEP while one underwent radical hysterectomy for final diagnosis of invasive squamous cell carcinoma. Conclusions: Hysterectomy is a radical procedure for preinvasive cervical lesions that can be treated with simple procedure like LEEP that saves time and financial resources. [ABSTRACT FROM AUTHOR]

A 4-year old child, previously operated case of tetralogy of Fallot present with recurrent episodes of massive lower gastrointestinal bleed of one year duration. Endoscopic evaluation revealed multiple bluish vascular lesions in the duodenum and proximal jejunum and a single rectal polyp. Histology of the lesion was suggestive of venous malformation consistent with blue rubber bleb nevus syndrome (BRBNS). Child underwent endoscopic snaring and surgical resection with end to end anastomosis. At six months' follow-up child was asymptomatic without any bleed episodes. [ABSTRACT FROM AUTHOR]

Introduction: Autologous Blood patching (ABP)has been usedto treat bronchopleural fistula in spontaneous pneumothoraxwith varying success. We evaluatedthe safety and efficacy of ABP when used in patients with primary (PSP) versus secondary (SSP) spontaneous pneumothorax. Methods: All patients with spontaneous pneumothorax with no evidence of pleural infection and in whom the air leak did not subside despite 48 hours of conservative management were included. A CT scan was done to categorize if there was underlying lung disease and classify patients into primary and secondary spontaneous categories. These patients underwent blood patching in one to three episodes in 50ml aliquots. Comparisons of the demographic profile, smoking status, success rate and complications in these two groups were done. Results: Between July 2012 and January 2014, 76 patients underwent ABP. The overall success rate of ABP was 58%. There were 29 patients who were classified as PSP and 47 with SSP. There was no difference in the sex distribution but patients with PSP were younger (P= 0.00), were more likely to present earlier (P=0.04) and had higher rates of residual pneumothorax (P= 0.05) after chest tube insertion. The success rates in the two groups were similar (P=0.76).The rate of complications was low and not different in the two types (P=0.58). Conclusion: ABP has modest success in sealing air leak of spontaneous onset. We found the success and complication rates in the two types of spontaneous pneumothoracesto be equivalent. [ABSTRACT FROM AUTHOR]

Introduction: Despite hundreds of repair techniques for hypospadias, the introduction of tubularized incised plate urethroplasty (TIP) by Warren T. Snodgrass has become popular because of good functional and cosmetic outcome. The objective of this study was to share our experience of Snodgrass tubularized incised plate (TIP) urethroplasty for the repair of distal and mid-penile hypospadias. Materials and Methods: This prospective study was carried out for a period of 24 months. It included 46 male patients with the mean age of 4.1 years (18 months to 10 years). Proximal hypospadias and those distal with moderate to severe chordee were excluded. All cases underwent TIP urethroplasty as described by Snodgrass and the neourethra was covered by single or double layer of dorsal prepucial layer. The results were analyzed on the basis of duration of surgery, types of postoperative complications like urethrocutaneous fistula, meatal stenosis and wound dehiscence. Functional results assessed with ease of voiding, force and direction of urinary stream and cosmetic with external look of penis. Results: The overall complication rate requiring surgical intervention was 8 (17.3%). Mean duration of surgery was 66 minutes (60-80 minutes). Urethrocutaneous fistula occurred in 5 (10.8%), meatal stenosis in 1 (2.1%) and wound dehiscence in 2 (4.3%) patient. The cosmetic appearance was excellent in all patients involved in this study except 2 cases of wound dehiscence. All of them had vertically oriented slit like meatus with straight urinary stream. Conclusion: Tubularized incised plate urethroplasty gives good functional and excellent cosmetic results with low rate of complications in distal and mid-penile hypospadias. [ABSTRACT FROM AUTHOR]

Introduction: Ano-rectal malformation (ARM) comprises a wide spectrum of diseases that involves the distal anus and rectum as well as the urinary and genital tracts. The factors that need to be considered during treatment are the type of anomaly, associated anomalies and patients general condition. The aim of this study is to analyze the types of anorectal malformations and their management in a tertiary level children's hospital. Materials and Methods: The medical records of patients with the diagnosis of anorectal malformation managed in the hospital during a period of January 2009 to January 2014 were reviewed. Results: There were 187 cases of ARM 126 (67.37%) males and 61 (32.62%) females. High/Intermediate type was 129 (68.98%). Low ARM was 58 (31.01%). In male high type ARM with recto-urethral fistula was seen in 60 (47.61%). ARM with Rectovestibular fistula(RVF) was seen in 40 (65.5%) female. High and intermediate ARMs were managed initially with colostomy and low ARM with primary anoplasty. ARM with rectovestibular fistula in females were managed with Anterior Sagittal Anorectoplasty without colostomy. Common cloaca in female was managed initially with colostomy followed by posterior sagittal ano-recto-vagino-urethroplasty. Colostomy closure was done after adequate size of anus was achieved with anal dilation. Conclusion: The type of ARM in newborn is diagnosed by perineal examination and X-rays. Low type ARM was managed by primary surgery without colostomy. High anomaly and complex defect was treated with stage surgeries. [ABSTRACT FROM AUTHOR]

Introduction: Incarceration of an indirect inguinal hernia in children is an acute emergency and one of the common complications that may occur before herniotomy. Inguinal hernias rarely go away, and therefore, virtually all should be repaired at any age of presentation. Incarcerated inguinal hernia can be reduced successfully by manual reduction if performed by experienced hands on time. The objective of this study was to assess the safety and efficacy of manual reduction of incarcerated indirect inguinal hernia. Materials and Methods: Thirty six patients who attended Emergency Department of Kanti Children's Hospital over 30 months period from January 2009 to July 2011 were studied prospectively. All patients were diagnosed case of inguinal hernia and waiting for elective herniotomy. Results: There were 30(83.33%) males and 6(16.66%) females, with male-to-female ratio of 5:1. Right sided inguinal hernia was 20(55.5%) and left 16(44.44%). The ages ranged from 1.5 months to 28 months with mean age of 15 months. Time of incarceration ranged from 3 hours to 30 hours. Manual reduction was successful in 30(83.33%). Remaining six had to undergo emergency surgery. Four patients with edematous but viable hernial contents had successful surgical reduction. Two patients with gangrenous small bowel loops had bowel resection and anastomosis. Conclusion: Manual reduction is safe and effective when performed timely. Herniotomy should be done without delay once diagnosed to avoid unnecessary complications. [ABSTRACT FROM AUTHOR]

Introduction: Nosocomial Citrobacter spp. is emerging as a successful nosocomial pathogen in neonates in Nepal. The important risk factor being poor infection prevention and control practices. The objective of this study was to investigate the clonal relatedness of Citrobacter freundii isolated from clinical and nonclinical sources in Neonatal Intensive Care Unit (NICU) and to determine the presence of Extended Spectrum Beta-Lactamase (ESBL) genes and class 1 integron element. Materials and Methods: Polymerase chain Reaction (PCR) and PCR-Randomly Amplified Polymorphic DNA typing of the isolates were performed in three isolates to amplify class 1 integron element integrase gene, ESBL genes, and to study the clonal relatedness, respectively. Results: Two isolates harbored class 1 integron element. The blaCTX-M was present in all isolates and blaTEM-1 was present in one isolate. An isolate carried blaCTX-M and blaTEM-1 genes. All of these isolates were not clonally related. Conclusion: The study for the first time documented the emergence and spread of ESBL genes and class 1 integron element in multidrug resistant C. freundii in Nepal and urge for monitoring and surveillance of these strains. [ABSTRACT FROM AUTHOR]

Introduction: Intussusception is the commonest cause of bowel obstruction in infancy and childhood. Early diagnosis and management is essential to reduce morbidity and mortality. The objective was to To review the diagnostic criteria of intussusception in infants and children to increase awareness of attending personnel for effective management decrease the rate of operative treatment and complications. Materials and Methods: The data collected of all 38 patients admitted in Kanti Childrens Hospital between 2008 September to 2009 September were studied prospectively. Each patient was evaluated in regard to age at presentation, sex, signs and symptoms, diagnostic method, treatment (operative, non-operative). Results: During study period of one year there were a total of 20 (52%) males and 18 (48%) females of age 3 months to 6 years. Pain abdomen was seen in 25(66%), vomiting 16(42%), diarrhea 15(40%), blood mixed with stool 10(26%). These symptoms were seen in different combination. X-ray erect abdomen was done in 15 and ultrasound in all 38 cases. Ten out of 15 (66.6%) patients with early presentation and diagnosis had successful barium enema reduction.10 (66.6%) had successful reduction and admitted to our hospital. 28(74%) patients were undergone laparatomy. Among 28 (74%) patents that had lapartotomy, manual reduction was successful in 18 and 10 required bowel resection and anastomosis. Conclusion: The awareness of early features of intussusception is important for early referral to tertiary centers for successful non-operative barium reduction and reduce the need of laparotomies in children. [ABSTRACT FROM AUTHOR]

Introduction: Despite a better understanding of the embryology, anatomy of anorectal malformations and of the physiology of continence, the management of children born with imperforate anus continues to be a surgical challenge and is still fraught with numerous complications and often leads to less than perfect qualitative results. Pediatric patients with recto-vestibular fistula have good prognoses in terms of bowel function when properly treated. Aim & Objective: The study was designed to assess the surgical morbidity of single stage Anterior Sagittal Anorectoplasty (ASARP). Methodology: This prospective study was carried for a period of 26 months. It included a total of 48 female patients (aged 0 - 14 years) with diagnosis of Anorectal Malformations (ARM) with vestibular fistula or perineal ectopic anus. In ASARP, Patient in lithotomy position, the anterior portion of sphincter muscles were cut through a midline perineal skin incision, rectum was separated from the vagina & then rectum was pulled through the center of these muscles. The perineal body was reconstructed and the normal appearance of perineum was achieved. Results: Short-term surgical outcome was satisfactory in all cases. No one needed colostomy. Conclusion: Single-stage ASARP is a good approach in experience hands for ARM with vestibular fistula and perineal ectopic anus in females and thereby complications and time involved in staged procedures including colostomy can be avoided. [ABSTRACT FROM AUTHOR]

Capsicum fruit, a popular spice as chili pepper, is an important ingredient of the formulations used in traditional medicines. Moreover, Capsicum fruit is listed as an official drug in several pharmacopoeias. Capsaicin, the most abundant component in Capsicum fruit, exhibits its therapeutic and adverse effects in a dose-dependent manner. Therefore, the known capsaicin content is the prerequisite for optimizing any formulation based on Capsicum fruit as a crude drug. We studied 16 samples of Capsicum fruits grown at different altitudes in Nepal and determined their capsaicin content by high-performance liquid chromatography. The capsaicin content was found to range from 2.19 to 19.73 mg/g of dry weight of Capsicum fruits. Capsaicin content in pericarp was found to be higher than in seeds. No correlation was found between the shape or size of the fruits and its capsaicin content. Our findings indicate that many of the formulations prepared from Capsicum fruit, even as described in pharmacopoeias, may vary in their strength, therapeutic activity, and possible side effects if the capsaicin content in Capsicum fruit is not standardized. [ABSTRACT FROM AUTHOR]

Previously we have shown that avian leukosis virus subgroup J (ALV-J) might be present in chicken flocks from Malaysia based on serological study and also on detection of tissue samples with myelocytic infiltration. In this study, the polymerase chain reaction was used to detect ALV-J sequences from archived frozen samples. Out of 21 tissue samples examined, 16 samples were positive for proviral DNA and four samples for ALV-J RNA. However, only nine samples were found positive for myelocytic infiltration. A total of 465 base pairs equivalent to positions 5305 to 5769 of HPRS-103 from each of the viral RNA positive samples were characterized. Sequence analysis indicated that the samples showed high identity (95.9 to 98.2%) and were close to HPRS-103 with identities between 97.4 and 99.3%. This study indicates that ALV-J-specific sequences can be detected by polymerase chain reaction from frozen tissue samples with and without myelocytic infiltration. [ABSTRACT FROM AUTHOR]

Presents a study which evaluated the effects of animal powered tillage on nutrient dynamics and soil properties at Claveria, Philippines. Methodology; Results; Discussion.

We have used the full potential-linearized augmented plane wave method to predict the structural, electronic and optical properties of Mn 1− x Cd x Te 2 compounds (x = 0, 0.25, 0.50, 0.625, 0.75, 0.875, 0.968, 1.0). The bands near the Fermi energy level are predominantly contributed by the Mn- d and Te- p states. A transition from metallic to semiconducting nature can be observed with increasing doping (Cd) concentration. The DOS and energy bands of these materials reflect semiconducting nature of CdTe 2 , with an energy band gaps of 0.71 eV, that has been enhanced (0.95 eV) close to the experimental report of 1.08 eV by employing mBJ functional. From the study of optical properties, it is found that CdTe 2 and MnTe 2 both have very high absorption coefficient, exceeding 104 cm−1. As the Cd concentration increases in the Mn site, the refractive index of the material decreases and the material becomes opaque in the lower frequency range. [ABSTRACT FROM AUTHOR]

We report a case of bladder prolapse through a patent urachus in a term male neonate with a large, red, tubular, mucosa lined mass inferior to the umbilical cord. A cystic mass communicating with fetal urinary bladder was detected in an antenatal ultrasound in a 26 years primigravida at 18 and 26 weeks gestation. The cyst disappeared at 35 weeks and a new solid mass was noted at the fetal abdominal wall. After birth a protruded mucosal mass inferior to the umbilical cord was noted. Urethral catherisation confirmed communication with bladder. On the second day of life excision of urachus, repair, reduction of bladder and reconstruction of abdominal wall was performed. The patient voided well and was discharged on ninth day without any complication. [ABSTRACT FROM AUTHOR]

Introduction: Thoracic empyema is a common problem. Use of minimal access surgery for the treatment is comparatively new. We audited our results with VATS in thoracic empyema. Methods: We analyzed the retrospective data from the patients who received Video-Assisted Thoracoscopic Surgery (VATS) for empyema thoracis from April 2011 to April 2013 at Manmohan Cardio-thoracic Vascular and Transplant Center (MCVTC). Results: Of the 44 patients who underwent surgery for empyema of various stages, 37 patients underwent the procedure via VATS. The average age was 26.4 ±17.19 yrs (1-64). The male to female ratio was 2:1. The duration of symptoms before VATS intervention varied very widely (7-712 days avg: 92.7±28.8 days). The duration was 32 days on an average among patients in whom deloculation sufficed but was 111 days among those in whom decortication was required. A complete VATS procedure with satisfactory lung expansion at the end of the procedure was possible in 34 patients (100% patients who underwent deloculation and 88% of those who underwent decortications). Inadequate lung expansion forced conversion in three and subsequent collapse necessitated re-operation in one. The operative times were: VATS converted to open decortication (150 mins), completed VATS decortication (60-180 mins, avg: 125.7 mins) and VATS deloculation (45-120 mins, avg: 69 mins). Post-operative chest tube drainage was shorter in patients in whom a successful VATS procedure was completed 4.0 Vs 40 days). Conclusion: Videothoracoscopic approach is feasible in surgical management of empyema thoracis. The results seem to be better in earlier stages. [ABSTRACT FROM AUTHOR]

An eleven years female presented with recurrent chest infection since childhood with markedly diminished air entry on her right chest and mediastinal shift. She also had vague facial deformity with multiple auricular appendages. Computed tomography showed collapse of the left lung and on thoracotomy, complete agenesis of the left lung was noted. Goldenhar anomaly is rare and presents with variable degree of external anomaly. Its association with bronchopulmonary agenesis is extremely rare with few cases reported in the world literature. Features of other congenital should be sought for in a child with facial asymmetry, external auditory appendages, malformation of the, nose, soft palate, lip and mandible etc so that appropriate treatment can be administered. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor regarding the Indian Wilson disease.

Background: Dendritic cells (DC) are key regulators of immune response with the ability to affect both the innate and adaptive immune responses and are abundant in the gut mucosa. The severity of shigellosis varies with the serotype involved with S. dysenteriae (SD) producing the severest infections and complications with S. sonnei (SS) being at other end of spectrum usually causing mild self-limiting diarrhea. While shigellae are known to induce the apoptosis of mature DCs, there is no information in cytokine milieu of DCs incubated with different serotypes of Shigellae. Methods & Materials: Monocyte derived dendritic cells (MoDCs) were developed from healthy human PBMC after 8 days of culture. They were characterized by four-color flow cytometry technique using Becton Dickinson FACS ARIA III, equipped with 488nm and 630nm argon laser and analysed by FACS Diva 6.1.2 Software on the basis of CD11c positive, HLA-DR positive and CD3 negative. DCs were infected with different Shigella serotypes. After 24 hour post infection, relative expression of cytokines IL-1 IL-6, IL-8, TNF-, IL-12p70, IL-17, IL-22 and IL-23 was studied by Real Time PCR and data was analysed by Graphpad prism 5. Results: IL-8, IL-17A, IL-22A and IL-23 expressions were highest in MoDCs stimulated with S. dysenteriae serotype1 and significant serotypic differences were noted between SD & SF and between SD & SS. The transcription levels of IL-23 were down regulated in S. flexneri & S. sonnei in comparison to normal MoDCs. IL-8 appears to be a major molecule orchestrating mucosal inflammation in shigellosis. It is the primary cytokine which induces neutrophil chemotaxis. SD1 induces more Th17 response which displays proinflammatory functions. IL23 is responsible for the expansion of Th17 previously differentiated. IL-23 promotes the development and expansion of activated CD4+ T cells. Conclusion: DCs are critical sentinel cells that relay microbial presence either directly or indirectly to naive T cells. In this study we found that Shigella dysenteriae caused maximum release of IL- 8. Similarly SD also caused highest release of IL-17A and IL-22A. It was the only serotype which increased IL-23. These findings could explain more severity of SD as compared to SF and SS. [ABSTRACT FROM AUTHOR]

Aims: To study the frequency of iatrogenic cause amongst the surgery done for genitourinary fistula and to study the type and cause of iatrogenic genitourinary fistula. Methods: This is retrospective study of women undergoing surgery for genitourinary fistula repair from year 2013 to 2018. The analysis considers frequency and characteristics of type of fistula. Results: Out of 223 genitourinary fistula 75 (33.6%) were iatrogenic. Vaginal vault fistula were 25% followed by uretero-vaginal fistula (32.9%), vesico-vaginal fistula (32.9%) and there were 4 iatrogenic recto-vaginal fistula; 81.6% of the iatrogenic fistula had preceding history of hysterectomy followed by emergency caesarean section (17.1%). There is annual increasing trend in iatrogenic fistula repair from 3 to 23. Conclusions: Women undergoing hysterectomy were under risk for iatrogenic fistula. Optimum work environment is important to reduce surgical error during procedures. Operating training should be emphasised on optimal surgical skills, decision making. [ABSTRACT FROM AUTHOR]

Clavibacter michiganensis subsp. michiganensis (Cmm) is a quarantine organism in Europe and in many other countries. It is one of the most severe bacterial pathogens affecting tomato. Screening tomato plants for their resistance level to Cmm requires a large amount of space under quarantine conditions and is therefore costly. This project developed a new inoculation protocol on in vitro tomato plants to facilitate a more economic and higher throughput disease screening. A new method using the PathoScreen system was tested to localize green fluorescent protein‐tagged Cmm in planta and to quantify the pathogen based on the percentage of corrected GFP (cGFP%). The system was sensitive in detecting the GFP‐tagged Cmm in the shoots, but in the roots a high autofluorescence masked detection and thus sensitivity of the assay. The in vitro protocol was tested on several wild relatives of tomato, which were previously screened in a greenhouse assay. The correlation between wilt symptoms in vitro and wilt symptoms in the greenhouse was overall moderate (r = 0.6462). The protocol worked well in differentiating the two parents that were used in the mapping studies. This study shows that the in vitro protocol can be efficiently used for resistance breeding in many tomato genotypes. [ABSTRACT FROM AUTHOR]

The authors reflect on the care of patients with portal hypertension. They describe further the extrahepatic portal vein obstruction (EHPVO), extrahepatic portal hypertension (EHPH), and the portal biliopathy. They suggest that portosystemic shunting procedures are definitive procedures to relieve the biliary stasis and prevent further stone formation.

Genetic characteristics were analysed for recent clinical isolates of methicillin-resistant and -susceptible Staphylococcus aureus (MRSA and MSSA respectively) in Kathmandu, Nepal. MRSA isolates harbouring Panton-Valentine leukocidin (PVL) genes were classified into ST1, ST22 and ST88 with SCC mec -IV and ST772 with SCC mec -V (Bengal Bay clone), while PVL-positive MSSA into ST22, ST30 and ST772. ST22 isolates (PVL-positive MRSA and MSSA, PVL-negative MRSA) possessed a variant of elastin binding protein gene ( ebpS ) with an internal deletion of 180 bp, which was similar to that reported for ST121 S. aureus previously outside Nepal. Phylogenetic analysis indicated that the ebpS variant in ST22 might have occurred independently of ST121 strains. This is the first report of ST772 PVL-positive MRSA in Nepal and detection of the deletion variant of ebpS in ST22 S. aureus. [ABSTRACT FROM AUTHOR]

Celiac disease presenting as proximal myopathy is rarely seen, particularly in children. We report a 5-year-old girl who presented with bilateral lower limb weakness and on examination had proximal myopathy. She also had florid rickets and short stature. On investigation, the underlying etiology turned out to be celiac disease. Proximal myopathy with celiac disease can be secondary to the disease per se or due to associated osteopenia and rickets. [ABSTRACT FROM AUTHOR]

Introduction: Pseudoaneurysms are major vascular complications in intravenous drug abusers. They are potentially fatal, often infected and require urgent management. Method: This is a retrospective study of the prevalent practice of their management in our center. The inpatient medical charts of the patients spanning 5 years (Sep 2006 to Aug 2011) were reviewed. Data were obtained on their demographic, clinical, management and outcome parameters. Result: Among the thirty intravenous drug users presenting with pseudoaneurysms (excluding one who bled to death before surgery), 28 had their femoral artery involved. Most of them (90%) were infected. Nearly half of the patients (45%) were seropositive for HIV and/or HCV. All were operated, with no mortality. Ligation and debridement was the technique used almost exclusively (83%). One brachial artery was repaired primarily, whereas 3 femoral and 1 brachial pseudoaneurysms were managed with autologous saphenous vein bypass. Five patients had neurological complications, and 5 others had non-limb threatening claudication which got better with medical management. Mean follow up period was 11 months. Conclusion: Ligation and debridement appears to be a simple, safe and effective procedure in infected pseudoaneurysms in IV drug users. [ABSTRACT FROM AUTHOR]

This research developed a model of saturated hydraulic conductivity for golf course and athletic field media. The model was developed from saturated flow data in packed sand cores, for which a pore-size distribution was derived from particle-size distribution, bulk density, and measured soil water characteristic data. The pores were first assumed to form an idealized structure, consisting of non-tortuous capillary tubes of uniform shape and size, and the Hagen-Poiscuille flow equation was applied to compute idealized saturated flow. The idealized saturated flows were compared with saturated flows derived from the measured saturated hydraulic conductivity data. Subsequently, an empirical relationship was established between the two in the form: Qt(m) = c + dQt(h-p), where Qt(m) is the saturated flow through the natural-structure sand cores and is the saturated flow through the idealized pore structure for the same core. In our study, parameters c and d had values of -1.675 and 0.308, respectively, and the r2 of the regression had a value of 0.871. The model was applied to 14 golf course sands and produced excellent results with minor anomalies. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the radiological spectrum of sequelae of corrosive acid and alkali injury to the upper gastrointestinal (GI) tract using barium contrast examination.Material and Methods: Barium contrast radiographic films of 155 patients with a history of corrosive ingestion, acid in 120 and alkali in 35 patients with grade 2b and 3 injury on initial endoscopy, were retrospectively evaluated. Barium contrast examination of the upper GI tract was performed in the course of follow-up, beyond 3 weeks of corrosive ingestion.Results: The esophagus was involved in 131 patients and the stomach in 74. Fifty patients had simultaneous involvement of esophagus and stomach. Radiological findings in the esophagus were solitary or multiple strictures of varying length, intramural pseudodiverticula, and carcinoma in long-standing corrosive injury. The stomach showed cicatrization, predominantly involving the antrum, linitis plastica type deformity with multiple pseudodiverticula. There was no difference in the radiological findings as to the type of corrosive ingested.Conclusion: Barium examination of the upper GI tract is useful in the evaluation of late sequelae of corrosive injury (acid/alkali). There was no difference in the radiological findings as to the type of corrosive ingested. Thus, contrary to general belief, we found that acid and alkali damage both the esophagus and the stomach with equal degree of severity. [ABSTRACT FROM AUTHOR]

Background Gallbladder (GB) hypomotility has been reported in adults with celiac disease (CD), but there is no literature on GB dysfunction in children with CD. We aimed to study GB motility in children with CD, before and after a gluten-free diet (GFD), using ultrasonography (USG) and technetium-99 labeled mebrofenin hepatobiliary scintigraphy (HBS). Methods Children with newly diagnosed CD were enrolled and evaluated for GB ejection fraction (GBEF) using HBS and USG. Those with reduced GBEF on initial HBS were again evaluated after 6 months of strict GFD and the results were compared. Results Of the 50 children with CD (mean age 9±2.1 years, 54% boys), 16% (n=8) had a low GBEF at baseline (19±13%). These children had a significantly greater delay in diagnosis compared to those with normal GBEF (6.5±2.0 vs. 2.3±1.2 years, P<0.001). A significant improvement in GBEF was noted on HBS post GFD (74±12%1 vs. 9±13%, P<0.001). GBEF also improved significantly as assessed by USG parameters after GFD (P<0.001). The fasting GB volume decreased (5.7±1.4 vs. 10.2±2.6, P=0.002), with a significant improvement in percentage postprandial GB volume change (52±10.5% vs. 24±16.5%, P=0.007) compared to baseline pre-GFD values. Orocecal transit time was also increased in children with reduced GBEF. Conclusions GB function is impaired in at least 16% of children with CD at diagnosis and is reversible with GFD. GB dysfunction is significantly associated with a delayed diagnosis and may be a part of general gastrointestinal dysmotility. [ABSTRACT FROM AUTHOR]

A first-principle computational method has been used to investigate the effects of Ru dopants on the electronic and optical absorption properties of marcasite FeS2. In addition, we have also revealed a new marcasite phase in RuS2, unlike most studied pyrite structures. The new phase has fulfilled all the necessary criteria of structural stability and its practical existence. The transition pressure of 8 GPa drives the structural change from pyrite to orthorhombic phase in RuS2. From the thermodynamical calculation, we have reported the stability of new-phase under various ranges of applied pressure and temperature. Further, from the results of phonon dispersion calculated at Zero Point Energy, pyrite structure exhibits ground state stability and the marcasite phase has all modes of frequencies positive. The newly proposed phase is a semiconductor with a band gap comparable to its pyrite counterpart but vary in optical absorption by around 106 cm−1. The various Ru doped structures have also shown similar optical absorption spectra in the same order of magnitude. We have used crystal field theory to explain high optical absorption which is due to the involvement of different electronic states in formation of electronic and optical band gaps. Lӧwdin charge analysis is used over the customarily Mulliken charges to predict 89% of covalence in the compound. Our results indicate the importance of new phase to enhance the efficiency of photovoltaic materials for practical applications. [ABSTRACT FROM AUTHOR]

Dyskeratosis congenita (DKC) is a rare inherited genodermatosis. We report familial occurrence of the disease. The index patient 12 years old had all classical features of DKC. There are 4 other siblings in the family suffering from similar disease. In additions to the features of DKC, the index patient presented with pain abdomen and vomiting. On investigation he had malrotation of gut and hiatus hernia. To the best of our knowledge this is being documented for the first time in association with DKC. [ABSTRACT FROM AUTHOR]

Neonatal ingestion of foreign body is a very uncommon occurrence. We describe a 25-day-old neonate who had a large-sized stone impacted in the cervical oesophagus. The stone was accidently lodged by one of the elder siblings while playing. The stone, after failure to be retrieved endoscopically, was successfully removed by open esophagotomy. The case describes the unusual occurrence at a very uncommon age. It also re-affirms the successful role of open surgery in such situations, which are otherwise commonly treated endoscopically. [ABSTRACT FROM AUTHOR]

Background: Giardia duodenalis is a common cause of chronic diarrhea especially in tropical countries. Diagnosis is based on microscopy (three stool samples) for trophozoites/cysts. Role of stool or duodenal biopsy PCR as a diagnostic method needs to be defined. We conducted a prospective study to determine the diagnostic characteristics of G. duodenalis stool and duodenal biopsy PCR in comparison to stool microscopy (reference standard). Later, we compared other techniques with stool PCR, considering it as new reference standard and characterized the type of Giardia assemblage. Methods: G. duodenalis stool nested PCR was first evaluated using 40 positive controls and 50 negative controls considering stool microscopy as reference standard. Patients with chronic diarrhea (n = 100) were evaluated by stool microscopy and nested PCR. In 30 patients in whom upper gastrointestinal endoscopy was performed, duodenal biopsy samples were obtained and evaluated by histopathology, imprint cytology, and nested PCR. The type of Giardia assemblage was detected by assemblage-specific PCR. Results: Stool nested PCR was found to have sensitivity and specificity of 100% and 94%, respectively, compared to stool microscopy. In patients with chronic diarrhea, 48% had evidence of Giardia infection. Stool microscopy detected 65%, stool PCR detected an additional 27%, and duodenal biopsy PCR detected an additional 8% of cases. The commonest assemblage found was assemblage B. Clinical and demographic characteristics were similar in patients harboring either assemblage A or B. Conclusion: Stool PCR is more sensitive than stool microscopy. By utilizing stool microscopy, stool nested PCR, and duodenal biopsy PCR in sequential manner, diagnostic yield can be increased. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori infection is a common and universally distributed bacterial infection. It is predominantly acquired in childhood. Endoscopic findings of antral nodularity can be seen in children much more frequently than in adults and believed that this gross change may suggest H. pylori infection and histologic gastritis. We conducted a study to assess the significance of Helicobacter pylori infection associated with endoscopic nodular gastritis (NG). Methods & Materials: This prospective study carried out over two years period and included 468 children in whom upper digestive endoscopy was performed for gastrointestinal symptoms and gastric antral mucosal biopsy was taken. Sixty-seven children were diagnosed as having NG and were included in the study. Demographics, clinical characteristics, endoscopic and pathologic findings were recorded. H pylori were recognized in gastric biopsy on H&E sections; a modified Giemsa stain was performed in biopsy suspicious for H pylori. Results: The prevalence of NG in children was 14.3% (67/468) and consisted of 46.3% male and 53.7% female. Children age ranged from 3-18 years (mean age, 9.2 + 0.4 years). The prevalence of NG increased gradually with age. H pylori infection was identified in 68/468 (14.5%) children. Nodular gastritis had a poor accuracy rate to determine H. pylori infection (sensitivity, 40.3%; positive predictive value, 39.7%) and was observed in 27/68 (39.7%) H pylori positive patients and in 40/400 (10%) H pylori negative patients. There was a significant increase in grade of inflammation, activity, atrophy, number of lymphoid follicles and H. pylori density on histologic evaluation in H pylori positive patients with NG than other groups. Conclusion: Nodular gastritis has a poor prediction for H. pylori infection in children. Gastric biopsies should always be obtained during endoscopy in children to establish the H pylori infection. H. pylori infection in children with NG identifies cases with severe gastritis and marked bacterial colonization. [ABSTRACT FROM AUTHOR]

Segmental dilatation of the ileum causing blind loop syndrome was seen in a 6-year-old boy presenting with nonspecific symptoms and severe malnutrition. Barium meal was characteristic. Resection of the affected segment and an end-to-end anastomosis was curative and restored normal bowel function. Clinicians' awareness of this entity would help in appropriately managing such cases. [ABSTRACT FROM AUTHOR]

Enteroaggregative Escherichia coli (EAEC) is an important diarrhoeal pathogen causing diseases in multiple epidemiological and clinical settings. In developing countries like India, diarrhoeal diseases are one of the major killers among paediatric population and oddly, few studies are available from Indian paediatric population on the variability of EAEC virulence genes. In this study, we examined the distribution of plasmid and chromosomal-encoded virulence determinants in EAEC isolates, and analysed cytokines response generated against EAEC with specific aggregative adherence fimbriae (AAF) type in duodenal biopsies using in vitro organ culture (IVOC) mimicking in vivo conditions. Different virulence marker combinations among strains were reflected as a function of specific adhesins signifying EAEC heterogeneity. fis gene emerged as an important genetic marker apart from aggA and aap. Further, EAEC infection in IVOC showed upregulation of IL-8, IL-1ß, IL-6, TNF-α and TLR-5 expression. EAEC with AAFII induced significant TLR-5 and IL-8 response, conceivably owing to more pathogenicity markers. This study sheds light on the pattern of EAEC pathotypes prevalent in North Indian paediatric population and highlights the presence of unique virulence combinations in pathogenic strains. Thus, evident diversity in EAEC virulence and multifaceted bacteria-host crosstalk can provide useful insights for the strategic management of diarrhoeal diseases in India, where diarrhoeal outbreaks are more frequent. [ABSTRACT FROM AUTHOR]

Introduction: Supracondylar fractures of the humerus are the commonest upper limb fractures in children, accounting for up to 70% of all pediatric elbow fractures. Supracondylar fractures of the humerus can be managed in outpatient setting but are often complicated by neurovascular injury. Methods: Retrospective study including 187 patients who had presented with supracondylar fracture of humerus with 47 neurovascular injuries during the period of July 2007 to June 2011. Out of 142 patients with Gartland type III fracture 107 underwent immediate open reduction, exploration and internal fixation. Results: Vascular injury is commonly associated with type II supracondylar fracture with posterior displacement. Twenty two patients had vascular injury and all of them had satisfactory outcome after surgery. Conclusion: A careful clinical evaluation, urgent surgical treatment and adequate fracture reduction can prevent lifelong handicap. [ABSTRACT FROM AUTHOR]

Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. This study was performed on Indian CF patients (n = 50) to investigate the spectrum of mutations in the CFTR gene and their association with intragenic and extragenic marker haplotypes. We report identification of 14 previously known and eight novel mutations, namely 3986-3987delC, 876-6del4, 1792InsA, L69H, S158N, Q493L, I530L and E1329Q. The frequency of delta F508 was found to be 27%. Absolute linkage between delta F508 and the KM.19-GATT-TUB9-M470V-T854T haplotype (2-2-1-1-1) predicts a relatively recent appearance of delta F508 in Indian CF patients. Low frequency of delta F508 mutation and detection of eight novel and thirteen rare mutations reflect a heterogeneous spectrum of mutations in Indian CF patients. Failure to detect mutations in 34% of alleles indicates the possible presence of gross deletions involving one or more exons or may indicate the location of the molecular defects in either the noncoding parts of the gene or in the promoter region, which warrants analysis of those regions. [ABSTRACT FROM AUTHOR]

Background: Neonatal deaths in developing countries make the largest contribution to global mortality in children younger than 5 years. 90% of deliveries in the poorest quintile of households happen at home. We postulated that a community-based participatory intervention could significantly reduce neonatal mortality rates.Methods: We pair-matched 42 geopolitical clusters in Makwanpur district, Nepal, selected 12 pairs randomly, and randomly assigned one of each pair to intervention or control. In each intervention cluster (average population 7000), a female facilitator convened nine women's group meetings every month. The facilitator supported groups through an action-learning cycle in which they identified local perinatal problems and formulated strategies to address them. We monitored birth outcomes in a cohort of 28?931 women, of whom 8% joined the groups. The primary outcome was neonatal mortality rate. Other outcomes included stillbirths and maternal deaths, uptake of antenatal and delivery services, home care practices, infant morbidity, and health-care seeking. Analysis was by intention to treat. The study is registered as an International Standard Randomised Controlled Trial, number ISRCTN31137309.Findings: From 2001 to 2003, the neonatal mortality rate was 26.2 per 1000 (76 deaths per 2899 livebirths) in intervention clusters compared with 36.9 per 1000 (119 deaths per 3226 livebirths) in controls (adjusted odds ratio 0.70 [95% CI 0.53-0.94]). Stillbirth rates were similar in both groups. The maternal mortality ratio was 69 per 100000 (two deaths per 2899 livebirths) in intervention clusters compared with 341 per 100000 (11 deaths per 3226 livebirths) in control clusters (0.22 [0.05-0.90]). Women in intervention clusters were more likely to have antenatal care, institutional delivery, trained birth attendance, and hygienic care than were controls.Interpretation: Birth outcomes in a poor rural population improved greatly through a low cost, potentially sustainable and scalable, participatory intervention with women's groups. [ABSTRACT FROM AUTHOR]

This paper presents a comparative prospective study of three modalities of surgical treatment for extrahepatic portal hypertension in children: central splenorenal shunt after splenectomy (CSS), side-to-side lienorenal shunt (SSLR) without splenectomy, and splenectomy and gastroesophageal devascularization (SGD). In an 18-month period, 27 procedures were performed: 10 CSS, 10 SSLR, and seven SGD. The outcomes were evaluated by fall in portal pressures, hematological parameters, shunt patency, splenic regression, and disappearance of esophageal varices. All three procedures were comparable in the fall of portal pressure after surgery. The average blood loss and operating time were statistically significant in favor of SSLR compared with CSS. At 3-month follow-up, shunt patency was confirmed by duplex Doppler study in all the patients in the SSLR group and in nine out of 10 patients in the CSS group. In the CSS and SGD groups, hypersplenism resolved in all the patients. In the SSLR group, blood counts improved in only five out of eight affected children. No patient re-bled during a follow-up of 3-5 years. There were no cases of hepatic encephalopathy or overwhelming postsplenectomy sepsis. In conclusion, CSS is useful when there is a large spleen, severe hypersplenism, and a shuntable splenic vein. SSLR is suitable when there is only mild splenomegaly, mild hypersplenism, and a shuntable splenic vein. Splenectomy and devascularization is the choice when there is no shuntable splenic vein. [ABSTRACT FROM AUTHOR]

PEUTZ­JEGHERS POLYPOSIS WITH ENTERITIS CYSTICA PROFUNDA--A DIAGNOSTIC PITFALL Nandita Kakkar, MD, and R. K. Vasishta, MD, FRC Pathol. u Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India Ujjal Poddar, MD, DNB, DM, and B. R. Thapa, MD u Department of Pediatric Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India CLINICAL HISTORY A10-year-old female childpresentedwith historyof o-and-onabdominalpain present for 2 years.The pain had become more frequent and colicky in the last 15 days. It was present in the hypogastrium and periumbilical area.There was history of constipation and an occasional episode of fresh blood with stools. She was the secondoftwinsandthe othertwin sister wasasymptomatic. Onexamination,mela- nosis was seen on the lips, oral mucosa, and tips of angers and toes since 1 year of age. Her mother had similar symptoms at15 years of age for which she underwent an abdominal surgery. A part of the small bowel was resected and it was said to be studded with a few polyps. No written document or histopathology report is avail- able.The mother has been asymptomatic ever since.The mother and the younger brotheralsohadoralmelanosis.Thebrother,however,hasbeenasymptomaticsofar. On examination of the indexcase there was a mass present inthe periumbilical area measuring 5Â3 cm. Reducible intussusception was present. Resection of the small intestine at two places was done with end-to-end anastomosis.Two segments (18 cm each) of the small intestine were resected,9 inches from the duodenojejunal junction and at the jejunoilial junction. Both segments of the small intestine con- tained two polyps each.The largest polyp (5 cm in diameter) was seen 9 cm distal to the duodenojejunal junction, was pedunculated, and there were small cysts with mucoid material present at all levels of the wall including the serosa (Figure 1). The other three polyps were sessile and ranged from 2 to 4 cm in diameter.They too showed small cystic spaces with mucoid material. Microscopically the polyps revealed a classic morphology. Normal small- intestinal glands rested on a branching smooth muscle framework (Figure 2). There was no evidence of dysplasia.Transmural herniation of the mucosal glands admixed with smooth muscle öbers and lamina propria was seen until the serosa (Figure 3). Apart fromthis there were cystically dilated spaces (0.2-1 cm diameter) Address correspondence to Dr. Nandita Kakkar, MD, Assistant Professor, Department of Histopathology, PGIMER, Chandigarh-160012, India. E-mail: nan@glide.net.in Pediatric Pathology and Molecular Medicine, 22: 369-373, 2003 Copyright #Taylor & Francis Inc. ISSN:1522-7952 print /1523-4525 online DOI:10.1080/15227950390223703 369 present in the mucosa, submucosa, and serosa, containing Loating benign epithelium, mucin, eosinophilic granular debris, and necrotic cells. Diagnosis: Peutz-Jeghers (PJ) polyposis with enteritis cystica profunda (ECP). DISCUSSION Peutz-Jeghers (PJ) syndrome is an autosomal dominant disorder character- ized by mucocutaneous pigmentation and multiple hamartomatous polyps [1,2]. FIGURE 2. Peutz Jeghers polyp normal small-intestinal glands resting on a branching smooth muscle fra- mework. H&E, Â140. FIGURE 1. Part of the small intestine showing a large pedunculated polyp. Small mucoid cysts canbe seen on the serosal aspect. 370 N. Kakkaret al. [ABSTRACT FROM AUTHOR]