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Long-duration spaceflight is known to cause immune dysregulation in astronauts. Biomarkers of immune system function are needed to determine both the need for and effectiveness of potential immune countermeasures for astronauts. Whereas plasma cytokine concentrations are a well-established biomarker of immune status, salivary cytokine concentrations are emerging as a sensitive indicator of stress and inflammation. For this study, to aid in characterizing immune dysregulation during spaceflight, plasma and saliva cytokines were monitored in astronauts before, during and after long-duration spaceflight onboard the International Space Station. Blood was collected from 13 astronauts at 3 timepoints before, 5 timepoints during and 3 timepoints after spaceflight. Saliva was collected from 6 astronauts at 2 timepoints before spaceflight, 2 timepoints during and 3 timepoints following spaceflight. Samples were analyzed using multiplex array technology. Significant increases in the plasma concentration of IL-3, IL-15, IL-12p40, IFN-α2, and IL-7 were observed during spaceflight compared to before flight baseline. Significant decreases in saliva GM-CSF, IL-12p70, IL-10 and IL-13 were also observed during spaceflight as compared to compared to before flight baseline concentrations. Additionally, plasma TGFβ1 and TGFβ2 concentrations tended to be consistently higher during spaceflight, although these did not reach statistical significance. Overall, the findings confirm anin-vivohormonal dysregulation of immunity, appearing pro-inflammatory and Th1 in nature, persists during long-duration orbital spaceflight. These biomarkers may therefore have utility for monitoring the effectiveness of biomedical countermeasures for astronauts, with potential application in terrestrial research and medicine.

Objectives: Our study was aimed at finding a definitive treatment protocol for the management of sudden sensorineural hearing loss (SSNHL) and to study the prognostic factors affecting it. Methods: This randomized clinical study was conducted on a total of 150 patients. All patients older than 10 years and presenting within 15 days of experiencing the symptom of SSNHL and with no known etiology were included. Patients were divided into 2 groups. In group I patients, we administered systemic steroids (injection dexamethasone 3 days, followed by oral deflazacort for 6 days) with liquid glycerol; and in group II, we administered systemic steroids alone (injection dexamethasone 3 days, followed by oral deflazacort for 6 days). The total time for which the treatment was instituted was 9 days and patients were assessed on the basis of their pure tone audiogram and speech discrimination score done at days 0, 3, 7, 21, and 42. Results: There were 77 males and 73 females. Vertigo ( P value < .00) and diabetes mellitus ( P value < .001) had a negative prognostic influence on the recovery rate in both the groups. The comparison revealed that group I (DG) in which patients received injection dexamethasone with oral glycerol had a higher recovery rate of 86.7% as compared to group II (D) patients, in which patients received injection dexamethasone alone (recovery rate = 48%; P = .000 highly significant). Conclusions: Vertigo and diabetes mellitus play a negative role in the recovery of SSNHL. The novel treatment protocol we used in group I patients that is liquid glycerol and systemic steroids was significantly better and effective in treating SSNHL as compared to the group II treatment protocol of systemic steroids alone. Hence, we concluded that SSNHL is treatable that too with a good recovery rate.

Introduction: Union of fracture is a complex process involving many systemic as well as local factors. Disturbance in any of these factors may lead to failure of process of union. This non-union is associated with increased morbidity, pain and functional disability. Autologous platelet injection at local site has been reported to be one of the effective measures in managing the cases of fracture of long bones complicated by non-union. We conducted this prospective study to know the effectiveness of autologous platelet injection at the fracture site in cases of fracture of long bones complicated by non-union. Materials and Methods: This was a prospective interventional study comprising of 30 cases of fracture of long bones complicated by non-union. The patients were included in this study on the basis of a predefined inclusion and exclusion criteria. The patients with established nonunion after fracture femur, tibia, humerus, radius and ulna were included in this study. Patients who were treated either by, by internal fixation, bone grafting or conservatively were added in this study. Imaging was done by X-rays and if needed by computerized tomography. Imaging was done till definite evidence of union was obtained. Results: Out of 30 cases there were 18 males and 12 females with a M:F ratio of 0.66. The most common bones involved were femur (60%), tibia (16.67%) and humerus (16.67%). Combined fractures of Radius and Ulna were seen in 3 (10 %) patients. The mechanism of injury was Road traffic accidents (66.66%) followed by direct blow and fall from height. All patients initially were treated conservatively or by surgery depending upon type of fractures. Non-union of fractures were treated by autologous platelet injection. All fractures showed radiological evidence of union within 4 months of treatment. Conclusion: Autologous platelet injection at local site is an effective management strategy in patients of fracture of long bones complicated by non-union. A non-infected site is the pre-requisite of this treatment.

Simian varicella virus (SVV) infection of non-human primates is the counterpart of varicella zoster virus (VZV) infection in humans. To develop non-invasive methods of assessing SVV infection, we tested for the presence of SVV DNA in saliva, as has been documented in human VZV infection, and in buccal cells to determine whether epithelial cells might provide a more reliable source of material for analysis. Five rhesus macaques intratracheally inoculated with SVV all developed varicella with viremia and macular-papular skin rash in 1-2 weeks, which resolved followed by establishment of latency. DNA extracted from longitudinal blood peripheral blood mononuclear cells (PBMCs), saliva and buccal samples collected during acute infection and establishment of latency were analyzed by real-time qPCR. After intratracheal inoculation, viremia was observed, with peak levels of 101-102 copies of SVV DNA in 100 ng of PBMC DNA at 4 and 7 days post inoculation (dpi), which then decreased at 9-56 dpi. In saliva and buccal cells at 7 dpi, 101-104 copies and 101-105 copies of SVV DNA in 100 ng of cellular DNA, respectively, were detected in all the five monkeys. At 9 dpi, saliva samples from only two of the five monkeys contained SVV DNA at 102-103 copies/100 ng of saliva DNA, while buccal cells from all five monkeys showed 100-103 copies of SVV DNA/100 ng of buccal cell DNA. Similar to viremia, SVV DNA in saliva and buccal cells at 11-56 dpi was lower, suggesting clearance of viral shedding. SVV DNA levels were generally higher in buccal cells than in saliva. Our findings indicate that SVV shedding into the oral cavity parallels acute SVV infection and underscore the relevance of both saliva and buccal cell samples to monitor acute varicella virus infection.

Coblation is a novel technology and has a wide application in the field of otorhinolaryngology. We conducted a randomized, noncontrolled study to compare the effectiveness of 2 types of wands used for turbinoplasty for nasal obstruction due to inferior turbinate hypertrophy. Reflex Ultra and Turbinator wands were compared on a total of 150 patients. These patients were divided into a group of 75 patients each in a randomized manner. Results were compared based on the visual analog scale, and objective assessment was done on the basis of endoscopic assessment, that is, Nasal Endoscopic Score (NES). Assessment was done on postoperative day 7, first month, third month, and first year. Both groups demonstrated significant and similar results in long term, but an immediate improvement at 1 week was seen in the Turbinator group. Hence, we conclude that coblation turbinoplasty is an effective technique for turbinate reduction and both wands are equally effective in long term. However, Reflex Ultra has the advantage of mucosal preservation and minimal morbidity, and Turbinator has the advantage of immediate relief in nasal symptoms.

India has taken a policy decision to move over to electric vehicles as the major mode of transportation in the country by the year 2030. This paper presents a review of the areas which the planning for introducing EVs on a large scale needs to cover. Specific aspects relating to the different areas like power generation, distribution, manufacturing, service, recycling, human resource training, financing is covered in brief. Possible initiatives to be taken bythe government to meet the planned objectives are also indicated.

The goal of this study is sustainable development of energy resources by gradual shift from fossil fuel based transportation system to electrically operated transportation system. India is currently ranked 2nd in population index hence requirement of any resource is huge if we consider the size of the population. There is a need for preservation of non-renewable energy resources. India currently ranks number 3 in list of oil importing countries only behind US and China and it is the single most reason for deficit of balance of payment account. It is evident we cannot stop the usage of these resources but can bring substitutes so that the pressure on these resources can be released. This paper critically analyzes the challenges which can be faced in India on transition from fossil fuel based to EV's it also throws light on possible solutions to the challenges along with the role of Indian government in this matter.

Summary Recent experimental data indicate a pathogenic role of complement activation in congestive heart failure (CHF). The aim of this study was to evaluate contact and complement systems activation in patients hospitalized for an acute episode of CHF. Forty-two of 80 consecutive patients admitted at our hospital with confirmed diagnosis of acute CHF were enrolled. They underwent blood sampling within 24 h from admission (T0) and at clinical stability (T1). Patients were stratified for ejection fraction (EF) based on echocardiographic test. We measured plasma levels of C3, C4, sC5b-9 and cleaved high molecular weight kininogen (contact activation marker). At T1, C3 levels increased significantly compared to T0 (97 ± 2 versus 104 ± 3% of total pooled plasma, P < 0·01). Classifying patients according to EF, only patients with preserved EF presented a significant increase of C3 from T0 to T1 (99 ± 3 versus 108 ± 4%, P = 0·03). When the sample was stratified according to clinical outcome, C3 (98 ± 3 versus 104 ± 4%, P = 0·03) and sC5b-9 levels (204 ± 10 versus 230 ± 11 ng/ml, P = 0·03) were increased in patients who had positive outcome after hospitalization. CHF patients with preserved EF and positive outcome after hospitalization showed higher levels of sC5b-9 in the T1 period compared with T0 (211 ± 14 versus 243 ± 14 ng/ml, P = 0·04). Our results suggest that the complement system reacts differently if CHF occurs with preserved or reduced EF. This finding is interesting if we consider the difference in epidemiology, pathogenesis and possible therapeutic approaches of these two clinical entities.

The role of oxidative-stress as a mechanism of hepatotoxicity caused by combination of isoniazid (INH) and Rifampicin (RMP) was investigated in young growing rats. A successful model of hepatotoxicity was produced by giving 50 mg/kg/day each of INH and RMP in two weeks. Liver showed type II hepatocellular changes (microvesicular fat deposition) with mild portal triaditis. The glutathione and related thiols were significantly decreased in both blood and liver tissues with combination of INH and RMP treatment. Superoxide dismutase, glutathione peroxidase, catalase and glutathione-S-transferases with CDNB and DCNB as substrates were decreased in the combination treated group. Glutathione reductase, glutathione-S-transferase with ethacrynic acid as substrate and lipid peroxidation exhibited a significant increase with treatment. The altered profile of antioxidant enzymes with increased lipid peroxidation indicated the enhanced oxidative-stress in combination of INH and RMP treatment. All the findings are faithfully reflected in the blood tissue except superoxide dismutase which showed significant enhancement in this tissue. INH and RMP hepatotoxicity is thus appeared to be mediated through oxidative-stress.

Acid-reducing drugs can cause increased growth of microbes, including fungus, because of high gastric pH. Our purpose was to evaluate the occurrence of mycotic infection in patients with duodenal ulcer on anti-ulcer therapy and to compare the effects of cimetidine, famotidine, and omeprazole. Eighty patients with duodenal ulcer (62 males and 18 female patients, 16-65 years old) were evaluated for mycotic infection before and after 6 weeks of therapy (cimetidine, 20 patients; famotidine, 40 patients; omeprazole, 20 patients). Mycotic infection was diagnosed by endoscopic biopsy from the ulcer edge subjected to smear, culture, and histopathology and by endoscopic brush samples and gastric aspirate. On the basis of these studies, patients were categorized as having no fungal growth, saprophytic growth, or significant fungal growth. Thirty-five (43.8%) patients had evidence of fungus before ulcer therapy, and 16 of the 35 (20%) had significant fungal growth. The fungal isolation rate was higher in older patients (and = 45 years of age) and in those with an ulcer sizeand = 2 cm. While there was no significant increase in the total number of patients with evidence of fungus after therapy (n = 36), there was a significant increase in those with significant growth (n = 27, p0.05) compared with pretreatment status. We found that posttreatment gastric pH ofand = 4 was associated with a higher fungal positivity rate (59.4%) than pH values4 (32.4%, p0.05). However, neither the type of drug used nor the response in terms of ulcer healing correlated with the presence of fungus. Regardless of the type of drug used, acid-reducing therapy is associated with increased significant fungal growth.

People are now talking of organic agricultural inputs for sustainable agriculture. The poor production/stagnant production with poor soil health is because of low application of organic manures and crop residues. To mitigate these harmful effects, the concept of organic farming has emerged. It is a production system, which favours maximum use of organic materials like crop residues, FYM, compost, green manure, oil cakes to improve soil health. The analysis indicated that knowledge percentage about organic manures and crop residues was found 65.57 per cent. Knowledge of farmers among various organic manures and crop residues aspects, the ‘time and quantity of farm yard manure required’ ranked first.

Watershed programme is an integrated one that addresses the problems in rain fed areas. It addresses the environmental and ecological problems like deforestation, over-utilization of water and most important point is that it seeks to convert unsustainable agriculture to sustainable agriculture. Among all the beneficiaries, the most benefited under watershed programme are the farmers. The study was conducted in purposively selected two districts Bhiwani and Yamunanagar of Haryana state. Bhaganwala and Sawad villages from Bhiwani and Dhanauraand Salapur villages from Yamunanagar were selected randomly as the watershed villages. The study revealed thatlow level of awareness regarding programme benefits, lack of clear understanding of project objectives, irregularity in payment of wages, decision made at higher level without consulting people and lack of demonstration were the major constraints perceived by the respondents in the implementation of Integrated Watershed Management Programme.

A 7-year-old child had unusual manifestation of cryptococcosis; liver and lymph node involvement predominated. There was evidence of cryptococcal hepatitis, extrahepatic biliary obstruction, and subsequent cirrhosis of the liver. Despite widespread dissemination, underlying immune disturbance was not evident. The patient was treated with two courses of amphotericin and 5-flucytosine.

We have evaluated 169 patients with portal hypertension receiving endoscopic variceal sclerotherapy in order to assess the predisposing factors, clinical profile, and treatment response of sclerotherapy-induced esophageal strictures. Of the 129 patients included in the final analysis, 20 (15.5%) developed persistent esophageal stricture. No significant difference was found with respect to age, nature of sclerosant (absolute alcohol, ethanolamine oleate, or sodium tetradecyl sulfate), etiology of portal hypertension, Child's class, initial variceal score, or intensity of sclerotherapy schedule between the patients who developed strictures and those who did not. However, female sex (P less than 0.01) and persistent esophageal ulceration (P less than 0.05) did predispose to stricture formation. Sclerotherapy-induced strictures presented with a variable grade of dysphagia, were always solitary, and were localized to the lower end of esophagus. Most of these could be dilated rapidly using Eder-Puestow metal olives (3.15 +/- 0.80 dilatation sessions per patient). Stricture formation did interrupt an effective sclerotherapy program but only temporarily, and successful variceal obliteration could be obtained after stricture dilatation.

Ten patients with tropical sprue (TS) and 10 with irritable bowel syndrome (IBS) as controls were studied to characterize the immunocytes in the jejunal mucosa. IgA cells numbered 516,155 +/- 48,715 cells/mm3 in TS and 729,308 +/- 146,011/mm3 in the IBS patients. IgG cell counts were 28,885 +/- 8,081/mm3 in TS and 10,615 +/- 4,100/mm3 in IBS; IgM counts were 170,729 +/- 25,015/mm3 in TS and 169,253 +/- 45,353/mm3 in IBS. A positive correlation was present between IgM-bearing plasma cells and corresponding serum immunoglobulins (r = +0.71; p less than 0.05). No correlation was evident between the different immunocytes (IgA, IgG, and IgM) and the duration of illness, serum albumin, and tests for absorption of fat, B-12, and D-xylose (p greater than 0.05). The gut immunocytes expressed in absolute numbers were higher in our controls and TS patients than reported in Western populations.

Esophageal intramural pseudodiverticulosis (EIP) is a rare disease, characterized by multiple, small flask-shaped diverticula in the esophageal wall, and best demonstrated on single-contrast barium examination. Though the condition is often associated with reflux esophagitis, Candida esophagitis, and esophageal dysmotility, corrosive-acid injury is not a commonly recognized cause. In a radiological study involving 59 patients with sequelae of corrosive-acid injury of the upper gastrointestinal (GI) tract, evaluated over a 5-year period, 14 cases (23.7%) of EIP were found. Esophageal stricture was a constant association; the diverticula tended to involve either the entire length of the stricture or its upper part. There was, however, no correlation between the length of the stricture and number of diverticula (p greater than 0.05). Endoscopic dilatation resulted in relief of dysphagia, and the diverticula regressed in number of disappeared altogether. Our experience suggests that EIP is a common sequelae of esophageal acid injuries, and that diverticula tend to form at the site of initial contact between acid and susceptible esophageal mucosa. Stricture dilatation leads to reduction or total disappearance of the diverticula.

In order to assess the comparative efficacy and safety of endoscopic injection sclerotherapy in patients with portal hypertension of different etiology, i.e., cirrhosis, non-cirrhotic portal fibrosis, and extrahepatic portal venous obstruction, 87 patients with variceal bleeding were initiated on sclerotherapy using absolute alcohol. There was no significant difference in the success rate of sclerotherapy as well as in the number of sessions and volume of alcohol required for variceal obliteration between the three groups. Major complications included esophageal ulcers (30.0%), symptomatic strictures (18.6%), and interval re-bleed (17.1%) with similar complication rates for the three groups (p greater than 0.05). There was no difference between patients with Child's class A cirrhosis compared with classes B and C together with respect to efficacy and complications of sclerotherapy. Fifty patients (25 cirrhosis, 11 non-cirrhotic portal fibrosis, and 14 extrahepatic portal venous obstruction) with complete variceal obliteration were followed up for a mean period of 16.5 months. Sixteen patients (32%) had variceal recurrence, but bleeding due to recurrent varices occurred in only one case. There was no difference among the three groups for overall variceal recurrence, although recurrence tended to be somewhat later in extrahepatic portal venous obstruction (9.4 +/- 4.0 months) compared with that in cirrhosis (5.1 +/- 3.6 months) and non-cirrhotic portal fibrosis (4.8 +/- 2.6 months).

We prospectively evaluated the role of fiberoptic esophagogastroduodenoscopy in the management of 81 patients with corrosive ingestion. A total of 381 endoscopic examinations were performed: 88 within 96 hours following corrosive ingestion, 108 between the third and ninth week, and 185 during the period of follow-up after bougie dilation of esophageal strictures. The customary endoscopic classification of burns (grades 0 to 3) was modified by subdividing grade 2 burns into 2a and 2b, and grade 3 burns into 3a and 3b for prognostic and therapeutic implications. There was no significant correlation between oropharyngeal and upper gastrointestinal tract injury. Early major complications and deaths were confined to patients with grade 3 burns. All patients with grade 0, 1, and 2a burns recovered without sequelae. The majority of patients (71.4%) with grade 2b injury and all survivors with grade 3 injury developed esophageal or gastric cicatrization, or both, which needed endoscopic or surgical treatment. There were no complications related to endoscopy. We conclude that early endoscopy is not only a safe, reliable, and accurate diagnostic tool in such patients, but also is of crucial importance in management and prognosis.

Study design Observational study. Purpose To correlate lumbar lordosis and lumbar core strength in information technology (IT) professionals. Overview of literature IT professionals have to work for long hours in a sitting position, which can affect lumbar lordosis and lumbar core strength. Methods Flexicurve was used to assess the lumbar lordosis, and pressure biofeedback was used to assess the lumbar core strength in the IT professionals. All subjects, both male and female, with and without complaint of low back pain and working for two or more years were included, and subjects with a history of spinal surgery or spinal deformity were excluded from the study. Analysis was done using Pearson's correlation. Results For the IT workers, no correlation was seen between lumbar lordosis and lumbar core strength (r=-0.04); however, a weak negative correlation was seen in IT people who complained of pain (r=-0.12), while there was no correlation of lumbar lordosis and lumbar core in IT people who had no complains of pain (r=0.007). Conclusions The study shows that there is no correlation of lumbar lordosis and lumbar core strength in IT professionals, but a weak negative correlation was seen in IT people who complained of pain.

156 patients of vasomotor rhinitis were treated with cryodestruction of nasal branches of vidian nerve. These patients were divided into two groups A and B. In Group ‘A’ intermittent partial nasal obstruction-was the main symptom (82 patients) and in Group ‘B’ watery nasal discharge was the predominant symptom (74 patients).

The aim of this prospective randomized controlled study was to find a safe and effective sclerosing solution for endoscopic injection sclerotherapy in the treatment of esophageal variceal bleeding. Ninety consecutive patients with portal hypertension and variceal bleeding were randomized to receive sclerotherapy with 5% ethanolamine oleate, 3% sodium tetradecyl sulfate, or absolute alcohol at an interval of 3 weeks. Sixty-four patients who received more than three sessions were analyzed. All three agents were found to have similar success and complication rates (p greater than 0.05). However, absolute alcohol required fewer sessions (p less than 0.01) and lesser amounts (p less than 0.01) to produce successful variceal sclerosis and had the added advantage of low cost and easy availability.

Tuberculosis involvement of pharynx is a rare entity. Whenever encountered, it is usually associated either with pulmonary tuberculosis or cervical lymphadenopathy. Isolated involvement of posterior oropharyngeal wall tuberculosis is presented in this paper.

40 MeV Si channeling studies have been performed on the strained In0.1Ga0.9As layer grown on GaAs substrate using Molecular Beam Epitaxy (MBE). Three samples with different layer thickness have been investigated in this study. Channeling experiment has been fully automated so as to minimize the radiation damage. Suitable software and hardware have been developed to control the precision goniometer using the CAMAC (Computer automation and control) based data acquisition system. In low energy He channeling, strain measurements are often misled by the beam steering effects caused due to broad critical angles if the strain is very low. Such effects can be minimized by increasing the probing beam energy as the channeling critical angle is inversely proportional to the square root of the incident energy. Hence small angular misalignments can also be resolved in the high energy channeling experiments. Heavy ions are chosen so as to have reasonably high scattering cross‐section and also to avoid the nuclear reactions.

Retropharyngeal cystic hygroma is a rare condition and needs to be differentiated from common clinical condition of retropharyngeal abscess. Two such cases are discussed in the present report.

We describe a modified ultrasound-guided transgastric drainage technique for pancreatic pseudocysts. Using a water-filled stomach to improve visualization, we have successfully drained pseudocysts in ten patients. This report also describes the use of a stiffening cannula to assist transgastric catheter placement. We emphasize the value of constant real-time tracking of the dilator and guidewire to ensure correct positioning of the drainage catheter.

Background: About a third of the world\'s countries still lack rubella vaccination programs, so the virus remains common in many developing nations including India. Aims & Objective: The present cross-sectional study was carried out to study awareness, vaccination coverage, reasons for not receiving vaccine and the outlook of unvaccinated subjects for future vaccination against rubella. Material and Methods: It was conducted among 202 women medical professionals from a tertiary care and teaching hospital of Ujjain district in central India. Results: The study revealed that though the awareness about rubella was high (94.1%) vaccination coverage was only 42.1%. The commonest reasons quoted for non-vaccination were related to their non-seriousness about the issue. Sources of information for rubella vaccination were their gynaecologist/doctor (62.3%) or medical books or literature (36.5%) and not any mass media. Conclusion: The study delineates the difference in the knowledge of rubella and vaccination status in medical professionals. The study shows that the awareness alone cannot influence the attitude of the people but better strategies are needed for that.

Fifty patients with idiopathic ulcerative colitis--25 with acute exacerbation of the disease (Group I) and 25 in quiescent phase (Group II)--were studied. None of the patients had a history of recent exposure to antimicrobial drugs or hospitalization. Evidence of infection with protozoal and bacterial agents and/or presence of Clostridium difficile toxin was demonstrated in eight (32%) patients in group I and one (4%) patient in group II (group I vs. group II, p < 0.05; chi 2 test with Yate's correction). In five of the six patients with demonstrable Clostridium difficile toxin in the stool, one patient with Entamoeba trophozoites, and another with Salmonella infection, the exacerbation responded clinically and endoscopically to specific antimicrobial therapy. Another two patients who had Entamoeba histolytica cysts in the stool had no change in their clinical status with metronidazole. We conclude that infectious agents are responsible for some of the exacerbations in patients of ulcerative colitis in a tropical country like India, where careful microbiologic examination is in order in every acute exacerbation of this disease. This contrasts with the findings in developed countries.

The aim of the study was to assess the accuracy of fibronectin, a glycoprotein, for the diagnosis of malignant ascites and to compare it with conventional parameters. Ascitic fluid samples from 50 patients, 25 with intra-abdominal malignancy and 25 without it were analysed for total protein concentration, fluid/serum protein ratio, glucose concentration, leucocyte count, pH, fibronectin concentration (by ELISA) and for malignant cell cytology. Twenty-two of the 25 patients with ascites and intra-abdominal malignancy had documented peritoneal metastases in group A. The 25 patients with non-malignant ascites constituted group B. Mean values of ascitic fluid fibronectin, for groups A and B were 538 +/- 46 micrograms/mL and 60 +/- 4.92 micrograms/mL, respectively (P less than 0.001). Within the group with malignant ascites, patients who had positive malignant cytology (n = 12) exhibited a significantly higher ascitic fluid fibronectin concentration than patients with negative cytology (P less than 0.05). While mean ascitic fluid protein concentration showed a significant difference (P less than 0.01) between the two groups, there was no difference in respect to ascitic fluid pH, glucose concentration and leucocyte count. Malignant cell cytology was positive in 54.5% of group A patients with no false positive report in group B. The diagnostic accuracy for differentiating malignant from non-malignant ascites was 100% for a fibronectin value of greater than or equal to 110 micrograms/mL as compared with 78.7% for ascitic fluid protein concentration greater than or equal to 0.5 g/dL, 57.4% for leucocyte count greater than or equal to 1000/mm3, 59.6% for pH less than 7.45 and 78.7% for malignant cell cytology.

We describe placement of a double pigtail cystogastric stent in 5 patients with pancreatic pseudocyst using real-time ultrasonography and fluoroscopy as guidance techniques. This was done as a two-step procedure. First, a transgastric drainage catheter was placed for a period of six days. All the patients continued to have high drainage output and the cyst size decreased, as seen sonographically. Simultaneous barium meal and sinogram were then done to measure the distance between the posterior gastric wall and the cyst. A polyurethane double pigtail stent of appropriate size was then introduced to achieve cystogastric drainage. The cyst resolved in all the patients by four weeks to six weeks, when the stent was removed endoscopically. There was no recurrence of pseudocyst during follow-up for 6 months to 13 months. None of the patients suffered any complication. Cystogastric drainage using a double pigtail stent is an easy and safe alternative to surgical cystogastrostomy.

Earlier studies have described a profile of peptic ulcer different in developing and developed countries. In a prospective endoscopic study in India over 5 years and 8 months involving 5,948 patients with upper gastrointestinal symptoms, we detected peptic ulcers in 1,188. There were 920 patients with duodenal ulcer (DU), 185 with gastric ulcer (GU), and 83 with combinations of the two. The male to female ratio was 4.2:1. About half the ulcers were in patients age greater than or equal to 40 years. Of the 223 (18.7%) patients with peptic ulcer complications, gastrointestinal bleeding was the most common (12.7%) and gastric outlet obstruction was less common (6.2%). Endoscopic evidence of duodenal bulb deformity was seen in 74.4% of DU patients. A comparison of these results with data from previous Indian studies suggests a changing trend of peptic ulcer with respect to age and sex distribution, the ratio between DU and GU, and complications of peptic ulcer. The profile of peptic ulcer in north India today is similar to that seen in Western countries four to five decades ago. We discuss possible factors responsible for this change.

In a prospective study, 37 consecutive patients with radiation-induced proctosigmoiditis were randomized to receive a four-week course of either 3.0 g oral sulfasalazine plus 20 mg twice daily rectal prednisolone enemas (group I, N = 18) or 2.0 g twice daily rectal sucralfate enemas plus oral placebo (group II, N = 19). The two groups were comparable with respect to demographic features, duration of symptoms, and clinical and endoscopic staging of the disease. Fifteen patients in group I and 17 in group II completed the trial. At four weeks, both groups showed significant clinical improvement (P less than 0.01 for group I and P less than 0.001 for group II) and endoscopic healing (P less than 0.01 for group I and P less than 0.001 for group II). When the two groups were compared, sucralfate enemas showed a significantly better response as assessed clinically (P less than 0.05), although endoscopically the response was not statistically different (P greater than 0.05). We conclude that both treatment regimens are effective in the management of radiation proctitis. Sucralfate enemas give a better clinical response, are tolerated better, and because of the lower cost should be the preferred mode of short-term treatment.

An intranasal encephalocele presenting as a nasal mass in an adult patient is being discussed. CT scan of paranasal sinuses and head was useful in establishing the diagnasis of intranasal encephalocele. The patient was treated by combined ENT and Neuro-Surgical team.

Lymphangioma circumscriptum, a variety of capillary hymphangioma is rarely seen in the oral cavity. We present a case of lymphangioma circumscriptum of right buccal mucosa in an adult patient. The leston was excised completely and mucosal defect was coverd with split thickness skin graft.

A study of 20 patients of laryngeal papillomatosis is presented with an analysis of epidemiological factors, results of surgery and systemic use of levamisole. The youngest patient was 6 months old. 9 out of 20 patients presented with stridor. Involvement of bronchus and lung parenchyma was not seen in any of the cases. Repeated surgical excision (14 on average) were needed in majority of patients to achieve cure. Role of levamisole needs further evaluation.

To the Editor.— Having read with interest, the article by Shah et al, 1 we studied 15 cases of alcoholic cirrhosis (8 cases of Child's C and 7 cases of Child's A category) and 15 age-matched healthy control subjects, to find out the incidence of pericardial effusion. All subjects were male. Alcoholismwas described according to the criteria described before. 2 In each case the diagnosis of alcoholic cirrhosis was established by biopsy and the patients were classified into Child's category according to the criteria of Child and Turcott. 3 Besides clinical examination and blood tests, each patient underwent a chest roentgenogram and electrocardiogram. Two-dimensional echocardiography and an M-mode cardiac study were done in each patient using an echocardiograph (Ultramark 8 [ATL]). Left ventricular function was studied by calculating the ejection fraction, left ventricular end-diastolic volume, and end-systolic volume, using Simpson's rule.4 While Shah et al 1 had used M-mode echocardiography

Anomalous junction of pancreatobiliary ducts (AJPB) is known to be associated with choledochal cyst and gallbladder cancer. This report describes our experience with eight patients with AJPB, six of whom were diagnosed at endoscopic retrograde cholangiography and two at transhepatic cholangiography. Four of the patients with AJPB had an associated congenital choledochal cyst, two had a normal biliary tree and one each had inspissated bile syndrome and cholangiocarcinoma. The last two associations have not been previously described. It is felt that the clinical spectrum of AJPB may unfold further with the widespread use of the cholangiographic techniques.

The clinical records of 162 cases of salivary gland tumours were studied. Parotid gland was the commonest site for origin of tumour (110 cases.) Commonest benign tumour was pleomorphic adenoma (42 cases) and the commonest malignant tumour was mucoepidermoid carcinoma (26 out of 162 cases). The next common tumours were adenoidcystic and undifferentiated carcinoma which constituted 23 and 20 cases respectively. Surgery or surgery with radiotherapy were the main modalities of treatment for the primary tumours. Twenty patients had recurrence within three years after the treatment. These patients were treated with either revision surgery or external radiations. Chemotherapy was given to one patient of soft tissue sarcoma. Twenty nine patients had post-operative complications like facial paralysis, parotid fistula, skin necrosis and Frey’s syndrome.

Ultrasonically guided percutaneous transhepatic biliary drainage was performed for palliative treatment in 31 patients and for pre-operative drainage in 21. The drainage was performed through a right intercostal approach with the ultrasound transducer placed in the midclavicular line without use of any specialized adaptor. No major complications were encountered. The main advantages of ultrasound guided drainage were (1) the rapidness of the procedure, (2) the negligible risk of puncturing blood vessels, and (3) the minimal exposure to radiation.

We have prospectively evaluated 41 patients who ingested acid for location, extent, severity, and outcome of the injury to the upper gastrointestinal tract. The injury was assessed within 36 h of acid intake by endoscopy or surgery, or at autopsy. Symptoms and signs were unreliable in predicting the extent and severity of injury. The degree of burns was classified as follows: grade 0 in 2 patients, grade 1 in 3, grade 2 in 16, and grade 3 in 20. Esophageal injury was seen in 87.8% of the patients, gastric injury in 85.4%, and duodenal injury in 34.1%. All patients with grade 0, 1, and 2a injury recovered without sequelae. Acute complications occurred in 39.1% of the cases, and death in 12.2%. It is significant that all such patients had grade 3 burns. Five of the 8 patients with grade 2b injury and all survivors of grade 3 injury developed esophageal or gastric cicatrization, or both, which subsequently needed endoscopic or surgical treatment. We find that endoscopy is not only the tool of choice for diagnosis in such cases but also aids in deciding upon treatment and prognosis. We conclude that acid injury of the upper gastrointestinal tract is a very serious condition that affects the esophagus and stomach equally and results in high morbidity and mortality.

A case of chloroquine resistant mixed malaria infection is reported. Patient had associated complications: cerebral malaria; glomerulonephritis with renal failure; disseminated intravascular coagulation; gastro intestinal complications of vomiting, diarrhea and melena and pulmonary edema. Response to quinine and other therapeutic measures was good but impairment of renal functions remained for a long period.

We have evaluated the results of endoscopic fine needle aspiration cytology in 50 consecutive cases of suspected malignancy of the esophagus and stomach and compared them with those of forceps biopsy and brush cytology. The diagnostic yield with forceps biopsy, fine needle aspiration, and brush cytology in 46 cases of carcinoma was 88.8%, 89.1%, and 80.4%, respectively. A combination of forceps biopsy and brush cytology gave an accuracy of 93.5% while the addition of fine needle aspiration increased the yield to 100%. This was due to a very high positive yield of fine needle aspiration in infiltrative tumors.

Thirty five cases of laryngotracheal trauma in the age group of 1–72 years are being reported in this study. Unilateral vocal cord palsy was noted in 20 cases and left side was involved more commonly than the right. The extent of the injuries varied from simple haematoma in the ventricle to a completely shattered larynx and avulsion of the trachea. All neck wounds were explored and debrided under general anaesthesia. Surgical exploration of laryngotracheal injuries was directed towards an open reduction and stabilization in position of function. Complications like laryngeal stenosis and permanent tracheostomy can be best avoided, if managed at the earliest.