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The process includes 6 molecules of reactants and 6 new covalent bonds are generated in the presence of a reusable catalyst.

Bone Marrow Necrosis (BMN) is regarded as a rare entity in the aspirates and the trephine biopsies which are obtained from living patients and it is a rare antemortem diagnosis. Usually, BMN is associated with a poor prognosis and it has a 90% association with malignancies (mainly haematological). Its other causes include infections, drugs and other non malignant haematological causes. BMN which occurs due to unknown causes (idiopathic), is very rare. The present case report describes a case of BMN in a 14 year old male child from rural background, who came to the medicine outpatient department of a tertiary care centre in north India, with the complaints of generalized weakness, severe bone pains, especially in the ribcage area and fatigue. His peripheral blood film revealed pancytopaenia. His bone marrow aspiration yielded a watery, sero-sanguinous fluid from 2 different sites. Microscopy revealed "ghost like" haematopoietic cells lying in eosinophilic, proteinaceous material. Bone marrow biopsies from both the sites revealed extensive foci of gelatinous transformation and necrosis. A diagnosis of BMN was rendered. No underlying neoplastic / non neoplastic cause was identified, even after a thorough systematic investigation (haematological/biochemical/ radiological and immunological). Thus, a final diagnosis of BMN due to an idiopathic cause, was finally given. The patient was given supportive treatment, after which he was referred to a higher centre. BMN which arises idiopathically is usually very rare and often precedes the aetiological diagnosis and obscures the diagnosis. Traditionally, the prognoses of the patients with BMN were considered as poor, but with better treatment aids (chemotherapy and supportive treatment), the prognoses of these patients have been found to improve. Vigorous supportive care, along with a disease specific treatment, is the key to its management. This case was worth reporting, as no cause of BMN was elicited in it and we have summarized the signs and symptoms, the associations, haematological and other lab investigations and the role of radiology, which helped in its diagnosis.

Background: The data available about the knowledge of tooth avulsion in Indian school children is minimal. There is a tremendous need to evaluate awareness regarding appropriate emergency measures to be followed after avulsion by them. Therefore, this study was planned. Aim: To assess the knowledge regarding tooth avulsion in athletically active high school children of Chandigarh. Materials and Methods: The sample consisted of 997 (750 boys, 247 girls) school players in the age range of 10–17 years. The participants were interviewed through a standardized questionnaire. Statistical analysis was done by Chi-square test. Results: In cases of participants who knew about tooth avulsion (37.3%), only 38.4% of them were in the opinion to replant the tooth in its socket. More number of males would try to replant the avulsed tooth and in older age group. Almost half of the players would transport the avulsed tooth in paper, plastic or cotton, 28.6% would transport in hand and only 11.9% in tap water. Milk was considered the ideal storage medium by only 4.8% of the participants. Conclusion: More emphasis should be made on organizing educational campaigns which provide education to teachers, parents, and school children regarding appropriate emergency measures to be followed after tooth avulsion.

Randomized trials have shown no survival difference for patients with stage I breast cancer treated with mastectomy versus breast-conserving surgery (BCS) with radiotherapy (RT). RT is recommended after BCS in order to decrease local recurrence and mortality. We sought to evaluate the treatment trends in patients with stage I breast cancer. We used the Surveillance, Epidemiology, and End Results (SEER) database to identify 194,860 women with stage I breast cancer diagnosed from 1988 to 2007. We evaluated factors that were associated surgical treatment and the utilization of RT after BCS. There was a progressive decline in the proportion of patients with stage I breast cancer who were treated with mastectomy from 1998 to 2007. Significant predictors for being treated with mastectomy included single/divorced women (p = 0.007), white race (p

Nasopharyngeal carcinoma (NPC), although rare but does occur in pediatric age group and can present with variable non-specific signs and symptoms. The objective of this report is to emphasize that, because of its rarity, it is not clinically suspected and kept in differential diagnosis of nasopharyngeal mass in children, leading to delayed diagnosis and significant therapeutic implications. We hereby, describe a case of 10 year old boy who presented with bilateral cervical lymphadenopathy and simultaneously developing proptosis of the left eye, which is one of the important rare manifestation of NPC, that creates a diagnostic challenge.

Thyroid lymphoma occurs rarely; constituting approximately 1-5% of all thyroid malignancies. Two cases of thyroid lymphoma are presented herewith. Both the patients were elderly females who presented with a rapidly enlarging anterior neck mass without cervical lymphadenopathy, leading to compressive symptoms like dysphagia, stridor and dyspnoea. Thyroid lymphoma is a great diagnostic and therapeutic challenge which requires high clinical suspicion with rapid and accurate diagnostic modalities to detect it as early recognition of this rare malignancy can lead to timely intervention and avoid morbidity associated with extensive surgery as chemotherapy and radiation are the mainstays of its treatment.

Ovarian cancers are commonly diagnosed gynecological malignancies worldwide. It ranks among the top ten diagnosed cancers and top five deadliest cancers in most countries. However, in spite of this squamous cell carcinoma (SCC) of the ovary is extremely rare. Here, we present a review of the literature along with a case of a 66-year-old postmenopausal female who presented with swelling, pain abdomen with constipation, and weight loss. She was diagnosed with pure (de novo) primary SCC of left ovary. No pre/co-existing ovarian lesion was identified. Despite external radiation and adjuvant chemotherapy, the patient died in 2 months.

Cysticercosis is a common parasitic infection in developing countries involving the central nervous system (CNS), eye, skeletal muscle, and subcutaneous tissue. Solitary intramuscular cysticercosis without CNS involvement is a rare entity. Here, we present a case of solitary cysticercosis involving a rare muscular site without any neurologic or systemic manifestation.

Papillary cystadenomas are rare, histologically distinct lesions that occur in the region of the epididymis and spermatic cord in young adults. Because of the intimate anatomic connection of the spermatic cord with scrotum and tunica vaginalis testis, it is often impossible to decide from which of these anatomic compartments these tumours have arisen. We report a case of 24 year old male with papillary cystadenoma of vas deferens who presented to us with a painless, gradually increasing swelling in the inguinal region.

245 Background: Multiple studies have demonstrated equivalence of single vs. multi-fraction regimens for palliation of uncomplicated bone metastases, but single fraction (SF) radiotherapy (RT) remains under-utilized in the United States. To increase physician and patient awareness of RT options for bone metastases, both AAHPM and ASTRO participated in the “Choosing Wisely” campaign. AAHPM recommended 8 Gy X 1 for uncomplicated bone metastases. ASTRO recommended against routine use of courses > 10 fractions and supported strong consideration for the use of SF RT for patients with limited prognosis or transportation difficulties. To identify possible changes in prescribing patterns following “Choosing Wisely”, we evaluated utilization rates of SF (8 Gy x 1) for treatment of bone metastases via treatment requests submitted for preauthorization over a 3 year period. Methods: A proprietary web-based application (eviti Connect ) enables oncology providers to obtain real time automated precertification for patients insured by payers across the U.S. that utilize the platform. All preauthorization requests for RT of bone metastases were evaluated for the prescription of 8 Gy X 1. The overall rate of SF use was calculated as were quarterly rates within the study period. Results: From 6/1/11-6/30/14 7,524 requests were submitted; 658 were for bone metastases. Overall SF was used in 7.6 % of cases. Prior to Q4 of 2012 no prescriptions for 8 Gy X 1 were used. In 2013 SF was prescribed in 9.6% of cases (30/314): 2.8%, 7.3%, 7% and 20% for Q1, Q2, Q3, and Q4 respectively. During 2014 use of 8 Gy X 1 was 23.9% in Q1 and 19.5% in Q2. Protracted schedules > 10 treatments were prescribed in 31% of cases, but decreased over the study period (from 40% prior to Q4 2012, to 28% in 2013, and to 23% in the first half of 2014). Conclusions: Within this unique dataset of working aged insured patients, utilization of 8 Gy X 1 for treatment of bone metastases has increased. Increases were most pronounced in 2013. This coincides with the announcement and dissemination of the “Choosing Wisely” initiatives. Longer follow-up is needed to determine if increased provider uptake of SF RT as a componant of patient-centered quality care persists.

Phyllodes tumors are fibroepithelial tumors of the breast, representing 2-3% of all fibroepithelial tumors, and

A highly efficient and green protocol for the synthesis of medicinally important fluorinated spiropyrimidine derivatives involving creation of six new covalent bonds has been developed using a magnetically separable and reusable heterogeneous copper ferrite nanocatalyst under mild reaction conditions. The synthesis of inverse spinel copper ferrite magnetic nanoparticles with average size of 38 nm has been achieved using combined sonochemical and co-precipitation techniques in aqueous medium from readily available inexpensive starting materials without any surfactant or capping agent. The particle size was determined by transmission electron microscopy (TEM), scanning electron microscopy (SEM) and X-ray diffraction (XRD) analysis. The magnetic nature of catalyst facilitates its easy removal from the reaction medium and can be reused five times without any significant loss of its catalytic activity. Negligible leaching of Cu and Fe in consecutive cycles makes the catalyst economical and environmentally benign. The structure of final products was established by single crystal X-ray analysis and spectroscopic techniques.

e18032 Background: Intrathoracic tumor control in patients (pts) with metastatic NSCLC is controversial as most die of distant disease. But a subset of good performance status pts with minimal burden of extrathoracic disease may benefit aggressive treatment. We report outcomes in a subset of pts with oligometastatic NSCLC treated with definitive radiotherapy (RT) to the primary tumor. Methods: We identified29 stage IV pts from 01/04 - 08/10 who had ECOG ≤2 and ≤4 metastases who received ≥50 Gy thoracic RT with chemotherapy. Pts were assessed for local control, overall survival and toxicity. An exploratory analysis was performed matching these pts to pts receiving chemotherapy (CT) alone. Results: In the 29 chemoradiotherapy (CRT) pts, median age was 57 yrs, 72% had ECOG 1 and 91% were staged with PET. Median survival was 22 months. Eight patients had grade 2+ pneumonitis. Nineteen patients had grade 2+ esophagitis. Next, 2 CT pts were matched with each CRT pt on 4 factors: age, ECOG, and presence of multi-organ or contralateral lung disease. We excluded 4 CRT pts who did not match 2 CT controls. Median survival was 22 vs 9 months (p