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   Table of Contents - Current issue
May-August 2018
Volume 45 | Issue 2
Page Nos. 51-110

Online since Monday, December 10, 2018

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Present scenario of adult hypertension: Family physician perspective Highly accessed article p. 51
Jayaprakash Shivalingappa Appajigol
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Clinicopathological predictors of extent of cervical lymph node metastases in locally advanced squamous cell carcinoma of mandibular gingivobuccal sulcus p. 53
Sidramesh Shivanand Muttagi, Ashok S Godhi, Basavaraj R Patil, Shivlingappa B Javali, Alka D Kale
Introduction: Locally advanced mandibular gingivobuccal sulcus (GBS) squamous cell carcinoma (SCC) has variable extent of cervical lymph node metastasis. Tumor thickness reliably predicts cervical lymph node metastases in early oral SCC, its reliability in predicting the extent of neck-node positivity in locally advanced GBS SCC is poorly studied. Objectives: The objective of this study is to study the association of extent of neck-node metastases with gross tumor thickness (GTT), preoperative histological differentiation (HD), and presence of clinical skin infiltration (CSI) in locally advanced SCC of mandibular GBS. Methodology: Biopsy-proven patients with locally advanced SCC of mandibular GBS, underwent composite resection with neck dissection from Level V to Level I, from January 2012 to February 2016 were included in this study. The intraoperative GTT was measured, the HD of primary tumor and presence of CSI were noted. Specimens were grossed as per guidelines established by the Royal College of Pathologists. The data were analyzed using SPSS version 22, Chi-square test, and Spearman's Rank correlation test. Results: In 130 patients, with gross tumor thickness >1 cm in 64 (49%) and <1 cm in 66 (51%), a statistically significant association (P = 0.0001) between the levels of neck-node positivity and HD, GTT, and presence of CSI was found. Preoperative HD showed a negative correlation whereas GTT and CSI showed a positive correlation with levels of positive node. Conclusion: Intraoperative GTT >1 cm, moderate-poor HD on biopsy, and presence of CSI were associated with extensive ipsilateral cervical lymph node metastases including Levels IV and V. These factors can help in predicting the extent of the neck dissection.
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Profile of human epidermal growth factor receptor 2 expression in epithelial ovarian carcinomas: A multicenter study from Southeast Nigeria p. 57
Chinedu Onwuka Ndukwe, Lasbrey Azuoma Asomugha, Cornelius Ozobia Ukah
Background: Human epidermal growth factor receptor 2 (HER2/neu) in epithelial ovarian cancers (EOCs) has been proposed in targeted oncological therapy as a way forward in the treatment of ovarian cancer. Currently, there is a paucity of data on the expression of HER2 in EOC in Nigeria. Objective: This study, therefore, aims to carry out an immunohistochemical study of histologically diagnosed EOC in Nnewi, Southeast Nigeria. Materials and Methods: The hematoxylin and eosin slides and formalin-fixed-paraffin-embedded tissue blocks of histologically diagnosed cases of epithelial ovarian carcinomas in the two histopathology laboratories in Nnewi, Anambra state, over a 12-year period were retrieved from the archives. Archival formalin-fixed-paraffin-embedded tissue blocks of histologically normal ovaries in these laboratories were also retrieved to serve as controls. Sections were made from the tissue blocks and stained with HER2 immunostain. Results: Fifty EOC specimens and 20 histologically normal ovaries were stained with HER2 immunostain. There was statistically significant difference in HER2 expression between normal ovaries and EOC (P = 0.016). HER2/neu- positive staining was not observed in the histologically normal ovaries. However, nine (18%) of the EOC showed HER2/neu- positive staining. HER2 positivity within EOC was independent of age (P = 0.134), tumor grade (P = 0.141), histological subtyping (P = 0.080), and molecular subtyping (P = 0.168). However, there was more HER2 positivity among those older than 50 years, low-grade carcinomas, mucinous EOC, and Type 1 EOC. Conclusion: Overall, these data support the dualistic model of ovarian carcinogenesis in Nigerian patients and therefore recommend further studies to determine the efficacy of anti-HER2/neu monoclonal antibodies in the treatment of EOC in these patients.
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Supine percutaneous nephrolithotomy in children p. 63
Rajendra B Nerli, Amit Mungarwadi, Shridhar C Ghagane, Neeraj S Dixit, Murigendra B Hiremath
Introduction: The stone disease in children shows wide geographic variations, and its incidence has increased worldwide in children of all ages. Percutaneous nephrolithotomy (PCNL) has gradually emerged as one of the standard treatment options for the management of renal stones >1.5 cm in pediatric cases. PCNL just like in adults has been performed in the prone position. Of late observing the successful use of supine position for PCNL in adults, pediatric urologists have been encouraged to use the supine access for PCNL in children. We report our early experience with supine PCNL in children. Materials and Methods: All children with symptomatic renal stones presenting to the pediatric urological services of our hospital were prospectively included into the study to undergo supine PCNL. Children with skeletal anomalies, bleeding diathesis, and active urinary tract infection were excluded from the study. Results: Ten children (six males and four females) with a mean age of 11.48 ± 2.08 years (9–18 years) underwent supine PCNL. The mean size of the stone was 22 mm (range 17–47 mm). The initial stone-free rate was 90% immediately after a single PCNL session. One child needed an additional extracorporeal shockwave lithotripsy session to clear a 7-mm fragment. The average operative time (from the beginning of the puncture trial to nephrostomy tube insertion) was 70 ± 5 min. Conclusions: Supine PCNL in children is feasible, safe, and an effective means for management of renal stones in the pediatric population.
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Soxhlet versus cold maceration: Which method gives better antimicrobial activity to licorice extract against Streptococcus mutans? p. 67
Roopali M Sankeshwari, Anil V Ankola, Kishore Bhat, Kirankumar Hullatti
Purpose: Licorice is called “grandfather of herbs” and is being used for wide various ailments since time immemorial. However, its use in dentistry has been recently. Soxhlet and Cold maceration are the two commonly employed methods for extraction of drug from raw products. But which of two is gives better antibacterial property to licorice root remains unanswered. Hence, the present study has been planned with an aim to compare antibacterial activity of licorice root extracts obtained from two methods (Soxhlet and cold maceration) against Streptococcus mutans. It is an in vitro study. Methodology: Licorice roots were authenticated from recognized taxonomist. They were washed, dried completely, and coarsely powdered. The weighed powder was mixed with ethanol (100 mg in 500 ml). Two such mixtures were made. One was used for cold maceration procedure and the other was used for Soxhlet method. Extracts so obtained were assessed for their minimum inhibitory concentration against S. mutans ATCC 25175 in triplicates using broth dilution and disc diffusion method. Extracts were also compared for their phytochemical components. Descriptive analysis and unpaired t-test were performed. Results: Cold maceration extract at concentration of 1.95 mg/ml and Soxhlet method at 3.906 mg/ml showed inhibition of S. mutans. Both of them possessed the same phytochemical components. Conclusion: Licorice root extract obtained through cold maceration had significantly better antimicrobial activity against S. mutans than licorice extract obtained through Soxhlet method. Cold maceration method is relatively simple and does not involve complex instruments and yet yields better extract.
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Anogenital distance in males attending assisted reproduction center p. 72
RB Nerli, Shridhar C Ghagane, Murigendra B Hiremath, Neeraj S Dixit, Shivayogeeswar Neelagund
Introduction: Anogenital distance (AGD) is a marker for endocrine disruption in animal studies in which decreased distance has been associated with testicular dysfunction. Measurement of AGD has also been used as a marker for genital development. Recently, it has been used to correlate with sperm production. In this study, we have investigated the relationship between AGD, sperm parameters, testicular size, and total testosterone levels in men attending assisted reproduction center (ARC). Materials and Methods: All the male partners of infertile couples presenting to the ARC were prospectively included in the study. Semen analysis, serum and blood biochemistry tests, and hormone assessment were done in all patients. The AGD measurements were done with the patient lying in supine position, and the distance from the posterior aspect of the scrotum to the anal verge was measured using a digital caliper. Results: The mean AGD was 3.19 ± 0.18 cm in patients with azoospermia, 3.40 ± 0.28 in oligospermia, 3.38 ± 0.24 in oligoasthenospermia, 3.30 ± 0.21 in oligoasthenoteratospermia, and 4.21 ± 0.23 in patients with normal sperm parameters. The testicular volume was significantly lower in patients with abnormal sperm parameters when compared to patients with normal sperm parameters. The total testosterone levels were significantly lower in patients with abnormal sperm parameters when compared to patients with normal sperm parameters. Conclusions: AGD may provide a novel metric to assess testicular function in men. A longer AGD is associated with fatherhood and may predict normal male reproductive potential.
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Clinicopathological profile and outcome of 29 lymph node tuberculosis cases Highly accessed article p. 76
Rajat Sanker Roy Biswas, Md Fazlee Kibria Chowdhury, Shaikh Md Hasan Mamun
Introduction: In countries like Bangladesh, tuberculous lymphadenopathy is a common extrapulmonary site. Its diagnosis and management is a challenge for the primary care physicians for its various clinical and pathological presentations. Hence, the objective of the present study is to describe the clinicopathological profile and outcome of lymph node tuberculosis (TB) cases in our setting. Methods: It was a prospective observational study done among 29 lymph node cases attending the outpatient and inpatient department of medicine of a tertiary care hospital in a period of 2 years. After written informed consent, clinical points are noted and fine-needle aspiration cytology (FNAC) or biopsy of lymph node was done and histologically evaluated and the patients were followed up further. After collection of all data, it was compiled and analyzed by SPSS version 20. Results: Among 29 cases, female patients (17, 58.6%) were more than the male (12, 41.4%) patients and most of the patients were at the age group of 21–30 years (48.3%). Most patients presented with fever (62.1%), weight loss (51.7%), night sweating 62.1%), anorexia (55.2%), and cough (27.6%). Among all, 20 (69%) patients presented with multiple enlarged lymph node group and 9 (31.0%) had involvement of single group. Cervical group involvement was the most common (25, 86.2%), and matting of lymph node was present in 20 (69%) cases. Among all, 24 (82.8%) cases were diagnosed by FNAC and 5 (17.2%) was diagnosed by biopsy. In microscopic evaluation, 18 (62.1%) cases had caseous necrosis, 27 (93.1%) had epithelioid cells and 8 (27.6%) had giant cells. Regarding other investigations, 8 (27.6%) patients had positive mantoux test (MT), 4 (13.8%) had concomitant pulmonary TB, and one case was found sputum positive for acid-fast bacilli. Regarding outcome evaluation, 20 (69%) cases were declared cured, 7 (24.1%) were lost to follow-up, one case died, and one cases was declared multi drug resistant tuberculosis (MDR) TB. Conclusion: In the study, bacteriological evaluation of the response to treatment cannot be done due to difficulty in obtaining follow-up specimens from the lymph node. Response was judged on the basis of clinical features and local examination findings.
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Animal models for preclinical drug research on ulcerative colitis: A review p. 80
Kritarth Naman M Singh, Paresh G Koli
Inflammatory bowel disease (IBD) represents a chronic, relapsing, remitting, and inflammatory condition categorized into two forms – ulcerative colitis (UC) and Crohn's disease. According to epidemiological data, the trend of IBD has been increasing in the world, including in India. The current management of UC does not aim at curing the patient from the illness but mainly at attenuating the symptoms and improving the daily life of the patient. Drugs such as sulfasalazine and corticosteroids are used to reduce inflammation, but they are associated with multiple side effects and the efficacy is also limited. Hence, there is an unmet need in exploring new drugs to manage UC in a more efficient and less harmful way. There are various animal models which have been used worldwide by researchers to assess new lead compounds before they can be tested in humans. Various types of models comprise of chemical models, bacterial models, immunity transfer models, and genetic models. In this review article, we try to give an overview of these animal models which can be used in drug research.
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Bladder preservation protocols in the management of muscle-invasive bladder cancer: A systematic review p. 84
Srikanth Pentyala, RB Nerli, Shridhar C Ghagane, Murigendra B Hiremath
Bladder cancer is one of the most common cancers worldwide causing a significant burden on healthcare system and society. Muscle-invasive bladder cancer (MIBC) is highly fatal, and if untreated, >85% of patients die within 2 years of diagnosis. Although radical cystectomy (RC) is the preferred treatment of choice in patients with MIBC, bladder preservation can be considered in patients who are either not eligible for cystectomy or are not willing to undergo cystectomy. The goal of bladder preservation is to achieve cancer survival at least equivalent to RC and to maintain better quality of life including sexual function. Strategies for bladder preservation include partial cystectomy, radical transurethral resection, radiation therapy, and chemotherapy. It is widely accepted that combination of these approaches could result in better outcomes in patients with MIBC. In this review, we describe different approaches for bladder preservation and their outcomes.
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Abdominal pseudocyst secondary to ventriculoperitoneal shunt along with left staghorn renal calculus management: A rare case report p. 90
Ajay Kumar Guntaka, B S R Prasad Babu, Anil Kumar Mutyala
Abdominal cerebrospinal fluid pseudocyst is an unusual and important complication in patients with ventriculoperitoneal (VP) shunt. Abdominal pseudocyst secondary to long-term (23 years) VP shunt is a rare complication, and associated staghorn calculus presentation is not yet reported in the literature. Herein, we present our management of abdominal pseudocyst with left staghorn calculus removal at the same sitting.
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Polyostotic fibrous dysplasia without craniofacial involvement: An unusual presentation p. 93
Seema Sharma, Milap Sharma, Parvinder Singh, Vipin Sharma
Fibrous dysplasia (FD) is a benign bone disorder resulting into the replacement of bone with fibrous tissue. These fibrous bones are prone for deformities, pain, and pathological fractures, hence requiring treatment. We report a case of polyostotic FD without craniofacial involvement.
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Synchronous bilateral wilms' tumor in a 2-year-old male child p. 97
RB Nerli, Shridhar C Ghagane, Neeraj S Dixit, Murigendra B Hiremath
Wilms' tumor (WT) is the most common malignant renal tumor in childhood. Approximately 5%–7% of WT patients present with bilateral disease, either synchronously or metachronously. Bilateral WT usually occurs in younger children and more often in girls. Management of a child with bilateral WT is very challenging. We report a case of bilateral WT in a 2-year-old male child. The child has undergone preoperative chemotherapy followed by nephron-sparing surgery.
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Anesthetic management of a child with homocystinuria p. 99
Chaitanya A Kamat, Manjunath C Patil, Guruprasad Shetty, Akshata Aravind Kulkarni
Homocystinuria is a disorder of methionine metabolism, leading to an abnormal accumulation of homocysteine and its metabolites in blood and urine. It is most often diagnosed in childhood and has variable expressions. We report a case of a 7-year-old male child with diminished vision since birth diagnosed as bilateral congenital cataract and superomedial subluxation of lens posted for cataract excision under general anesthesia. The key points of perioperative management included prevention of hypoglycemia, optimal hydration, prevention of thromboembolic episodes, and total intravenous anesthesia.
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Trigeminal neuralgia - microvascular decompression by teflon patch p. 102
Rajesh Shenoy, Ravi Ichalakaranji, Prakash Mahantashetti, Samanvaya Soni
According to the international headache society (IHS), trigeminal neuralgia (TN) is a disorder characterized by recurrent unilateral brief, shock-like pain abrupt in onset and termination, limited to the distribution of one or more divisions of the trigeminal nerve. Peak incidence is between the ages of 50 and 60 years, more common in women. Patients with TN are best managed by coordinated multidisciplinary approach (medical and surgical management). Early surgery helps the patient to have a better quality of life rather than waiting with the medical therapy alone. Here we present a case of an old aged male patient with h/o right side facial pain in V1 and V2 distribution, diagnosed with trigeminal neuralgia, and was on prolonged drug therapy for the same with no signs of improvement. We subjected the patient for Microvascular decompression after confirming the vascular loop compressing the ipsilateral trigeminal nerve. Patient showed improvement with symptom free interval subsequently.
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Chondromyxoid fibroma at an unusual site p. 106
Karthik Srevatsa, Ranjit P Kangle, Pradnya Kangle, Sameer Haveri
Chondromyxoid fibroma (CMF) is a rare tumor, accounting for <1% of all bone tumors. It generally affects the metaphysis of long bones of the lower limbs and involvement of the upper limb is rare. It can be confused with chondroblastoma and chondrosarcoma. Its recognition and differentiation from other tumors are of paramount importance. Here, we report a case of CMF involving the right ring finger.
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Preoperative management of hypertension p. 110
Jayaprakash Shivalingappa Appajigol
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