137 Giant Lipomas of The Hand; A Case Series and Review of a Rare Tumour

Introduction

Whilst lipomas are the most common tumour of the human body, it is rare in the hand. Less than 50-cases are reported in the literature. We present six-cases from a specialist hand unit, UK, presenting over a 10-year period. All patients had a distinct swelling within the affected hand which was growing in size.

Method

Patients were investigated with MRI and given the benign appearance; no pre-excision biopsies were performed. All excised tissue was sent for histology. Only one patient reported altered neurology of the hand, describing altered sensation within the ulnar nerve distribution of the index finger.

Results

In all cases, the lipoma originated in the deep palmar space from adipose tissue surrounding the deep palmar arch. They all extended distally, along natural tissue planes, encasing neurovascular and tendinous structures. In two cases the lipoma extended into the dorsum of the hand, following the perforating artery between the index and middle metacarpal heads. The lipomas all spread radialwards, penetrating the thenar muscles. The largest was 13x12x4cm in size.

Conclusions

Giant lipoma is a rare cause of symptomatic swelling of the hand. Compression of structures is extremely rare, but careful excision is critical as neurovascular bodies are classically enveloped within the growing lipoma.

Prevalence of Known Risk Factors of Breast Cancer and Breast Cancer Screening Practices Among Women in Thiruvananthapuram, Kerala, India

Background: Breast cancer rates are rising both in the developed and the developing world, probably due to increase in life expectancy, increasing urbanization and adoption of western lifestyles. Incidence of breast cancer is reported to be increasing in India and it has become the most common cancer among women. Kerala and its capital city Thiruvananthapuram are also following the same pattern. Early detection and treatment of breast cancer is highly beneficial as it leads to increased survival rates and better quality of life to the patient. By identifying the risk factors and through regular and proper screening practices, we can detect the high risk population for this disease and contribute to its prevention and early treatment. Aim: 1. To study the prevalence of known risk factors of breast cancer among women aged 20 years and above in Thiruvananthapuram, Kerala, India. 2. To describe the breast cancer screening practices prevalent in the study population and to find out the proportion of high risk individuals using breast cancer risk calculator. Methods: A community based cross sectional survey was conducted among 2000 women hailing from Thiruvananthapuram. General population was invited through mass media to attend breast cancer screening camps. 2000 women aged more than 20 years who attended the camps and gave informed consent were included in the study. Data were collected from 40 participants each from 50 camps out of a total of 150 screening camps. A semi structured pro forma was used to collect the data regarding the sociodemographic profile, the various known risk factors of breast cancer according to research literature and breast cancer screening methods undergone. Descriptive statistics was done using SPSS version 16. Results are expressed in proportions with 95% confidence interval, wherever appropriate. Results: The mean age of the study population was 45.67 years. Majority of the women 82.5% had never undergone any sort of breast cancer screening. Clinical breast examination alone was undergone by 9.8%. Breast cancer risk calculator showed that 65% of the women screened had normal risk, 22.2% had moderate risk and 12.9% had high risk. Conclusion: Increased prevalence of major known risk factors of breast cancer like positive family history, low breast feeding duration, late age at menopause, are found. Also the prevalence of modifiable risk factors like obesity and low physical activity are high. Majority of the study participants have never undergone any breast cancer screening. Breast cancer risk calculator showed a fairly high prevalence of study participants in high risk and moderate risk category and therefore women need to be motivated to undergo regular screening.

Clinical Breast Examination Campaign: Experience From Thiruvananthapuram, South India

Background and context: Thiruvananthapuram has the highest breast cancer incidence in India and majority of cases are detected late pointing to the inefficiency of early detection programs. Primary health care providers do not advise regarding regular screening and most women never resort to any screening practices. Mammogram is not cost-effective and clinical breast examination (CBE) is not popular as a screening modality in our population. Aim: To describe the conduct, utilization and outcome of mass screening program conducted in Thiruvananthapuram. Strategy: A mass screening program with media publicity to motivate organizations and residential associations was planned. CBE was conducted by one of the five lady doctors who were trained by an expert breast surgeon at a tertiary care center to detect suspicious lumps. All suspicious cases referred to experts who would further evaluate the cases at a clinic outside the tertiary care center. Advocacy and expert service at accessible sites and availability of expert service outside the tertiary care center at convenient timings improved the acceptance of screening. Intersectoral coordination, community participation, accessible expert services and appropriate technology were followed. Program/Policy process: 9942 women had CBE along with breast awareness in 101 camps over 66 days and it was probably “the first ever marathon breast cancer screening campaign” in the world. Sociodemographic variables, details regarding previous screening, breast symptoms and known risk factors were collected. Anyone with suspicious findings was referred to experts. Outcomes: 868 (8.73%) women with suspicious findings were referred to experts who advised 258 mammograms and confirmed breast cancer in 16 women (1.61 per 1000 women). Mean age was 45.46 years. 82.5% had screening for the first time. Uniformity in examination, three levels of screening and minimum utilization of diagnostic procedures makes this campaign distinct from others. All participants are kept on follow-up through a free clinic maintained by a nonprofit NGO in Thiruvananthapuram. Effective planning and selfless service along with coordinated effort of an apex institution (Regional Cancer Centre, Thiruvananthapuram), a private medical college (Sree Gokulam Medical College, Thiruvananthapuram) and media partners were the key to success. What was learned: Early detection of breast cancer is possible by CBE, provided women can be motivated for regular screening and adequate expertise is available. CBE campaigns can improve screening behavior and breast awareness among women. Primary health care providers and mass media could educate women regarding the benefits of breast awareness and motivate them for regular screening. Proper referral system including certified intermediate referral centers should be in place to ensure the success of early detection by CBE.

Caffeine consumption does not have an effect on digital microvascular perfusion assessed by laser Doppler imaging on healthy volunteers: a pilot study

Caffeine is one of the most commonly consumed pharmacologically active ingredients in the Western world. It is postulated to cause peripheral vasoconstriction and decreased digital blood flow. As a result, many hand surgeons forbid caffeine consumption post-operatively by patients undergoing replantation surgery for fear of compromising healing. We hypothesized that caffeine has no effect on digital microvascular perfusion. Healthy volunteers were recruited and digital microperfusion was assessed using laser Doppler probes attached to the finger pulp, both before and after ingestion of 100 mg of caffeine. A total of 34 patients were included in the final study. The mean flow before the consumption of caffeine was 226.15 PU. The mean flow following the consumption of caffeine was 197.7 PU. This decrease was not statistically significant. This study revealed no decrease in digital blood flow following the ingestion of 100 mg of caffeine by healthy volunteers, as measured by laser Doppler flow monitoring.

LEVEL OF EVIDENCE

3.

Doubling of electrochemical parameters via the pre-intercalation of Na+ in layered MnO2 nanoflakes compared to α-MnO2 nanorods

The pre-intercalation of Na⁺ ions in layered birnessite-MnO₂ is shown to have a dramatic influence on its electrochemical properties.

The development of varicosities within a free radial forearm flap used for distal-third tibial reconstruction

Reports of varicosities developing in free flaps are very rare. The presence of varicose veins in recipient sites influencing the development of varicosities in free flaps, though physiologically possible, has not been documented in literature. We encountered an unusual case of varicosities developing in a free radial forearm flap used in soft-tissue reconstruction of an open distal-third tibial fracture, which is presented here. This case report thus adds an important dimension to the assessment of a patient when planning a free flap procedure in a recipient area with pre-existing varicosities.

Community rehabilitation of disabled with a focus on blind persons: Indian perspective

India, the largest democratic country in the world, is marching ahead strongly on the growth and developmental front and is poised to be the leader in the market economy. This role creates and increases far greater responsibilities on us in ensuring that the benefit of the developmental cycle reaches each and every citizen of this country, including the able and the disabled ones. It has been enshrined in the Constitution of India to ensure equality, freedom, justice, and dignity of all individuals and implicitly mandates an inclusive society. With increase in consideration of quality parameters in all spheres of life including availability, access, and provision of comprehensive services to the disabled, it is pertinent to have a look on the contribution of government in keeping the aspiration and commitment towards common people. The article attempts to review the concept of rehabilitation for the disabled keeping a focus on the blind person, and list out the activities, programs/schemes, institutional structure and initiatives taken by the Government of India (GOI) for the same and the incentives/benefits extended to blind persons. The article concludes by reiterating the importance of individual need assessment and mentioning new initiatives proposed on Low Vision services in the approved 11^th plan under National Programme for Control of Blindness (NPCB). The source of information has been annual reports, notification and the approved 11^th five-year plan of GOI, articles published with key words like rehabilitation, disability, assistive devices, low vision aids, and/or blind person through the mode of Internet. Annexure provides a list of selected institutions in the country offering Low Vision services compiled from various sources through personal communication and an approved list of training institutes under NPCB, GOI offering Low Vision training.

School eye screening and the National Program for Control of Blindness

Childhood blindness and visual impairment are as important and perhaps more devastating and disabling than adult onset blindness, because of the long span of life still remaining to be lived. Refractive errors and more particularly myopia, place a substantial burden on the individual and society. School-age children constitute a particularly vulnerable group where uncorrected refractive errors may have a dramatic impact on learning capability and educational potential. This article provides an overview of school eye screening from the perspective of National Program for Control of Blindness (NPCB), Government of India; and challenges, future directions and thrust area envisaged under the program for amelioration of childhood blindness.

Controlled synthesis and application of ZnO nanoparticles, nanorods and nanospheres in dye-sensitized solar cells

Several important synthetic parameters such as precursor concentration, rate of evaporation and reaction time are found to determine the growth of ZnO nanostructures. These reaction parameters can be tailored and tuned to produce a variety of nanostructures ranging from nanoparticles, nanorods and nanospheres. The nanorods are structurally uniform made up of crystallographically oriented attached nanoparticles while the nanospheres are made up of several closely packed and randomly aligned nanocrystallites. XRD spectra of both the nanoparticles and nanorods exhibit typical diffraction peaks of a well-crystalline wurtzite ZnO structure. Finally, solar cells made up of ZnO nanoparticles and nanorods electrodes with absorbed ruthenium dye (N3) were measured to have a power conversion efficiency of 0.87% and 1.32%, respectively.

Conversion efficiency versus sensitizer for electrospun TiO(2) nanorod electrodes in dye-sensitized solar cells

The electrochemical and optical properties of three indoline dyes, namely C(35)H(28)N(2)O(2) (D131), C(37)H(30)N(2)O(3)S(2) (D102), and C(42)H(35)N(3)O(4)S(3) (D149), were studied and compared with that of the N3 dye. D131 has the largest bandgap and lowest unoccupied molecular orbital (LUMO) energies compared to the other dyes. A size-dependent variation in the absorptivity of the indoline dyes was observed-the absorptivity increased with increase in the molecular size. The dyes were anchored onto TiO(2) nanorods. The TiO(2) nanorods were obtained by electrospinning a polymeric solution containing titanium isopropoxide and polyvinylpyrrolidone and subsequent sintering of the as-spun composite fibers. Absorption spectral measurements of the dye-anchored TiO(2) showed blue shifts in the excitonic transition of the indoline dyes, the magnitude of which increased with decrease in the molecular size. Dye-sensitized solar cells (DSSCs) were fabricated using the indoline dyes, TiO(2) nanorods, and iodide/triiodide electrolyte. The D131 dye showed comparable energy conversion efficiency (η) to that of the N3 dye. A systematic change in the short circuit current density (J(SC)) and η of the indoline DSSCs was observed. The observed variation in J(C) is most likely originated from the difference in the electronic coupling strengths between the dye and the TiO(2).

Current estimates of blindness in India

BACKGROUND

Evidence based planning has been the hallmark of the blindness control programme in India. A nationwide survey was undertaken in 1999-2001 to document the magnitude and causes of blindness.

METHODS

One district each in 15 populous states was covered. 25 clusters were randomly selected in each district and all individuals aged 50 years and above were enumerated. Presenting and best corrected vision was recorded using retroilluminated logMAR tumbling E charts and detailed eye examination was offered.

RESULTS

The response rate was 89.3%. Presenting vision <6/60, in the better eye, was observed in 8.5% (95% CI: 8.1 to 8.9). Age, sex, residence, literacy, and working status were associated with blindness. The highest risk was among those aged 70+ and the illiterate. Cataract was responsible for 62.4% of bilateral blindness. Prevalence of cataract blindness was 5.3% (95% CI: 4.97 to 5.62). Reduction in blindness prevalence among people aged 50 years and above was observed compared to earlier studies.

CONCLUSION

Blindness control efforts seem to have played a part in arresting the increasing prevalence of blindness in India and there is hope that the goals of the "Vision 2020--right to sight" initiative can be achieved if there is strong political will and prioritised action.

Community ophthalmology in the Indian perspective

Community ophthalmology is as important as practice of clinical ophthalmology. Community ophthalmology deals the part of ophthalmology which is meant for identifying common causes of ocular morbidity in different regions, assessing the needs of the population, selecting appropriate intervention strategies, planning education programmes and analysing the utilisation patterns. Community ophthalmology denotes the use of appropriate strategies to reduce the burden of eye diseases in the community and the consequences of ocular ill health, while striving to ensure the best possible ocular health status for a major proportion of the community. Community-based services do not mean that institutional care is being downgraded. Institutions will always be central to the success of community-directed programme. The rational for practising community ophthalmology has been pointed in the text portion.

Spermine reduces infarction and neurological deficit following a rat model of middle cerebral artery occlusion: a magnetic resonance imaging study

The role of nitric oxide (NO) in post-ischemic cerebral infarction has been extensively examined, but few studies have investigated its role on the neurological deficit. In the present study, we investigated the effect of spermine on the temporal evolution of infarct volume, NO production and neurological deficit using magnetic resonance imaging in a model of permanent focal cerebral ischemia in rats. Spermine given at 10 mg/kg 2 h after ischemia reduced the infarct volume by 40% and abolished brain NO production and improved the neurological score 24 h, 48 h and 72 h after ischemia. Spermine also reduced the neurological deficit as evaluated by rotamex, grip strength and neurological severity score tests.

See & treat protocol for evaluation & management of cervical intraepithelial neoplasia

BACKGROUND & OBJECTIVES

The incidence of cervical cancer in India remains high, largely due to ineffective screening and poor patient compliance for follow up. A one step procedure where evaluation and treatment are performed at the same sitting may be a good strategy. Therefore the present study was undertaken to evaluate the feasibility of a see and treat protocol for cervical intraepithelial neoplasia in a hospital population.

METHODS

A prospective study was carried out on 285 women with using cytology and colposcopy followed by large loop excision of the transformation zone when indicated as a one step procedure.

RESULTS

There was a concordance between colposcopic and cytologic diagnosis. Eighteen women underwent large loop excision. Over treatment rate was 61 per cent but 80 per cent of them occurred in the low grade squamous intraepithelial lesions. The over treatment rate in high grade lesions was 20 per cent.

INTERPRETATION & CONCLUSION

A single step see and treat protocol is a feasible management strategy for high grade squamous intraepithelial lesions. However, patient education is essential before undertaking the procedure.

Tamoxifen-induced endometrial changes in postmenopausal women with breast carcinoma

OBJECTIVES

To assess the effects of tamoxifen (TAM) on the endometrium in postmenopausal women.

METHODS

A case control study of postmenopausal women with breast carcinoma, who were undergoing treatment in the Department of Radiotherapy and Surgery at the Christian Medical College Hospital, Vellore, India was done. Thirty-five women who were on tamoxifen (20 mg/day) for a period of at least 6 months formed the study group. Thirty-three women who were not receiving tamoxifen, formed the control group. Subjects in both groups had a pelvic examination and transvaginal sonogram followed by endometrial biopsy.

RESULTS

There was a statistically significant difference in the mean endometrial thickness between the study group and control group (7.8+/-6.4 mm vs. 4.0+/-2.0 mm, respectively) More women in the tamoxifen group had an endometrial thickness of >5 mm but the number of women with polyps or hyperplasia of the endometrium did not differ significantly between the two groups. There were no women with endometrial carcinoma in either group.

CONCLUSION

All patients on tamoxifen need to be evaluated by clinical examination annually. A transvaginal sonogram and endometrial biopsy/hysteroscopy may be performed on patients with abnormal vaginal bleeding, bloody discharge, staining or spotting.

Synthesis of nanoparticles of barium lanthanum hafnium oxide by a modified combustion process

Barium lanthanum hafnium oxide, a complex perovskite ceramic, has been synthesized as nanoparticles by a modified combustion process for the first time. The Ba, La, and Hf ions required for the formation of Ba2LaHfO5.5 were obtained in solution by dissolving in boiling nitric acid a stoichiometric mixture of BaCO3, La2O3, and HfO2 that had been heated at 1200 degrees C for 4 h. By complexing the ions with citric acid and using ammonia as fuel, it was possible to get Ba2LaHfO5.5 as nanoparticles in a single-step combustion process. The powder obtained by the present combustion process was characterized by X-ray diffraction, BET surface area analysis, differential thermal analysis, thermogravimetric analysis, infrared spectroscopy, and scanning and high-resolution transmission electron microscopy. According to the results of X-ray and electron diffraction, the powder synthesized through the combustion process showed single-phase barium lanthanum hafnium oxide. The transmission electron microscopic investigations showed a grain size of 42 nm, with a standard deviation of 8 nm. The nanoparticles of Ba2LaHfO5.5 synthesized by the present combustion technique could be sintered to > 97% of the theoretical density at a relatively low temperature of 1425 degrees C. Scanning electron microscopic studies on the sintered Ba2LaHfO5.5 samples showed that the final grain size of the sintered specimen was < 500 nm.

Visual outcomes after cataract surgery and cataract surgical coverage in India

Visual outcomes of 2369 cataract operated persons(3655 eyes) across seven major Indian states were assessed in 1998. This is the largest ever study over the past decade in the country. 9.54 per cent of the examined population had undergone operation for cataract in one or both eyes. Intra-capsular cataract extraction was the commonest surgical modality adopted (91.62%). Intraocular lens implants resulted in better visual outcomes with 71.4 per cent of such patients achieving a good visual outcome (> or = 6/18 in operated eyes). Visual outcome was also good if ICCE operated patients were provided good quality aphakic spectacles. There were no gender differentials in surgical uptake rates. The risk of poor postsurgical visual outcome was strongly associated by type of surgery (Adjusted OR for ICCE-2.78; 95% CI: 1.41-5.49) and the non-availability or poor quality aphakic spectacles (Adjusted OR for poor/no spectacles 4.59-95% CI: 3.53-5.97). Duration since surgery and the source of surgery did not influence visual outcomes. Half the cataract blind remained unoperated in the study population.

Sclerosing stromal tumour of the ovary. A case report

Sclerosing stromal tumors (SST) of the ovary are a distinct, but rare benign neoplasms. These tumors appear solid and are very vascular and therefore give the impression of a malignant tumor. They occur mostly in young women. Morphologically and histologically they have distinct characteristics, which make them different from other stromal tumors. The importance of this report is that, though the tumor appears malignant (solid and vascular) since it occurs in young women, care should be taken before embarking on radical surgery.

Transvaginal sonography of the endometrium in south Indian postmenopausal women

Endometrial carcinoma is not commonly seen in India as in the West. Nevertheless, the diagnosis has to be entertained in women presenting with postmenopausal bleeding. The aim of the study was to compare the transvaginal sonographically-measured endometrial thickness with the histopathological diagnosis in postmenopausal women. Eighty postmenopausal women were studied prospectively. All of them underwent transvaginal sonography followed by either an office dilatation and curettage and/or a hysterectomy. Eight women had endometrial carcinoma and their mean endometrial thickness was 12.6 +/- 5 mm (mean +/- SD). Taking 4 mm endometrial thickness as cut off the sensitivity of transvaginal scan to detect endometrial pathology was 97%, specificity 98%, positive predictive value 97% and negative predictive value 94%. Hence, we conclude that measurement of endometrial thickness by transvaginal scan is a good screening test in postmenopausal women for differentiating endometrial pathology from those who do not have an endometrial lesion.

Synthesis of 7-substituted-4-(3',4',5'-trisubstituted-1-pyrazolyl)pyramido-[5,4-c] cinnolines and their anti-inflammatory activities

Eight title compounds were synthesised from substituted anelines. All compounds were tested for inhibition of bovine serum albumin denaturation. Few selected compounds were studied for their ability to provide protection against carrageenin-induced edema in rat paw and to inhibit denaturation of bovine serum albumin in an attempt to elucidate their cellular mechanism of action. There was no relationship between anti-inflammatory activity of 7-substituted-4-(3',4',5'-trisubstituted-1-pyrazolyl)pyrimido[5,4- c] cinnolines and their bovine serum albumin denaturation effectiveness.