Madhumati Goel

Lipid peroxidation and antioxidants in different stages of cervical cancer: Prognostic significance

BACKGROUND Free radical Injury is associated with cancer, but how the extent of oxidative stress correlates with the FIGO (International Federation of Gynecology and Obstetrics) stage in Carcinoma Cervix (Ca Cx), and its significance as a prognostic marker, is not clear and needs an in-depth study. AIM To correlate the blood levels of Lipid Peroxidation (LPO), Reduced Glutathione (GSH), Superoxide Dismutase (SOD), and Vitamin A and E levels with the clinical stage in Ca Cx. SETTINGS AND DESIGN This is a Prospective Case Control Study. MATERIALS AND METHODS LPO, SOD, reduced GSH were estimated by Bio Chemical Assays and Vitamins by High Performance Liquid Chromatography (HPLC). STATISTICAL ANALYSIS The cases and controls were compared using One Way ANOVA and different stages over different time periods were individually compared by Repeated Measure Analysis of Variance. RESULTS The results indicated a statistically significant increase of LPO vis-a-vis the FIGO stage of Ca Cx and control, while the antioxidant status as depicted by GSH and SOD decreased. Vitamin A and E levels were significantly lower in cancer cases as compared to the control. CONCLUSION Increased LPO and reduced antioxidant levels may be taken as associated predictive markers, thus suggesting that Ca Cx cases should get nutritive supplements to contain the blood LPO level and maintain a positive balance of antioxidants for a better outcome in terms of delayed recurrence and better Quality of Life (QOL).

Development of a new antigen detection dot-ELISA for diagnosis of tubercular lymphadenitis in fine needle aspirates.

A sandwich dot enzyme-linked immunosorbent assay (ELISA) was standardized to detect mycobacterial antigen in fine needle aspirates of patients with tubercular lymphadenitis (TBLN). The assay was performed on nitrocellulose paper by using antibodies raised in mice and rabbits against crude soluble protein (CSP) of Mycobacterium tuberculosis. The test was able to detect as low as 5 ng protein/ml. A total of 225 suspected cases of tubercular lymphadenopathy were screened, out of which 96 were cytomorphologically confirmed as cases of tubercular lymphadenitis (50 acid-fast bacilli (AFB)-positive and 46 AFB-negative). These were considered as positive controls. Only 28 cases were proven to be of nontubercular etiology and were considered as negative controls. In the remaining 101 (39 scanty) aspirates, tubercular etiology could neither be ruled out nor confirmed. Out of 50 AFB-positive confirmed cases of tubercular lymphadenitis, 46 were ELISA-positive. Out of 46 AFB-negative but cytomorphologically confirmed aspirates, antigen could be demonstrated in only 42 aspirates. Four samples from patients with nontubercular etiology were also found to be ELISA-positive. Antigen was picked up in a total of 90.3% of aspirates with suspicion of tuberculosis and 79.5% of scanty aspirates. The assay was found to be 91.6% sensitive and 85.7% specific. The assay was found to be simple and rapid, and hence, could be performed in areas where health facilities are rudimentary.

Comparative study between liquid-based cytology & conventional Pap smear for cytological follow up of treated patients of cancer cervix

Background & objectives: Cancer cervix is one of the most common forms of genital malignancy among Indian women. Recurrence is seen in a significant number of cases. The conventional cervical smear technique has inherent problems and screening and interpretation errors. This study was undertaken to assess the efficacy of liquid-based cytology (LBC) as a method for cytological follow up and detection of recurrence in treated cases of cancer cervix and to compare it with conventional Pap smear technique to find the best screening method for detection of recurrence in these patients. Methods: This cross-sectional study was conducted over a period of one year. Patients attending Gynecology and Radiotherapy outpatient departments for follow up after treatment of cancer cervix were included. Pap smear and LBC were taken in all cases. Colposcopy and biopsy were done for those having epithelial cell abnormality in cytology report. Colposcopy and biopsy were taken as gold standard for diagnosis of cancer cervix recurrence. Results: Ninety four treated patients of carcinoma cervix were studied. The diagnostic accuracy for detection of recurrence of conventional Pap smear was 79.16 per cent, and that of LBC was 97.6 per cent. The difference between the two methods was significant (P<0.001). Interpretation & conclusions: Our findings showed that LBC performed better than the conventional method of cytology to detect recurrence of squamous cell carcinoma. Its sensitivity, specificity as well as accuracy were much higher than conventional method. LBC can be a better method of cytological follow up of post-treated patients of cancer cervix.

Evaluation of Use of Adipose Cells in Various Procedures of Plastic Surgery and its Volumetric Quantification using High Resolution Ultrasound.

INTRODUCTION Autologous fat transfer is based on one of the principles of plastic surgery, replace like with like. It is used in wide variety of aesthetic procedures such as lip, facial augmentation and reconstructive procedures such as involutional disorders, post traumatic defects etc. AIM This prospective study was on the use of adipose cells in various procedures of plastic surgery, the role of high resolution ultrasound in estimating the volume of the grafted fat, comparison of the results based on the different donor sites of the harvested fat and comparison of the effectiveness of grafted fat in extremities and craniofacial region. MATERIALS AND METHODS In this prospective study a total of 34 patients underwent fat grafting procedure at various sites of the body from May 2012 till November 2013. After noting the details of the patient, details of the defect, laboratory and radiological investigations, the consent for the fat grafting procedure was taken. Clinical photographs and High Resolution Ultrasound (HRUS) volume estimation was done on a regular basis as per the protocol. RESULTS Out of 34 patients, 29 patients underwent free fat grafting and five patients underwent derma fat grafting. HRUS at six months revealed a mean 73.5% and 63.5% of the injected fat remained in contour deformity in extremities and craniofacial region respectively. HRUS at one year revealed a mean 57.4% and 41.4% of the injected fat remained in contour deformity in extremities and craniofacial region respectively. CONCLUSION HRUS is an excellent handy modality for serial volume estimation, cost-effective, non-invasive, multi planar modality, does not require any preparation, and easily done outdoor procedure. Follow up is a practical proposition. Autologous fat grafting is a safe procedure with no significant complications other than fat reabsorption and it can be done under local anaesthesia in contour deformity of smaller areas. Disadvantage of autologous fat grafting is the fat reabsorption needing multiple sittings.

Ectopic tubal choriocarcinoma: a rarity

Herein, we present a case of tubal choriocarcinoma which was diagnosed initially as chronic ectopic pregnancy. During laparotomy we noticed a haemorrhagic friable mass in the left flank, adherent to the bowel. Left-sided salpingoopherectomy was performed. Serum β HCG (human chorionic gonadotropin) levels performed in the postoperative period were elevated. Histopathology demonstrated choriocarcinoma. She was given six cycles of chemotherapy (etoposide, methotrexate, actinomycin D-cyclophosphamide, vincristine/oncovine (EMA-CO) regime) and monitored by serial β HCG estimation. This case highlights the importance of undertaking histopathological examination of the tubal tissue in every patient who presents with ectopic pregnancy. This important diagnostic test prevents the potential of missing this rare and highly malignant disease which is otherwise curable in most instances.

Pulmonary congenital cystic adenomatoid malformation involving upper lobe with successful surgical management

A four-week-old infant born after a normal vaginal delivery presented with dyspnea of one month duration. His radiologic evaluation showed multiple cystic lesions involving the left upper lobe, although lower lobe is the usual site. It was removed after pnemonectomy and the fi nal pathological diagnosis was congenital cystic adenomatoid malformation (type II). The postoperative follow up showed excellent recovery and normal development of the child.