The incidence of pancreatic diseases is increasing in view of changing lifestyle. Better understanding of the pathophysiology of chronic pancreatitis and improved postoperative care has led to the increasing role of surgery in those cases where all conservative measures fail. Drainage procedures, particularly for idiopathic variety, which is commoner in these parts, give gratifying results. Resection procedures such as Whipple's operation are reserved for small duct disease as in alcoholic pancreatitis. In the West, some centers even practice a total pancreatectomy followed by islet auto-transplantation, which not only relieves pain but also minimizes the otherwise inevitable diabetes.

Introduction: There are about 5 million truck drivers in India. As the eye sight plays a prominent role in safe driving, the truck driver's visual tasks/vision sense needs to be checked periodically. Aims: The aim of the study was to detect refractive errors and color blindness among truck drivers. Materials and Methods: We carried out a cross-sectional study on truck drivers. Truck drivers were screened at their resting places after obtaining their prior consent. In our study, we screened 140 truck drivers in various age groups. Statistical analysis used: We have analyzed the data obtained from the study by using Microsoft Office Excel 2007. Results: Out of 140 truck drivers screened, the number of truck drivers with visual acuity 6/6 (normal vision) was 100 (71.43%) while the drivers with refractive errors were 40 (28.57%). Of the 40 truck drivers with refractive errors; 11 were having myopia, 20 hypermetropia, and nine were found to have astigmatism. In the entire study, 44 truck drivers were found to have presbyopia. None of the divers had color blindness and/or night blindness. Conclusions: Most of the truck drivers having defective vision were in the age group of 41-60 years. This indicates that the drivers of this age group should be screened frequently to detect visual defects and they should be encouraged to wear corrective glasses (spectacles) to have normal visual acuity.

Context: Establishing etiology of pleural effusion is a common diagnostic problem in clinical practice. The most common cause is tuberculosis (TB). Adenosine deaminase (ADA) is one of the biochemical markers commonly used in the etiological diagnosis of tuberculous pleural effusion. In the past decade several studies on pleural fluid interferon gamma (IFN-γ) showed that it is an important diagnostic marker of TB. Aim: To evaluate the role of immunological marker IFN-γ in pleural fluid and to compare with pleural fluid ADA in the diagnosis of tuberculous pleural effusion with reference to pleural biopsy histology and treatment outcome. Materials and Methods: A total of 50 pleural fluid samples with more than 80% lymphocytes were analyzed for IFN-γ by enzyme-linked immunosorbent assay (ELISA) method and the results were compared with pleural fluid ADA. Clinical, radiological, and laboratory evaluation and response to treatment were noted. Among the 50 test samples, 31were from tuberculous pleural effusion, 14 from malignant effusion and five from effusion due to other causes. Results: Pleural fluid levels of IFN-γ and ADA were significantly higher in tuberculous than in nontuberculous pleural effusions. At the cut off value of 3.7 IU/mL for IFN-γ and 40 U/L for ADA it was found to have sensitivity and specificity of 96.77 and 94.73% for IFN-γ and 83.87 and 78.94% for ADA, respectively; differentiating tuberculous from nontuberculous pleural effusions. Conclusion: IFN-γ is more sensitive and specific marker than ADA for differentiating tuberculous from nontuberculous pleural effusions and helps in rapid and efficient diagnosis.

Background: About 200 million people in India are living in urban slum areas without basic health facilities. Poor environmental conditions, compounded by poverty, malnutrition, and deficient health-care, make the children and women susceptible to a host of infectious diseases. Research Question: What is the burden of health morbidities in under-fives in urban slum area? Aim and Objectives: Study of burden of health morbidities in under-fives in urban slum area. Materials and Methods: Community based cross-sectional study. Conducted in the slum area covered by the field practice area of Urban Health Centre, Dr. V. M. Medical College, Solapur during the period of January 2007 to April 2007. A total of 420 under-five children were selected from six slum areas. Seventy under-fives from each slum were selected by simple random sampling. Results: Out of total 420 under-fives 238 (56.67%) were males and 182 (43.33%) were females. The average age of the under-fives was 32.97΁17.02 months. 84.76% children were suffered from one or more than one morbidities. Overall health morbidities were significantly more in female. The most common health morbidity observed was protein energy malnutrition (PEM)(67.62%), followed by acute respiratory infection (ARI)170 (40.48%), pyrexia of unknown origin (PUO)85 (20.24%), acute diarrheal disease 77 (18.33%), and worm infection 57 (13.57%). PEM, ARIs, PUO, and acute diarrhea were common in female while, worm infection, skin infection, and injuries were more in male children. Conclusion: Maximum (84.76%) under-fives in urban areas suffered from one or more health morbidities. This intensifies the need of comprehensive and need based planning of health policies for slum area.

Aim : To assess the oral health status and pH of saliva in pregnant women in comparison to non-pregnant women and to appraise the awareness and attitude towards regular dental checkups and oral health maintenance among patients and clinicians attending a hospital gynecology ward. Study Design: The oral health status and extra-oral manifestations of 220 healthy women,including 110 pregnant women, attending the government hospital, Bhimavaram were considered. The findings were recorded along with a questionnaire and documented in a specially designed proforma. The response to another set of questions answered by 60 clinicians attending the gynecology ward was recorded in a separate proforma. Results: The clinical manifestations showed statistical significance (P = <0.001) values with 91% patients positive for gingivitis and 85% patients with ptyalism during their pregnancy. There were only 14.5% of pregnant women who consulted a dentist for their oral health problems during pregnancy, and only 35% of the clinicians have advised their patients regarding maintenance of good oral hygiene and routine dental checkups during pregnancy. Conclusion: Results show that certain oral manifestations were more prevalent among the pregnant women, and very few expecting mothers know about these changes related to pregnancy and follow maintenance of good oral hygiene and routine dental checkups. Hardly any gynecologists advised these women regarding the maintenance of good oral hygiene during pregnancy. Hence, oral health intervention programs should be targeted to the risk groups.

Objectives: A study was made of the effect of nonsurgical periodontal treatment upon blood glucose control in Type 2 diabetics with periodontal disease. Materials and Methods: The study sample consisted of 20 patients who were diagnosed to have diabetes with an age range of 42 to 81 years. In all cases, non- surgical periodontal treatment was carried out and was completed in several sessions. Approximately, 30 days after the last session the clinical examination was carried out using a pre-post repeated measures analytical design. Results: The improvement in glycosylated hemoglobin (HbA1c) after nonsurgical periodontal treatment on comparing the baseline (9.490 ± 0.491) and final values (8.990 ± 0.442) was 0.500 ± 0.066, and proved statistically significant ( P≤ 0.0001). Conclusions: A decrease in HbA1c was observed after treatment, thus indicating improved blood glucose control in Type 2 diabetics with periodontal disease.

Ventriculo-peritoneal (VP) shunting used in the treatment for hydrocephalus is associated with several complications. Bowel perforation is an unusual, but serious complication of VP shunting. We report the case of a 9-month-old girl who presented with transanal protrusion of VP shunt catheter. The shunt catheter was removed and a fresh VP shunt was inserted on the opposite side. Presently, the child is doing well on follow-up.

Gastrointestinal stromal tumors (GIST) of intestine presenting as acute abdomen due to perforation of the tumor is extremely rare.We present three cases of jejunal GIST which presented as acute abdomen resulting from perforation of the tumor. All the three cases underwent emergency laparotomy and resection of the tumor with clear margin. Histopathological examination was compatible with GIST and c-Kit/CD 117 was positive in immunohistochemistry. All the three patients received adjuvant chemotherapy with imatinib.

Cutaneous metastases of the hepatocellular carcinoma are very rare. The metastases are usually manifested on the face, scalp, chest, and abdomen. Skin metastasis is symptom of progressive disease and usually a sign of poor prognosis. It can be the first sign of the disease. The entire skin should be carefully inspected whenever, malignant disease is suspected. We report a case of skin metastasis of hepatocellular carcinoma for its rarity.

Mesoblastic nephroma (MN) is an uncommon congenital tumor of infancy that rarely occurs in adults. We report a case of cellular MN in a 40-year-old woman. The tumor showed an unusual pattern of growth as an intracystic mass involving the adjacent renal parenchyma. Microscopically, it consisted of spindle cell proliferation with entrapped dilated renal tubules. Cartilaginous islands and numerous atypical mitotic figures were also noted. Spindle-shaped tumor cells show immunoreactivity for vimentin and variable positivity for estrogen and progesterone receptors (ER and PR). Epithelial membrane antigen was positive only in epithelial component. A combination of histological and immunohistochemical findings is useful in the differential diagnosis of cellular MN from other tumors of the kidney with spindle cell component.

Congenital diaphragmatic hernia (CDH) is a common congenital anomaly that frequently occurs in conjunction with other major anomalies, including chromosomal abnormalities. Fryns syndrome (FS) is a lethal syndrome that most frequently features CDH as a cardinal feature in addition to pulmonary hypoplasia, coarse facies, distal digital hypoplasia, and organ malformations. The exact genetic defect has not yet been identified, although it is regarded to follow an autosomal recessive pattern of inheritance. We describe the autopsy findings of a medically terminated 20 weeks fetus with left-sided CDH, hypoplastic left heart, lungs, horse-shoe kidney and other anomalies, confirming to the phenotypic diagnostic guidelines of FS.

We report a case of a postrenal transplant patient currently on immunosuppressive therapy, with an unusual presentation of pulmonary nocardiosis. The patient presented with a right-sided chest wall abscess. Pus was aspirated from the abscess and culture yielded pure growth of Nocardia asteroides. The patient responded well to surgical drainage and long term treatment with cotrimoxazole.

Even though clonidine poisoning has been repeatedly reported in last decade, but in recent past there is paucity of this, especially in a scenario of developing countries like India. We report a toddler with clonidine poisoning who developed lethargy, respiratory depression, and hypotension following accidental ingestion of 0.2 mg clonidine. The toddler also developed myocardial ischemia due to hypotension and recovered with due supportive care.

A 54-year-old male presented with nodular lesions over the tongue and progressive discoloration around the eyes of 1-year duration. Patient had history of dysphagia, dyspnea, dysphonia, progressive weakness, and tingling and numbness of the extremities. Clinical examination revealed macroglossia, periorbital purpura, carpal tunnel syndrome, and waxy nodules around the eyes and lateral borders of the tongue. A diagnosis of primary systemic amyloidosis was made. Biopsy showed eosinophilic deposits in the papillary dermis on hematoxylin and eosin (H and E) staining. Congo red stained sections showed areas of apple green birefringence under polarized light microscopy, confirming the diagnosis of amyloidosis.

Fine needle aspiration cytology (FNAC) has been employed with increasing frequency as a diagnostic tool for lesions of the major and minor salivary glands. The reported sensitivity and specificity of FNAC of salivary gland lesion ranges approximately between 60 and 100% and 90 and 100%, respectively. The major reason for varied statistics in diagnosis is due to its diverse morphological patterns and overlapping features that makes it a challenging job for pathologists to give a precise diagnosis. If established diagnostic criteria are present and strictly followed, a great majority of common variations of non-neoplastic lesions, benign and malignant salivary gland tumors can be diagnosed with high level of accuracy with FNAC. A patient with high operation risk may benefit from the information obtained by FNAC. We report a case of adenoid cystic carcinoma of maxillary sinus in a 46-year-old male patient diagnosed mainly through FNAC and also discuss the possible differential diagnosis and pitfalls of FNAC in diagnosing adenoid cystic carcinoma.

The Zimmermann-Laband syndrome also known as Laband-Zimmermann syndrome or Laband's syndrome was reported by Zimmermann in the year 1928. It is a rare inherited autosomal dominant disease characterized by pathognomonic triad of extensive gingival enlargement (gingival fibromatosis), abnormalities of the nose and ears, absence or hyperplasia of the nails or terminal phalanges of the hands and feet. The syndromic characteristics are highly variable and complicated. The present study describes a case report of father and son aged 42 years and 13 years respectively, presenting features of Zimmermann-Laband syndrome.

Gorlin-Goltz syndrome is an inherited autosomal dominant disorder characterized by the presence of multiple odontogenic keratocysts of jaws, basal cell carcinomas, palmar, plantar pits and intracranial calcifications. Apart from these many dental, skeletal, ophthalmic and neurological abnormalities have been reported. Here, we present a case of familial Gorlin-Goltz Syndrome, characterized by multiple odontogenic cysts, calcification of falx cerebri, hypertelorism and neurologic disorder.