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Malignant melanoma is a rare tumor in otorhinolaryngology. In this paper, we have reported the first case of melanoma of nasopharynx which we came across in 20 years of ENT practice. A 55 year old male patient with complaints of swelling of nose and left side of neck, nasal blockage and epistaxis was diagnosed as melanoma of nose with metastasis in the neck based on clinical and radiological examination. The tumour was excised by lateral rhinotomy with supraomohyoid block dissection on the left side. The tumour was found to originate from lateral wall of nasopharynx and middle turbinate. The surgery was followed by radiotherapy. Diagnosis of melanoma was confirmed on histopathology. During 30 months follow-up, no recurrence was noticed.

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Blood culture reports were studied in 1266 cases of clinically suspected neonatal septicemia, to determine the bacteriological profile and antibiotic sensitivity pattern of the cultured isolates. Blood culture was positive in 24.88% of cases. Gram negative septicemia was encountered in 87.1% of these neonates. Klebsiella and Enterobacter species were the predominant pathogens amongst Gram negative organisms. Of Gram positive isolates, Staphylococcus aureus was the predominant isolate (79.0%). Salmonella species was isolated in 2.4% of these cases.

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Jaw bones are rarely involved in secondary hyperparathyroidism. We report a case of 13 year old girl who presented with progressive chronic renal failure and secondary hyperparathyroidism. Five months after beginning of hemodialysis, a large brown tumor developed on the hard palate, extending to the maxilla causing difficulty in swallowing and breathing. She died of massive intestinal hemorrhage five months after excision of the mass.

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A facile and sensitive high performance liquid chromatographic (HPLC) technique has been developed for the determination pyrazinamide (PZA) in human plasma. Nicotinamide(NIA) is used as internal standard(IS). Plasma is deproteinized with 0.7 M perchloric acid; clear supernatant is neutralized with 1M NaOH and injected onto HPLC. The separation of pyrazinamide and the internal standard is carried out on a Supelco LC-18 (DB) column with a basic mobile phase. Pyrazinoic acid, the major metabolite, other anti-tuberculous drugs and endogenous components do not interfere with measurement of pyrazinamide. The limit of detection of pyrazinamide with this method is 0.2 mg/0.2 ml plasma (CV 8.2%).

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Case histories of 2 renal transplant recipients are reported who had presenting features of fever, leukocytosis and pain/tenderness over right iliac fossa and were diagnosed to be due to acute appendicitis rather than more commonly suspected acute rejection episode which has very similar features. Diagnosis of acute appendicitis was suspected on the basis of rectal examination and later confirmed by laparotomy. The purpose of this communication is to emphasize the need for proper diagnosis in patient with such presentation; otherwise wrong treatment may be received.

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A 30 year old woman (gravida 4, para 2) presented with 2 1/2 mth amenorrhoea and vaginal spotting. On bimanual pelvic examination, an old tear was felt on posterior cervical lip with enlarged cervix and normal sized uterus. Ultrasonography revealed ectopic pregnancy with placenta implanted on isthmus and upper cervix. Dilatation and curettage was done with cervical packing.

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A prospective study was undertaken to study the haemorheology in patients with diabetic foot lesions. Haemorheology of 30 patients with foot lesions and 30 age and sex matched controls was studied. The haemorheological parameters evaluated were whole blood and plasma viscosity and RBC filter ability. Plasma viscosity was significantly increased (p < 0.05). It substantiates the need for using rheomodulators in management of diabetic foot lesions.

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A 2 1/2 month old male child was admitted with loose motions and mild dehydration. He was full term normal delivery, born of a non-consanguinous marriage. On examination, he had trigonocephaly; anteverted nostrils, long philtrum and hypoplastic supraorbital ridges. X-ray showed sutural separation. Karyotyping confirmed deletion of short arm of chromosome 9 distal to band p22.

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Twenty-seven live related donor renal allograft recipients were evaluated for dyslipoproteinemia. Twenty-two patients received dual immunosuppression with prednisolone and azathioprine. Five patients received cyclosporin as well. Total cholesterol (Tch), triglycerides (TG), HDL cholesterol (HDLch), LDL cholesterol (LDLch) and VLDL cholesterol (VLDLch) levels were estimated. Fifteen (56%) patients showed significant lipoprotein abnormalities. Renal allograft recipients showed significantly lower levels of Tch (p < 0.05) and LDLch (p < 0.05) and higher levels of TG (p < 0.005) and HDLch (p < 0.05). Diet and beta blockers did not influence lipoprotein levels. A significant negative correlation was noted between post-transplant duration and Tch, TG and VLDLch levels. Increased TG levels were associated with increase in weight and higher daily prednisolone dosage at the time of evaluation. The study confirms the existence of dyslipoproteinemia in renal allograft recipients.

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Eighty-four patients of bilateral diabetic retinopathy were divided into 2 groups: Group I comprised of 60 patients (mean age 46 yrs) having non-proliferative diabetic retinopathy with maculopathy (total no. of eyes = 120). Group II consisted of 24 patients (mean age 49.1 yrs) with proliferative diabetic retinopathy with maculopathy (total no. of eyes under study = 48). One eye of each patient in group I was treated as a control and the other was subjected to focal laser therapy. While 48/60 control Group I eyes (80%) had 6/24 vision at the outset, at one year follow-up only 39/60 cases (65%) had 6/24 vision. Diabetic maculopathy persisted in all the 60 control eyes at one year. In contrast, 44/60 eyes (73%) subjected to focal laser therapy in Group I, had 6/24 vision at outset but one year later, 49/60 eyes (81%) had 6/24 vision. Maculopathy completely regressed in 48/60 eyes (80%). The 48 eyes of Group II patients were subjected to focal and scatter laser therapy. 20/48 eyes (41.6%) had 6/24 vision prior to treatment but one year after treatment, 25/48 eyes (52%) had 6/24 vision. Neovascularization and macular edema regressed after one year in 42/48 eyes (87.1%) and only 4/48 eyes (8.3%) developed localized vitreous hemorrhage. Laser therapy in Group I improved visual acuity by reducing macular edema. In Group II, it improved the vision and reduced the risk of vitreous hemorrhage, detachment and glaucoma.

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A case of subdural haematoma (SDH) having atypical features (headache, vomiting, drowsiness but normal haematological and metabolic parameters and no localising neurological signs) is reported. The SDH rapidly enlarged and liquefied in five days as evident on computerised tomographic (CT) scan and operative findings. Rapid improvement was observed following this. Abnormally excessive fibrinolytic activity in the SDH is a possible cause.

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