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One of the common serological hallmarks of autoimmune disorders is the presence of various autoantibodies in the sera of patients affected by these disorders. Antinuclear antibodies (ANA) detection is often needed to aid the diagnosis in several autoimmune disorders. In view of the different methodologies available for their detection, it becomes essential to understand the advantages and pitfalls of each procedure. This brief review discusses some methodological aspects of ANA detection and the clinical relevance of the presence of some of the autoantibodies found in the sera of patients with autoimmune disorders.

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Monitoring respiratory function is important in a Paediatrics Intensive Care Unit (PICU), as majority of patients have cardio-respiratory problems. Non-invasive monitoring is convenient, accurate, and has minimal complications. Along with clinical monitoring, oxygen saturation using pulse oximetry, transcutaneous oxygenation (PtcO2) and transcutaneous PCO2 (PtcCO2) using transcutaneous monitors and end-tidal CO2 using capnography are important and routine measurements done in most PICUs. Considering the financial and maintenance constraints pulse oximetry with end tidal CO2 monitoring can be considered as most feasible.

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Pathology, also called morbid anatomy, is macroscopically, microscopically, and molecularly so manifest an array of phenomena that it has compelled medical men to closely link it up with disease, dis-ease, and death. But there is more than meets the eye of the morbid anatomists, microscopists, and the molecular biologists. The obvious science of pathology is governed by numerous abstract, subtle, non-pathological factors. A pathological phenomenon is subservient to cosmic noumenon. Such a sea-change allows a newer perspective that cures modern medicine of many of its dogmas and provides epistemologically valid directions to research methodologies on the one hand and clinical practices on the other.

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Neurofibromatosis (NF), Noonan syndrome (NS), and LEOPARD syndrome are all autosomal dominant conditions, each being a distinct clinical entity by itself. Rarely, one encounters cases with features of NF and NS and is termed as the 'Neurofibromatosis-Noonan syndrome' (NF-NS). The authors report a clinical dilemma with major clinical features of the NF-NS syndrome and LEOPARD syndrome co-existing in the same patient. Also, features of Noonan syndrome and LEOPARD syndrome are compared with the case reported.

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AIMS: To evaluate the ink impression made by the palm of the dominant hand as a screening tool for difficult laryngoscopy in diabetic patients. SUBJECTS AND METHODS: In this prospective study, airway of 50 adult diabetic patients, undergoing elective surgery under general anaesthesia, was assessed preoperatively using the common clinical indices such as Modified Mallampati test, thyromental distance, degree of head extension and a specific index- the palm print test. Following induction of anaesthesia and neuromuscular relaxation, laryngoscopy was performed and the laryngoscopic view scored. The sensitivity, specificity and positive predictive value of each airway evaluation index were calculated. RESULTS: The incidence of difficult laryngoscopy was 16%. The palm print test had the highest sensitivity (75%) of all the indices. The thyromental distance less than six cm had the highest specificity (95.2%) but was least sensitive (25%). 87% of patients with difficult laryngoscopy had two or more indices abnormal. CONCLUSION: Though the palm print test was the most sensitive index of the four indices studied, a better prediction of difficult laryngoscopy can be achieved by evaluating all the four airway indices preoperatively.

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AIMS: The purpose of the study was to objectively determine the effects of early mobilisation in terms of grip strength and work of hand muscles in cases of closed diaphyseal fracture radius - ulna treated with dynamic compression plating. SUBJECTS AND METHODS: Fifty normal subjects and Twenty-one patients, (Eleven patients treated with early active and resistive goal directed mobilisation and Ten control group) were assessed for pinch strength and grip strength on Pinch Dynamometer and Jamar Dynamometer and work of hand muscles on Ergograph. Standardised positions of the equipments and patients were maintained throughout the study. RESULTS: Results showed highly significant reduction in performance in patients treated with early mobilisation as compared to normal subjects in their first assessment (Fourth week post operatively). These patients showed significant improvement in successive assessments (sixth & eighth post operative week) on exercising in between these assessments. CONCLUSIONS: There are significant effects on grip strength and work of hand muscles in patients treated with that early active and resistive goal directed mobilisation.

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The diagnosis of intestinal obstruction during pregnancy poses problems, as vomiting which is an important symptom of the obstruction can be attributed to hyperemesis of pregnancy and radiological investigation are avoided during this period. A case of intestinal obstruction due to volvulus resulting from congenital malrotation of the gut is reported here. The patient first presented during pregnancy. The case emphasises the need for thorough investigations in a case of persistent vomiting in pregnancy.

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Maternal mortality in the presence of Eisenmenger syndrome is reported to be 30 to 50% & increases further with associated complications. A case of Eisenmenger syndrome in pregnancy where the patient progressively deteriorated postpartum & expired 3 weeks later is reported.

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AIMS: To evaluate the clinical significance of estimation of the regional cerebral oxygen saturation (rSO2) in the patients with ischaemic stroke by the cerebral oximetry during acute, sub-acute and chronic phases. SUBJECTS AND METHODS: In this prospective study, 24 patients with ischaemic stroke in the middle cerebral artery territory were included. A detailed clinical examination and appropriate laboratory investigations were carried out. The rSO2 was determined by oximetery (INVOS 3100-SD) bilaterally on the first, third, seventh, and fifteenth days. The blood pressure, the peripheral capillary oxygen saturation and the arterial blood gas values were noted too. the changes were evaluated along with Glasgow coma scale (GCS) using unpaired student t-test and one way ANOVA test. RESULTS: There were significant differences between the rSO2 values in acute, subacute and chronic phases on the side of the lesion (p value < 0.05). The values of oxygen saturation gradually increased throughout the chronic phase. These values showed a positive correlation with GCS, but the results were not significant statistically. The rSO2 values were also significantly higher on the non-lesional side than those on the lesion side in the acute phase (p= 0.0034), the discrepancy disappeared during the sub-acute and chronic phases. CONCLUSION: Cerebral oximetry can be used as a measure to evaluate the cerebral oxygenation during the various phases of ischaemic stroke. It has a potential to serve as a useful marker for detection of cerebral oxygenation imbalances, to judge the effectiveness of the management and for the follow-up of patients with ischaemic stroke.

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Giant cell tumour (osteoclastoma) of talar bone is a rare entity and is seen more commonly in the third decade of life. We report this disease entity in a 17-years-old girl. The patient presented with painful swelling of the left ankle with an osteolytic lesion in the talus on conventional radiographs. Intralesional curettage and autologous bone grafting was performed following which patient's pain and swelling disappeared. Complete range of movement at the ankle joint was regained with minimal restriction at the subtalar joint. There is no evidence of relapse at six months follow up.

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A 26-year-old lady presented with a history of abdominal pain and distension since two months. The ultrasound examination showed an epigastric mass, which was delineated as a filling defect in the stomach on barium studies. The computerised tomographic scan showed a gastric mass with pockets of air in it, without post-contrast enhancement. This case highlights the characteristic appearance on computerised tomography of a bezoar within the stomach, a feature that is not commonly described in medical literature.

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AIMS: To evaluate giant prosthesis for reinforcement of visceral sac (GPRVS) as a treatment for complex bilateral and recurrent inguinal hernias. SUBJECTS AND METHODS: The prospective study carried out in a single surgical unit at a tertiary health care center involved consecutive series of 31 patients with complex bilateral and recurrent inguinal hernias who underwent GPRVS. All were men and the mean age was 58 years (range 49-95 years). Factors predicting high risk for recurrence included a large hernia ( greater, similar5cms, 32%, 10/31 patients), failure of one or more previous repairs (45%, 14/31 patients), chronic obstructive pulmonary disease (25%, 8/31 patients) and poor muscle tone (70%, 22/31 patients). Operative time, length of postoperative stay, complications and death were the main outcome measures. RESULTS: Mean -/+ SEM operative time was 65 -/+ 11 minutes (range 45-115 minutes). Mean -/+ SEM length of stay was 3.5 -/+ 0.7 days (range 2-5 days). There were 4 minor complications, but no mesh infections and death. Follow up was obtained for a mean period of 14.6 months (range 12-23 months); there were no recurrences. CONCLUSION: GPRVS provides a definitive and safe cure for repair of complex bilateral and recurrent inguinal hernias because of its simplicity, ease of the procedure, good results and low recurrence rate.

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A 28 years old lady presented with Sprengels deformity and hemivertebrae for Fothergills surgery. Clinically there were no anomalies of the nervous, renal or the cardiovascular systems. She had a short neck and score on modified Mallapati test was grade 2. She was successfully anaesthetised using injection Propofol as a total intravenous anaesthetic agent after adequate premedication with injection Midazolam and injection Pentazocine. Patient had an uneventful intraoperative and postoperative course.

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Scleredema adultorum is a rare connective tissue disorder reported usually following streptococcal infection, influenza, measles, and mumps. It has been reported occasionally following trauma and tuberculous lymphadenitis. This is a report of scleredema adultorum developing after chicken pox in an eight-year-old male child. The diagnosis was established by characteristic picture on skin biopsy using special stain. The patient had a benign course and a spontaneous recovery in two weeks. The case has been reported as the first case of scleredema adultorum developing after chicken pox.

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A rare case of relatively asymptomatic giant hepatic artery aneurysm of atherosclerotic aetiology is presented. The importance of imaging findings in the diagnosis of this condition and the differential diagnosis including the pertinent literature on the topic is discussed.

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A 38 years old female presented with pain in the epigastrium, jaundice and fever since one and half month. The computerised tomographic scan of the abdomen revealed a multiloculated abscess of the left lobe of liver. The pus drained from the liver abscess at laparotomy showed acid fast bacilli on microscopy. A detailed search failed to identify any other focus of tuberculous infection. The case has been reported for the rarity of isolated hepatic tuberculous abscess and its presentation with jaundice, a rare feature, and to highlight the importance of microscopic or culture diagnosis in a suspected case of pyaemic abscess.

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AIM: To detect an association between the sudden epidemic with respiratory symptoms, and fogging with dichlorovos in Jaipur town and to find out probable mechanism of causation of the epidemic. SUBJECTS AND METHODS: In this community based study of the epidemic, house to house survey of households selected using systematic random sampling was carried out. The incidence in the exposed and unexposed population, the relative risk and attributable risk were calculated. RESULTS: The incidence of cases was high (58.9%) in subjects present on roads at the time of fogging as compared to in those who were inside rooms of the houses (5.4%) and in those who were not in the locality at that time (1.8%) [Relative Risk (RR)=32.7 and Attributable Risk (AR)=96.9%]. CONCLUSION: High RR and AR in the present epidemic indicate strong association between fogging and occurrence of symptoms. In absence of signs and symptoms of organophosphorus poisoning it suggests that this could have been due to an inappropriate solvent or defective functioning of fog generator, leading to generation of an unusual dark fog, that might have irritated eyes and respiratory tract of exposed residents.

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