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 AIPG 2008 paper solved 1which peptide antibiotic is an antitumor agent? a)valinomycin b)bleomycin ans c)dactinomycin Bleomycin is a glycopeptide antibiotic produced by the bacterium Streptomyces verticillus. Bleomycin refers to a family of structurally related compounds. When used as an anti-cancer agent, the chemotherapeutical forms are primarily bleomycin A2 and B2. Bleomycin A2 is shown in the image. The drug is used in the treatment of Hodgkin lymphoma (as a component of the ABVD regimen), squamous cell carcinomas, and testicular cancer, pleurodesis as well as plantar warts. Q2most common cause of maternal mortality in India is Haemorrhage ans abortion septicemia obstructed labour Q.3 MOST SENSITIVE TEST FOR ACUTE KNEE INJURY ? LACHMAN ANT DRAWER PIVOT ANTERIOR CRUCIATE LIGAMENT Introduction The incidence of ACL injuries has increased dramatically over the last 2 decades. More than 200,000 new ACL injuries occur in the United States annually. These injuries are important because of the extent of disability associated with ACL tears. Normal ACL Torn ACL Approximately 50% of patients with ACL tears also have meniscal tears. The lateral meniscus is torn more frequently than the medial meniscus in acute ACL injuries, but in chronic ACL tears the medial meniscus is more commonly torn. Attempts to identify athletes at greatest risk for ACL injury have identified a few predisposing factors. Individuals with a narrow intercondylar notch of the femur appear to have a higher risk of non-contact ACL injuries. Women also appear to be more susceptible to non-contact ACL injuries compared to male counterparts. A two-fold increase in ACL injuries in women collegiate soccer players and a four-fold increase in basketball players. The cause of this gender difference is not clear. Knee instability secondary to anterior cruciate tears is the most common cause of long-term disability of the knee. The ACL is the primary restraint to hyperextension and anterior translation of the tibia on the femur. It also protects against excessive varus valgus stress and internal and external rotation as a seconary restraint. As a result of this wide range of function , a variety of injury mechanisms , most of which are non-contact in nature, may damage this ligament. History: Patients with acute ACL injuries commonly report giving way of the knee with stopping, cutting, or jumping. A pop, immediate pain and swelling within several hours usually occurs with ACL injuries. Physical Examination: The examination of the knee with an acute ACL injury is often difficult because the pain and swelling cause muscular guarding by the patient. . Early examination prior to the onset of the guarding is advantageous and comparison to the normal knee is mandatory. The Lachman test is the most accurate test for diagnosis of acute ACL tears. The Lachman test and the varus-valgus tests often are the only tests that can be reliably performed in an acute knee injury. A positive pivot shift is diagnostic for ACL tears but it can only be elicited in 25% of acute ACL tears. Examination with a knee ligament arthrometer may be helpful in diagnosis of acute knee injuries, a side to side difference of 3 mm. or more is diagnostic of an ACL tear. Diagnostic Imaging Every knee suspected of ACL damage should be evaluated with plain X-rays. Osteochondral fracture can be visualized. The Segond's fracture , which is seen at the lateral edge of the tibia on an AP view, is diagnostic of an ACL tear. In the chronic setting , X-ray findings associated with anterior cruciate insufficiency include intercondylar spurring and intercondylar notch narrowing . MRI can be useful with diagnosis of ACL injuries when the clinical exam is limited because of pain and swelling. This test can also identify associated injuries to the menisci, articular cartilage or bone. The accuracy of MRI in determining acute ACL injury is approximately 90%. .4organism involved in crohn's disease?a)Mycobacterium avium subspecies paratuberculosis Mycobacterium avium subspecies paratuberculosis is a pathogenic bacteria in the genus Mycobacteria.[1] It is often abbreviated Map, M. paratuberculosis, or M. avium sub. paratuberculosis. The type strain is ATCC 19698 (equivalent to CIP 103963 or DSM 44133).[2] Contents [hide] 1 Pathophysiology 1.1 Crohn's disease 2 Genome 3 See also 4 References [edit] Pathophysiology Map causes Johne's disease in cattle and other ruminants, and it has long been suspected as a causative agent in Crohn's disease in humans; this connection is controversial.[3] Recent studies have shown that Map present in milk can survive pasteurization, which has raised human health concerns due to the widespread nature of Map in modern dairy herds. Map is heat resistant and it is capable of sequestering itself inside white blood cells, which may contribute to its persistence in milk. It has also been reported to survive chlorination in municipal water supplies. Even though Map is hardy, it is slow growing and fastidious, which means it is difficult to culture. Many negative studies for Map presence in living tissue, food, and water have used culture methods to determine whether the bacteria is present. Due to recent advances in our knowledge of the bacterium, some or all of these studies may need to be re-evaluated on the basis of culture methodology. Map, like most mycobacteria, is difficult to treat. It is not susceptible to anti-tuberculosis drugs (which can generally kill Mycobacterium tuberculosis), but can only be treated with a combination of antibiotics such as Rifabutin and a macrolide such as Clarithromycin. Treatment regimes can last years. [edit] Crohn's disease MAP is recognized as a multi-host mycobacterial pathogen with a proven specific ability to initiate and maintain systemic infection and chronic inflammation of the intestine of a range of histopathological types in many animal species including primates. On the assumption that Map is a causative agent in Crohn's, the Australian biotechnology company Giaconda is seeking to commercialise a combination of Rifabutin, clarithromycin and clofazimine as a potential drug therapy for Crohn's. As of April 2007, Giaconda received United States FDA IND approval for this medication, now called Myoconda Q.5pollicization refers to? ans.thumb reconstruction Pollicization is a plastic surgery technique in which a thumb is created from an existing finger. Typically this consists of surgically migrating the index finger to the position of the thumb in patients who are either born without a functional thumb (most common) or in patients who have lost their thumb traumatically and are not amenable to other preferred methods of thumb reconstruction such as toe-to-hand transfers. During pollicization the index finger metacarpal bone is cut and the finger is rotated approximately 120 to 160 degrees and replaced at the base of the hand at the usual position of the thumb. The arteries and veins are left attached. If nerves and tendons are available from the previous thumb these are attached to provide sensation and movement to the new thumb ("neopollux"). If the thumb is congenitally absent other tendons from the migrated index finger may be shortened and rerouted to provide good movement. The presence of an opposable thumb is considered important for manipulation of most objects in the physical world. Children born without thumbs often adapt to the condition very well with few limitations therefore the decision to proceed with pollicization lies with the child's parents with the recommendation of their surgeon. Persons who have grown to adulthood with functional thumbs and then lost a thumb find it highly beneficial to have a thumb reconstruction, not only from a functional but from a mental and emotional standpoint. Retrieved from "http://en.wikipedia.org/wiki/Pollicization" .6radiosensitive phase of cell cycle? a)g2 m ans b)g1 c)s Q7 ALL OF THE FOLLOWING ARE TRUE ABOUT V CHOLERA O 139 EXCEPT? SIMILAR TO EL TOR DISCOVERED IN CHENNAI PRODUCES O1 LIPOPOLYSACCHARIDE ans .cytogenetic abnormality in synovial sarcoma? ans: t(X;1 translocation ans Synovial sarcoma constitutes 8-10% of all sarcomas and most commonly affects adults in the third to fifth decades of life. This malignancy usually involves the extremities, especially the lower extremities around the knees. Synovial sarcoma is frequently misdiagnosed as a benign condition because of its often small size, slow growth, and well-defined appearance.1, 2 Pathophysiology Gross specimens are usually well-demarcated, pink, fleshy masses with a heterogeneous appearance and may display solid, hemorrhagic, or cystic components on sectioning. Calcification foci are occasionally noted; heavy calcification tends to indicate less aggressive lesions and offers a more favorable prognosis. Synovial sarcoma is named for its resemblance to developing synovial tissue under light microscopy. It arises from the pluripotential mesenchymal cells near joint surfaces, tendons, tendon sheaths, juxta-articular membranes, and fascial aponeuroses. The histologic appearance is that of large polygonal cells (epithelioid) that secrete hyaluronic acid and show an organization that is suggestive of microscopic joint spaces. These cells are surrounded by spindle cells that simulate subsynovial mesenchymal cells. The typical morphology is that of 2 strikingly distinct, well-differentiated cell populations. Depending on which cell type predominates, the overall histologic appearances can be described as biphasic (epithelioid and spindle cell), monophasic spindle cell, or monophasic epithelioid. Marked cellular pleomorphism and atypia are uncommon, but when they are present, their appearance overlaps with that of a high-grade malignant fibrous histiocytoma and fibrosarcoma. Specific cytogenetic abnormalities have been identified. More than 90% of patients have a t(X;1 translocation mutation, which is not associated with other sarcomas. The translocation involves the SYT gene on chromosome 18 (at 18q11) and the SSX1 or SSX2 gene on the X chromosome (at Xp11).3, 4 These genes appear to be transcription regulators, whose functions occur primarily through protein-protein interactions. Subtypes of these translocations have been shown to correlate with distinct histologic subtypes. Frequency United States Synovial sarcoma is the fourth most commonly occurring sarcoma,1 accounting for 8-10% of all sarcomas. Approximately 800 new cases of synovial sarcoma are diagnosed per year. Mortality/Morbidity Overall, survival rates are 36-76% at 5 years and 20-63% at 10 years. Synovial sarcoma of the head and neck region has a better prognosis than that of sarcoma involving the extremities, with 5-year survival rates of 47-82%. Sex Although different studies have cited a slight male or female predominance, a study including 672 cases at the Armed Forces Institute of Pathology (AFIP) demonstrated no significant sex or ethnic predilection for synovial sarcoma.1 Age Synovial sarcoma can occur in patients with a wide age range, but it is most common in patients in the third to fifth decades of life. In a series of 121 cases, 83.6% of tumors occurred in patients aged 10-50 years, with a median age of 31.3 years. Another large study included patients with ages ranging from 5 to 87 years.5 Anatomy Synovial sarcoma is the most common sarcoma that involves the upper extremity, hip, groin, and buttocks in patients aged 16-25 years. In patients aged 6-45 years, synovial sarcoma is the most common sarcoma in the foot and ankle. Most synovial sarcomas are found within 5 cm of a joint. Despite the misnomer, only 10% of cases are intra-articular. The tumors are usually well circumscribed, but in unusual cases, they may interdigitate between muscles and tendons or encase neurovascular structures. Invasion of the adjacent bone is seen in 11-20% of patients, a feature that is uncommon in other sarcomas. The region around the knee is the most common site of involvement. In a large study, 73% of synovial sarcomas occurred in the lower limb; 34% in the upper limb; and 16% in the chest/abdominal wall. Tumors that occur in the upper extremity tend to affect the distal extremity rather than the elbow or shoulder. Less common sites of involvement include the retroperitoneum, mediastinum, and head and neck regions. The most common site in the head and neck is the hypopharynx. Other head and neck locations include the cervical or parapharyngeal regions, masticator space, soft palate, tongue, suboccipital and infratemporal fossa regions, and sinonasal space. HMB-45 An antibody to a premelanosome glycoprotein found to be present in melanomas and other tumors derived from melanocytes Corporo basal index is for sex (ref: reddy page 51) Q.joint b/n ear ossicles? ans:synovial REF:bdc p.223 incudomalleolar jt. is saddle & incudostapedial jt. is ball & socket both are types of synovial joint Anal Fissures Clinical Presentation and Diagnostic Evaluations An anal fissure is a linear ulcer of the lower half of the anal canal, usually located in the posterior commissure in the midline ( Fig. 49–10 ). Often misnamed as "rectal fissures," in fact, these lesions truly involve just the anal tissues and are typically best seen by visually inspecting the anal verge with gentle separation of the gluteal cleft. Location may vary, and an anterior midline fissure is seen more often in women, although most fissures in women and men reside in the posterior midline. Characteristic associated findings include a sentinel pile or tag externally and an enlarged anal papilla internally. Fissures away from these two locations should raise the possibility of associated diseases, especially Crohn's disease, hidradenitis suppurativa, or STDs. Because it involves the highly sensitive squamous epithelium, fissure in ano is often a painful condition. With defecation, the ulcer is stretched, causing pain and mild bleeding. The diagnosis is secured by the typical history of pain and bleeding with defecation, especially if associated with prior constipation and confirmed by inspection after gently parting the posterior anus. Digital as well as proctoscopic examination may trigger severe pain, interfering with the ability to visualize the ulcer. An endoscopic examination should be performed, but it can be delayed 4 to 6 weeks, until the pain is resolved with medical management or until surgery is performed for those cases refractory to medical therapy. REGARDING DIFFUSE AXONAL INJURY ,WHICH OF THE FOLLWING IS CORRECT? A)Frontal and temporal white matter,caudate nuclei, thalamus are most commonly involved. B) C)... D?????? Diffuse axonal injury (DAI) is a frequent result of traumatic deceleration injuries and a frequent cause of persistent vegetative state in patients. DAI is the most significant cause of morbidity in patients with traumatic brain injuries, which most commonly result from high-speed motor vehicle accidents. Typically, the process is diffuse and bilateral, involving the lobar white matter at the gray-white matter interface. The corpus callosum frequently is involved, as is the dorsolateral rostral brainstem. The most commonly involved area is the frontal and temporal white matter, followed by the posterior body and splenium of the corpus callosum, as well as the caudate nuclei, thalamus, tegmentum, and internal capsule. Internal capsule lesions are associated more frequently with hemorrhage than are the other lesions and are secondary to the proximity of the lenticulostriate vessels. The following stages of involvement have been described by Adams and colleagues according to the anatomic location of the lesions4: * Stage I - This involves the parasagittal regions of the frontal lobes, the periventricular temporal lobes, and, less likely, the parietal and occipital lobes, internal and external capsules, and cerebellum. * * Stage II - This involves the corpus callosum in addition to the white-matter areas of stage I. Stage II is observed in approximately 20% of patients. Most commonly, the posterior body and splenium are involved; however, the process is believed to advance anteriorly with increasing severity of disease. Both sides of the corpus callosum may be involved; however, involvement more frequently is unilateral and may be hemorrhagic. The involvement of the corpus callosum carries a poorer prognosis. * * Stage III - This involves the areas associated with stage II, with the addition of brainstem involvement. A predilection exists for the superior cerebellar peduncles, medial lemnisci, and corticospinal tracts. there was a repeat question about a neonate presenting with non passage of meconium, abd distension and vomiting for 48 hrs. investigation of choice will be a. trypsinogen assay b. gene testing for cystic fibrosis c. rectal manometry d. lower gastrointestinal tract contrast studies do not remember the EXACT stem and options but pls read the text below which is taken from SABISTON SURGERY 17th edition Meconium Plug Meconium plug syndrome is a frequent cause of neonatal intestinal obstruction and associated with multiple conditions including Hirschsprung's disease, maternal diabetes, hypothyroidism, and CF. Although most children with meconium plug syndrome are normal, further studies to exclude Hirschsprung's disease and CF are warranted. Typically, affected infants are often preterm and present with signs and symptoms of distal intestinal obstruction. Abdominal distention is a prominent feature. Plain abdominal radiographs reveal multiple dilated loops of intestine. The diagnostic and therapeutic procedure of choice is a water-soluble contrast enema. This often results in the passage of a plug of meconium and relief of the obstruction. Facial colliculus - LEVEL OF PONS Answers to these pls Final common pathway 3rd, 4th, 6th cranial nerves - VESTIBULAR NUCLEUS? Somatic afferent 3rd/ 4th/ 6th/ 7th cranial nerves Q.what supplementation is required in pregnant females taking heparin? a)folic acid b)calcium ANS c)zn REF:http://cmbi.bjmu.edu.cn/uptodate/Val...t%20valves.htm Heparin — Heparin is a large molecule that does not cross the placenta. Thus, it does not carry the same risk of teratogenicity as warfarin. However, heparin does cause bone loss, and there are many case reports and series of pregnant women with osteoporotic fractures during and after prolonged use of heparin [14]. One of the largest studies followed 184 pregnant women who were given heparin: osteoporotic vertebral fractures were found in four (2.2 percent) [15]. Although the incidence of fractures was not very high, they occurred in a population of young women in whom osteoporotic fractures are extremely rare. Other series have confirmed that chronic heparin therapy increases the rate of bone loss and reduces bone mineral density (BMD) in many patients [16,17,18]. One study, for example, monitored hip bone density in 14 pregnant women requiring heparin and in 14 matched pregnant controls [18]. Mean hip BMD fell by about 5 percent in the women treated with heparin (p<0.01), while there was no significant change in pregnant controls. More than a 10 percent reduction in hip BMD occurred in 5 of the 14 women taking heparin (36 percent) versus none of the pregnant controls. Similar results were reported in another controlled study which examined the effect of heparin on forearm BMD [17]. Recovery of BMD occurs postpartum after the heparin is discontinued [16,17,18]. It is unclear, however, if the recovery is complete. We recommend calcium supplementation (1.2 g/day) during pregnancy and postpartum for women taking heparin to insure that the RDA is achieved. .Somatic efferent includes all except? 3n. 4n. 6n. 7n. ans. REF:The somatic efferent neurons (GSE, 'somatomotor, or somatic motor fibers), arise from motor neuron cell bodies in the ventral horns of the gray matter within the spinal cord. They exit the spinal cord through the ventral roots, carrying motor impulses to skeletal muscle. Of the somatic efferent neurons, there exist subtypes. Alpha motor neurons (α) target extrafusal muscle fibers. Gamma motor neurons (γ) target intrafusal muscle fibres. Examples of nerves that contain GSE fibers include the oculomotor nerve, the trochlear nerve, the abducens nerve, and the hypoglossal nerve. [1] Q.Meniscus can be repaired if injuryis at? a)outer1/3 ans b)middle1/3 c)inner1/3 REF: The meniscus is a C-shaped piece of fibrocartilage which is located at the peripheral aspect of the joint. There are two meniscii in each knee, the medial meniscus, and the lateral meniscus. The majority of the meniscus has no blood supply. For that reason, when damaged, the meniscus is usually unable to undergo the normal healing process that occurs in most of rest of the body. In addition, with age, the meniscus begins to deteriorate, often developing degenerative tears. Typically, when the meniscus is damaged, the torn piece begins to move in an abnormal fashion inside the joint. Because the space between the bones of the joint is very small, as the abnormally mobile piece of meniscal tissue moves, it may become caught between the bones of the joint (femur and tibia). When this happens, the knee becomes painful, swollen, and difficult to move. Usually this situation requires that the torn piece be removed. However, sometimes, the meniscus tear is along the peripheral (outer) aspect of the tissue. Diffuse axonal injury (DAI) is a frequent result of traumatic deceleration injuries and a frequent cause of persistent vegetative state in patients. DAI is the most significant cause of morbidity in patients with traumatic brain injuries, which most commonly result from high-speed motor vehicle accidents. DAI is a significant medical problem because of the high level of debilitation that is suffered by the patient, the stress that must be endured by the patient's family when the patient is in a persistent vegetative state, and the staggering medical cost of sustaining the patient in this state. DAI typically consists of several focal white-matter lesions measuring 1-15 mm in a characteristic distribution (see below). Pathophysiology The pathophysiology of DAI first was described by Holbourn in 1943, using 2-dimensional gelatin molds.1 His work led to the understanding that shear injury is not induced by linear or translational forces but rather by rotational forces. Sudden acceleration-deceleration impact can produce rotational forces that affect the brain. The injury to tissue is the greatest in those areas where the density difference is the greatest. For this reason, approximately two thirds of DAI lesions occur at the gray-white matter junction. When shearing forces occur in areas of greater density differential, the axons suffer trauma; this results in edema and in axoplasmic leakage (which is most severe during the first 2 weeks following injury). The exact location of the shear-strain injury depends on the plane of rotation and is independent of the distance from the center of rotation. Conversely, the magnitude of injury depends on the following 3 factors: The distance from the center of rotation The arc of rotation The duration and intensity of the force The true extent of axonal injury typically is worse than that visualized using current imaging techniques. On the microscopic level, the axon may not be completely torn by the initial force, but the trauma still can produce focal alteration of the axoplasmic membrane, resulting in impairment of axoplasmic transport. This would lead to axoplasmic swelling, with the axon subsequently splitting into 2 pieces and a retraction ball—a pathologic hallmark of shearing injury—forming. The axon would then undergo wallerian degeneration. Dendritic restructuring might occur, with some regeneration possible in mild to moderate injury. Within the basal ganglia, the effect of DAI produces parenchymal atrophy brought on by shrinkage of astrocytes in the lateral and ventral nuclei, with sparing of the anterior and dorsomedial nuclei, the pulvinar, the centromedian nuclei, and the lateral geniculate bodies. Cholinergic neurons have been found to be slightly more susceptible to trauma than are neurons belonging to other neurotransmitters. Peripheral lesions usually are smaller than central lesions. The lesions typically are ovoid or elliptical, with the long axis parallel to the direction of the involved axonal tracts. A high association is seen between thalamic injury and DAI. Both silver staining and beta-amyloid precursor protein immunohistochemical staining have proven useful in the pathologic identification of DAI lesions. DAI was classically believed to represent a primary injury (occurring at the instant that the trauma occurred). It has become apparent, however, that the axoplasmic membrane alteration, transport impairment, and retraction ball formation may represent secondary (or delayed) components of the disease process. Frequency United States DAI represents approximately one half of all intra-axial traumatic lesions. Mortality/Morbidity DAI rarely results in death. As many as 90% of patients remain in a persistent vegetative state. Race No racial predilection exists. Sex No sex predilection exists. Age DAI can occur at any age. Some studies suggest that DAI may occur in utero if a pregnant woman is subjected to sufficient force. Anatomy Typically, the process is diffuse and bilateral, involving the lobar white matter at the gray-white matter interface. The corpus callosum frequently is involved, as is the dorsolateral rostral brainstem. The most commonly involved area is the frontal and temporal white matter, followed by the posterior body and splenium of the corpus callosum, as well as the caudate nuclei, thalamus, tegmentum, and internal capsule. Internal capsule lesions are associated more frequently with hemorrhage than are the other lesions and are secondary to the proximity of the lenticulostriate vessels. The following stages of involvement have been described by Adams and colleagues according to the anatomic location of the lesions4: Stage I - This involves the parasagittal regions of the frontal lobes, the periventricular temporal lobes, and, less likely, the parietal and occipital lobes, internal and external capsules, and cerebellum. Stage II - This involves the corpus callosum in addition to the white-matter areas of stage I. Stage II is observed in approximately 20% of patients. Most commonly, the posterior body and splenium are involved; however, the process is believed to advance anteriorly with increasing severity of disease. Both sides of the corpus callosum may be involved; however, involvement more frequently is unilateral and may be hemorrhagic. The involvement of the corpus callosum carries a poorer prognosis. Stage III - This involves the areas associated with stage II, with the addition of brainstem involvement. A predilection exists for the superior cerebellar peduncles, medial lemnisci, and corticospinal tracts. Clinical Details Classically, DAI has been considered a primary-type injury, with damage occurring at the time of the accident. Research has shown that another component of the injury comprises the secondary factors (or delayed component), since the axons are injured, secondary swelling occurs, and retraction bulbs form. Of patients with DAI, 80% demonstrate multiple areas of injury on computed tomography (CT) scans. The degree of microscopic injury usually is considered to be greater than that seen on diagnostic imaging, and the clinical findings reflect this point. DAI is suggested in any patient who demonstrates clinical symptoms disproportionate to his or her CT-scan findings. DAI results in instantaneous loss of consciousness, and most patients (>90%) remain in a persistent vegetative state, since brainstem function typically remains unaffected. DAI rarely causes death. Compared with patients who have an epidural hematoma, patients with DAI are less likely to have a lucid interval. There is little association between DAI and the presence of skull fractures; in addition, the existence of DAI has no bearing on whether a subarachnoid or subdural hemorrhage is present. The chance that a patient will remain in a persistent vegetative state is greater when lesions are observed in the supratentorial white matter, corpus callosum, and corona radiata. The prognosis also worsens as the number of lesions increases. For the almost 10% of patients who experience a return to any form of normal function, this improvement will be seen within the first year. DAI lesions can result in deficits in information transfer between the 2 sides of the corpus callosum, commonly resulting in auditory deficits. nigro protocol for treatment of epidermoid carcinoma anal ca Anal Canal Neoplasms Epidermoid Carcinoma Tumors arising in the anal canal or in the transitional zone that have a squamous, basaloid, cloacogenic, or mucoepidermoid epithelium share a similar behavior in clinical presentation, response to treatment, and prognosis and are considered collectively. They typically present as a mass, sometimes with bleeding and pruritus . At the time of diagnosis, nearly one fourth of these are superficial or in situ; half are less than 3 cm in size, and the other half are larger. About 71% have deep tumor penetration; 25% are node positive, and 6% present with distant metastases. In the past, treatment modalities have included either surgery alone or radiation therapy alone. Patients with tumors confined to epithelial or subepithelial tissue have been treated by local excision and patients with more advanced lesions by APR. The introduction of multimodality therapy combining irradiation and chemotherapy promised to preserve continence, avoid colostomy, and offer similar survival advantage. In keeping with this concept, local excision alone remains an option for superficial, early-stage lesions, which have been associated with variable survivorship (61% to 87%; 100% in at least one study if the lesion was smaller than 2 cm. Although some small superficial lesions can be treated with local excision, most patients are best treated with combined chemotherapy and irradiation. Combined-modality therapy has evolved as the preferred alternative to radical surgery because, in theory, surgical mortality and morbidity are largely avoided, intestinal continuity is preserved, and survival compares favorably with that after surgery. Nigro and colleagues[77] were the first to promote radiation therapy plus chemotherapy as definitive treatment for epidermoid anal canal malignancies. The current "Nigro protocol" includes externalbeam radiation therapy to the pelvic tumor and pelvic and inguinal nodes, to a total dose of 3000 cGy starting on day 1 using 15 fractions (200 cGy/day).[77] Systemic chemotherapy includes 5-fluorouracil (5-FU), 1000 mg/m2 for 24 hours as continuous infusion for 4 days, commencing on day 1 and again on day 28 (two cycles total). MitomycinC is delivered as an intravenous bolus at 15 mg/m2 starting on day 1 only. Many institutions have modified the pelvic radiation doses, approximating the doses typically delivered in rectal cancer. Although some reports have described comparable results using radiation therapy alone, current studies support the continued use of 5-FU and mitomycin C.[80] Although radiation plus chemotherapy has largely replaced the need for APR in anal canal cancers, there remain subsets of patients in whom abdominoperineal resection may be considered appropriate as either single-modality or combinedmodality therapy. Such groups would include patients who are already in need of a stoma for fecal incontinence, those for whom chemotherapy or radiation therapy is contraindicated, and those whose disease fails to resolve completely after radiation therapy plus chemotherapy SABISTONS TEXTBOOK OF SURGERY 17th edition Prions are infectious protinaceous particles Extrahepatic biliary obstruction has been seen with various parasitic infections such as Strongyloides, Ascaris, and liver flukes such as Clonorchis sinensis and Fasciola hepatica. what abt diploic veins a/e?a:valveless....b:thin wal........c  resent in cranial bones.....d:develop at 8th week of gestation Diploic veins are valveless & are present in cranial bones 4 sure ans cud most probably be d:develop at 8th week of gestation The sigmoid sinuses, which pass through the jugular foramen and empty into the jugular veins, are the primary routes for venous drainage of the brain. However, human brains, unlike other mammals, also use accessory veins called emissary veins which pass though emissary foramen in the base of the skull and empty into the vertebral venous plexus inside the spinal canal. The vertebral venous plexus is an extensive system with a very large capacity and, unlike the veins in the rest of the body, the veins of the vertebral venous plexus have no valves. Similarly, the emissary veins, diploic veins, and craniofacial veins, as well as the dural sinuses, have no valves and are all interconnected to form on large valveless venous network. Since the basicranium contains the primary outlets for both venous drainage routes of the brain, it seem logical that changes in craniocervical relationships may affect these drainage ports. In addition, stenosis of the neural canal may compress the spinal veins. Q.1which peptide antibiotic is an antitumor agent? a)valinomycin b)bleomycin c)dactinomycin Bleomycin is a glycopeptide antibiotic produced by the bacterium Streptomyces verticillus. Bleomycin refers to a family of structurally related compounds. When used as an anti-cancer agent, the chemotherapeutical forms are primarily bleomycin A2 and B2. Bleomycin A2 is shown in the image. The drug is used in the treatment of Hodgkin lymphoma (as a component of the ABVD regimen), squamous cell carcinomas, and testicular cancer, pleurodesis as well as plantar warts. Q.waterline in iceberg represents demarcation b/n? 1 sypmtomatic and asymptomatic 2 dignosed and undiagnosed 3 apparent & inapperent disease 4 case & carriers REF ark 18ed/p.35 .community health center is?a)first referral unit b)2nd r.u. c)3rd r.u REF ark/18ed/p.28 Q.about Gomez classification all are true except? a)based on height b)normal is 50thcentile of Boston standards c)72% represents 2nd degree malnutrition d)has prognostic value for hospitalized childrens REF:It is based on weight retardation & not on height(park) Q.Anti-fungals are ALL EX a)Ciclopirox b)ketoconazole c)Undecyclenic acid d)Clofasamine ref:goodman gillman .wrong statement is A)india is signatore to 1978 alma ata declaration b)health is a central gov. responsibility REF /18ed/21 it is a state responsibility .Aortic Arch on Right seen in ? Corrected TGA Truncus arteriosus TOF Q.Coronary ligament of knee, is situated ?- a)Between two anterior attachment of meniscus b)Between two posterior attachment of meniscus c)b/n meniscus & tibia d)b/n meniscus & femur REF:BDC Q.Corporo basal index used for ? stature / sex / age / race Q.Dementia precox term coined by? Schneider Bleuler krapelin freud REF:ahuja 5thed/p.55 Q2most common cause of maternal mortality in India is Haemorrhage ans abortion septicemia obstructed labour Q.3 MOST SENSITIVE TEST FOR ACUTE KNEE INJURY ? LACHMAN ans ANT DRAWER PIVOT ANTERIOR CRUCIATE LIGAMENT Introduction The incidence of ACL injuries has increased dramatically over the last 2 decades. More than 200,000 new ACL injuries occur in the United States annually. These injuries are important because of the extent of disability associated with ACL tears. Normal ACL Torn ACL Approximately 50% of patients with ACL tears also have meniscal tears. The lateral meniscus is torn more frequently than the medial meniscus in acute ACL injuries, but in chronic ACL tears the medial meniscus is more commonly torn. Attempts to identify athletes at greatest risk for ACL injury have identified a few predisposing factors. Individuals with a narrow intercondylar notch of the femur appear to have a higher risk of non-contact ACL injuries. Women also appear to be more susceptible to non-contact ACL injuries compared to male counterparts. A two-fold increase in ACL injuries in women collegiate soccer players and a four-fold increase in basketball players. The cause of this gender difference is not clear. Knee instability secondary to anterior cruciate tears is the most common cause of long-term disability of the knee. The ACL is the primary restraint to hyperextension and anterior translation of the tibia on the femur. It also protects against excessive varus valgus stress and internal and external rotation as a seconary restraint. As a result of this wide range of function , a variety of injury mechanisms , most of which are non-contact in nature, may damage this ligament. History: Patients with acute ACL injuries commonly report giving way of the knee with stopping, cutting, or jumping. A pop, immediate pain and swelling within several hours usually occurs with ACL injuries. Physical Examination: The examination of the knee with an acute ACL injury is often difficult because the pain and swelling cause muscular guarding by the patient. . Early examination prior to the onset of the guarding is advantageous and comparison to the normal knee is mandatory. The Lachman test is the most accurate test for diagnosis of acute ACL tears. The Lachman test and the varus-valgus tests often are the only tests that can be reliably performed in an acute knee injury. A positive pivot shift is diagnostic for ACL tears but it can only be elicited in 25% of acute ACL tears. Examination with a knee ligament arthrometer may be helpful in diagnosis of acute knee injuries, a side to side difference of 3 mm. or more is diagnostic of an ACL tear. Diagnostic Imaging Every knee suspected of ACL damage should be evaluated with plain X-rays. Osteochondral fracture can be visualized. The Segond’s fracture , which is seen at the lateral edge of the tibia on an AP view, is diagnostic of an ACL tear. In the chronic setting , X-ray findings associated with anterior cruciate insufficiency include intercondylar spurring and intercondylar notch narrowing . MRI can be useful with diagnosis of ACL injuries when the clinical exam is limited because of pain and swelling. This test can also identify associated injuries to the menisci, articular cartilage or bone. The accuracy of MRI in determining acute ACL injury is approximately 90%. -  |
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01-15-2008, 03:04 PM
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| Q.4 organism involved in crohn's disease?a)Mycobacterium avium subspecies paratuberculosis Mycobacterium avium subspecies paratuberculosis is a pathogenic bacteria in the genus Mycobacteria.[1] It is often abbreviated Map, M. paratuberculosis, or M. avium sub. paratuberculosis. The type strain is ATCC 19698 (equivalent to CIP 103963 or DSM 44133).[2] Contents [hide] 1 Pathophysiology 1.1 Crohn's disease 2 Genome 3 See also 4 References [edit] Pathophysiology Map causes Johne's disease in cattle and other ruminants, and it has long been suspected as a causative agent in Crohn's disease in humans; this connection is controversial.[3] Recent studies have shown that Map present in milk can survive pasteurization, which has raised human health concerns due to the widespread nature of Map in modern dairy herds. Map is heat resistant and it is capable of sequestering itself inside white blood cells, which may contribute to its persistence in milk. It has also been reported to survive chlorination in municipal water supplies. Even though Map is hardy, it is slow growing and fastidious, which means it is difficult to culture. Many negative studies for Map presence in living tissue, food, and water have used culture methods to determine whether the bacteria is present. Due to recent advances in our knowledge of the bacterium, some or all of these studies may need to be re-evaluated on the basis of culture methodology. Map, like most mycobacteria, is difficult to treat. It is not susceptible to anti-tuberculosis drugs (which can generally kill Mycobacterium tuberculosis), but can only be treated with a combination of antibiotics such as Rifabutin and a macrolide such as Clarithromycin. Treatment regimes can last years. Crohn's disease MAP is recognized as a multi-host mycobacterial pathogen with a proven specific ability to initiate and maintain systemic infection and chronic inflammation of the intestine of a range of histopathological types in many animal species including primates. On the assumption that Map is a causative agent in Crohn's, the Australian biotechnology company Giaconda is seeking to commercialise a combination of Rifabutin, clarithromycin and clofazimine as a potential drug therapy for Crohn's. As of April 2007, Giaconda received United States FDA IND approval for this medication, now called Myoconda Q.5pollicization refers to? ans.thumb reconstruction Pollicization is a plastic surgery technique in which a thumb is created from an existing finger. Typically this consists of surgically migrating the index finger to the position of the thumb in patients who are either born without a functional thumb (most common) or in patients who have lost their thumb traumatically and are not amenable to other preferred methods of thumb reconstruction such as toe-to-hand transfers. During pollicization the index finger metacarpal bone is cut and the finger is rotated approximately 120 to 160 degrees and replaced at the base of the hand at the usual position of the thumb. The arteries and veins are left attached. If nerves and tendons are available from the previous thumb these are attached to provide sensation and movement to the new thumb ("neopollux"). If the thumb is congenitally absent other tendons from the migrated index finger may be shortened and rerouted to provide good movement. The presence of an opposable thumb is considered important for manipulation of most objects in the physical world. Children born without thumbs often adapt to the condition very well with few limitations therefore the decision to proceed with pollicization lies with the child's parents with the recommendation of their surgeon. Persons who have grown to adulthood with functional thumbs and then lost a thumb find it highly beneficial to have a thumb reconstruction, not only from a functional but from a mental and emotional standpoint. Retrieved from "http://en.wikipedia.org/wiki/Pollicization" Q.6radiosensitive phase of cell cycle? a)g2 m b)g1 c)s Q7 ALL OF THE FOLLOWING ARE TRUE ABOUT V CHOLERA O 139 EXCEPT? SIMILAR TO EL TOR DISCOVERED IN CHENNAI PRODUCES O1 LIPOPOLYSACCHARIDE Q.cytogenetic abnormality in synovial sarcoma? ans: t(X;1 translocation Synovial sarcoma constitutes 8-10% of all sarcomas and most commonly affects adults in the third to fifth decades of life. This malignancy usually involves the extremities, especially the lower extremities around the knees. Synovial sarcoma is frequently misdiagnosed as a benign condition because of its often small size, slow growth, and well-defined appearance.1, 2 Pathophysiology Gross specimens are usually well-demarcated, pink, fleshy masses with a heterogeneous appearance and may display solid, hemorrhagic, or cystic components on sectioning. Calcification foci are occasionally noted; heavy calcification tends to indicate less aggressive lesions and offers a more favorable prognosis. Synovial sarcoma is named for its resemblance to developing synovial tissue under light microscopy. It arises from the pluripotential mesenchymal cells near joint surfaces, tendons, tendon sheaths, juxta-articular membranes, and fascial aponeuroses. The histologic appearance is that of large polygonal cells (epithelioid) that secrete hyaluronic acid and show an organization that is suggestive of microscopic joint spaces. These cells are surrounded by spindle cells that simulate subsynovial mesenchymal cells. The typical morphology is that of 2 strikingly distinct, well-differentiated cell populations. Depending on which cell type predominates, the overall histologic appearances can be described as biphasic (epithelioid and spindle cell), monophasic spindle cell, or monophasic epithelioid. Marked cellular pleomorphism and atypia are uncommon, but when they are present, their appearance overlaps with that of a high-grade malignant fibrous histiocytoma and fibrosarcoma. Specific cytogenetic abnormalities have been identified. More than 90% of patients have a t(X;1 translocation mutation, which is not associated with other sarcomas. The translocation involves the SYT gene on chromosome 18 (at 18q11) and the SSX1 or SSX2 gene on the X chromosome (at Xp11).3, 4 These genes appear to be transcription regulators, whose functions occur primarily through protein-protein interactions. Subtypes of these translocations have been shown to correlate with distinct histologic subtypes. Frequency United States Synovial sarcoma is the fourth most commonly occurring sarcoma,1 accounting for 8-10% of all sarcomas. Approximately 800 new cases of synovial sarcoma are diagnosed per year. Mortality/Morbidity Overall, survival rates are 36-76% at 5 years and 20-63% at 10 years. Synovial sarcoma of the head and neck region has a better prognosis than that of sarcoma involving the extremities, with 5-year survival rates of 47-82%. Sex Although different studies have cited a slight male or female predominance, a study including 672 cases at the Armed Forces Institute of Pathology (AFIP) demonstrated no significant sex or ethnic predilection for synovial sarcoma.1 Age Synovial sarcoma can occur in patients with a wide age range, but it is most common in patients in the third to fifth decades of life. In a series of 121 cases, 83.6% of tumors occurred in patients aged 10-50 years, with a median age of 31.3 years. Another large study included patients with ages ranging from 5 to 87 years.5 Anatomy Synovial sarcoma is the most common sarcoma that involves the upper extremity, hip, groin, and buttocks in patients aged 16-25 years. In patients aged 6-45 years, synovial sarcoma is the most common sarcoma in the foot and ankle. Most synovial sarcomas are found within 5 cm of a joint. Despite the misnomer, only 10% of cases are intra-articular. The tumors are usually well circumscribed, but in unusual cases, they may interdigitate between muscles and tendons or encase neurovascular structures. Invasion of the adjacent bone is seen in 11-20% of patients, a feature that is uncommon in other sarcomas. The region around the knee is the most common site of involvement. In a large study, 73% of synovial sarcomas occurred in the lower limb; 34% in the upper limb; and 16% in the chest/abdominal wall. Tumors that occur in the upper extremity tend to affect the distal extremity rather than the elbow or shoulder. Less common sites of involvement include the retroperitoneum, mediastinum, and head and neck regions. The most common site in the head and neck is the hypopharynx. Other head and neck locations include the cervical or parapharyngeal regions, masticator space, soft palate, tongue, suboccipital and infratemporal fossa regions, and sinonasal space. .true about kawasaki disease?ans: Coronary aneurysms develop in up to 25% of patients with Kawasaki disease The acute presentation is described by fever, rash, conjunctival injection, cervical lymphadenitis, inflammation of the lips and oral cavity, and erythema and edema of the hands and feet. The subacute phase of the disease follows resolution of the acute presentation with desquamation of palms and soles. The most well known features present on angiography are aneurysms in the coronary arteries. Saccular and fusiform aneurysms usually develop during the subacute phase; however, later aneurysm formation is possible. Coronary aneurysms develop in up to 25% of patients with Kawasaki disease (8,9). Fifty percent of these aneurysms resolve within 2 years of the illness (. Although regressed, previous aneurysm sites may manifest later stenosis, thrombotic occlusion, and accelerated atherosclerosis (10). Q.best view for C1-C2 #?ans:Odontoid View - Discussion: - to evaluate C1 (Jefferson), Dens, superior facets of C2; - for evaluating dens fractures, body of C2, & rotary C1-C2 dislocations; - mach lines - teeth, C1 arch; - open mouth view, along w/ lateral view, will reveal fractures of the dens ; - atlantoaxial articulation & integrity of dens and body of C2 are best seen on the odontoid view; - this is most technically most difficult film to obtain as it requires patient to open his mouth as wide as possible; - lateral masses of C1 should align over the lateral masses of C2; - lateral displacement of masses of C1 w/ respect to C2 may indicate Jefferson or burst fracture of the Atlas; - combined lateral mass displacement > 7 mm suggests that transverse ligament is torn; - children: - overlapping lateral masses can be a normal variant in children and therefore this view may not allos assessment of whether frx is stable or unstable; - Normal Variants of Dens: (see dens frx) - dens may be completely absent, hypoplastic, or incompletely fused to body of C2 (lesion called Os Odontoideum) - Os Odontoideum is smaller than normal dens & is fixed to anterior ring of C1: 2 move as a unit; - subluxation and instability are common; - Assessment of RA Patient: - state of the odontoid peg and the lateral processes can be assessed by open mouth views, though disease of the tempomandibular joint can make this difficult; - concomitant vertical subluxation may conceal amount of anteroposterior movement at the atlantoaxial level because broader base of odontoid peg comes to lie opposite anterior arch of the Atlas; - Technique: - the patient is positioned as for the supine AP; - central beam directed perpendicular to the midpoint of the open mouth; - patient should softly say 'ah' to depress the tongue to the floor of mouth during exposure; .Ferruginous bodies seen in ? Silicosis / Asbestosis / Byssinosis / Bagassosis Ferruginous bodies are a histopathologic finding in patients with fibrotic lung diseases. They appear as small brown nodules in the septum of the alveolus. Ferruginous bodies are typically indicative of asbestos inhalation (when the presence of asbestos is verified they are called "asbestos bodies"). In this case they are fibers of asbestos coated with an iron-rich material derived from proteins such as ferritin and hemosiderin. [1] Ferruginous bodies are believed to be formed by macrophages that have phagocytized and attempted to digest the fibers.[/quote] Q.1which peptide antibiotic is an antitumor agent? a)valinomycin b)bleomycin c)dactinomycin Bleomycin is a glycopeptide antibiotic produced by the bacterium Streptomyces verticillus. Bleomycin refers to a family of structurally related compounds. When used as an anti-cancer agent, the chemotherapeutical forms are primarily bleomycin A2 and B2. Bleomycin A2 is shown in the image. The drug is used in the treatment of Hodgkin lymphoma (as a component of the ABVD regimen), squamous cell carcinomas, and testicular cancer, pleurodesis as well as plantar warts. Q.waterline in iceberg represents demarcation b/n? 1 sypmtomatic and asymptomatic 2 dignosed and undiagnosed 3 apparent & inapperent disease 4 case & carriers REF ark 18ed/p.35 .community health center is?a)first referral unit b)2nd r.u. c)3rd r.u REF ark/18ed/p.28 Q.about Gomez classification all are true except? a)based on height b)normal is 50thcentile of Boston standards c)72% represents 2nd degree malnutrition d)has prognostic value for hospitalized childrens REF:It is based on weight retardation & not on height(park) Q.Anti-fungals are ALL EX a)Ciclopirox b)ketoconazole c)Undecyclenic acid d)Clofasamine ref:goodman gillman .wrong statement is A)india is signatore to 1978 alma ata declaration b)health is a central gov. responsibility REF /18ed/21 it is a state responsibility .Aortic Arch on Right seen in ? Corrected TGA Truncus arteriosus TOF Q.Coronary ligament of knee, is situated ?- a)Between two anterior attachment of meniscus b)Between two posterior attachment of meniscus c)b/n meniscus & tibia d)b/n meniscus & femur REF:BDC Q.Corporo basal index used for ? rce/sex/stature Q.Dementia precox term coined by? Schneider Bleuler krapelin freud REF:ahuja 5thed/p.55 Q2most common cause of maternal mortality in India is Haemorrhage abortion septicemia obstructed labour Q.3 MOST SENSITIVE TEST FOR ACUTE KNEE INJURY ? LACHMAN ANT DRAWER PIVOT ANTERIOR CRUCIATE LIGAMENT Introduction The incidence of ACL injuries has increased dramatically over the last 2 decades. More than 200,000 new ACL injuries occur in the United States annually. These injuries are important because of the extent of disability associated with ACL tears. Normal ACL Torn ACL Approximately 50% of patients with ACL tears also have meniscal tears. The lateral meniscus is torn more frequently than the medial meniscus in acute ACL injuries, but in chronic ACL tears the medial meniscus is more commonly torn. Attempts to identify athletes at greatest risk for ACL injury have identified a few predisposing factors. Individuals with a narrow intercondylar notch of the femur appear to have a higher risk of non-contact ACL injuries. Women also appear to be more susceptible to non-contact ACL injuries compared to male counterparts. A two-fold increase in ACL injuries in women collegiate soccer players and a four-fold increase in basketball players. The cause of this gender difference is not clear. Knee instability secondary to anterior cruciate tears is the most common cause of long-term disability of the knee. The ACL is the primary restraint to hyperextension and anterior translation of the tibia on the femur. It also protects against excessive varus valgus stress and internal and external rotation as a seconary restraint. As a result of this wide range of function , a variety of injury mechanisms , most of which are non-contact in nature, may damage this ligament. History: Patients with acute ACL injuries commonly report giving way of the knee with stopping, cutting, or jumping. A pop, immediate pain and swelling within several hours usually occurs with ACL injuries. Physical Examination: The examination of the knee with an acute ACL injury is often difficult because the pain and swelling cause muscular guarding by the patient. . Early examination prior to the onset of the guarding is advantageous and comparison to the normal knee is mandatory. The Lachman test is the most accurate test for diagnosis of acute ACL tears. The Lachman test and the varus-valgus tests often are the only tests that can be reliably performed in an acute knee injury. A positive pivot shift is diagnostic for ACL tears but it can only be elicited in 25% of acute ACL tears. Examination with a knee ligament arthrometer may be helpful in diagnosis of acute knee injuries, a side to side difference of 3 mm. or more is diagnostic of an ACL tear. Diagnostic Imaging Every knee suspected of ACL damage should be evaluated with plain X-rays. Osteochondral fracture can be visualized. The Segond’s fracture , which is seen at the lateral edge of the tibia on an AP view, is diagnostic of an ACL tear. In the chronic setting , X-ray findings associated with anterior cruciate insufficiency include intercondylar spurring and intercondylar notch narrowing . MRI can be useful with diagnosis of ACL injuries when the clinical exam is limited because of pain and swelling. This test can also identify associated injuries to the menisci, articular cartilage or bone. The accuracy of MRI in determining acute ACL injury is approximately 90%. - Q.4 organism involved in crohn's disease?a)Mycobacterium avium subspecies paratuberculosis Mycobacterium avium subspecies paratuberculosis is a pathogenic bacteria in the genus Mycobacteria.[1] It is often abbreviated Map, M. paratuberculosis, or M. avium sub. paratuberculosis. The type strain is ATCC 19698 (equivalent to CIP 103963 or DSM 44133).[2] Contents [hide] 1 Pathophysiology 1.1 Crohn's disease 2 Genome 3 See also 4 References [edit] Pathophysiology Map causes Johne's disease in cattle and other ruminants, and it has long been suspected as a causative agent in Crohn's disease in humans; this connection is controversial.[3] Recent studies have shown that Map present in milk can survive pasteurization, which has raised human health concerns due to the widespread nature of Map in modern dairy herds. Map is heat resistant and it is capable of sequestering itself inside white blood cells, which may contribute to its persistence in milk. It has also been reported to survive chlorination in municipal water supplies. Even though Map is hardy, it is slow growing and fastidious, which means it is difficult to culture. Many negative studies for Map presence in living tissue, food, and water have used culture methods to determine whether the bacteria is present. Due to recent advances in our knowledge of the bacterium, some or all of these studies may need to be re-evaluated on the basis of culture methodology. Map, like most mycobacteria, is difficult to treat. It is not susceptible to anti-tuberculosis drugs (which can generally kill Mycobacterium tuberculosis), but can only be treated with a combination of antibiotics such as Rifabutin and a macrolide such as Clarithromycin. Treatment regimes can last years. Crohn's disease MAP is recognized as a multi-host mycobacterial pathogen with a proven specific ability to initiate and maintain systemic infection and chronic inflammation of the intestine of a range of histopathological types in many animal species including primates. On the assumption that Map is a causative agent in Crohn's, the Australian biotechnology company Giaconda is seeking to commercialise a combination of Rifabutin, clarithromycin and clofazimine as a potential drug therapy for Crohn's. As of April 2007, Giaconda received United States FDA IND approval for this medication, now called Myoconda Q.5pollicization refers to? ans.thumb reconstruction Pollicization is a plastic surgery technique in which a thumb is created from an existing finger. Typically this consists of surgically migrating the index finger to the position of the thumb in patients who are either born without a functional thumb (most common) or in patients who have lost their thumb traumatically and are not amenable to other preferred methods of thumb reconstruction such as toe-to-hand transfers. During pollicization the index finger metacarpal bone is cut and the finger is rotated approximately 120 to 160 degrees and replaced at the base of the hand at the usual position of the thumb. The arteries and veins are left attached. If nerves and tendons are available from the previous thumb these are attached to provide sensation and movement to the new thumb ("neopollux"). If the thumb is congenitally absent other tendons from the migrated index finger may be shortened and rerouted to provide good movement. The presence of an opposable thumb is considered important for manipulation of most objects in the physical world. Children born without thumbs often adapt to the condition very well with few limitations therefore the decision to proceed with pollicization lies with the child's parents with the recommendation of their surgeon. Persons who have grown to adulthood with functional thumbs and then lost a thumb find it highly beneficial to have a thumb reconstruction, not only from a functional but from a mental and emotional standpoint. Retrieved from "http://en.wikipedia.org/wiki/Pollicization" Q.6radiosensitive phase of cell cycle? a)g2 m b)g1 c)s Q7 ALL OF THE FOLLOWING ARE TRUE ABOUT V CHOLERA O 139 EXCEPT? SIMILAR TO EL TOR DISCOVERED IN CHENNAI PRODUCES O1 LIPOPOLYSACCHARIDE Q.cytogenetic abnormality in synovial sarcoma? ans: t(X;1 translocation Synovial sarcoma constitutes 8-10% of all sarcomas and most commonly affects adults in the third to fifth decades of life. This malignancy usually involves the extremities, especially the lower extremities around the knees. Synovial sarcoma is frequently misdiagnosed as a benign condition because of its often small size, slow growth, and well-defined appearance.1, 2 Pathophysiology Gross specimens are usually well-demarcated, pink, fleshy masses with a heterogeneous appearance and may display solid, hemorrhagic, or cystic components on sectioning. Calcification foci are occasionally noted; heavy calcification tends to indicate less aggressive lesions and offers a more favorable prognosis. Synovial sarcoma is named for its resemblance to developing synovial tissue under light microscopy. It arises from the pluripotential mesenchymal cells near joint surfaces, tendons, tendon sheaths, juxta-articular membranes, and fascial aponeuroses. The histologic appearance is that of large polygonal cells (epithelioid) that secrete hyaluronic acid and show an organization that is suggestive of microscopic joint spaces. These cells are surrounded by spindle cells that simulate subsynovial mesenchymal cells. The typical morphology is that of 2 strikingly distinct, well-differentiated cell populations. Depending on which cell type predominates, the overall histologic appearances can be described as biphasic (epithelioid and spindle cell), monophasic spindle cell, or monophasic epithelioid. Marked cellular pleomorphism and atypia are uncommon, but when they are present, their appearance overlaps with that of a high-grade malignant fibrous histiocytoma and fibrosarcoma. Specific cytogenetic abnormalities have been identified. More than 90% of patients have a t(X;1 translocation mutation, which is not associated with other sarcomas. The translocation involves the SYT gene on chromosome 18 (at 18q11) and the SSX1 or SSX2 gene on the X chromosome (at Xp11).3, 4 These genes appear to be transcription regulators, whose functions occur primarily through protein-protein interactions. Subtypes of these translocations have been shown to correlate with distinct histologic subtypes. Frequency United States Synovial sarcoma is the fourth most commonly occurring sarcoma,1 accounting for 8-10% of all sarcomas. Approximately 800 new cases of synovial sarcoma are diagnosed per year. Mortality/Morbidity Overall, survival rates are 36-76% at 5 years and 20-63% at 10 years. Synovial sar |
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