ObjectiveThe results of proximal splenorenal shunts done in children with extrahepatic portal venous obstruction were evaluated. Summary Background DataExtrahepatic portal venous obstruction, a common cause of portal hypertension in children in India, is being treated increasingly by endoscopic sclerotherapy instead of by proximal splenorenal shunt. It is believed that surgery (or the operation) carries high mortality and rebleeding rates and is followed by portosystemic encephalopathy and postsplenectomy sepsis. However, a proximal splenorenal shunt is a definitive procedure that may be more suitable for children, particularly those who have limited access to medical facilities and safe blood transfusion. MethodsBetween 1976 and 1992, the authors performed 160 splenorenal shunts in children. Twenty were emergency procedures for uncontrollable bleeding and 140 were elective procedures -102 for recurrent bleeding and 38 for hypersplenism. ResultsThe overall operative mortality rate was 1 .9%-10% (3/160-2/20) after emergency operations and 0.7% (1/140) after elective operations. Rebleeding occurred in 17 patients (1 1% ConclusionsA proximal splenorenal shunt, a one-time procedure with a low mortality rate and good long-term results, is an effective treatment for children in India with extrahepatic portal venous obstruction.Extrahepatic portal venous obstruction (EHO), the main reasons for this change are that EST is easy to permost common cause of upper gastrointestinal hemor-form, atraumatic, and effective in preventing bleeding, rhage in children,'"2 is being treated increasingly by en-once the esophageal varices are obliterated. Surgery is fadoscopic sclerotherapy (EST) instead of by surgery. The vored less because it is thought to be accompanied by 193

Portal cavernoma cholangiopathy (PCC) is defined as abnormalities in the extrahepatic biliary system including the cystic duct and gallbladder with or without abnormalities in the 1st and 2nd generation biliary ducts in a patient with portal cavernoma. Presence of a portal cavernoma, typical cholangiographic changes on endoscopic or magnetic resonance cholangiography and the absence of other causes of these biliary changes like bile duct injury, primary sclerosing cholangitis, cholangiocarcinoma etc are mandatory to arrive a diagnosis. Compression by porto-portal collateral veins involving the paracholedochal and epicholedochal venous plexuses and cholecystic veins and ischemic insult due to deficient portal blood supply or prolonged compression by collaterals bring about biliary changes. While the former are reversible after porto-systemic shunt surgery, the latter are not. Majority of the patients with PCC are asymptomatic and approximately 21% are symptomatic. Symptoms in PCC could be in the form of long standing jaundice due to chronic cholestasis, or biliary pain with or without cholangitis due to biliary stones. Endoscopic retrograde cholangiography has no diagnostic role because it is invasive and is associated with risk of complications, hence it is reserved for therapeutic procedures. Magnetic resonance cholangiography and portovenography is a noninvasive and comprehensive imaging technique, and is the modality of choice for mapping of the biliary and vascular abnormalities in these patients. PCC is a progressive condition and symptoms develop late in the course of portal hypertension only in patients with severe or advanced changes of cholangiopathy. Asymptomatic patients with PCC do not require any treatment. Treatment of symptomatic PCC can be approached in a phased manner, coping first with biliary clearance by nasobiliary or biliary stent placement for acute cholangitis and endoscopic biliary sphincterotomy for biliary stone removal; second, with portal decompression by creating portosystemic shunt; and third, with persistent biliary obstruction by performing second-stage biliary drainage surgery such as hepaticojejunostomy or choledochoduodenostomy. Patients with symptomatic PCC have good prognosis after successful endoscopic biliary drainage and after successful shunt surgery. ( J CLIN EXP HEPATOL 2014;4:S2-S14)

Background and Objectives:Coenzyme Q10 is a well studied antioxidant in medical literature, but studies regarding its efficacy in periodontal diseases are few. Hence, the aim of this study was to test the efficacy of coenzyme Q10 in the form of gel (Perio-Q) in patients with chronic gingivitis and periodontitis.Materials and Methods:A total of 12 patients were enrolled. A split mouth design was used for topical (extrasulcular) application, intra-pocket application alone, intra-pocket application combined with scaling and root planing (SRP) and SRP only in each quadrant, respectively. Clinical parameters such as plaque index, gingival index, gingival bleeding index, probing pocket depth, clinical attachment level were assessed at baseline, 3rd week, and 6th week. The results were subjected to statistical analysis, which were expressed as mean±SD and proportions as percentages. Intra group comparisons were made by paired t-test and one way analysis of variance (ANOVA) for inter-group comparisons. Categorical data was analyzed by Fisher's exact test.Results:The results showed on intra-group analysis significant reduction (P<0.01) of clinical parameters (plaque index (PI), gingival index (GI), gingival bleeding index (GBI), periodontal probing pocket depth (PPD), and clinical attachment level (CAL)) in all four treatment groups, whereas on inter-group analysis, intra-pocket gel application in combination with SRP showed significant reduction (P<0.05) for PI, GI, GBI, and CAL in comparison to intra-pocket gel alone.Interpretation and Conclusion:In the present study, in chronic periodontitis patients, sub-gingival mechanical debridement only and with Perio-Q gel showed almost similar clinical results without any statistically significant differences. Hence, it confirmed the primary role of basic mechanical approaches in periodontal therapy and did not provide enough clinical support for the superiority of adjunctive use of Perio-Q gel. However, it appears that Perio-Q gel in this study may have a potential additive effect. Further, long term clinical studies of Perio-Q gel with various doses and duration need to be conducted.

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A 37-year-old man, treated case of left temporal glioblastoma presented with headache, seizures, and progressive right-sided weakness with MRI evidence of recurrence. Exploratory 68Ga-PSMA PET/CT demonstrated PSMA expression in the recurrent lesion; it was decided to treat this patient with 177Lu-PSMA-617. After 3 cycles of 177Lu-PSMA-617, 68Ga-PSMA PET/CT showed significant reduction in PSMA uptake and regression in size of lesion on MRI with improvement in patient’s symptoms and performance status. 177Lu-/68Ga-PSMA theranostics has potential in patients with recurrent glioblastoma multiforme when other therapeutic options are not feasible.

Objective: The aim of this study was to examine the expression of apoptosis-related proteins in cervical cancer, and investigate their correlation with the apoptotic index (AI), telomerase activity, human papilloma virus (HPV) infection and clinicopathological characteristics. Methods: Fifty cervical cancer samples and 20 normal cervical tissues were assessed for the protein expression of survivin, Bcl-2, Cox-2, p53 and p73 by immunohistochemistry. HPV DNA was detected by PCR, telomerase activity by PCR-ELISA, and AI by TUNEL assay. Results: 46/50 cervical tumors (92%) showed an increased telomerase activity as compared to 3/20 (15%) controls. 45/50 (90%) cervical tumors were positive for HPV, of which 30 were HPV-16 positive and 5 were HPV-18 positive. 24/50 (48%) tumors were positive for survivin, 14 (28%) for Bcl-2, 13 (26%) for Cox-2, 19/45 (42%) for p73, 10/45 (24%) for p53. Telomerase activity was highest in tumors with the poorest grade. A positive correlation was seen between survivin and Bcl-2, survivin and tumor stage, Bcl-2 and Cox-2, p73 and p53 and p73 and the AI. Despite the overexpression of various antiapoptotic proteins, no significant difference was observed in the AI between tumors and controls. Conclusions: Since deregulation of the apoptotic pathway appears to occur in cervical cancer, some apoptosis-related proteins could be assessed as potential markers for progression/prognosis in cervical cancer. Additionally, newer proteins such as p73 may play a compensatory role for the nonfunctional proteins such as p53.

Cavernous hemangioma can be a rare cause of perimenopausal bleeding. The same found in a polyp may be treated successfully by polypectomy.

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