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Mucinous rectal carcinoma is morphologic subtype of Colorectal carcinoma. Both colloid ( mucin lakes ) and intracellular mucin ( signet ring cells ) are relatively rare. Various studies have been done to know whether palliative or radical treatment beneficial in treatment of advanced stage colorectal carcinoma. In our institute, we studied the prognostic factors in a case of 26 yr female in which abdominoperineal resection with endcolostomy with B/L salpingoohrectomy was done for stage 4 rectal carcinoma with synchronous secondaries in B/L ovaries.

Microspheres are one of the novel drug delivery system which possess several applications and are made up of assorted polymers. Microspheres can be defined as solid, approximately spherical particles ranging in size from 1 to 1000 μm range in diameter having a core of drug and entirely outer layers of polymers as coating material. They are made up of polymeric, waxy or other protective materials i.e. biodegradable synthetic polymer and modified natural products such as starches, gums, proteins, fats and waxes. Preformulation is a group of studies that focus on the physicochemical properties of a new drug candidate that could affect the drug performance and the development of a dosage form. This couldprovide important information for formulation design or support the need for molecular modification. Every drug has intrinsic chemical and physical properties which has been consider before development of pharmaceutical formulation. This property provides the framework for drugs combination with pharmaceutical ingredients in the fabrication of dosage form. Objective of preformulation study is to develop the elegant, stable, effective and safe dosage form by establishing kinetic rate profile, compatibility with the other ingredients and establish Physico-chemical parameter of new drug substances. The purpose of the present study was to systematically investigate some of the important physicochemical properties of pralidoxime chloride for preparation of microspheres. The physicochemical properties such as solubility, pKa, dissolution, melting point, assay development, excipient compatibility etc. of pralidoxime chloride was carried out. Before selection of excipients, the Preformulation study of drug pralidoxime is completed for successful formulation of microspheres. The result of Preformulation studies shows good flow properties, excipient compatibility, solubility efficiency and melting point. From this study we concluded that pralidoximewith HPMC and EC can be used to formulate pralidoxime microspheres for modified release. Keywords: Microspheres, Preformulation, Pralidoxime chloride, Physico-chemical parameter.

BACKGROUND Paediatric testicular tumours are rare and it accounts for 2% of solid malignant neoplasm in boys. Below 2 years of age, it is very rare and difficult to diagnose. Since retrospective study may not provide information due to non-availability of records as required, a prospective study was planned at SMS Medical College and attached SPMCH Institute, Jaipur, from Jan 2009 till April 2012 and continued at National Institute of Medical Sciences, Jaipur, from May 2012 to December 2015, a 7-year period. MATERIALS AND METHODS A proforma was made and kept in OPD and ward and a qualified paediatric surgeon were appointed to fill the form regarding age, provisional diagnosis, symptomatology, investigations, routine and special like USG, CT, MRI, tumour marker study, treatment plan, result and followup. Undescended testis and torsion testis were excluded, whereas infants with scrotal swelling below 2 years of age were included. RESULTS Out of 17 patients, one died after 6 months due to relapse in mixed germ cell tumour group, rest all sixteen survived and have 6 to 1 years’ followup. Surgery was done in all cases, whereas 5 cases needed chemotherapy in addition to surgery. Radiotherapy was not given in any case. Tumour markers like -fetoprotein and -hCG markedly reduced after orchidectomy. CONCLUSION Yolk sac tumour and teratoma all cases responded well to high inguinal orchiectomy, chemotherapy required only in 5 cases. One case of mixed germ cell tumour have relapse after surgery and chemotherapy and died after 6 months postoperatively.

BACKGROUND Prolonged intercostal drainage for empyema thoracis in children is difficult to manage by parents at home and at the same time prolonged stay at hospital increases the financial burden on them. Hence, aim of this study is to get rid of intercostal drainage earliest by performing surgery thereby decreasing the morbidity and mortality. This is a prospective study done in infant and children below age of 12 at Paediatric Surgery Department, National Institute of Medical Science, Jaipur-Delhi Highway, Jaipur, from May 2012 to April 2016. Total number of cases in which surgical intervention done were 13 out which 2 required lobectomy whereas in 11 cases decortication and removing of peel was done. MATERIALS AND METHODS Out of all thirteen patients, the age ranging from 6 months to 10 years, a proforma was made and kept in OPD and ward filling with investigation, symptomatology, treatment and follow up. RESULTS Out of all 13 cases, lung expansion was complete and all are symptom free, follow up 3 years to 1 month was there. CONCLUSION Early surgical intervention of empyema thoracis is beneficial in children as prolonged intercostal drainage increase the misery of the patients as well as their parents.

Spontaneous biliary perforation is a rare cause of surgical jaundice in infants and children. It typically presents in infants aged 1–12 weeks. Fewer than 200 cases have been reported in the medical literature. The lack of knowledge regarding the pathogenesis of spontaneous biliary perforation and its extreme rarity makes preoperative diagnosis and its management difficult. We report a case of a 7-year-old boy with spontaneous biliary perforation, who presented with clinical features of acute peritonitis. Cholecystectomy with simple drainage by using a T-tube resulted in satisfactory recovery. We suggest that in a jaundiced child with symptoms of abdominal pain, distension, vomiting, acholic stools, and a previous anicteric period of good health, the diagnosis of spontaneous biliary perforation should be considered if there is a triad of: (1) signs of peritonitis; (2) absence of pneumoperitoneum on erect abdominal radiography; and (3) bilious abdominal paracentesis under ultrasonographic guidance. Routine abdominal paracentesis is not recommended for infants and children. Although there are several surgical options for the disease, cholecystectomy, flushing of the bile duct and external biliary drainage, constitute the most favorable treatment. Pediatricians and surgeons should consider this disease because early surgical intervention is the only option for ensuring a favorable prognosis.

Summary Background/Introduction Hydatid disease is relatively uncommon in children. The liver and lungs are most commonly involved, while involvement of other sites in the body is unusual. Purpose(s)/Aim(s) To study the presentation of hydatid disease in children, evaluate the risk factors, and derive appropriate management recommendations for prevention of recurrence and disease control. Methods This was a retrospective study performed from April 2006 to April 2014 in three pediatric institutes. Results There were 18 cases of hydatid disease in children; their age ranged from 7 to 16 years, and the male to female ratio was 8:1. All 18 patients were from a rural background or a farming community and of low socioeconomic status. Cattle rearing was common to the households of all patients. Nine (50%) patients had isolated liver hydatid cyst and three (16.7%) had isolated primary lung hydatid cyst. Two (11.1%) patients had multiple cysts with lung and liver involvement, while four (22.2%) had unusual presentation, i.e., primary hydatid cyst of the spleen in three (16.7%) and primary hydatid cyst of the brain in one (5.5%). All cases were managed surgically and there was no recurrence in any of our patients. Conclusion Hydatid disease is not rare in the pediatric age group. The liver and lung are commonly involved, but it may also present as primary disease in unusual sites like the spleen and brain. Proposed risk factors are rural background, farming community, low socioeconomic status, cattle rearing, lack of supply of potable water, and male sex. Intrinsic defects in the filter mechanism of the liver and lungs, dissemination through enteric lymphatic channels, and patency of the ductus arteriosus in early infancy are the proposed causes of unusual presentation of hydatid disease in children. During cyst removal, spillage of the contents must be avoided to prevent recurrence. Community-based measures are recommended for prevention and disease control.

Currarino syndrome is a triad of sacral defect, anorectal malformation and a presacral mass. The diagnosis is usually made late in childhood and about 50% of cases are familial with autosomal dominant inheritance. We present two neonates (one with vestibular fistula, and another with cloacal malformation) with the features consistent with Currarino syndrome, but with Altman’s type II sacrococcygeal teratoma, that is, presacral mass having an external sacrococcygeal component also. We believe that this triad should be considered a variant of Currarino syndrome. In first case, excision of the mass along with coccyx, followed by primary Posterior Sagittal AnoRectoPlasty was performed in the same setting. The patient succumbed to death due to septicemia as a result of wound sepsis. Learning from the previous experience, we decided to do a diverting sigmoid loop colostomy followed by posterior sagittal excision of the mass along with coccyx, in same sitting in the second case. There was no recurrence. Though HLXB9 has been identified as the major causative gene in Currarino syndrome, exact pathogenesis is still unclear. We herein highlight the significance of this variant of Currarino syndrome and propose a theory on the basis of an embryological association between the malformation complex.

Ewing′s sarcoma / peripheral primitive neuroectodermal tumors occur most often in bone and soft tissues of children and young adults. The intracranial manifestation of the disease is rare, and when present, this is often misdiagnosed with other varieties of primary brain tumors. We report such a case of extraosseous Ewing′s sarcoma, which was initially suspected to be a case of meningioma in an 11-year-old girl.

Pneumoperitoneum in the neonate generally is an acute surgical emergency, which has grave implications, and immediate surgical intervention is needed to ensure survival. The most common cause is a perforated hollow viscus. However, there are causes that cannot be attributed to this etiology, constituting what has been called non-surgical, asymptomatic, benign, misleading, spontaneous or idiopathic pneumoperitoneum. Knowledge of this entity and its likely aetiological factors should improve awareness and possibly reduce the imperative to perform an unnecessary emergency laparotomy on an otherwise normal neonate with an unexplained pneumoperitoneum.

Introduction: The prospective interventional single-institution randomized control study was carried out to compare the pain relieving efficacy among different bisphosphonates at the cost of incidence of skeletal-related events (SRE). Materials and Methods: During June 2008 and May 2011, 256 patients with painful bone metastasis in solid tumors with a pain score of at least 5 were randomized into three arms: zoledronic acid (4 mg, i.v.), ibandronate (6 mg, i.v.) and pamidronate (90 mg, i.v.). Radiation was given to all patients, either 800 cGy single fraction or 20 Gy in five fractions. The ANOVA test was used for analysis. The Pearson test was used to correlate pain scores with proportions of responders as statistical estimation of pain relief. Results: With a mean baseline pain score of 6.5 ± 1.2, there was no difference in pain scores among the three treatment arms, assessed at 3 months and at the end of the study. However, the pain scores at 6 months were statistically reduced in zoledronic acid-receiving patients (1.5 ± 0.4) unlike the scores in patients receiving ibandronate (3.1 ± 0.5) and pamidronate (2.3 ± 0.4), with a P-value of 0.024. The response was statistically significant at 6 months (0.039) and at the end of the study (0.023), in favor of zoledronic acid. Pearson's correlation demonstrated a statistically significant positive correlation between pain scores and response rates. There were no statistical differences in the narcotic scores among the treatment arms during the study period. The overall duration of pain relief was not different in any of treatment arms. The time of detection of hypercalcemia was no different; however, the incidence of hypercalcemia was significantly less in the zoledronic acid arm (28.3%) against 44.6% and 50% in ibandronate and pamidronate arms, respectively, with a P-value of 0.041. Conclusion: The use of bisphosphonates for 6 months or more results in a statistical significant improvement in bone pain, more so with zoledronic acid. Hypercalcemia, an SRE, was significantly less in the zoledronic acid arm.

Packaging in Pharma Industry is an extensive, comprehensive and multi-faceted task. From containment and protection to convenience, identification and delivery, packaging's role in the market cannot be underestimated. It is a means of protecting and preserving items contained within, as well as communicating marketing and regulatory information to consumers. Earlier the requirements of these packaging focused exclusively on preserving the quality of enclosed product, whereas today the packaging occupies a significant portion of the overall food and drugs markets. These are extended to cover criteria such as stability and shelf life; convenience and compliance of product use; prevention of product tampering and counterfeiting; ensuring product safety; and brand identity. These products should be designed in such a way that it gives a soothing impact to the users; also the medicine itself has healing effect, so its packaging should complement its features as well. While there is a drive for customisation within packaging industries, there have been concerns that innovation is being hindered by factors such as budgets and regulation. As the packaging industry continues to develop increasingly sophisticated concepts, industries are starting to embrace innovations in this field to improve patient adherence to drug regimens.

Radiation recall phenomenon is an inflammatory process occurring at sites of previous radiation subsequent to administration of pharmacologic agents. The most common chemotherapeutic agents implicated with radiation recall phenomenon are anthracyclines and taxanes. Skin is the most common site for radiation recall. About 63% of the radiation recall events are reported to manifest as dermatitis. This finding differs from radiation recall due to Gemcitabine, in which approximately 70% cases manifested as inflammation of internal organs or tissues and 30% manifested as dermatitis. Here, we report a case of post-operative peri-ampullary carcinoma who developed radiation recall dermatitis during adjuvant chemotherapy with inj. Gemcitabine and inj. Carboplatin after concurrent chemoradiation with capecitabine.

Background In rare cases, blunt trauma of the abdomen (BTA) can be a direct cause of appendicitis. Purpose To evaluate whether appendicitis or appendiceal perforation following BTA occurs by chance or cause. Methods This retrospective study was performed for the period July 2010–December 2014. Results In total, 245 pediatric cases were included. The cause of appendicitis was idiopathic in 190 (77.55%), appendicolith in 30 (12.24%), trivial abdominal trauma in 17 (6.93%), intraoperatively identified hyperplastic lymphoid tissue in six (2.44%), and significant BTA in two (0.81%) children. The symptoms of the two children who developed appendiceal perforation after sustaining BTA began from trauma inception, and BTA was the only apparent etiological factor. The children were a 9-year-old boy who sustained BTA through a bicycle handlebar 4 days previously and an 11-year-old girl who presented at our hospital after falling over a boulder. Both cases were associated with appendicolith, without solid organ injury. Conclusion Acute appendicitis or appendiceal perforation following significant BTA is rare. In the two corresponding cases in this study, the etiology may have been dislodgement of the appendicolith at the moment of injury. Moreover, children may erroneously implicate appendicular pain to be trivial trauma sustained during play (6.8% of the current cases). In all children presenting with right lower abdominal pain and vomiting following BTA (although trivial), the possibility of appendiceal pathology should be considered.