Design of Plethora Bridge at Kanyakumari

The  discrete  tourist  place  such as  Vivekananda  Rock Memorial  and  Thiruvalluvar  Statue  firmed  at  the  offshore  of  Kanyakumari  is connected  by  the  Plethora  Bridge.  This  bridge  is  designed  to  connect  the  span  of  550 m  between  Kanyakumari  sea  shore  and Vivekananda  Rock  Memorial  and  to  allied  the  short  span  of 110 m  between  anterior  bridge  and  Thiruvallur  Statue. It consists  of  a  Multi  Cellular  Concrete  Box  Girder  Deck  Slab,  Bearing,  Pier, Pile  Foundation and  Staircase. A  Multi  celled  prestressed  concrete  box girder  deck  is  designed  by  Prestressed  method  as  per  the  recommendation  of IRC: 21-2000, Clause 304.2.1, IRC:6-2000 by  using  Freyssinet type anchorages  with  M60  grade  concrete  and  Fe 415  grade  steel. Reinforced bearing plate is used in between Pier and Deck. Reinforced  bearing  plate is  designed  by  working stress  method  with  M30  grade  concrete  and  Fe 415  grade  steel.  The  Solid  RCC  Pier  is  designed  for  the  axial  dead  load  and   live  load  from  the  slab,  girders,  deck  beam. Pile  Foundation  is  designed  based on   safe  load  bearing   in  the  soil  and water  current. Staircase  is  designed  by  limit   state  method  with  M25  grade  concrete  and  Fe 415  grade  steel

Continuous ambulatory peritoneal dialysis catheter placement: Is omentectomy necessary?

<b>Context:</b> There are different methods of continuous ambulatory peritoneal dialysis (CAPD) catheter placement. Open surgical technique is a widely followed method. The complication rate following catheter placement varies and catheter blockage due to omental plugging is one of the main reasons. <b>Aim:</b> To analyze the need for routine omentectomy during CAPD catheter placement. <b>Materials and Methods:</b> This was a retrospective analysis of 58 CAPD catheter placements performed between July 2002 and June 2007. Tenckhoff double cuffed catheter was used in all. The postoperative complications were analyzed. <b>Results:</b> There were 44 males and 14 females. The mean age was 51 years ranging from 15 to 76 years. Of these, 40 (69&#x0025;) patients underwent omentectomy (group A) and 18 (31&#x0025;) did not (group B). Laparoscopic and open techniques were performed in 5 and 53 patients, respectively. Omentectomy was not performed in 13 patients with open technique and all the five in the laparoscopic group. One patient in group A developed hemoperitoneum which was treated conservatively. None from group A developed catheter blockage, whereas five (27.8&#x0025;) from group B developed catheter blockage postoperatively. The median time interval between the primary procedure and development of catheter blockage was 45 days (ranged from 14 to 150 days). <b>Conclusions:</b> Omentectomy during CAPD catheter placement prevents catheter blockage and secondary interventions

Renal cell carcinoma associated with granulomatous reaction

Granulomatous inflammation is a distinctive pattern of chronic inflammatory reaction characterized by accumulation of epithelioid histiocytes and multinucleate giant cells. The cause of granulomas can be infectious or non-infectious. Granulomas have been described within the stroma of malignancies like carcinomas of the breast and colon, seminoma and Hodgkin′s lymphoma, where they represent T-cell-mediated reaction of the tumor stroma to antigens expressed by the tumor. Granulomatous reaction in association with renal cell carcinoma (RCC) is uncommon, with only few published reports in the literature. We describe three cases of conventional (clear cell) RCC associated with epithelioid granulomas within the tumor parenchyma