A Study of Total Colonic Aganglionosis.

INTRODUCTION : Intestinal Aganglionosis extending from anus to small bowel is called Total Colonic Aganglionosis (TCA) which may be present with or without small bowel involvement. It is an uncommon form, occurring in 5 to 15 % of all patients with Hirschsprung’s Disease. Though this subgroup has difficulty in diagnosis and treatment, nowadays there is an increase in the reported incidence of Total Colonic Aganglionosis because of greater awareness of this entity, which has led on to improved survival by afforded definitive corrective surgery. Though the Total Colonic Aganglionosis considered to be exceedingly rare, they are important subset because of the associated increased morbidity and mortality. AIM : Aim of the study is to review our experience in the management of 19 patients of Total Colonic Aganglionosis over 7 years (July 1998 to June 2005) MATERIALS AND METHODS : Retrospective review of 302 cases of Hirschsprung’s Disease treated at the Institute of Child Health and Hospital for Children, Egmore, Chennai from July 1998 to June 2005. Showed 19 patients with Total Colonic Aganglionosis. The medical records of the patients were analyzed with emphasis on age & sex incidence, presentation, type of operative procedures, complications of disease and therapy and follow up. CONCLUSION : TCA is a severe form of HD, most commonly recognized in the Neonatal period. Male predominance was seen in this study. Martin’s modification of Duhamel procedure results are better. Functional outcome were good in cases who underwent definitive procedure. Kimura Procedure was not done in this study. Most of the cases in this study presented with bilious vomiting, Abdominal distension, Altered meconium history. Only 4 cases were diagnosed as Total Colonic Aganglionosis by Barium Enema Investigation. Acetyl choline sterase study was not done in any patient in this study. Manometric studies performed in two cases, in which only one case established the diagnosis, and the procedure was not repeated in any of the cases after definitive procedure. According to literature type III colonic atresia is more common than any other type though the presentation is very rare. In this study there was one case of type I atresia seen near the left end of transverse colon, which was associated with Total Colonic Aganglionosis. This was treated by Soave pullthrough and the child is alive and coming for follow up. There were no case of Down syndrome or genitourinary anomalies seen associated with Total Colonic Aganglionosis in this study. In no case Total Parentral Nutrition (TPN) was used in this study. In this study no case presented with a family history of HD or TCA. Child with Total Colonic Aganglionosis admitted at 8 hours after birth was the youngest to present and 15 hours old was the earliest time at which surgery was performed in this study. The best time for pullthrough procedure would be around 6 months of age according to literature. In our Institute we have done pullthrough at the age of 3 months. Almost all the operated TCA children had poor weight gain. Total Colonic Aganglionosis associated with perforation of bowel near the proximal end of aganglionic segment were seen in two cases. As mentioned in the literature child presenting with perforation even at the time of birth was also seen in this study. Constipation- the postoperative complication of Soave pullthrough was relieved rather by posterior sphincterotomy than anal dilatation. The procedure in this study coincides with Elsen hamme (1974) description (he suggested immediate myectomy instead of sphincter dilatation as it causes laceration and fibrosis). Nearly one third of the TCA treated child (Ileostomy) has lost for follow up in this study. Mortality was seen in TCA with associated anomaly and in preterm baby with a complication of ileal perforation and peritonitis, otherwise the survival in TCA is good in operated cases. Morality rate of Total Colonic Aganglionosis in this study is similar to that of literature report

Clinical profile of congenital diaphragmatic hernia and their short-term outcome in a tertiary care neonatal unit: A retrospective study

Background: Recent developments in the antenatal diagnosis, surgical techniques, and neonatal intensive care had widely increased survival rates in neonates with congenital diaphragmatic hernia (CDH) in the western world. In developing countries, however, high mortality in neonates with CDH still continues to be a challenge. Objective: The aim of this study is to study the clinical profile of neonates with CDH and to analyze the various factors affecting mortality. Materials and Methods: In this retrospective study, 148 babies with a diagnosis of diaphragmatic hernia admitted to a tertiary care neonatal unit in South India, from the year 2010 to 2015, were reviewed. Results: The total survival rate was 58.1%, and the operative survival rate was 85.1%. Prenatal diagnosis was made in only 7 cases, and of these, 5 (71.42%) survived. Higher mortality was associated with age at admission <24 h, low Apgar score, early onset of respiratory distress, right-sided CDH, presence of persistent pulmonary hypertension of newborn, and high FiO2 requirement at the time of admission, during stabilization and surgery (p<0.01). Significantly higher mortality was also observed among babies who required positive-pressure ventilation during transport, required inotropes during hospital course (p<0.01), and had low PaO2, high PCO2, and high oxygenation index (p<0.01). Conclusion: Babies admitted to hospital within 24 h of age and who manifested early had a poor outcome indicating severe disease. Antenatal diagnosis of this condition should improve to prevent delay in stabilization and poor outcome

Design of an Intelligent Controller for Armature Controlled DC Motor using Fuzzy Logic Technique

This paper presents a fuzzy control approach to the speed control of DC shunt motor using armature control. This paper presents concept of development of conventional controller and the design of a fuzzy logic controller applicable to DC Motor Speed Control System (MSCS) with high performance of the FL controller. Since armature voltage supply has a major influence in controlling speed, therefore one of the inputs to the proposed FL Controller will be actual armature voltage supply (Va) while another input will be error (e) in speed. The transfer function model of the DC shunt motor has been obtained via experimentation and calculations and simulated and then as per requirement and specification, the proposed fuzzy logic controller has been designed and simulated using Fuzzy Logic and Simulink Toolboxes of MATLAB 7. Results show robustness against changing loading conditions

A Novel Hybrid Security Framework (HSF) with Vshield Based Firewall to Secure Cloud Computing Environment

Cloud Computing is an emerging technology that provides an enormous amount of computing resources which includes networks, servers and storages which are accessed through the internet. In addition it allows useful provisioning of the resources based on the user’s demands. A crucial aspect of cloud computing infrastructure is to provide secure and reliable services.  The main challenge lies in the security issues is to reduce the impact of third party attacks in the cloud computing environment. Hence a novel Hybrid Security Framework(HSF) based on Reinforcement Learning (RL) Methodology with Vshield Firewall is proposed for securing the cloud environment.  The RL method is used for deep packet inspection and VShiled based firewall is established to deny the attacks which are malicious when authenticating the signature of incoming packets. The bipartite pattern matching approach is integrated with the RL method to verify the signatures for obtaining the decisions quickly.  The simulation results shows that the hybrid security framework is effective when compared with the existing methods by considering response time, resource utilization and denial of malicious attacks.  This indicates that our proposed framework achieves not only better security but also attains better efficiency in cloud computing environment

Bis(μ-phenyl­tellurido-κ2 Te:Te)bis­[tetra­carbonyl­rhenium(I)]

The title compound, [Re2(C6H5Te)2(CO)8], crystallizes with two mol­ecules in the asymmetric unit, in which two Re atoms are coordinated in a slightly distorted octa­hedral environment and are bridged by two Te atoms, which show a distorted trigonal-pyramidal geometry. The torsion angles for the Te—Re—Te—Re sequence of atoms are 19.29 (18) and 16.54 (16)° in the two mol­ecules. Thus, the Re—Te four-membered rings in the two mol­ecules deviate significantly from planarity. Two intra­molecular C—H⋯O inter­actions occur in one of the mol­ecules. Te—Te [4.0551 (10) Å] inter­actions between the two mol­ecules and weak inter­molecular C—H⋯O inter­actions stabilize the crystal packing

4-[4-(Diethyl­amino)­phen­yl]-N-methyl-3-nitro-4H-chromen-2-amine

In the title compound, C20H23N3O3, the dihydro­pyran ring adopts half-chair conformation. The chromene system makes a dihedral angle of 87.35 (5)° with the adjacent benzene ring. An intra­molecular N—H⋯O hydrogen bond generates an S(6) motif, which stabilizes the mol­ecular conformation. In the crystal, weak inter­molecular C—H⋯O hydrogen bonds contribute to the stabilization of the packing

Plasmonic Gold Decorated MWCNT Nanocomposite for Localized Plasmon Resonance Sensing

The synergism of excellent properties of carbon nanotubes and gold nanoparticles is used in this work for bio-sensing of recombinant bovine growth hormones (rbST) by making Multi Wall Carbon Nanotubes (MWCNT) locally optically responsive by augmenting it optical properties through Localized Surface Plasmon Resonance (LSPR). To this purpose, locally gold nano particles decorated gold–MWCNT composite was synthesized from a suspension of MWCNT bundles and hydrogen chloroauric acid in an aqueous solution, activated ultrasonically and, then, drop-casted on a glass substrate. The slow drying of the drop produces a “coffee ring” pattern that is found to contain gold–MWCNT nanocomposites, accumulated mostly along the perimeter of the ring. The reaction is studied also at low-temperature, in the vacuum chamber of the Scanning Electron Microscope and is accounted for by the local melting processes that facilitate the contact between the bundle of tubes and the gold ions. Biosensing applications of the gold–MWCNT nanocomposite using their LSPR properties are demonstrated for the plasmonic detection of traces of bovine growth hormone. The sensitivity of the hybrid platform which is found to be 1 ng/ml is much better than that measuring with gold nanoparticles alone which is only 25 ng/ml