Suppressed acid formation by cofeeding of glucose and citrate in Bacillus cultures: emergence of pyruvate kinase as a potential metabolic engineering site

Microbial cultures typically produce acids when metabolizing the common carbon source, glucose. Acid production not only represents a waste of carbon, but its accumulation can limit cell concentration and culture stability, thereby reducing productivity. On the basis of prior work, acid production was attributed to be due to a mismatch between glycolytic and tricarboxylic acid (TCA) cycle capacities. To suppress acid production, a strategy entailing adding citrate to glucose minimal medium proved extremely effective. The effect of citrate on in-vivo flux distribution was quantified using a detailed flux-model. When the molar glucose-citrate ratio was varied between 3 and 6, a significant reduction in glycolytic flux and essentially complete suppression of acid formation was found as compared to chemostat cultures grown solely on glucose. Adding other biosynthetic precursors such as glutamine did not invoke the same suppression, thus indicating that citrate's effect is at the regulatory level. We hypothesized that the reduction of glycolytic flux in the presence of citrate results from its transport being coupled with the uptake of divalent metal ions. Citrate transport alters the intracellular balance of metal ions which in turn could trigger a sophisticated series of metabolic events leading to reduction of the activities of the pyruvate kinase and phosphofructokinase (PFK), the regulatory enzymes of glycolysis. On the basis of this scenario and other regulatory information, pyruvate kinase has emerged as a potential metabolic engineering site. It's deactivation in Bacillus subtilis or Escherichia coli strains is expected to yield constructs with a much lower tendency for making acid byproducts.

Sweet syndrome in chronic myeloid leukaemia

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Structure-activity study on antiulcer agents using Wiener's topological index and molecular connectivity index

The relationship of Wiener's topological index and molecular connectivity index with antiulcer activity of a series of 4-substituted-2-guanidino thiazole analogs has been investigated. The values of Wiener's topological index and molecular connectivity index of 128 compounds were computed and active ranges were identified. The activity assigned to each analog using these topological descriptors was subsequently compared with the reported in vitro and in vivo activities against gastric hydrogen-potassium stimulated adenosine triphosphatase (H+K(+)-ATPase) enzyme. Predictions with an accuracy of the order of approximately 89% were observed with regard to in vivo activity using these topological indices.

Structure-activity study on antiinflammatory pyrazole carboxylic acid hydrazide analogs using molecular connectivity indices

The relationship between molecular connectivity indices and the antiinflammatory activity of a series of pyrazole carboxylic acid hydrazide analogs has been investigated. The values of molecular connectivity index, valence molecular connectivity index, and a modified index, termed as atomic molecular connectivity index for 76 compounds, were computed and active ranges were identified. Each compound was assigned an activity which was subsequently compared with the reported activity against lipoxygenase enzyme. Predictions with a degree of accuracy above 80% were observed using the valence molecular connectivity index.

Preoperative shunts in suprasellar tumours

A series of 22 cases of large suprasellar tumours was studied retrospectively. These patients had undergone a preoperative shunt to facilitate surgical exposure of the tumour and to reduce intracranial pressure in critically ill patients. Our observations on the clinical progress of these patients following the shunt is analysed. Nine patients worsened to a varying degree following insertion of the shunt. Seven patients became drowsy, one developed worsening of vision and a hemiparesis, and one became an akinetic mute. The worsening was probably related to alteration of intracranial pressure dynamics and resultant compression in the hypothalamic region by subtle superior migration of the tumour. Operative difficulties were encountered during the dissection of the tumour from the neural structures in these cases. We conclude that with the availability of modern decongestive measures and basal surgical exposures, preoperative shunting is rarely indicated and can be occasionally dangerous. In the absence of actual proof, it is postulated that the secondary ventricular enlargement appears to be a protective mechanism of the brain helping to reduce tumour pressure on the basal forebrain structures.

Infratemporal fossa interdural approach for trigeminal neurinomas

A small craniectomy in the infratemporal fossa incorporating the foramen ovale was used to resect 4 large trigeminal neurinomas. The tumour extended from the posterior cranial fossa and involved Meckel's cave and the lateral wall of the cavernous sinus in each instance. The dural sheath around the mandibular nerve and Gasserian ganglion was opened to expose the entire lesion. The head position and the surgeon's view of the tumour were modified to obtained a basal view. The craniectomy at this strategic site provided an avenue for control of the carotid artery at the petrous apex, avoided the need for brain retraction and permitted safe and complete resection of the tumours. The approach appears to be ideal for selected cases of trigeminal neurinomas.

Chordoma and chondrosarcoma: relationship to the internal carotid artery

In 6 patients with chordoma and 1 patient with a chondrosarcoma in the petroclival region, the internal carotid artery (ICA) showed a rather interesting relationship. The striking finding was the marked anterior (ventral) displacement of the adjacent segments of the ICA by the tumour. Complete encasement of the artery was not seen despite the massive size of the tumour. Narrowing of the caliber of ICA was seen in 1 case. The displacement of the ICA pointed toward the origin of the tumour and the pattern of its spread suggested pre-operatively the pathological diagnosis. Pre-operative recognition of the carotid artery neoplasm relation helped to better protect the ICA during surgery on these formidable lesions.

Extended middle fossa approach for petroclival lesions

A modification of the previously described transcochlear approach to extra- and intradural petroclival and clival lesions is described in this report. It is an approach from the middle cranial fossa. It involves unroofing and depression of the external ear canal, removal of the glenoid cavity of the temporo-mandibular joint, exentration of the middle ear ossicles, posterior mobilization of labryrinthine and tympanic segments of the facial nerve, and drilling of the petrous bone from an entirely lateral perspective. An extensive and low exposure of the petroclival region, posterior aspect of the cavernous sinus, upper and mid clivus and the cerebellopontine angle is obtained. The anterior surface of the brain stem upto the pontomedullary junction is exposed with minimal or no retraction of the temporal lobe of the brain. The vein of Labbe and sigmoid sinus drainage is unhampered. Anterior and posterior extension of the exposure is possible. Only a limited mastoidectomy and labyrinthectomy, necessary to facilitate exposure and mobilization of the facial nerve is necessary. The inferior limit of the exposure is set by the dome of the jugular bulb. Hearing is sacrificed. The technique and merits of the procedure are discussed in this report. The study is based on surgical experience of 4 cases.

Replantation and amputation of digits: user analysis

There now is extensive literature on the survival and function of replanted digits but little on the function of the hand as a whole after this procedure, as opposed to amputations. In our review of the literature, we found almost nothing on the patient's perspective of the outcome from these procedures. This study was a preliminary attempt to study the outcome of these procedures from the patient's viewpoint. There were nine replantations and ten amputations of digits in the final study groups, based on medical record screening and patient questionnaires. Multivariate analysis, Hotelling T2, was used to test significant differences between the variables in the two groups. Significant differences were found in the two groups. The replantations had longer lengths of treatment and therapy, were off work longer (34.4 wk of therapy and 40 wk off work), and rated their function poorer compared with amputations. The patients with digit amputations had 7.2 wk of therapy and lost 6.8 wk of work. Ninety percent of the amputees rated their function as good or excellent, in contrast to 44.4% of the replantation patients. These findings are supported by existing literature that suggests that single-digit replants do not help with function of the whole hand, which is the therapeutic aim.

Tentorial dural flap for transtentorial surgery

For a subtemporal transtentorial approach to the anterior part of the posterior fossa a tentorial dural flap is described. An incision is begun at the free edge of the tentorium at the level of the posterior edge of the cerebral peduncle and is then directed anterolaterally towards the superior petrosal sinus. A triangular flap of the tentorial dura is everted over the superior petrosal sinus. The flap has the advantage of being simple and safe, and provides a wide window to the infratentorial structures. In addition the occasional troublesome bleeding from the superior petrosal sinus and the petrosal vein is avoided. The fourth and fifth cranial nerves are protected and exposed widely.

A simple microassay for computing the hemolytic potency of drugs

A simple microassay and computer program are described for determining the erythrocyte hemolytic potency of drugs in vitro. This microassay is sensitive for both micro as well as macro ranges of hemoglobin concentration. An ELISA reader has been adapted to read erythrocyte lysis (hemolysis), which reduces the number and culture of replicates. A computer program was developed that calculates parameters such as C50 (concentration of drug causing 50% hemolysis), C100 (concentration of drug causing 100% hemolysis) and beta (slope of the curve) and graphically expresses the hemolytic patterns of various drugs simultaneously. The program can obtain optical densities directly from a 96-well plate ELISA reader by interfacing the microplate reader to the computer or by using a keyboard. This method is useful for screening a large number of hemolytic drugs and requires lower amounts of test compounds. It may also be applicable to quantitative functional assays, such as complement-mediated hemolysis and enumeration of antibody-secreting cells. The program can be obtained from the authors on request.

Hypoparathyroidism with extensive intracranial calcification: a case report

We present a case of hypoparathyroidism, demonstrating extensive intracranial calcification, not only in basal ganglia, but also outside the extrapyramidal system. The patient presented with an unexplained epileptifors disorder, accompanied by extrapyramidal dysfunction in the form of choreoathetosis and hemiballismus. Hemiballismus is reported for the first time to our knowledge in association with hypoparathyroidism.

Hepatoprotective effects of Liv-52 and its indirect influence on the regulation of thyroid hormones in rat liver toxicity induced by carbon tetrachloride

This study was undertaken to investigate the protective effect of Liv-52, a herbal formulation, on various serum and liver marker enzymes, lipid peroxidation and histological changes in the liver of male albino rats suffering long-term carbon tetrachloride (CCl4) poisoning. It was observed that the activities of serum marker enzymes, hepatic enzymes and NADPH-dependent lipid peroxidation were significantly elevated after treatment with CCl4. However, in rats given Liv-52 at the same time as CCl4, the levels of all the marker enzymes were closer to those found in control animals. A similar trend was seen in the case of lipid peroxidation after Liv-52 treatment. CCl4 alone caused severe liver damage, but when Liv-52 was simultaneously given, there was much less effect on the structure of the organ. Circulating T3 and T4 concentrations were also determined after 6 weeks of simultaneous treatment with Liv-52 and CCl4. Concentrations of T3 were significantly lowered after CCl4 treatment alone, but Liv-52 administration together with CCl4 resulted in maintenance of the T3 activity within normal limits, thus suggesting indirect beneficial effects of Liv-52 on the regulation of thyroid hormone concentrations.

Flux adaptations of citrate synthase-deficient Escherichia coli

The results from the experiments performed with a mutant deficient in citrate synthase activity can be summarized as follows. (1) Totally blocking entry into the TCA cycle did not appreciably alter the cellular ATP yield. The unchanged yield suggests that for growth on abundant glucose, the sensitivity of ATP yield to TCA cycle flux is low. ATP production in the mutant is altered, in part, by modulating the relative amounts of formate and acetate produced. (2) The in vivo operation of pyruvate-formate lyase and malic enzyme corresponds to proposals developed from in vitro studies. Namely, pyruvate activates the former, and acetyl CoA inhibits the latter. Overall, the diversion of pyruvate to formate under aerobic conditions constitutes an adaptation of the mutant to the enzymatic lesion. The low alpha-ketoglutarate dehydrogenase flux estimated for the mutant indicates that the enzyme is highly repressed in cells growing rapidly on glucose, which is in accord with prior induction-repression studies. Moreover, the lack of a change in uptake flux during the bulk of batch growth is consistent with prior induction-repression studies. (3) The mutant exhibits a heightened sensitivity to CO2 as compared to wild-type counterparts. Growth rate is increased, and the production of formate, malate, glycerate, and pyruvate is reduced. This sensitivity illustrates that citrate synthase is more than an expendable component in an amphibolic pathway. Its presence in wild-type cells "immunizes" against the effect of CO2 fluctuations. (4) The effects of CO2 can be tentatively explained by assuming that the PEP carboxylase-catalyzed reaction is stimulated.

Intraparenchymal schwannoma of the frontal lobe

A 45 year old woman with bifrontal headaches and progressive diminution in vision over 6 months was found to have bilateral papilloedema. CT scan showed large right frontal lesion with surrounding oedema. Right basal frontotemporal craniotomy was performed to excise the multinodular, intraparenchymatous tumor. Hispathology confirmed the diagnosis of schwannoma. Post-operative course was uneventful with disappearance of pre-operative signs and symptoms.

Microalbuminuria in non insulin dependent diabetes and essential hypertension: a marker of severe disease

Sixty five (65) hypertensive, 91 non-insulin dependent diabetes and 50 matched, healthy controls were examined for the presence of microalbuminuria, using the Micral strip test. Microalbuminuria was observed in 25 per cent of diabetics and 21.54 per cent of hypertensive subjects. None of the controls demonstrated microalbuminuria. Diabetics with microalbuminuria were poorly controlled and demonstrated significantly higher systolic pressure. In hypertensive subjects, microalbuminuria was seen more in patients with severe disease. In both diabetics and hypertensives, presence of microalbuminuria was significantly influenced by the disease duration.

A study of hyperinsulinaemia in Indian hypertensive subjects

Fasting and 2 hours post-prandial serum insulin levels were estimated in 100 hypertensive subjects and 25 matched, healthy controls, by radio-immuno assay (RIA). Seventy four of the 100 hypertensives exhibited fasting hyperinsulinaemia. Post-prandial hyperinsulinaemia was present in 85 hypertensives. None of the healthy individuals demonstrated hyperinsulinaemia. Although, most hyperinsulinaemic patients exhibited an abnormal lipo-protein profile, there was no statistical correlation between absolute values of lipo-protein and insulin.

Evaluation of zinc in the regulation of serum T3 and T4 levels and hepatic functions in carbontetrachloride-intoxicated rats

Circulating tri-iodothyronine (T3) and thyroxine (T4) concentrations were determined after 6 wk of zinc treatment to carbontetrachloride (CCl4) intoxicated male albino rats. Concentrations of T3 were observed to be significantly depressed following CCl4 treatment alone. On the contrary, no significant change was noticed in the concentrations of T4 when compared to controls. However, zinc administration to hepatotoxic animals resulted in restoring the T3 activity to within normal limits, thus indicating the indirect effects of zinc on the regulation of thyroid hormone concentrations. The activities of all the serum and hepatic marker enzymes were found to be significantly elevated following CCl4 treatment. However, following zinc supplementation to these intoxicated animals, the levels of the marker enzymes decreased significantly when compared to the CCl4-treated animals. A similar trend was seen in the case of lipid peroxidation following zinc treatment.

Plate and screw fixation for atlanto-axial subluxation

Our experience with 30 cases of atlanto-axial dislocation, over the period of 3 years and 9 months, is described. A modified plate and screw method of fixation of the lateral masses of the atlas and axis was successfully used in these cases. The technical aspects and merits of the method, wherein a 100% union rate was achieved, with no morbidity, mortality, or instrument fatigue or failure, are presented. The average follow-up period is of 19 months. The technique provided immediate rigid segmental internal fixation, permitting early mobilization with minimal external support. Onlay and interfacetal bone grafts subsequently produced bony fusion. Direct application of screws to the atlas and axis, thus utilizing the firm purchase in their thick and large cortico-cancellous lateral mass, provides a biomechanically strong fixation of the region. Occipito-cervical fusion can be achieved in selected cases by a modification of the method. It appears that such a method of fixation could be useful at least in some complex congenital or traumatic craniovertebral region instability where the conventional methods have failed or are not suitable.

Vascularized bone flap for anterior skull base reconstruction

A case is reported where a vascularized outer-table of the frontal bone was successfully used to reconstruct a large defect in the anterior skull base following excision of a massive olfactory groove meningioma extending into the ethmoid sinuses. The flap provided a firm barrier between the cranial cavity and paranasal air sinuses, as the dural and bony integrity of the base was compromised after the radical resection of the tumour. It appears that such a flap can be effectively used for skull base reconstruction.

An unusual trigeminal neurinoma

We report a large trigeminal neurinoma in an 18-month-old child involving the Gasserian ganglion and all three divisions in a plexiform pattern. The tumour in the ophthalmic division extended all the way to the supraorbital nerve. The child presented with proptosis which had been observed since she was 4 months of age. There was a family history of neurofibromatosis.

Technique of extended transcranial approach for massive nasopharyngeal angiofibroma

Various surgical approaches have been described to deal with extensive nasopharyngeal angiofibromas. These lesions, particularly those with a large intracranial extension and involving the cavernous sinus, pose a formidable surgical challenge. An extended transcranial approach was employed to resect successfully 2 such lesions.

Massive benign osteoblastoma of the clivus and atlas

A case of massive benign osteoblastoma involving the clivus and atlas is reported. Usually, these tumours involve the posterior elements of a vertebra and are detected when small as a result of the usual presenting symptom of pain. The unusual site, massive size and presentation with neurological deficits are rare for benign osteoblastomas. The problems encountered in the surgical management of the patient are discussed.

Vascularized osteomyoplastic flaps for skull base reconstruction

A temporalis osteomyoplastic bone flap was successfully used for reconstruction of the middle cranial fossa base. Rotation vascularized pedicle bone flaps are particularly suited for reconstruction after skull base surgery.

Transoral plate and screw fixation of the craniovertebral region--a preliminary report

A transoral plate and screw fixation of the clivus to the body of the cervical vertebra is described. The procedure was successfully performed in a patient with congenital basilar invagination after odontoidectomy.

Extended vascularized temporalis muscle-fascia flap

The use of an extended vascularized temporalis muscle flap is described. The deep layer of the temporalis fascia is partially everted over the temporalis muscle preserving its vascularity. A composite flap comprising temporalis muscle and its fascia attached along its superior border, is rotated for reconstruction of postoperative defects in the middle cranial fossa floor and mastoidectomy cavities. The versatility of this flap is discussed.

Dural cavernous haemangioma of posterior cranial fossa

A rare case of extracerebral dural cavernous angioma sited near the sigmoid sinus is reported. This 60 yr old male patient gave history of episodic ataxia of left sided limbs experienced twice on same day and occasional giddiness. Examination did not reveal any findings. A mass was diagnosed on CT Scan following which angiography was carried out. The features matched with those of a meningioma. Retro-sigmoid craniectomy was performed. Occipital artery was coagulated. Tumor was dissected out. Post-operative course of the patient was uneventful. Histopathology revealed that the mass was a cavernous haemangioma.

Visceral larva migrans

We present a case of visceral larva migrans which came as a complete histologic surprise. The patient was operated as a case of chronic cholecystitis and was found at operation to have multiple hepatic nodules. A cholecystectomy with a biopsy of the liver nodule was performed. Histopathologically a diagnosis of visceral larva migrans was made. To our knowledge this is the first case report of the disorder from India. A discussion based on the review of literature is presented.

Immunocytochemical detection of prolactin binding sites in fine needle aspiration smears of breast lesions

Specific prolactin (PRL) binding sites were demonstrated in the fine needle aspiration cytology (FNAC) specimens from 68 patients with benign and malignant diseases of the breast using highly sensitive technique of DNP hapten sandwich staining procedure and antibody against human PRL. In 16 patients, immunocytochemical staining was also carried out on paraffin embedded sections of corresponding lesions. FNAC specimens included 52 neoplasms and 16 non-proliferative and proliferative benign breast disease. The reaction varied in different lesions, being maximum (72%) in malignant tumours and 60 per cent in benign tumours. However, benign breast disease showed a reaction that varied with the lesion. The technique was found to be simple, sensitive and economical for demonstrating specific PRL binding sites in cytology specimens of breast lesions.

Chronically exposed calvarium following electrical burns

Electrical burns of the scalp and calvarium are uncommon, but due to various conditions peculiar to India such injuries are seen frequently. The presentation of such patients at hospital is late because of the paucity of specialized care facilities and understanding of the disease process. Such injuries usually cause necrosis of the scalp and underlying calvarium with sequestered bone being retained in situ by the flimsy adhesions of underlying granulation tissue and overhanging edges of the scalp all around caused by secondary wound contraction. This paper gives our experience of 14 such cases, explaining the reasons for the chronic state and their subsequent clinical management.

Vein graft replacement of the distal vertebral artery

Vein graft reconstruction of the cervical portion of the vertebral artery has been commonly used for the treatment of atherosclerotic arterial disease. In this article, we describe two instances of vein graft replacement of the distal portion of the vertebral artery. In the first case, the vein graft was placed from C2 transverse foramen to the intradural portion of the vertebral artery to replace an artery abnormally encased and involved by meningioma. The grafting was done in this case to preserve the cerebrovascular reserve in a young patient. In the second case, a vein graft was placed from the extradural C1 portion to the intradural artery beyond the posterior inferior cerebellar artery. This was done to replace a segment of the artery involved by a giant aneurysm, which could not be clipped without occluding the parent artery. In this case, the vein graft replacement was necessitated by changes of somatosensory evoked potentials after the aneurysm was clipped, demonstrating the need to preserve the patency of the artery. Vein graft replacement of the proximal intradural vertebral artery is feasible by the combination of standard cerebro-vascular techniques and the exposures afforded by skull base surgery.

Whither preoperative shunts for posterior fossa tumours?

Some degree of hydrocephalus is present in almost all cases of medium to large posterior fossa tumours. The initial symptoms in such cases are usually due to the hydrocephalus and the consequent increased supratentorial pressure, and more often precede the symptoms primarily due to the local invasion and compression of the brain stem and cerebellum by a significant length of time. In our experience, based on 62 posterior fossa tumour operations, insertion of a cerebrospinal fluid (CSF) diverting shunt because of hydrocephalus makes the subsequent tumour excision more difficult and hazardous. The various problems presumed to be related to preoperative shunt surgery are discussed in this report. It is concluded that preoperative shunts for posterior fossa tumours are rarely indicated.

Cerebrospinal fluid rhinorrhoea: unusual presentation of acoustic neurinoma

A 40-year-old male presenting with spontaneous cerebrospinal fluid (CSF) rhinorrhoea was found to have raised intracranial pressure due to an acoustic tumour. This report adds to the scant literature on an intracranial tumour causing markedly raised intracranial pressure leading to a non-traumatic CSF rhinorrhoea. After a ventricular shunt and resection of the tumour the CSF leak stopped.

Cladosporium bantianum (trichoides) infection of the brain

A 32 yr old male patient with history of convulsion and bitemporal headache was diagnosed as suffering from tuberculoma based on CT Scan. He worsened after anti-tuberculous therapy. The patient underwent parieto-occipital craniotomy with drainage of abscess. The histopathological examination of brain abscess revealed the infection with cladosporium bantianum. The details of this rare case of opportunist fungal cerebral lesions in healthy individual are reported.

Bilateral otogenic cerebellar abscesses

An unusual presentation of bilateral otogenic cerebellar abscesses observed in two of our patients is reported. Both gave a history of otorrhoea, fever, headache, vomiting and had bilateral cerebellar signs and conductive hearing loss. The abscesses were detected on computerised tomography. X-rays revealed bilateral mastoiditis. The therapy followed was excision of abscesses, mastoidectomy and antibiotic therapy.

A shunting procedure for cerebrospinal fluid fistula, employing cannulation of the third and fourth ventricles

A modified third/fourth ventriculoperitoneal shunt is described. This procedure was used to deal with postoperative cerebrospinal fluid fistulae refractory to treatment by simpler routine measures. The possible indications of the operation are discussed.

Late course of preserved hearing and tinnitus after acoustic neurilemoma surgery

The late course of preserved hearing and tinnitus following retrosigmoid transmeatal surgery for acoustic neurilemoma is reported. Over a period of 5 years, useful hearing was preserved in 15 patients after preservation was attempted in 42 patients. In five patients the hearing was better than the preoperative level; in three it was worse. Three patients developed delayed worsening and fluctuations of hearing in the surgically treated ear during a median follow-up period of 2 1/2 years. While the exact reason for such worsening was not clear in two patients, in one patient it appeared that the muscle graft placed in the internal auditory canal after tumor resection resulted in fibrosis and compromise of the cochlear nerve. The causes of delayed worsening of hearing in the absence of tumor recurrence are analyzed, and possible treatment and methods of prevention of worsening are suggested. In six patients, tinnitus persisted after surgery in the ear with successful preservation of hearing, but hearing was not worsened and the tinnitus was not bothersome to the patient. In one patient with preoperative tinnitus, hearing was not preserved and tinnitus persisted sufficiently to necessitate reexploration and cochlear nerve section.

A study of bronchial reactivity in relation to baseline pulmonary functions in patients with chronic obstructive lung disease

Baseline bronchial reactivity was studied in 36 patients with chronic obstructive lung disease (COLD) and 20 normal healthy controls using the inhalational histamine challenge test. Using a cut off PD20 dose of 0.195 mg of histamine, 83.3% patients of COLD demonstrated bronchial hyper-reactivity. Presence of bronchial reactivity correlated significantly with the baseline FEV1, FEF25-75 and the ratio FEV1/FVC (p = 0.0019, 0.00001 and 0.008) respectively. Thus, bronchial reactivity in subjects with COLD correlates most significantly with the maximum mid-expiratory flow rate (FEF25-75).

Fell walking injuries in Cumbria: a review

An analysis of injuries sustained during fell walking in Cumbria and seen at the West Cumberland Hospital over a 3-year period is presented. There were 90 patients, including 19 multiple injuries and four deaths. This report focuses attention on the seriousness and magnitude of injuries associated with a pastime often thought to be harmless and risk-free.

Management of electrical injuries of the abdomen

High voltage electrical burns may involve intra-abdominal viscera with or without an abdominal wound. The risk of such an involvement is much higher when a wound is present. Depending upon the amount of heat produced vapourization of tissues may occur. If it includes part of the peritoneum, visceral damage is revealed immediately. If it does not occur to that extent, necrosed tissues remain in continuity and visceral involvement remains concealed until slough separates. The prognosis is related to early diagnosis of the associated visceral injury. It is recommended that the debridement should be undertaken at 2-3 days postburn. Laparotomy is indicated if part of the peritoneum is also debrided. Reconstruction of the abdominal wall may be a formidable task. Among the options available, pedicled muscle and musculocutaneous flaps seem to be ideally suited for the purpose.

Bilateral cataracts as the presenting manifestation of chronic renal failure

A 26 year old female, a case of chronic renal failure secondary to chronic pyelonephritis with renal osteomalacia, came with dimunition vision as the presenting complaint. She was found to have bilateral cataracts. All other known causes of cataract were excluded. Cataracts due to hypocalcaemia in chronic renal failure are a rare phenomenon.

Evaluation of unguided transbronchial biopsy in the diagnosis of pulmonary disease--its safety and efficacy as an out-patient procedure

Sixty-five patients underwent unguided fiberoptic transbronchial biopsy on an out-patient basis. Satisfactory material for histopathological examination was obtained in 55 patients. A reasonably definite pathological diagnosis could be established in 51 patients. The commonest diagnosis arrived at was that of interstitial fibrosis. Complications were observed in 4 (6.2%) patients. Fiberoptic transbronchial biopsy is, therefore, a safe and efficacious out-patient technique for establishing a pathological diagnosis in patients with infiltrative, diffuse or localized pulmonary disease.