Multiple primary visceral malignancy--a review with report of two cases

Multiple primary cancers are being reported with increasing frequency in recent years, the frequency varying from 0.3 to 4.3% in different studies. A combination of primary cancer of larynx and lung is the most common followed by malignant neoplasm involving lip-larynx, skin-larynx, skin-lung, breast-ovary and breast-endometrium. Two interesting cases of rare combinations of primary cancers are being presented. In the first case primary adenocarcinoma of the gall bladder was associated with appendiceal adenocarcinoma. In the second case primary malignant papillary serous cystadenocarcinoma of right ovary and squamous cell carcinoma of cervix uteri were found.

Biochemical speciation of enterococci causing human infections

As Enterococci are now coming up as important nosocomial pathogens, their speciation and antibiotic sensitivity testing is important. 120 isolates of Enterococci from various clinical samples were physiologically and biologically characterised. Speciation on the basis of recommended methods revealed 114(95%) as E. faecalis and 6(5%) as E. faecium. Antibiogram of the 120 isolates showed that 100(83.3%) were sensitive to Ampicillin. Combination of Penicillin and Gentamicin was more effective. E. faecium was more drug resistant.

Glutathione regulation of tumor necrosis factor-alpha-induced NF-kappa B activation in skeletal muscle-derived L6 cells

TNF alpha is implicated in several skeletal muscle pathologies including muscle wasting of cachexia. Muscle wasting and other conditions such as physical exercise and immobilization are also associated with disturbances in muscle glutathione status. Hence, it was of interest to investigate the role of endogenous glutathione status in TNF alpha induced NF-kappa B activation in skeletal muscle-derived cells. TNF alpha proved to be a potent inducer of transient NF-kappa B activation in L6 myoblasts. In buthioninesulfoximine (BSO) treated cells, TNF alpha induced NF-kappa B activation was markedly potentiated suggesting that such activation is sensitive to cellular GSH, but may have been independent of high levels of intracellular GSSG. Because this activation was inhibited by the antioxidant pyrrolidinedithiocarbamate (PDTC) the involvement of reactive oxygen species in this activation system seems likely. NF-kappa B activation in L6 cells was also observed in response to direct H2O2 treatment. Results from GSSG reductase inhibited cells suggest that GSSG may participate in, but is not required for, TNF alpha induced NF-kappa B activation. The inhibitory effect of PDTC on NF-kappa B activation correlated with its effect on ICAM-1 expression suggesting that this GSH status modifying agent not only influenced nuclear translocation of NF-kappa B proteins but also regulated kappa B dependent transcription.

Viral antibodies in blood in obsessive compulsive disorder

IgG viral antibodies for herpes simplex virus -1, varicella zoster virus, cytomegalovirus, measles and mumps were studied in 76 subjects with obsessive compulsive disorder and compared with a control population. There was a significantly higher titre for some of the antibodies, most specifically for herpes simplex virus type 1 and mumps. This suggests a possible role for these viral infections in the pathogenesis of obsessive compulsive disorder.

An investigation into the psychobiology of social phobia: personality domains and serotonergic function

The aim of the present study was to explore a psychobiological perspective in the aetiology of social phobia. The emphasis was on serotonergic function and personality. A total of 20 social phobics according to ICD-10 DCR criteria were assessed with the Schedule for Clinical Assessment in Neuropsychiatry and the International Personality Disorder Examination. They were compared with an age-matched normal population with regard to scores on the Fear of Negative Evaluation Scale, the Social Avoidance and Distress Scale, the Temperament and Character Inventory, and platelet 5HT2 receptor function. Other Axis-I disorders and cluster C personality disorders were frequently encountered. The social phobia group was characterized by high levels of harm avoidance, and low levels of novelty seeking, co-operativeness and self-directedness. Platelet 5HT2 receptor density did not differentiate between the groups, but was associated with severity of social phobia. An integrated psychobiological model is presented.

Exploring the human brain using single-unit microelectrode technique during awake stereotactic functional neurosurgery

In neuroscience research, the use of true single-unit microelectrode technique has been confined largely to the animal neurophysiology laboratory due to the complexity of the equipment required and the fastidious, time-consuming nature of the methodology. We report here our successful clinical use of this technique in human patients with Parkinson's disease undergoing awake stereotactic movement disorder neurosurgery. The common targets in such operations are the postero-ventral portion of the globus pallidus interna in the basal ganglia (for dopa-induced dyskinesias particularly) and the ventro-intermediate nucleus of the thalamus (for tremor-predominant Parkinson's disease). Accurate and exquisite neurophysiological localisation of these small targets deep within the brain can be obtained with single-unit microelectrode technique prior to the insertion of a deep brain stimulator or definitive neurosurgical radiofrequency lesioning in the target area. This accuracy translates into better outcomes for patients and a reduced incidence of complications. The wealth of data gained from studying the abnormal behaviour of neurons within the basal ganglia and thalamus also provides us with fundamental insights into the pathophysiology behind Parkinson's disease.

Cerebrospinal fluid viral antibodies in obsessive-compulsive disorder in an Indian population

Immunoglobulin G viral antibodies for herpes simplex virus type 1, varicella zoster virus, cytomegalovirus, measles, and mumps were studied in 76 subjects with obsessive-compulsive disorder and compared with a control population. There was a significantly higher titer for herpes simplex virus type 1 antibodies. Sera: cerebrospinal fluid ratios were suggestive of intrathecal synthesis.

Dorsal hippocampus field CA1 pyramidal cell responses to a persistent versus an acute nociceptive stimulus and their septal modulation

In urethane anaesthetized rats subcutaneous formalin injection in the right hind paw, a model of persistent pain, produced (i) a prolonged increase in the period of field rhythmic sinusoidal (or theta) activity, (ii) a depression of dorsal hippocampal field CA1 pyramidal cell synaptic excitability (mean peak depression of population spike amplitude being 50 +/- 6%) observed to the 60th min post injection, and (iii) a persistent decrease in extracellular activity of the majority of CA1 pyramidal cells (15/20 or 75%) with only a small percentage excited (5/20 or 25%). In contrast an intense noxious heat stimulus applied briefly to the distal end of the tail evoked a short duration increase in period of theta activation and suppression of pyramidal cell responses. With this acute stimulus the proportion of CA1 pyramidal cells excited (8/16) were similar to that suppressed (7/16). Finally, electrolytic lesions centred in the medial septal vertical limb of diagonal band of Broca (or septal region) prevented a noxious stimulus-induced theta and depression of CA1 pyramidal cell responses. Rather, in such lesioned animals noxious stimulation excited the majority CA1 complex spike cells studied (8/10). The above data are consistent with the notion that septohippocampal inputs are involved in noxious stimulus-induced CA1 pyramidal cell suppression. The formalin injection-induced selective activation of CA1 complex spike cells against a background of widespread pyramidal cell suppression might produce a "signal to noise" contributory to nociceptive processing in limbic structures. Such a processing might be involved in the affective motivational component of pain.

Therapy with amineptine, a dopamine reuptake inhibitor, in patients with major depression

The original tricyclic antidepressant drugs are consistently underused in major depression because of side effects, delayed onset of action, and potential for overdose. In an open study of 6 weeks' duration, we studied the efficacy and acceptability of amineptine, a dopamine reuptake inhibitor, at fixed dose of 200 mg per day in 50 patients with major depression.Intention-to-treat analysis showed a patient response rate of 64% (95% CI 77-50) in HDRS, 62% (95% CI 75-48) in MADRS, 46% (95% CI 59-32) in ZUNG scale, 52% (95% CI 66-38) in Social Activity scale, and 26% ("95% CI 38-14) in CGI-severity of illness after 7 days treatment. Response in CGI-global improvement was 38% (95% CI 51-25), and in CGI-efficacy index 48% (95% CI 62-34) after 14 days of treatment. With continued therapy, only CGI-severity of illness showed a significant increase in response rate after 42 days. The treatment effect of amineptine was reflected in a significant and progressive improvement in all depression, social activity, and CGI rating scale scores throughout the study period. Somatic symptoms and side effects assessed by AMDP-5 showed significant improvement at each assessment.The clinically useful response in depression which occurred by the first week of treatment, favourable side effect profile, and the convenience of a fixed dose could make amineptine a suitable first line alternative for the treatment of major depression.

Medical and financial aspects of same-day bilateral total knee arthroplasties

In this retrospective study, we compared forty-five patients who had undergone same-day bilateral total knee arthroplasties with 144 patients who had undergone unilateral total knee arthroplasty procedures. All procedures were performed by a single surgeon using a single prosthetic design between June 1994 to May 1996. The issues studied were the length of hospital stay, hospital charges, units of blood transfused, units of homologous blood transfused, and the rate and type of complications. This study also examined the usage and financial charges of extended care facilities and/or home health care following discharge from the hospital. Results show that, for patients suffering from symptomatic bilateral knee disease, the same-day bilateral total knee procedure is significantly less costly than staged bilateral procedures. The rate and type of complications seen in the same-day bilateral cases were not significantly different from complications seen in unilateral cases.

Degradation of crude oil by Acinetobacter calcoaceticus and Alcaligenes odorans

Two types of Indian crude oil (Bombay High and Gujarat) were tested for their biodegradability by Acinetobacter calcoaceticus and Alcaligenes odorans. Acinetobacter calcoaceticus S30 and Alc. odorans P20 degraded Bombay High crude oil by 50% and 45%, while only 29% and 37% of Gujarat crude oil (heavy crude oil) was degraded by these isolates, respectively. Acinetobacter calcoaceticus and Alc. odorans in combination degraded 58% and 40% of Bombay High and Gujarat crude oils, respectively, which were significantly higher than that of by individual cultures. Acinetobacter calcoaceticus S30 degraded more of the alkanes fraction than the aromatics fraction of both crude oils. GC fingerprinting of alkane fraction showed major degradation of heptadecane (C17), octadecane (C18), nonadecane (C19), eicosane (C20), docosane (C22), tricosane (C23) and tetracosane (C24) of crude oil, while the Alc. odorans P20 degraded alkanes and aromatics equally. The asphaltenic component increased in both types of crude oil after biodegradation . The two strains grew very well on n-alkane up to C33 as well as on pristane (branched-chain alkane) but could not grow on cycloalkanes. Acinetobacter calcoaceticus S30 could not grow on pure polycyclic aromatic hydrocarbon (PAH) compounds except naphthalene but Alc. odorans P20 could grow on anthracene, phenanthrene, dibenzothiophene, fluorene, fluoranthene, pyrene and chrysene.

Phenomenological study of late-onset schizophrenia

The phenomenological presentation of late-onset schizophrenia is a topic of considerable debate. This study aims to look at the clinical presentation of late-onset schizophrenia. Charts of all subjects who received a diagnosis of schizophrenia between January 1990 and December 1993 with age of onset being 45 or more were systematically analysed using the OPCRIT checklist. Of the 89 subjects chosen for analysis, 59 satisfied the ICD-10 DCR criteria for schizophrenia and formed the sample of the study. Of them, 20 were males and 39 were females. The mean age of onset for males was 51.6±5.7 years and for females, 53.2±16.7 years. The commonest phenomenon was persecutory delusion (83%) followed by delusion of influence and hallucinations in any modality (66%each). 53% of the subjects had third person auditory hallucinations, while 42% showed negative symptoms. Delusional perception and thought echo were not found in any subject. The implications of these phenomenological findings are discussed.

Alprazolam-induced hypomania

OBJECTIVE

There are reports of alprazolam-induced hypomania/mania. Here is a case report of a patient who developed hypomania during treatment with alprazolam, but not with diazepam, another benzodiazepine derivative.

CLINICAL PICTURE

The illness was of 2 months' duration and the patient received a diagnosis of anxious depression. Following treatment with alprazolam, the patient developed hypomania characterised by euphoria, overactivity, overtalkactivity, racing thoughts, oversocialisation, enhanced self-confidence and disturbed sleep.

TREATMENT

Hypomania subsided when alprazolam was withdrawn. There was no recurrence with fluoxetine or diazepam that ameliorated the primary condition.

OUTCOME

The patient was symptom-free on follow-up.

CONCLUSIONS

Alprazolam can induce hypomania/mania and, perhaps, it differs from other benzodiazepines in its mode of action. Clinicians have to be alert to the possibility of their patients developing hypomania/mania while on alprazolam.

Central noradrenergic neurons signal via ATP to elicit vasopressin responses to haemorrhage

It is now clear that ATP acts as a neurotransmitter in both the peripheral and central nervous systems. In the periphery, purinergic transmission has been best studied at certain sympathetic neuroeffector junctions where ATP, co-localized with noradrenaline, is used to elicit the primary post-junctional response. More recently, several groups have raised the possibility that central catecholaminergic neurons might use ATP in a similar fashion. Accordingly, we now present findings from immediate early gene expression and electrophysiological studies which indicate that ATP, acting through P2 purinoreceptors, is used as a transmitter by caudal brainstem noradrenergic neurons, the A1 group, in their interaction with vasopressinergic neurosecretory cells. Supraoptic nucleus vasopressin cell responses to moderate haemorrhage, known to be generated by the A1 projection, were suppressed by hypothalamic application of the P2 receptor antagonist suramin. However, suramin did not alter vasopressin cell responses to osmotic challenge or severely hypotensive haemorrhage, two stimuli known to excite vasopressin cells independently of the A1 projection. These data are consistent with an identity of action between the A1 input to vasopressin cells and the activation of ATP receptors on vasopressin cells. The use of ATP as a transmitter by other catecholamine neurons in the brain awaits further confirmation, but the present findings suggest that in certain instances the therapeutic manipulation of central catecholamine neuron output might best be achieved with pharmacological agents which target purinergic rather than adrenergic transmission.

Carcinoembryonic antigen: an invaluable marker for advanced breast cancer

Serial serum Carcinoembryonic antigen (CEA) levels were measured in 150 individuals (50 patients with breast cancer, 50 benign breast diseases and 50 other controls). These levels were correlated with clinicopathological parameters and follow-up information. Serum CEA levels were independent of the primary tumor status, their histology, lymphoreticular response and the patients' characteristics as well as the age, sex and the menstrual status. However, the nodal status, number of involved nodes and the grade of the tumors had significant influence on the level of serum CEA. Breast cancer patients especially those with metastasis had significantly higher serum CEA levels as compared to the controls and those with localised disease, irrespective of the site of metastasis. These levels were lowered appreciably by the disease regression and were raised or stable during the disease progression. Receiver operating characteristic (ROC) curve showed metastasis to be more frequent in patients with pretreatment serum CEA levels above 25 ng/ml and persistent post treatment CEA levels above 15 ng/ml. Serum CEA level was found to be a valuable prognostic indicator for advanced breast cancer and serial serum CEA levels provided an average lead time of about 3.9 months before the clinical appearance of metastasis.

Intra nuclear estrogen receptor status and its clinicopathological correlation in breast cancer patients

Intranuclear estrogen receptor (ERn) content of breast cancer tissue is thought to be more closely related to prognosis, and response to hormone treatment, as compared to conventional cytosolic estrogen receptor (REc). ERn and ERc levels in primary breast carcinoma tissue were assayed by ER-Enzyme immuno assay (ER-EIA), and the correlation of ERn with ERc and clinico-pathological parameters were assessed. ERn concentration and positive status, with 15 fmol as the cut-off value for positivity, is related to increasing age, lesser parity, post-menopausal status and smaller tumor size. A significant correlation exists between ERn and lesser metastatic axillary nodes and the early TNM stage. ERn was found to be correlated to better tumor differentiation, absent or slight L-R response and tumor necrosis.

Resinifying therapy in endodontics. II--Histological and bacteriological evaluation

This study was conducted on six rabbits, six rats and six human permanent teeth to evaluate histologically the effect of resin resorcinol in the periapical areas, the bacteriological aspect of the resin and the penetration of resin in the dentinal tubules. After 12 days period of observation plenty of lymphocytes and macrophages were evident along with granulomas which are suggestive of the tendency of the resin to stay longer. It was observed that the resin penetrate approximately three fourth distance inside the dentinal tubules. In the last phase the resin was found to be effective against the eight commonly found micro organisms. Though the histological results indicated that the periapical tissue would take longer time for complete repair, yet clinically the tooth functions well. Resinifying therapy is effective and economical method in root canal treatment.

Obsessive-compulsive disorder and rheumatic chorea: is there a connection?

There is increasing evidence to suggest basal ganglion involvement in the aetiopathogenesis of obsessive-compulsive disorder (OCD). Twenty subjects with rheumatic chorea were assessed for presence of OCD and evaluated on Leyton's Obsessional Inventory. Four subjects had OCD. The study group had markedly higher scores on all the scales of Leyton's Obsessional Inventory. The findings implicate that caudate dysfunction is not sufficient on its own to explain the presence of obsessive-compulsive behaviour and that additional basal ganglion regions/rostral connections also have to be involved to produce co-morbidity.