Ovarian sertoliform endometrioid carcinoma

Sertoliform endometrioid carcinoma (SEC) is a rare ovarian neoplasm occurring almost exclusively in post-menopausal patients. We studied a 71-year-old patient who underwent a total hysterectomy with bilateral salpingo-oophorectomy for a right ovarian mass measuring 25 cm in its maximal dimension. Histology revealed an SEC, featuring foci of typical endometrioid carcinoma and areas of clear cell differentiation. This particular type of ovarian neoplasm, already described in 21 reported cases in the literature, must be distinguished from Sertoli cell tumours and Sertoli-Leydig cell tumours which are encountered at a younger age. We discuss the elements of the differential diagnosis and insist upon the value of anti-epithelial membrane antigen in identifying an SEC.

The pathology of cutaneous leishmaniasis due to Leishmania major in Sudan

The pathology of cutaneous leishmaniasis in Sudan, where the disease is caused by Leishmania major, was studied by light and electron microscopy. Lesions were classified into four distinct groups based on the ratio of different cell types, especially lymphocytes, macrophages, and plasma cells in the inflammatory infiltrate, and the formation of compact epithelioid granulomas or the presence of necrosis. In the lesions, there was a positive correlation between the number of lymphocytes and the number of activated macrophages and epithelioid cells. We suggest that the parasites are eliminated from the lesion by two processes: 1) a lytic mechanism in which parasites are lysed within activated macrophages and 2) necrosis of parasitized macrophages. Morphologic evidence for these two mechanisms of parasite elimination was detected by both light and electron microscopy. The evolution of the pathology of the lesions was followed by rebiopsy when the lesion had regressed in size under antileishmanial therapy.

Dichotomy of the T cell response to Leishmania antigens in patients suffering from cutaneous leishmaniasis; absence or scarcity of Th1 activity is associated with severe infections

The T cell response was studied in 25 patients suffering from cutaneous leishmaniasis caused by Leishmania major with severe (n = 10) and mild (n = 15) disease manifestations. Peripheral blood mononuclear cells (PBMC) from the patients were activated by sonicates of Leishmania promastigotes (LMP) and amastigotes (LDA), and the surface protease gp63. The proliferative responses to Leishmania antigens were lower in patients with severe disease than in patients with mild disease (P = 0.01-0.05), and such a difference was not observed in the response to purified protein derivative of tuberculin (PPD) or tetanus toxoid (TT). LMP-induced interferon-gamma (IFN-gamma) production was lower in patients with severe than in patients with mild disease (P < 0.05). When the IL-4 and IFN-gamma responses of each patient were considered, two response patterns were observed in the cultures activated by the Leishmania sonicates. One response pattern was characterized by high production of IFN-gamma without production of IL-4 (a Th1-like pattern), the other was characterized by low IFN-gamma levels which in most cases were associated with IL-4 production (not a Th1-like pattern). These patterns could not be distinguished when the cells from the same donors were stimulated by TT and PPD. The percentages of patients with a Th1-like response pattern after stimulation by LMP in patients with severe and mild disease manifestations were 30% and 80%, respectively. This difference was statistically significant (P = 0.034).

Herpetic endometritis after pregnancy

A case of endometrial herpex simplex virus infection with severe uterine post-partum bleeding is reported. Histopathologic analysis of curettage samples revealed endometrial necrosis and diffuse herpes-type nuclear inclusions in the glandular epithelial cells. Immunohistochemistry, in situ hybridisation, and electron microscopy confirmed the diagnosis.

Heavy metals in freshwater snails of Kuala Klawang's rice field, Negeri Sembilan, Malaysia

A study of heavy metal contents in freshwater snails from rice fields have been made. The results indicate that the levels of heavy metals, Pb, Cu, Zn and Cd, are low and within the permissible limit of Malaysian Food Regulations. The results can serve as background data for further reference.

Dichotomy of the human T cell response to Leishmania antigens. I. Th1-like response to Leishmania major promastigote antigens in individuals recovered from cutaneous leishmaniasis

The T cell response to antigens from Leishmania major promastigotes was investigated in peripheral blood mononuclear cells from Sudanese individuals with a history of cutaneous leishmaniasis (CL), Sudanese individuals with positive DTH reaction in the leishmanin skin test but with no history of skin lesions, and in Danes without known exposure to Leishmania parasites. Proliferation and production of interferon-gamma (IFN-gamma) and IL-4 in antigen-stimulated cultures was measured. Lymphocytes from individuals with a history of CL proliferated vigorously and produced IFN-gamma after stimulation with either a crude preparation of L. major antigens or the major surface protease gp63. These cultures produced no or only little IL-4. Also cells from leishmanin skin test-positive donors with no history of CL produced IFN-gamma and no IL-4 in response to L. major antigens. Cells from the unexposed Danes were not activated by gp63. The cells from Danish donors produced either IFN-gamma or IL-4, but not both cytokines after incubation with the crude preparation of L. major antigens. The data show that the T cell response to Leishmania antigens in humans who have had uncomplicated CL or subclinical L. major infection is an IFN-gamma-producing Th1-like response.

Rupture of the uterus in labor: a review of 150 cases

We analyzed 150 cases of uterine rupture in late pregnancy that occurred over an 8-year period at the State Maternity Hospital in Ankara, Turkey. The incidence of uterine rupture was 1 in 966 deliveries, and 114 uterine ruptures occurred in previously scarred uteri. Rupture of the unscarred uterus is a more catastrophic event. There is a marked difference in fetal and maternal outcome between the group with a previously scarred uterus and the group without a previous scar. Common etiological factors for uterine rupture were grandmultiparity, cephalopelvic disproportion, fetal malpresentation, and oxytocin stimulation of labor. The fetal wastage was high, a perinatal mortality of 32.2% being recorded, but 98% of mothers were saved. Hysterectomy was commonly performed in this group. Repair of the uterus should only be performed when the rupture is simple, is in the lower segment and has no sign of infection.

Oral health status and treatment needs of an insured elderly population

The purpose of this study was to describe the oral health status and treatment needs of an elderly group of religious sisters whose dental care expenses had been covered for most of their adult life. While the residents displayed high levels of treated dental disease on examination, evidence of a need for further treatment was considered to be a reflection of their decreasing ability to manage their personal home care and the reduction in professional services available to them. The results of this study reinforce the notion that the continuous provision of preventive and educational strategies coupled with accessible treatment services are essential, especially in an aging population.

Prevalence of cutaneous leishmaniasis along the Nile River north of Khartoum (Sudan) in the aftermath of an epidemic in 1985

Based on a pilot clinical study of the prevalence of cutaneous leishmaniasis (CL) among school children in villages on both banks of the Nile River north of Khartoum, Sudan in the aftermath of a 1985 epidemic, we studied a random sample (303 individuals) from one of these villages to determine the prevalence of infection and exposure to CL. Four percent of the population had active CL lesions, 47% had healed lesions, and another 43% reacted positively to sensitization with leishmanin in the absence of past or active CL lesions. Ninety-one percent of the total population reacted positively to leishmanin. The present status of CL in the area and possible reasons for the emergence of the epidemic are discussed, and gaps in our knowledge about the epidemic are identified.

Glioependymal cysts: CT and MR findings

Four patients with intracranial glioependymal cysts were evaluated in our institution in the last 7 years. All underwent surgical drainage and biopsy of the cyst wall. Cranial CT revealed a uniformly hypodense lesion with no contrast enhancement in all cases. Magnetic resonance imaging studies revealed a well defined cyst that was isointense to CSF on T1-weighted images and iso- or mildly hyperintense to CSF on proton density and T2-weighted images. In one case, a fluid-fluid level was demonstrated within the cavity, indicating the presence of fluid with a high protein content. A diagnosis of glioependymal cysts can be suggested based on CSF-like intensity patterns on T1-weighted images and iso- or mild hyperintensity on T2-weighted images.

Antibacterial and antiviral activity of camel milk protective proteins

Lysozyme (LZ), lactoferrin (LF), lactoperoxidase (LP), immunoglobulin G and secretory immunoglobulin A were extracted from camel milk. The activity of these protective proteins was assayed against Lactococcus lactis subsp. cremoris, Escherichia coli, Staphylococcus aureus, Salmonella typhimurium and rotavirus. Comparative activities of egg white LZ, bovine LZ and bovine LF are also presented. The antibacterial activity spectrum of camel milk LZ was similar to that of egg white LZ, and differed from bovine milk LZ. Bovine and camel milk LF antibacterial activity spectra were similar. The camel milk LP was bacteriostatic against the Gram-positive strains and was bactericidal against Gram-negative cultures. The immunoglobulins had little effect against the bacteria but high titres of antibodies against rotavirus were found in camel milk. The LP system was ineffective against rotavirus.

Dot enzyme immunosorbent assay for the serodiagnosis of typhoid fever

A nitrocellulose membrane strip dotted with a specific 50 kDa outer membrane protein of Salmonella typhi was applied for the serodiagnosis of typhoid fever. Using horseradish peroxidase conjugated IgM and IgG antibodies with 4-chloronaphthol as substrate, antibodies in typhoid patients were clearly visualised as bluish purple dots while sera from patients with non-typhoid fevers gave negative results. The detection of specific IgM and IgG antibodies in typhoid patients suggest either recent or current infection. Combined with the high specificity, reliability and rapidity of the test, the dot EIA technique provides a simple and useful method for the serodiagnosis of typhoid using a single serum specimen.

Demonstration of an antigenic protein specific for Salmonella typhi

Current studies were undertaken to determine the presence of a specific antigenic protein on the outer membrane of Salmonella typhi. Immunoblot analysis using sera from patients with fevers revealed that the 50 kD band was specifically recognized only by typhoid sera. The 50 kD band located on the outer membrane is protein by nature and is not a Vi (capsular), dH (flagellar), or O9 (somatic) antigen of S. typhi. These results indicate the usefulness of the specific antigen in the development of a serodiagnostic test for typhoid fever since antibodies of both the IgM and IgG class responses were obtained.

GM1 ganglioside protection against ethanol-induced gastric mucosal injury

The gastroprotective properties of GM1-ganglioside, an indigenous component of epithelial cell membrane, was investigated. The experiments were conducted with groups of rats with and without indomethacin pretreatment. The animals received intragastrically either a dose of GM1 as emulsion in 5% gum arabic or vehicle alone, followed by ethanol given at various time intervals up to 3 h after the GM1. The animals were sacrificed 30 min after the ethanol dose and their gastric mucosa subjected to macroscopic and histologic assessment, and physicochemical measurements. In the absence of GM1, ethanol caused extensive gastric hemorrhagic lesions which were significantly reduced by pretreatment with GM1 at dose as low as 70 micrograms/100 g body weight. Removal of sialic acid from GM1 led to the loss of gastroprotection. Furthermore, the effect of GM1 was not thwarted by indomethacin. The maximal protection was achieved 1 h following GM1 dose and this protective effect persisted at least 2.5 hr. The results of physicochemical measurements revealed that GM1 was capable of preventing the detrimental effect of indomethacin on the adherent mucus gel dimension, and on its content of sulfo- and sialomucins, protein, and phospholipids. The effects brought by GM1 were also accompanied by a significant (40-60%) increase in mucus gel viscosity, hydrogen ion retardation capacity (35-46%) and hydrophobicity (70-94%). The results indicate that the gastroprotective action of GM1 occurs through the enhancement of the physicochemical characteristics of the mucus layer, and does not appear to be mediated by endogenous prostaglandins.

Placement and replacement of restorations in a military population

The purpose of this study was to investigate the reasons for placement and replacement of restorations provided to military personnel by all 34 dentists stationed in the four Atlantic provinces of Canada. All dentists who participated in this study are salaried. Over a period of 30 working days, each dentist recorded information on all restorations performed. Data were collected on dentists' year of graduation, patient age, treatment requirements, tooth number, restoration class, materials used and reasons for placement and replacement. All dentists used the same data collection form which was pilot tested. Information was collected on 2,280 restorations from 643 adults, 18 to 57 years of age. Of all restorations, 54.3% were placements and 45.7% were replacements. No difference in placement and replacement rates between amalgam and composites was reported. The major reason for placement was primary caries (90%). The major reasons for replacements were recurrent caries (40.0%), primary caries of interproximal surfaces (18.9%), and fractured restorations (12.3%). Of the 297 MOD restorations, 74.3% were replacements and of the 1,140 Class I + III + V restorations, 27.8% were replacements. This study showed that about half of the restorative work carried out were replacements. Caries is the primary reason for placement and replacement of restorations in adults.

Protection against alcohol-induced gastric mucosal injury by nitecapone

1. The mechanism of gastric mucosal protection by an anticular agent, nitecapone, against injury was investigated in rats with and without indomethacin pretreatment. 2. Animals received intragastrically either a dose of nitecapone or vehicle alone, followed by ethanol given at various intervals up to 5 hr, and their gastric mucosa subjected to histologic and physicochemical assessment. 3. Ethanol caused extensive gastric hemorrhagic lesions which were essentially prevented by nitecapone at doses of 30 mg and higher per kg body weight. The maximal protection was achieved by 1.5 hr which persisted up to 4 hr and was not thwarted by indomethacin. 4. Physicochemical measurements revealed that nitecapone evoked 78% increase in mucus gel dimension, and showed 21% increase in phospholipids, and the content of sulfo-(22%) and sialomucins (72%). This was accompanied by 1.6-fold increase in mucus viscosity, 31% increase in H+ retardation capacity and 2.2-fold increase in hydrophobicity. 5. The results suggest that the gastroprotective action of nitecapone occurs through the enhancement of the physicochemical characteristics of mucus layer.

Evaluation of the GO Slide, a growth transport system for the laboratory diagnosis of gonorrhoea

A growth transport system, the GO Slide (Roche Diagnostica), for the isolation of Neisseria gonorrhoeae from clinical specimens was evaluated. This system was compared with culture on chocolate agar (CA) and modified Thayer-Martin (MTM) agar, and Gram-stained smear for the diagnosis of gonorrhoea. Of 94 urethral specimens from symptomatic males, 77.7% were positive on MTM, 80.9% were positive on CA and Gram stain, and 81.9% were positive on GO Slide. Of the 77 isolates, 26.0% were penicillinase producers, 12.3% belonged to WI serogroup and 87.7% belonged to WII/III serogroup. The ease of transportation and the easy examination of growth on agar surfaces make the GO Slide an attractive system. It would be particularly useful for general practitioners without culture facilities to transport specimens to the laboratory for the isolation of N. gonorrhoeae.

The young pregnant teenager--why the poor outcome?

Studies have repeatedly emphasised the poor obstetric outcome in teenage pregnancies. This study examined 444 teenagers of 16 years and under and demonstrated little difference in the outcome between 14 years and under group and 15 to 16 year old. The poor pregnancy outcome, however, was predominantly related to the adequacy of antenatal care. The discussion emphasises the point that teenage pregnancy is not primarily a medical problem and much effort is required to create an awareness so that prenatal care is both accessible and acceptable to the pregnant teenager.

The alteration of serum potassium level during sample transit

A delay of only three hours between venepuncture and processing the blood can increase the level of potassium unpredictably and may be clinically significant.