Multiplane transesophageal echocardiography: our initial experience

We present our experience in the diagnostic assessment of a wide spectrum of cardiovascular disorders using multiplane transesophageal echocardiography (MP-TEE). Two hundred and seventeen patients in the age range of 11-71 years were subjected to MP-TEE from January to November 1993. The male:female ratio was 1.1:1. One hundred and ten patients had predominantly mitral valve disease of rheumatic origin, eleven had mitral valve prolapse, twenty patients had aortic valve disease and thirty seven patients had more than one valve involvement. Six patients with suspected prosthetic heart valve dysfunction and ten patients of hypertrophic cardiomyopathy were also studied. Two patients had unexplained pulmonary hypertension, three had pericardial disease and three had proximal aortic dissections. Twenty six patients with congenital heart disease were studied of which nineteen had atrial septal defects, one had corrected transposition of great vessels with pulmonic stenosis and one adult had Ebstein's anomaly of the tricuspid valve. In our experience, MP-TEE enhances the versatility of TEE by providing incremental diagnostic information and enhancing delineation of pathology. The procedure was well-tolerated and no complications occurred.

Role of computers in learning--application in formative assessment

Computers can help to liberate students from the burden of rote learning of facts and enhance the role of reason and imagination in the learning process. Arguably, the computers constitute the most important single resource ever to become available to the teachers and students since the invention of the printing press, and may well have a similar revolutionary effect on the way education is carried out, bringing about the massive shift from conventional expository teaching to the mediated individualized learning which is interactive, stimulating and rewarding. Soon, computers will be involved in almost all teaching. Apart from acting as data bases for information, computers will guide students through hypertext and will provide assessment at critical junctures, giving immediate feedback.

Recognition of the avirulence gene avrB from Pseudomonas syringae pv. glycinea by Arabidopsis thaliana

The response of Arabidopsis thaliana land race Columbia to the bacterial pathogen Pseudomonas syringae pv. maculicola 4326 harboring cloned avirulence genes avrB and avrC from P. syringae pv. glycinea and avrA and avrD from P. syringae pv. tomato was examined. Only avrB was recognized by Columbia, as evidenced by attenuation of disease symptoms, slower bacterial multiplication in planta, and differentially greater induction of mRNA for several defense-related genes. This contrasts with two A. thaliana land races where P. s. pv. maculicola strains containing avrB were not recognized. These plants showed typical disease symptoms, and bacterial multiplication in planta was not reduced in response to P. s. pv. maculicola containing avrB. In addition, there was no differential induction of defense-related mRNAs in these susceptible land races after infiltration with bacteria containing or lacking avrB. These results extend previous observations that avirulence genes from pathogens of one host plant can be recognized by "nonhost" plants and provide the genetic framework for analysis of the plant-specified response to the bacterial avrB gene product in A. thaliana.

Primary diagnosis of soft tissue echinococcosis by aspiration cytology

A case of hydatid cyst of soft tissue diagnosed by Fine needle aspiration of a cyst is reported. The patient presented with gradually increasing swelling in the anterior-inferior aspect of shoulder. The provisional clinical diagnosis of cold-abscess shoulder was made, patient was referred for Fine needle aspiration cytology (F.N.A.C.). Swelling was aspirated by 23-gauge needle obtaining 1.5 ml of blood-mixed fluid. Smears of fluid showed protoscolices, fully developed scolices with rostellum and scattered hooklets, pathognomonic of Echinococcosis. Histopathologic examination of surgically removed cyst showed chronically inflamed echinococcal cyst. No complication was observed.

Effect of some pesticides/weedicides on cathepsin B activity and lysosomal membrane

The in vitro inhibitory effects of various weedicides and pesticides on goat brain cathepsin B and their labilizing potency on the lysosomal membrane were quantitated. Endosulfan an organochlorine insecticide inhibited the enzymic activity to approximately 50% at 7 mM concentration followed by methyl parathion, aldrin, melathion and benzene hexachloride (BHC) in that order. Among the weedicides, butachlor was found to be most inhibitory (approximately 50% activity was lost at 6 mM) followed by isoproturone (28%) and anilophos (19%). When the labilizing/stabilizing potency of all these drugs was observed on lysosomal membrane it was found that none of these was capable of stabilizing the membrane. At 40 degrees C and 1 mM drug concentration, aldrin, endosulfan, melathion and anilophos were found to be strong labilizers of the lysosomal membrane. Others like isoproturone, BHC and methyl parathion had moderate labilizing effect. The labilization potency of the drugs was temperature dependent and was less pronounced at 25 degrees C as compared to 40 degrees C.

Electrocardiographic diagnosis of left ventricular hypertrophy in the presence of left bundle branch block: an echocardiographic correlation

Surface electrocardiographic findings of 10 cases of left bundle branch block with echocardiographically determined left ventricular hypertrophy were compared with another 10 cases of left bundle branch block without left ventricular hypertrophy. Horizontal plane QRS- and T-wave angle > or = 150 degrees was highly sensitive (70%) and specific (90%) in diagnosing left ventricular hypertrophy in the presence of left bundle branch block. This diagnosis criterion was better than any other conventional criterion described before.

Reproductive functions in obese women

The prevalence of obesity is increasing in the developed as well as underdeveloped countries. Obesity in women is associated with reproductive disorders. The levels of estrone and androgens are higher in obese women along with a reduction in the levels of sex hormone binding globulin ( SHBG ). The pituitary secretion of hormones is altered either due to a deficient peripheral feedback regulation or a concomitant central defect in the obese. Luteinizing hormone ( LH ) level may increase in some of the obese subjects. The secretion of LH in response to luteinizing hormone releasing hormone ( LHRH or GnRH ), clonidine and naloxone may be altered in obese women. The levels of circulating prolactin may fall along with a delay in the nocturnal surge of the hormone. The secretion of prolactin in response to thyrotropin releasing hormone ( TRH ), insulin-induced hypoglycemia, arginine and chlorpromazine is altered. Similarly growth hormone secretion in response to growth hormone releasing hormone ( GHRH ), clonidine, naloxone and arginine is also altered in obesity. The literature suggests an alteration in the autonomic nervous system activity and the metabolism of carbohydrates and fats in the obese. Steroid hormones could affect the distribution of fat in the various regions of the body, and the distribution of body fat is linked with the severity of hyperandrogenism and metabolic disorders in obese subjects. However, it is heartening to note that many of the endocrinological and reproductive disorders are reversible with weight reduction in the obese subjects.

Value of venous pressure and phlebography in detecting deep vein thrombosis after major surgery and in primary venous disease

A total of 60 patients from high risk group for deep vein thrombosis, which included the patients after major surgery and patients of primary venous diseases, were studied. Peripheral venous pressure measurement performed on 42 cases, detected deep vein abnormality in 6 patients (14.3%) only out of which 2 patients were designated as cases of deep vein thrombosis and 4 of chronic venous stasis syndrome. But phlebography detected deep vein thrombosis in 28 cases (46.6%) and other deep vein abnormalities in rest of the cases.

Cytological evaluation of conjunctival scrape smears in cases of conjunctivitis

The present study was conducted on 130 cases of untreated conjunctivitis and 25 control cases to assess the diagnostic value of cytology. Conjunctival scrapings from all cases were stained with Giemsa and Papanicoloau's stain and categorized cytologically and later correlated with the clinical profile. Normal cytologic profile was obtained in 7 cases (5.4%) of the study group and 14 cases (56%) of the control group. Cytologic diagnosis of trachoma was made in 63 cases (48.5%) including 48 out of 51 clinically diagnosed cases of trachoma, 9 cases of allergic conjunctivitis and 6 cases of acute follicular conjunctivitis, positive clinico cytologic correlation being 76.2%. Mucopurulent conjunctivitis was diagnosed in 24 cases (18.5%) both clinically as well as by cytological technique. Viral conjunctivitis was diagnosed in 24 cases (18.5%) including 19 cases (14.6%) of clinically diagnosed viral conjunctivitis and 5 cases (3.9%) of acute follicular conjunctivitis, positive correlation being 79.2%. Only 2 cases (1.5%) out of 15 clinically diagnosed cases of allergic conjunctivitis were confirmed cytologically. In all the 4 cases (3.1%) of spring catarrh and 6 cases (4.6%) of phlyctenular conjunctivitis the cytologic features were found to be consistent with the clinical diagnosis.

Percutaneous ultrasound-guided fetal skin biopsy: a new approach

Our preliminary experience with this unreported percutaneous ultrasound guided method using a fine needle system showed 100% success (seven cases) in obtaining fetal skin biopsies. The fetal scalp was chosen for biopsy. This technique is easy, less invasive, simple, has minimum procedural difficulties and complications and thus it may replace fetoscopy for obtaining fetal skin biopsy.

Pseudo-Meigs' syndrome secondary to broad ligament leiomyoma: a case report

An unusual and rare case of broad ligament leiomyoma with massive ascites and bilateral pleural effusion is described. The ascites and pleural effusion resolved dramatically following removal of the tumor. Patients with pseudo-Meigs' syndrome may present a diagnostic problem as they masquerade as carcinoma with malignant effusions. Thus they should always be considered for exploratory laparotomy.

Pelvic fibromatoses--a rare gynecological entity

A rare case of pelvic fibromatoses is reported. This condition is rarely encountered in gynecological practice but when encountered, creates a diagnostic and therapeutic challenge. The reported patient highlights the difficulties encountered in surgical excision (done twice) and illustrates the local aggressive growth behavior of this entity.

Clinical evaluation of steroid receptors in ovarian neoplasms

Estrogen and progesterone receptors were estimated in a total of 25 ovarian neoplasms. None of the benign tumors showed steroid receptors. In malignant tumors serous tumors were more often receptor positive than the mucinous. Receptor levels were correlated with the staging of the disease, menstrual status and the resectability of the tumor. The response to chemotherapeutic drugs was better in patients with low estrogen and progesterone receptors as compared to those with high levels. The latter group showed a definite response to progesterone treatment in vitro. These are the group of patients who may benefit by combination of hormones and chemotherapeutic drugs.