Hypertension in the rural population of Bangladesh--a preliminary survey

A total of 5,026 persons constituting 75% of the total population of a village of Bangladesh were screened for elevated blood pressure. Three hundred thirty seven (6.7%) showed diastolic blood pressure of 90 mm Hg or above. Those with diastolic blood pressure of 95 or above constituted 2% of the population. 74% of the hypertensives were asymptomatic while 86.3% of the cases were undetected and therefore remained untreated. Our findings indicate the need for early detection and control of elevated blood pressure to prevent complications. It is recommended that a large scale community survey programme may be undertaken for detection and early treatment of hypertension which helps prevention of total complications.

Sexual abuse of young children

For an 18-month period, all sexual abuse cases were referred to a project social worker. From her initial interview and the medical records, data were analyzed for 113 children who were 12 years of age or younger. It was found that half were five years or younger and three-fourths of the cases were female children. Reasons were discussed as to why females are more likely to be identified as sexually abused cases. A higher than average rate of gonorrhea was found among the pediatric group studied. While only 44 per cent of abusers were relatives of the abused, almost all (93%) were known to the family. If a relative were the alleged abuser, there was a high probability that it was a father, stepfather, or uncle.

Intraventricular hemorrhage from ruptured aneurysm. Retrospective analysis of 91 cases

Intraventricular hemorrhage (IVH) from aneurysm rupture is generally considered to be of grave prognostic significance. Ninety-one cases have been studied retrospectively from seven medical centers. The overall mortality rate was 64%. The dramatically poor condition of these patients leads to their rapid admission to the hospital. Eighty-seven percent were admitted on Day 0 or 1, and more than half were classified neurologically as Grade 4 or 5. A multiple regression analysis explained 56% of the variance in survival, using the variables of ventriculocranial ratio (VCR), day of admission, diastolic blood pressure, location of aneurysm, associated intracerebral hematoma, age, grade on admission, sex, and systolic blood pressure. No patient with a VCR of more than 0.25, as calculated from the initial computerized tomography (CT) scan, survived. No patient whose smallest VCR was 0.23 or more survived. This ratio can be simply measured with a millimeter ruler from the CT scan. Patients with IVH usually had enlarged ventricles, even initially. The overall results suggest that early management of intracranial hypertension should be more generally considered, although even when this was done the prognosis was still guarded. The timing of surgery was not an important determinant of outcome, although a significant number of patients died awaiting surgery.

Timing of surgery for intracerebral hematomas due to aneurysm rupture

✓ Intracerebral hematomas (ICH) from aneurysm rupture are not rare and can now be diagnosed easily and accurately by computerized tomography. The authors have collected 132 such cases from 11 medical centers. Of these patients, 38% died prior to discharge from the hospital. Seventy-eight percent of cases were admitted to the neurosurgical services on Day 0 or 1 after rupture of the aneurysm; of these patients, 15% died without surgery, 28% had surgery and died postoperatively, and 57% were operated on and survived. Mortality rates were increased in patients who were hypertensive, had poor neurological grades, showed evidence of brain herniation, or had larger clots. If the patient lived beyond the first few days and did not have brain herniation, the timing of surgery was not of great consequence, although there was a tendency toward lower morbidity in earlier surgery. This was true despite the fact that earlier operations were carried out on an initially sicker group of patients. Ischemic deterioration attributed to vasospasm occurred in 26% of cases; even when deaths at the acute stage were excluded, it was no more common in patients with early than in those with late surgery. Morbidity and mortality rates were prohibitively high in operations consisting solely of evacuation of ICH without clipping of the aneurysm. Parietal hematomas were particularly dangerous, while those in the temporal lobe were associated with the best outcome. Since it is impossible to predict survival with a high degree of reliability, even when the prognostic indicators are known, the authors recommend that patients with a significant ICH have it removed as soon as possible and that their ruptured aneurysm be clipped at the same time.

Dual role of the liver in regulating circulating polymeric IgA in man: studies on patients with liver disease

The human liver probably removes circulating polymeric IgA by two routes: (1) secretory component-mediated endocytic transport of polymeric IgA from portal tract blood vessels into bile across biliary epithelial cells and (2) uptake with possible catabolism by hepatocytes and/or sinusoidal phagocytic cells by uncharacterized receptor(s). Failure of either clearance mechanism due to liver disease results in elevated serum polymeric IgA levels. In patients with cholestasis, the raised serum polymeric IgA concentration is due to reflux of biliary secretory immunoglobulin into the blood.

Antigen shared by human hemopoietic precursor cells and T and B lineage cells

In this study, we investigated antigens present at the surface of acute myeloblastic leukemia (AML) cells by using the monoclonal antibody (MAb) approach. The MAb AGF43 reacted with acute myeloid and lymphoid leukemia cells and chronic lymphocytic leukemia cells and was unreactive against chronic myeloid leukemia cells. A large proportion of AML blasts showing minimal or no differentiation (AML-M1) were intensely labeled by AGF43 in contrast to a smaller percentage of blasts showing partial differentiation (AML-M2 and acute myelomonocytic leukemia). The AGF43 antigen is expressed by bone marrow lymphoid (TdT+) and myeloid (CFU-GM) progenitor cells, 95% of B cells and 65% of T cells in the blood and absent from monocytes. Only 17% of normal myeloblasts were weakly stained by AGF43. Sections of tonsil and spleen were used to confirm that, unlike antibodies to MHC class II antigens, AGF43 stained a majority of T cells and macrophages were unreactive. In conclusion, the MAb AGF43 identifies a new precursor cell antigen. The distribution of this antigen during normal myelopoiesis and on AML cells support the suggestion that acute myeloid leukemias originate in pluripotent or closely related myeloid stem cells.

Analytical study of burns in Kashmir

Kashmir Valley is part of Jammu and Kashmir State. It is surrounded on all sides by the Pirpanchal range of mountains, and as a result of this position it is cold in the valley for about three-quarters of the year. The population of the Kashmir Valley is 31 30 090 and that of the Srinagar district is 7 21 078. The people of the valley use a 'Kangri' which is a portable unguarded heater to keep themselves warm. Burns being common in the area it prompted the undertaking of an analytical study of 100 burn cases admitted to the Medical College Hospital, Srinagar, Kashmir. The pattern of cases referred to or admitted directly in our hospital reflect the percentage of burn injuries sustained in Kashmir Valley since it is the only provincial hospital of its kind in the Valley having facilities for the undertaking of plastic surgery.

Studies on the uterine inhibitory actions of diphenylhydantoins

Diphenylhydantoin and diphenyl-thio-hydantoin inhibited the spontaneous motility of rat uterus in a dose-dependent manner. On molar basis diphenyl-thio-hydantoin was found to be 2.7 times as potent as diphenylhydantoin. The stimulant effects of acetylcholine, oxytocin, adenosine triphosphate, prostaglandins I2 and E2 were reduced by both hydantoins. Furthermore, hydantoins potentiated the inhibitory effects of sympathomimetic amines, theophylline, nitroglycerin and dibutyryl cyclic adenosine monophosphate. The uterine inhibitory actions of adrenaline, isoprenaline and phenylephrine were antagonized by propranolol but not by phentolamine. However, adrenergic blocking agents were ineffective against hydantoins indicating that their effects were not mediated through adrenergic receptors. Ouabain and sodium fluoride caused stimulation of uterine motility. Pre-treatment with ouabain did not block the inhibitory effect of hydantoins, while, sodium fluoride antagonized the inhibitory effects of hydantoins. Furthermore, even increasing the diphenylhydantoin concentration 10 times did not produce any relaxation in the presence of sodium fluoride. The results are discussed in relation to the effect of hydantoins on sodium pump and on membrane permeability.

The influence of radiation therapy quality control on survival, response and sites of relapse in oat cell carcinoma of the lung: preliminary report of a Southwest Oncology Group study

Two hundred and ninety-eight patients with limited (confined to chest and supraclavicular area, encompassable by a single radiation portal) small cell carcinoma of the lung were entered on Southwest Oncology Group Protocol 7628. Patients were treated with multi-agent chemotherapy and radiation therapy with or without BCG. Radiation therapy quality control analysis, including dosimetric reconstruction and port film review was introduced after the protocol was activated and was retrospectively applied. Patients who were considered major protocol variations had statistically worse survival (40 weeks versus 60 weeks; P = .002), a lesser improvement in response rate after induction chemotherapy (27 versus 48%; P = .05) and a higher chest failure rate (77 versus 55%; P = .047) than evaluable patients. Five patients relapsed in the brain, all associated with chest failure. Quality control is essential in cooperative group studies.

Role of protein content in CSF ascites following ventriculoperitoneal shunting. Case report

The case is reported of an 11-year-old girl with a recurrent craniopharyngioma who developed massive ascites following a ventriculoperitoneal (VP) shunt procedure for hydrocephalus, associated with an elevated cerebrospinal fluid (CSF) protein level. The ascites resolved after removal of the shunt. The CSF protein returned to normal levels following excision of the recurrent craniopharyngioma, and ascites did not recur after a second VP shunt was inserted for recurrent hydrocephalus. In this case, elevated CSF protein is believed to have been responsible for ascites developing after VP shunting. There was no recurrence of ascites after the peritoneal cavity was again used for shunting, at which time the protein had returned to normal values. Twelve previous cases of ascites complicating VP shunting are reviewed and the etiology of the condition is discussed.

Patterns of Shigella infection in families in rural Bangladesh

To assess the mode of transmission of Shigella infection in rural Bangladesh, questionnaire and culture surveys were conducted in baris (neighborhoods) where persons with diarrhea associated with Shigella infection and index controls with non-Shigella diarrhea lived. Nineteen percent of persons in Shigella baris and 7% of persons in control baris were infected during the survey periods (P less than 0.001). The prevalence of Shigella infection was highest for children 1-9 years of age and for females than 39 years and was not related to socioeconomic status, family size or household crowding. Use of surface water for drinking was not a risk factor for Shigella infection; in fact, use of river water was more frequent in control baris. Both household and bari contacts of Shigella index cases frequently excreted different serotypes from that excreted by the person with the index case. In Shigella baris, families with infection were significantly more likely than uninfected families to have a history of an overnight stay away from home by a family member during the previous week. These observations suggest there were multiple introductions of Shigella into some families and that the epidemiology of Shigella infection for families in rural Bangladesh differs from that observed for families living in more industrialized countries.

Effects of neuroleptics on platelet monoamine oxidase activity

Platelet MAO activity in schizophrenics was significantly decreased, by about 15%, after 3 weeks of treatment with haloperidol. Treatment with thioridazine or butaperazine also tended to decrease platelet MAO activity. The neuroleptic-induced decrease began to appear within a few days of treatment and did not show tolerance over 1-2 months of treatment with haloperidol. Platelet MAO activity of schizophrenic patients measured during drug-free base-line was not significantly different from that of normal controls, but MAO activity of schizophrenics was significantly lower than normals after 3 weeks of treatment with neuroleptics. The extent of decrease in platelet MAO activity correlated negatively with base-line prolactin and its increase after 24 hr. With PEA as substrate, the decrease in activity correlated positively with steady state plasma haloperidol.

Migrant mu+ delta+ and static mu+ delta- B lymphocyte subsets

Immunoglobulin isotype expression in isolated lymph node (LN), spleen and blood lymphocyte suspensions was assessed in rats. The proportion of mu+ delta- B cells in spleen (34%) was approximately twice that in blood and LN. Immunohistological examination of spleens showed the cells of the marginal zones to be predominantly mu+ delta-. On the other hand, mu+ delta+ B cells were mainly confined to the follicles in both spleen and LN. These follicles had a minor mu+ delta- component. The migratory properties of B cells with these two phenotypes were assessed by depleting lymphocytes migrating through the white pulp of rat spleen. This was achieved by placing a 32P-impregnated beta-emitting polythene strip over one half of the spleen. Examination of the nonirradiated half of the spleen, LN and peripheral blood after 12 days irradiation showed selective loss of delta + B cells. The mu + delta- cells of the splenic marginal zone were numerically unaltered. There was also a substantial residual mu + delta- B cell presence in the small lymphocyte compartment of follicles of LN and spleen in depleted animals. In addition, the blood selectively retained a mu + delta- B cell component. This was not derived from the spleen, as mu + delta- blood B cell numbers were sustained even where both halves of the spleen were irradiated. It is concluded that: (a) the major static B cell component of spleen and LN is mu + delta-, (b) that most if not all delta + B cells repeatedly migrate through the spleen and (c) there is a blood-born mu + delta- component which is resistant to depletion by splenic irradiation.,

Epidemiology of eltor cholera in rural Bangladesh: importance of surface water in transmission

In order to define the role of water used for drinking, cooking, bathing, and washing in the transmission of Vibrio cholerae biotype eltor infections in an area with endemic cholera, surveillance was initiated in neighbourhoods with a culture-confirmed cholera index case and others with index cases with non-cholera diarrhoea as controls. In neighbourhoods with cholera infection, 44% of surface water sources were positive for V. cholerae, whereas only 2% of surface sources were positive in control neighbourhoods. Canals, rivers, and tanks were most frequently positive. There was an increased risk of infection for families using water from culture-positive sources for drinking, cooking, bathing, or washing and for those using water sources used by index families for drinking, cooking or bathing. Analysis of the results for individuals showed that in this case there was an increased risk of infection associated with using water from culture-positive sources for cooking, bathing, or washing, but not with using water from culture-positive sources for drinking. Individuals who used the same water source as an index family for bathing were more likely to be infected than those using different sources. For families drinking from a culture-negative source, there was an association between infection and bathing in a positive source. For families using a different bathing source from the index family there was an association between infection and drinking from the same source as the index family, and for families using a different drinking source from the index family there was an association between infection and bathing in the same source as the index family. These data suggest that use of surface water is important in the transmission of V. cholerae and that, in addition to providing safe drinking water, education regarding the risk of transmission of infection by water from potentially contaminated sources used for other purposes, especially bathing, may also be necessary to control transmission in areas where eltor cholera is endemic.

Cirrhosis of liver

Clinical analysis of 293 cases of cirrhosis from two moderate sized hospitals in the city of Dacca has been presented. Maximum number of cases were in the age group over 40 with 150 (51.2%) males and 19 (5.8%) females. Significant past history included viral hepatitis (21.5%), kala-azar (11.6%) and malaria (10.24%). History of alcoholism was present only in 16 (5.5%) cases. Weakness (84.3%), weight loss (72%) and anorexia (39.3%) constituted the most common symptoms. Ascites (45%), haematemesis (11.6%) and melaena (28.7%) were the next common symptoms. Hepatosplenomegaly was found in about one-third of the cases. Testicular atrophy was recorded in 41.63% cases whereas gynaecomastia was relatively less common (5.5%). Scanty body hair and white nails were present in almost equal number of cases (14.7% and 18%). The cases presented here are those with overt manifestation. Nevertheless, the clinical features are not materially different from those reported by other authors. In the absence of alcoholism, viral hepatitis is presumably the most important aetiological factor in our cases and the clinical features compare favourably with non-alcoholic cirrhosis of the western writers. Cryptogenic cirrhosis has been considered to be most common type constituting 43.7% of our cases.

Intracellular mannitol, a product of glucose metabolism in staphylococci

Mannitol (Mtl), not previously reported as an intracellular component of bacteria, although it has been found as an extracellular end product of anaerobic carbohydrate metabolism, accumulated within strains of all 10 staphylococcal species tested after aerobic incubation of washed cell suspensions in phosphate-buffered 1% glucose for 2 h. Phenol extracts of the cells, before and after incubation, were analyzed for Mtl content by periodate utilization and paper chromatography and for Mtl 1-phosphate content, with Mtl 1-phosphate dehydrogenase. In Staphylococcus aureus Towler, the content of Mtl increased from a 0-h value of less than 2.4 to 16 mumol/g (dry weight) after incubation, and the level of Mtl 1-phosphate increased from a 0-h value of 1 to 8 mumol/g. The identification of Mtl was confirmed as the per-O-acetyl ester by gas-liquid chromatography and as the per-O-methyl ether by mass spectrometry. Also tested were 5 additional S. aureus strains and 32 coagulase-negative staphylococcal strains. All strains accumulated Mtl, even those strains that could not utilize exogenous Mtl during aerobic growth, usually in the range 4 to 25 mumol/g. Furthermore, three strains accumulated very high Mtl levels. Bacteria from several other genera were tested, and some were found to accumulate low to moderate levels of Mtl under similar incubation conditions. The metabolic conversion of glucose to intracellular Mtl, probably via Mtl 1-phosphate, is a common feature of staphylococci and also occurs in some other bacteria.

Infant feeding practices in rural Meheran, Comilla, Bangladesh

Since 1930 breast-feeding has declined worldwide. Differences exist in breast-feeding practices between developed and developing countries and between urban and rural people. In order to define the breast-feeding practices in Bangladesh, we studied longitudally 401 rural children and cross-sectionally 193 urban children. Collections of dietary data and anthropometric measurements were done monthly during the 1st year and quarterly thereafter by trained paramedical staff. One hundred percent rural, 98% urban poor, and 78% urban elite mothers breast-fed their babies at birth. At 1 year 97% rural, 90 urban poor, and 25% elite continued breast-feeding. By 2 years it decreased further. Only some rural children but many of the urban children were provided with cow's milk during breast-feeding. At 10 months, 100% urban elite, 33% of the urban poor, and 6% of rural mothers provided rice and bread to babies. The growth pattern from 4th months of age fell behind the developed countries. Heavier mothers produced heavier children. Mothers should be trained about supplementation of food and the time of supplementation. Breast-feeding is still quite prevalent in the villages of this country. Maternal nutrition and timely supplementation are important for development of children.

Clinical electrophysiological effects of propranolol on normal sinus node function

In 35 patients aged 18 to 69 years (mean 48) with clinical, electrocardiographic, or electrophysiological evidence of normal sinus node function, the effect of intravenous propranolol (0.1 mg/kg) was assessed on 3 indices of sinus node function. The drug significantly prolonged sinus node cycle length (12%), slightly prolonged the corrected sinus node recovery time (15%), and slightly but insignificantly lengthened sinuatrial conduction time. Propranolol may be administered safely in patients with normal sinus node function without the fear of producing severe sinus bradycardia, sinuatrial block, sinuatrial pauses, or prolonged sinus asystole, after spontaneous or stimulation-induced conversion of a tachycardia.

Epidemiology of Shigella dysenteriae, type 1 infections, in Dacca urban area

A prospective study of 47 families with an index case of Shigella dysenteriae type 1 was conducted in the urban areas of Dacca. The subsequent infection rates in contacts type 1 were 30.6% and 28.3% in the age groups 0--4 and 5--9. Total secondary infection rate was 20.4% with rates in males higher than in females. Among the contacts 12.5% developed diarrhoea caused by the same serotype, but 22.1% developed diarrhoea with undiagnosed causes. For one hospitalised case there were seven symptomatic cases and 10 infections. All the infected infants age 0--4 developed diarrhoea and one fourth needed hospitalisation; but none aged over 9 needed it. Of these families 19% coincidentally had infections with other shigela types. Many factors were related with the higher infection rate. Use of open source of water was a significant factor. Multiple resistance to antibiotic was found, however, Shigella shiga was sensitive to Ampicillin, Kanamycin, Colistin and Furazolidone.

Disseminated histoplasmosis in renal transplant recipients

Five cases of disseminated histoplasmosis complicating renal transplantation are reported. Nine previously reported cases from the literature are reviewed. In this setting disseminated histoplasmosis usually presents as a nonspecific systemic febrile illness that may be fulminant or more subacute. Five of 14 patients presented with skin lesions; only one patient presented with primary pulmonary symptoms of cough and dyspnea. Three of our patients and three others previously reported on survived the infection and maintained good function in the transplanted kidney despite prolonged therapy with amphotericin B. Immunosuppression was the only predisposing factor that could be identified with certainty in the five patients reported on herein. However, in two of the five patients the onset of disseminated histoplasmosis coincided with a well documented cytomegalovirus infection; the viral infection may have been a factor predisposing to infection in these two cases.

Differentiation of posterior myocardial infarction from right ventricular hypertrophy and normal anterior loop by echocardiography

The differentiation of posterobasal myocardial infarction (PMI) from either right ventricular hypertrophy (RVH) or normal subjects displaying an anterior loop (AL) by electrocardiography (ECG) or vectorcardiography (VCG) is difficult. M-mode echocardiography (echo) via the anterior and subxiphoid methods has been helpful in defining cardiac chamber size and wall motion abnormalities. We tested whether this relatively more direct method would better separate these entities compared with the other two techniques. ECG and VCG using established criteria failed to distinguish the three conditions effectively. By echo, distinguishing characteristics were observed in each of the groups. Thus, right ventricular diastolic dimension and wall thickness were significantly increased only in the RVH group, echo dimensions and wall motion were normal in the AL group and the posterior left ventricular systolic thickening response and ejection phase indices were significantly reduced only by the subxiphoid method in the PMI group. To test the specificity of the latter finding, posterior wall motion in three infarction groups (posterior, combined posteroinferior and inferior) were examined and suggested that the target of the subxiphoid beam focuses on a more superior posterobasal left ventricular segment than the anteriorly placed transducer. Echocardiography can differentiate PMI from either RVH or AL more directly than ECG or VCG, and may be of practical clinical importance.

Infective aneurysm of the left ventricle: angiographic and echocardiographic features

A 17-year-old man with staphylococcal endocarditis of the mitral valve developed an infective aneurysm of the posterior left ventricular wall. Echocardiography revealed an echo-free space posterior to the posterior left ventricular wall. This echo-free space undoubtedly represented the aneurysmal sac, because it could be temporarily obliterated by injecting saline into it and was no longer detectable following surgical closure of the sac. Thus echocardiography may be helpful in the detection of an infective aneurysm of the left ventricle.

A rapid, sensitive method for accurate analysis of individual bile acids in biological fluids by high performance thin-layer chromatography and densitometry

1. A rapid new micromethod for quantitative analysis of individual bile acids in duodenal juice by high performance thin-layer chromatography (HPTLC) and densitometry is described and evaluated by comparison with standard TLC and spectrophotometry. 2. Advantages of HPTLC over TLC include more rapid separation, better resolution and more sensitive detection (5 - 10 fold), without the need for prior extraction. Densitometry provides simple, direct and rapid quantitation. 3. The method is accurate and reliable over a range of bile acid concentrations. In the 0.5 mM range, recovery was greater than 89%, and coefficients of variation for within-day analysis were 2 - 12% and for between-day analysis were 6 - 18% for the individual bile acids. Twenty analyses can be performed by one worker in a single day. 4. We conclude that the method offers several advantages over most currently described techniques, is suitable for routine use and is deserving of wider application.

Rapid loss of factor XII and XI activity in ellagic acid-activated normal plasma: role of plasma inhibitors and implications for automated activated partial thromboplastin time recording

Rapid prolongation of the aPTT of normal plasma upon incubation with ellagic acid containing aPTT reagents was observed. The aPTT prolongation was not due to time-dependent changes in pH in the incubation mixture or loss of activity of the labile coagulation factors VIII and V but occurred as a result of rapid progressive inactivation of ellagic acid-activated factors XII and XI. Prolongation of the aPTT and loss of contact factor activities was not observed in plasma incubated with particulate activator reagents. This finding seemed to indicate that adsorption of factors XII and XI to larger particles during the activation process might protect these factors from inactivation by naturally occurring plasma inhibitors. Evidence is presented which supports previous findings that C1-INH, alpha1-AT, and antithrombin (in the presence of heparin) contribute to factor XIIa and XI a inactivation in ellagic acid-activated plasma and that plasma albumin may compete with factor XII for ellagic acid binding. The data indicate that ellagic acid-containing aPTT reagents have unfavorable properties which seriously limit their usefulness in the clinical laboratory, particularly in respect to recording of the aPTT with certain fully automated clot timers.

Characterization of alpha-galactosidase isoenzymes in normal and Fabry human-Chinese Hamster somatic cell hybrids

The alpha-galactosidases in normal man-Chinese hamster somatic cell hybrids were investigation with antibodies specific for human alpha-galactosidase A and antibodies specific for Chinese hamster alpha-galactosidase. It was found that an isoenzyme in hybrid cells, which has an electrophoretic mobility between that of human alpha-galactosidase A and Chinese hamster alpha-galactosidase, contains immunologic determinants of both human and Chinese hamster origin, suggesting that it is a heteropolymeric molecule. Moreover, the locus for human alpha-galactosidase, which was found to be X-linked, is the locus coding for alpha-galactosidase A. Hybrids isolated after fusion of Chinese hamster cells with cells of a patient with Fabry's disease did not express human alpha-galactosidase A or the heteropolymeric molecule even in the presence of the active human X chromosome, indicating that the deficiency of alpha-galactosidase A in Fabry's disease is probably due to a mutation in a structural gene resulting in the inability to form immunologically detectable and functionally active molecules of alpha-galactosidase A.

[Intranasal skin grafting for Osler's disease (author's transl)]

Between 1965-1972, 12 patients with Osler's disease of the nose were treated surgically by a modification of the method suggested by Saunders. The mucosa of the entire nasal septum and entire floor of the nose up to the insertion of the inferior turbinate was removed without interference to the perichondrium or periosteum. The denuded area was covered with split thickness skin graft taken from the thigh. Haemorrhage, which was never severe, occassionally occurred. In all patients, there occurred crusting and foetor, which was controlled by nasal douching. Patients with Osler's disease should be treated as early as possible in order to curtail the work disability.

Epidemiologic investigation of an outbreak of Shiga bacillus dysentery in an island population

An epidemic of dysentery broke out in St. Martin island during May through July 1973. The epidemic was caused by Shigella dysenteriae type 1. The dysentery could not be controlled by conventional antibiotics and other antidysenteric drugs. The average attack rate was 32.9%. The age specific attack rate was highest in the age group 1-4 years (52.2%). The attack rates were higher in smaller families. The rates were not greatly different amongst people using different sources of water. The overall death rate was 2.1%. The overall infection-to-death rate was 6.4% but amongst children less than a year old, it was 41.1%. A common source outbreak was unlikely. The higher attack rate in smaller families suggested limited possibility of person to person spread. No particular water source could be implicated with higher attack rate. Flies may have played an active role in transmission.

Cirrhosis of liver in Bangladesh. (A preliminary report)

The incidence of cirrhosis of liver in Bangladesh, its possible aetiological factors and clinical features have been studied. This being the initial report, embraces the population of only two hospitals in Dacca viz., Institute of Postgraduate Medicine and Research (P.G. Hospital) and Sir Salimullah Medical College Hospital situated three and a half kilometers apart. In a population of 5889, a total of 154 cases (2.6%) of cirrhosis of liver have been recorded. Nutritional deficiency has been considered to be the important aetiological factor whereas alcoholism does not appear to have any significant role. Almost all the cases (94.2%) were non-alcoholic. Pattern of clinical features have been compared with those of other authors and variations recorded. Further study on an elaborate scale has been suggested.

Biosynthesis of digalactosyl diglyceride in Vicia faba leaves

Developing and mature leaf tissue from Vicia faba plants were pulse-fed 14-CO2. The lipids were extracted at intervals after exposure to light, and the galactolipids monogalactosyl diglyceride (MGDG) and digalactosyl diglyceride (DGDG) were separated. After methylation and methanolysis, gas-liquid chromatography was used to separate the two galactose units of DGDG and the galactose of MGDG. The specific activities of the galactoses and the changes over the time period of the experiment were determined. The results support the view that DGDG is formed by galactosylation of MGDG. This does not take place by a rapid two-enzyme system reaction but more slowly in two phases: galactosylation of a pool of newly formed MGDG and a more random galactosylation of MGDG. There is no evidence of a high turnover of galactose in these lipids.