Expanded programme of immunization in Karachi

Immunization status of children and their mothers and reasons for their failure to be immunized were studied. The study lasted for two months, i.e., August and September, 1993 at the Paediatric Outpatient Department of Civil Hospital, Karachi. Three groups of patients were targeted. Six hundred and twenty-four children under 1 year of age, 955 children between the ages of 1 to 5 years and 1579 mothers were registered. These women were questioned regarding their immunization status and that of their children. In the group below 1 year of age, BCG, DPT and polio (3 doses) and measles were given to 75%, 35% and 23% respectively. Tetanus toxoid (2 doses) was given to 47% of their mothers. In the group of children between 1-5 years, BCG, DPT and polio 3 doses and measles were given to 84%, 63% and 58% respectively. Tetanus toxoid (2 doses) were given to 64% of their mothers. The main reasons for not vaccinating were lack of information and lack of motivation.

Analysis of interlaced video signals and its applications

This paper presents a model of interlaced video. The model uses the assumption that the whole scene, which is captured by a camera, is moving at a constant speed. Within this model, the Fourier transform of the interlaced video signal is analyzed for various modes used in picture coding, such as intrafield, intraframe, interfield (with motion compensation), and interframe (with and without motion compensation) processing. The main spectral components of the signal are identified. The analysis yields new insight into the nature of the components. This insight is useful in the design of video processing systems, which is illustrated by various applications.

The effects of retinoids and terbinafine on the human hepatic microsomal metabolism of cyclosporin

Following the observation of increased trough whole blood cyclosporin A (CyA) concentrations and reduced renal function in a patient with recalcitrant generalized pustular psoriasis treated with a combination of CyA and etretinate, the effect of vitamin A analogues on human microsomal cytochrome P450-dependent CyA metabolism was investigated in vitro. In addition, the effect of terbinafine, a new allylamine antifungal agent, was also tested. Etretinate, its major metabolite acitretin, and isotretinoin, each at a single concentration of 100 microM, inhibited total hepatic microsomal CyA metabolism to a similar extent (33-45%, compared with control values). The generation of total primary and total secondary CyA metabolites was also inhibited to a similar extent by each of the retinoids. Conversely, terbinafine was without significant effect on CyA metabolism in vitro. The results, which suggest that inhibition of hepatic CyA metabolism by retinoids may contribute to increased circulating CyA concentrations, are discussed in relation to other potential drug interactions, and to the use of etretinate in reducing the CyA administered dose.

Renal cell carcinoma insulated in the renal capsule with calcification and ossification

We describe a case of renal-cell carcinoma insulated and entrapped in the renal capsule by a calcified and ossified rim. To our knowledge, this is the first time a renal-cell carcinoma of the renal capsule is reported. The fact that the tumor cells originated from the distal/medullary tubules was supported by immunohistochemical studies. The pertinent literature is reviewed.

Neurofilament immunoreactivity in Merkel-cell tumors: a differentiating feature from small-cell carcinoma

To differentiate Merkel-cell tumor (MCT) from other neuroendocrine (NE) carcinomas, we immunostained (using avidin-biotin-peroxidase method) nine MCT and 37 NE (including 28 small-cell) carcinomas for NE markers (neuron-specific enolase and chromogranin), cytokeratin, neurofilament, vimentin, and a number of other markers. Cytokeratin was positive in 100% of MCT and in 85% of small-cell carcinomas; neurofilament and vimentin were positive in respectively 100% and 22% of MCT and 0% of NE carcinomas. Our data suggest that the coexpression of cytokeratin and neurofilament by an undifferentiated dermal or visceral tumor is of significant help in diagnosing MCT and differentiating it from small-cell carcinomas. The vimentin reactivity is a weak and insignificant discriminant.

Influence of the distance between interrupted sutures and the tension of sutures on the healing of experimental colonic anastomoses

Certain technical factors determine the success of the creation of intestinal anastomoses. The influence of the distance between interrupted sutures and the suture tension on wound healing was investigated in an experimental study using a specially designed suture model. The combination of a long suture distance (group A, 2.5 mm) and a short suture distance (group B, 1.5 mm) with three different suture tensions, i.e., (1) no tension; (2) moderate tension; and (3) high tension, resulted in six different techniques. Tension was created by means of a spring balance. The anastomoses were examined macroscopically, histologically by microangiography, and by bursting pressure. Apposition of the bowel wall between the interrupted sutures was inappropriate due to prolapse of the mucosa in 7.9% of the patients in group A but did not occur in groups B2 and B3. The leakage rate was 4.6% in group A and 1.3% in group B. Early healing of the mucosa was noted in group B2. Bursting pressure was significantly higher on day 2 and 4 in groups B2 and B3. The results demonstrate the influence of suture technique on the wound healing of intestinal anastomoses. The best healing pattern was achieved by a small distance between the sutures and a moderate suture tension.

Radiation-induced malignant fibrous histiocytoma of the pulmonary artery

We describe a malignant fibrous histiocytoma (MFH) of the pulmonary artery. The patient received, 25 years ago, at the age of 43 years, radiation therapy to the chest for squamous-cell carcinoma of the lung. We believe the patient's second tumor was induced by radiation and, to our knowledge, this case represents the first report of radiation-induced MFH of the pulmonary artery. The diagnosis was confirmed by findings from electron microscopy and extensive studies with immunohistochemical stains. We discuss the value of studies with immunohistochemical stains in the diagnosis and differential diagnosis of MFH. The presentation of this case underlines that MFH can occur in the pulmonary artery and may be--as is the MFH in other locations--induced by radiation.

Hodgkin's disease associated with systemic lupus erythematosus

We report on the rare association of Hodgkin's disease with systemic lupus erythematosus. Two years after the diagnosis of systemic lupus erythematosus, the patient developed upper abdominal pain, jaundice, splenomegaly, and fever of unknown origin. He had a rapidly fatal clinical course, despite being treated for systemic lupus erythematosus, cholecystitis, and possible sepsis. Autopsy revealed Hodgkin's disease, lymphocyte-depletion type, involving lymph nodes, liver, spleen, and bone marrow. The awareness of the association of Hodgkin's disease with systemic lupus erythematosus and its modes of presentation will help in the early diagnosis and management of such patients.

Immunoreactivity of neurofilament proteins in neuroendocrine neoplasms

We immunostained histologic sections of formalin-paraffin-processed specimens from 112 neuroendocrine tumors to evaluate the expression of intermediate filaments, especially neurofilament (NF) protein. The commercially available anti-human NF protein monoclonal antibody was raised against the Mr 200,000 and 70,000 components of neurofilaments. None of our tumors exhibited unequivocal immunoreactivity for Mr 200,000 or 70,000 neurofilament proteins. The failure of a tumor to express the Mr 200,000 or 70,000 component of NF protein does not question its neuroendocrine nature. However, the unequivocal positivity for Mr 200,000 or 70,000 components of NF in an undifferentiated tumor with a differential diagnosis between neuroendocrine small-cell carcinoma and a neurogenic tumor should support the latter consideration.

Cytokeratin immunohistochemistry as a diagnostic tool for distinguishing malignant from benign epithelial lesions of the prostate

The basal cell layer (BCL) is believed to be absent in malignant but present in nonmalignant epithelial lesions of the prostate. Using the avidin-biotin-peroxidase complex (ABC) immunoperoxidase method, we examined the value of the monoclonal antibody cocktail MA-903, which stains selectively the prostatic BCL layer, in the distinction between benign and malignant epithelial lesions of the prostate. We immunostained histologic sections of 63 prostates, containing 235 morphologic appearances: normal prostate glands, 43; benign prostate hyperplasia (BPH), 59; basal cell hyperplasia (BCH), 24; adenosis, seven; prostatic intraductal neoplasia (PIN 1), 21; PIN 2, 25; PIN 3, 16; and cancer, 40. Some degree (continuous, continuous with focal disruption, and disrupted patterns) of basal cell staining was demonstrable in all normal and BPH, BCH, and PIN 1 lesions, but was absent in 39 of 40 cancers. However, not every gland in benign lesions stained positively. Further, two of 25 PIN 2 and six of 16 PIN 3 lesions failed to reveal BCL. Our results suggest that the presence or absence of BCL, predicated on cytokeratin MA-903 immunoreactivity, may be a useful indicator in the distinction between benign and malignant epithelial lesions of the prostate.

Effect of truncal vagotomy on parietal cell mass and antral gastrin cell mass in dogs

Vagotomy is known to reduce acid secretion and to increase serum gastrin concentrations. However, there is minimal information on the effect of vagotomy on parietal cell mass or gastrin cell mass. Basal and maximal acid secretions and fasting serum gastrin concentrations were measured in 22 gastric fistula dogs with pyloromyotomy before and up to 56 days following complete bilateral truncal vagotomy (n = 11) or sham vagotomy (n = 11). Dogs underwent total gastrectomy on postoperative days 9 (n = 5 per group) or day 56 (n = 6 per group). Parietal cells were stained with Luxol fast blue and parietal cell mass determined with computer-assisted histomorphometry. Parietal cell mass averaged 10.68 +/- 0.90 billion in control dogs and correlated significantly with maximal acid output (r = 0.76; P less than 0.01). Vagotomy reduced maximal acid output by 40%-50% (P less than 0.001) but had no significant effect on parietal cell mass (8.99 +/- 1.00 billion). Vagotomy increased serum gastrin concentrations significantly, but antral gastrin cell mass in vagotomized dogs (5.66 +/- 1.00 million) was not significantly different than that in control dogs (4.74 +/- 0.50 million). Thus, vagotomy did not lead to parietal cell hypoplasia or gastrin cell hyperplasia despite profound alterations in parietal cell and gastrin cell function.

Leiomyoblastoma stomach

Three patients with epithelioid leiomyomatous tumors (leiomyoblastomas) of the stomach are presented.

[Percutaneous transhepatic cholangioscopy. A new method for the diagnosis of bile duct malignancies]

Percutaneous transhepatic cholangioscopy combines the advantages of endoscopic and radiological examinations. It makes it possible to assess the intraluminal spread of bile duct disease as well as histological and cytological examination of biopsies obtained under vision. Eight PTCs were performed without complication in seven patients with cancer of the bile duct. In four, the histology and extent of the tumour was defined endoscopically before any surgical intervention. In three others the results of treatment were objectified. A flexible choledochoscope, as used intraoperatively, was employed (CHF-P10). A stepwise dilatation of the percutaneous access-route was undertaken in several sessions in order to avoid bleeding complications. The procedure is done without general anaesthesia.

Multiple primary malignant tumors involving the large bowel

We reviewed 5680 autopsy protocols in order to determine the frequency of Multiple Primary Malignant Tumors (MPMT) in different organs. The large bowel was the organ most frequently involved, making up to 32 per cent of all MPMT cases. Of 26 patients with colorectal MPMT, six were multicentric in the large bowel, and 20 were associated with extracolonic malignancies. The tissues harboring primary malignancies were, in order of decreasing frequency, liver, lung, and female and male reproductive organs. We compared the exact location of large bowel cancers in patients with and without a prior cholecystectomy; there was no statistically significant difference between the two groups, especially for right-sided colonic carcinoma in women.

Multiple primary malignant tumors involving the liver

We reviewed 5,680 autopsy protocols from the Black Forest area of West Germany and found 2,005 (35.3%) malignant neoplasms; among them there were 93 cases (4.9%) with 186 (9.3%) multiple primary malignant tumors (MPMTs) arising in two different organs or organ systems. Whereas single primary malignant neoplasms of the liver constituted only 3.4% of the total malignant neoplasms, the liver was involved in 11% cases of MPMTs. We also compiled data on the involvement of other organs with MPMTs.

Bioptic diagnosis of Wegener's granulomatosis in the absence of vasculitis and granulomas

We report a case of Wegener's granulomatosis (WG) which differed significantly from the WHO-definition. The patient presented himself with fever and skin lesions which exacerbated after penicillin therapy. The nasal biopsy did not reveal the expected classical vasculitis and granulomas, which were present at autopsy only in the liver and spleen. We emphasize that vasculitis and granulomas may be absent in the biopsy specimen. We stress the institution of chemotherapy with cyclophosphamide, once the clinicopathological impression of WG is probable.