Renal aspergilloma due to Aspergillus flavus

Renal aspergillomas have been reported only rarely. We report a case of Aspergillus flavus colonization of the renal pelvis and upper ureter of a patient with concomitant urinary schistosomiasis. The diagnosis was based on the demonstration of characteristic hyphal elements on direct microscopy and isolation of the fungus in culture. The patient was successfully treated with liposomal amphotericin B. This case emphasizes the importance of direct microscopic examination of urine specimens for prompt diagnosis of fungal infections of the urogenital system. Renal aspergilloma should be considered in the differential diagnosis of filling defects of the urinary tract, especially in patients who are immunocompromised.

Fine needle aspiration cytodiagnosis of subcutaneous fat necrosis of newborn. A case report

We recently diagnosed subcutaneous fat necrosis in a newborn female infant using fine needle aspiration cytology. The neonate had perinatal asphyxia and her mother a difficult labor, but otherwise the neonate was well developed and healthy and within a few days developed well-defined areas of subcutaneous induration all over. On cytologic examination of the aspirated material, many necrotizing fat cells were found with refractile, needle-shaped crystals arranged in a sheaflike or starburst pattern. Subcutaneous fat necrosis of the newborn is uncommon today, and although the histologic findings from excised tissue are known, this appears to be the first case in which the diagnosis was possible from a sample of fine needle aspirate.

Laboratory evaluation of a new repellent camouflage face paint

A combined formulation of the U.S. Army's camouflage face paints and the new extended duration topical insect/arthropod repellent was tested on human volunteers to determine repellency and duration of protection (2-12 h) against Aedes aegypti and Anopheles stephensi. Under laboratory conditions (27 degrees C and 80% RH), the face paint/repellent formulation provided > or = 95% repellency or better for up to 6 h for Ae. aegypti and 8 h for An. stephensi. An analysis of variance showed no significant differences in the repellent efficacy of the 4 camouflage colors: white, green, loam, and sand.

The magnetic resonance renogram in renal transplant evaluation using dynamic contrast-enhanced MR imaging

To assess the role of the dynamic gadolinium DTPA (Gd-DTPA) magnetic resonance (MR) renogram in differentiating various causes of renal allograft dysfunction, contrast-enhanced MR imaging studies were performed in 5 normal renal allografts, 5 patients with acute rejection (AR), and 7 patients with cyclosporine nephrotoxicity. Time-versus-signal intensity (SI) curves were plotted. Normal renal allografts showed a rapid increase and slow decay, with a definite peak in cortical (CX) SI curves (peak mean signal intensity (Amax 338.6 +/- 46.5). The outer medullary (OM) (Amax 306.5 +/- 59) and inner medullary (IM) (Amax 263.4 +/- 47.4) curves did not show a definite peak. The OM curve slowly reached a steady state and caught up with the CX curve. AR episodes were characterized by a blunted uprise and delayed peak of CX (Amax 180 +/- 70.9) and a low-amplitude vascular phase with a slow constant uprise of the inner medullary curve (Amax 120.35 +/- 42.4). The OM signal intensity curve (Amax 150.73 +/- 78) failed to catch up with the CX curve. The maximum amplitude of SI curves in CsA-induced allograft dysfunction were low, with no definite peak, and CX, OM, and IM curves ran parallel to each other with a constant gap. Dynamic Gd-DTPA, MR imaging is a noninvasive technique that shows distinct characteristics in acute rejection, cyclosporine nephrotoxicity, and normally functioning renal allografts.

Somatosensory evoked potential changes following electro-acupuncture therapy in chronic pain patients

Somatosensory evoked potentials were recorded in 20 healthy volunteers and 20 patients with chronic pain undergoing electro-acupuncture therapy. The values of absolute peak latency and amplitudes of N19 and P22 in the control group were compared with the corresponding baseline values in the study group and after electro-acupuncture therapy at three stages during a 10-treatment cycle. On these occasions the intensity of pain was recorded using a 100 mm visual analogue scale score. Each patient in the study group had 10 treatments given on alternate days. The absolute peak latency of N19 was significantly delayed (p < 0.05) in chronic pain patients when compared to the control group. This increase in latency of N19 persisted after the first electro-acupuncture treatment (p < 0.05), tended to revert to normal after the fifth treatment (p > 0.05) and reverted completely to control values after the 10th treatment (p > 0.05). Visual analogue scores also decreased significantly (p < 0.05) after the fifth and 10th electro-acupuncture sessions. These observations suggest that there is an interaction of the neural mechanisms of electro-acupuncture with the thalamic generator of somatosensory evoked potentials i.e. N19.

Aspiration cytodiagnosis of metastatic Merkel-cell carcinoma

A case of metastatic Merkel-cell carcinoma to lymph nodes on the left side of the neck and left parotid is described. The primary was at the left side of the cheek and bridge of the nose. The cytologic features in needle aspirates of metastases included increased cellularity, discohesive or loose groups of small-to-medium size malignant cells with uniform, round-to-oval nuclei, delicate nuclear membranes, fine chromatin, multiple micronucleoli, and scanty cytoplasm. Additionally, rare intermediate filament "buttons" and frequent mitotic figures were found. The primary tumour showed similar features. On immunostaining, although a positivity for chromogranin was noted in the primary tumour, it was found to be negative in the cytologic material. All other histochemical and immunostains were found to be negative in both the primary and metastatic neoplasm. The problems in differential diagnosis from other small cell tumours and the features of this unique tumour that may be helpful in the diagnosis are discussed.

Undiagnosed retroperitoneal mass. Report of a case in which needle aspiration cytodiagnosis led to investigation and timely management

Needle aspiration cytology of an undiagnosed retroperitoneal mass was performed on a 37-year-old male. The cytologic findings were highly consistent with a seminoma. In the differential diagnosis the possibility of non-Hodgkin's lymphoma, melanocarcinoma and metastatic adenocarcinoma was considered. The cytologic features in the aspirate included uniform, single to loose groups of malignant cells with round nuclei and prominent nucleoli and pale cytoplasm with occasional vacuoles. A variable number of lymphocytes were intermingled with the neoplastic cells. On immunostaining, the markers for lymphoma, melanoma and epithelial malignancy were negative, while alpha-1-antitrypsin was positive in malignant cells, and alkaline phosphatase activity was weakly positive in the cytoplasm. In view of the cytologic diagnosis, a clinical examination of the testes was undertaken and followed by an ultrasound examination, which demonstrated a well-demarcated tumor in the left testis. It was removed and diagnosed as a typical seminoma. This case is of interest since needle aspiration cytodiagnosis not only suggested the correct diagnosis in an otherwise-undiagnosed retroperitoneal mass but also led to a timely investigation and correct management.

Method for quantitation of IgG subclass antibodies in mouse serum by enzyme-linked immunosorbent assay

One of the methods for calibration of antigen specific antibodies in a serum involves parallel titration of known concentrations of purified normal immunoglobulins (Igs) and a specific antiserum. We evaluated the effect of three methods for capturing known concentrations of purified normal mouse Igs (IgG, IgG subclasses and IgM) on the anti-tetanus toxoid antibody concentrations assigned to a reference mouse serum: (1) direct coating, (2) capture by pre-coated anti-mouse IgG (Fc) specific antibodies, and (3) capture by pre-coated anti-mouse IgG (Fab) specific antibodies. Direct coating of purified Igs onto plastic was the least efficient and would greatly overestimate antigen specific antibody concentrations. Equivalent concentrations of purified IgG subclasses and IgM produced higher absorbances when captured by anti-Fab antibodies pre-coated on plates than by anti-Fc antibodies. As a consequence, the anti-Fc capture method resulted in the assignment of IgG1, IgG2a and IgG2b tetanus specific antibody concentrations which exceeded the total IgG1, IgG2a and IgG2b concentrations. Additionally, the sum of tetanus specific IgG subclass antibodies exceeded the tetanus specific IgG antibody concentration by > 2-fold. In contrast, the anti-Fab capture method resulted in 2-9-fold lower assigned tetanus antibody concentrations which did not exceed the total Ig concentrations. We conclude that when using enzyme-linked immunosorbent assays, parallel titration of purified normal Ig standards captured by anti-Fab antibodies is superior to anti-Fc capture or direct coating for calibrating antigen specific antibodies in a reference serum.

5-fluorouracil induced cardiotoxicity in albino rats

Since 1975, many cases of 5-fluorouracil (5-FU) associated cardiotoxicity have been described in the literature. A histopathological study of 5-FU induced cardiotoxicity was performed on 50 Swiss albino rats. Multiple interstitial myocardial hemorrhages, multifocal myofibre necroses, inflammatory reaction, vascular changes, valvulitis and pericarditis have been noted especially in the left heart ventricles of rats under study. The mechanism of 5-FU associated cardiotoxicity is controversial. A probable mechanism has been proposed; it explains the endothelial damage leading to extravasation of the drug containing blood into myocardium resulting in myofibre necroses and inflammatory reaction.

Ultrasound guided percutaneous fine needle aspiration cytology of pancreas: a review of 61 cases

The study includes 61 cases which were subjected to ultrasound (US) guided fine needle aspiration cytology (FNAC) to find out the utility of this technique in the diagnosis of pancreatic lesions. Age of the patients ranged from 23 to 85 years with a median of 50 years. Male to female ratio was 36:25. One or more clinical diagnoses were offered in 16 and in 9 of these, the disease was related to pancreas. Subsequent to US, the lesions were localized to pancreas in 57 and the nature of pathology in the pancreatic lesion could be diagnosed in 31. By FNAC, 31 cases (50.8%) were diagnosed to have pancreatic malignancy which included adenocarcinoma (23 cases), papillary cystic tumour (1), muco-epidermoid carcinoma (1), acinic cell carcinoma (1), islet cell tumor (1), and non Hodgkin lymphoma (4). FNAC of liver in 2 cases and retroperitoneal lymph node in a case of pancreatic adenocarcinoma revealed metastasis. During follow up, 1 case of non Hodgkin's lymphoma showed CSF involvement. Three cases (4.9%) were suspected to have epithelial malignancy of which one was confirmed as an adenocarcinoma following surgery and histology. Four (6.6%) were benign lesions which included nonspecific inflammation (2 cases), tuberculous pancreatitis (1) and pseudopancreatic cyst (1). The remaining 23 cases (37.7%) had normal or inadequate cytology. Of these, FNAC of liver showed metastasis in 2 cases and one case each were diagnosed as adenocarcinoma and pseudopancreatic cyst respectively following surgery. None of the patients had any complication following FNAC. We recommend US guided FNAC to be routinely used for diagnosis of pancreatic lesion.

Development of a guinea pig model to assess immunogenicity of Haemophilus influenzae type b capsular polysaccharide conjugate vaccines

There is currently no animal model which reliably predicts the immunogenicity of Haemophilus influenzae type b (Hib) polysaccharide-protein conjugate vaccines in human infants. We evaluated various Hib vaccines in guinea pigs using techniques similar to the United States potency test for adsorbed diphtheria and tetanus toxoids with a view to developing a method for evaluating the potency of a combined adsorbed tetanus, diphtheria, pertussis and Hib conjugate vaccine. Groups of 6-8 guinea pigs received 1.5 single human doses of vaccine at 0 and at 6 or 8 weeks and were bled at 6 weeks and 2 weeks after the booster injection. Total antibodies to polyribosylribitolphosphate (PRP), the Hib capsular polysaccharide, were measured in individual animals and in serum pools by radioimmunoassay. The relative antibody responses of guinea pigs to Hib conjugate vaccines qualitatively resembled those of human infants. Unconjugated polysaccharide was not immunogenic; PRP-D produced a low antibody response, HbOC, PRP-T (Merieux) and Hib-T (MPMBL) produced a low response to the first dose and a strong anamnestic response to the booster (geometric mean anti PRP > 1 micrograms ml-1). PRP-OMP uniquely produced a strong response after the first dose which was further boosted by the second dose. Experimental Hib-T vaccine lots with low levels of conjugation were poorly immunogenic in guinea pigs. Combinations of DTP and Hib-T vaccines showed equivalent or greater immunogenicity than Hib-T alone. We propose that the guinea pig model may be useful to verify the immunogenicity of PRP conjugate vaccines and for pre-clinical evaluations of DTP-Hib combination vaccines containing PRP conjugates.

Brain metabolite changes on in vivo proton magnetic resonance spectroscopy in children with congenital hypothyroidism

Localized in vivo proton magnetic resonance spectroscopy and imaging were performed in five children with untreated congenital hypothyroidism to look for biochemical markers of abnormal myelin and neuronal development. The patients had high levels of choline-containing compounds, which returned to normal with euthyroidism. These metabolic alterations may reflect blocks in myelin maturation that are reversible by thyroid hormone replacement throughout childhood.

Role of brain [Mg2+]i in alcohol-induced hemorrhagic stroke in a rat model: a 31P-NMR in vivo study

One hundred percent of anesthetized rats administered 6.6 gm/kg of ethanol IP died within 10-35 min of alcohol injection; upon autopsy of the brain all demonstrated profound subarachnoid and intracranial bleeding, clear signs of hemorrhagic stroke. Pretreatment of rats with 4 mumol/min MgCl2, but not saline, via IV administration (for 30-45 min), prevented hemorrhagic stroke in all animals so treated with 6.6 gm/kg ethanol. Administration of the stroke dose of alcohol resulted in rapid (within 3-5 min) and marked deficits in whole brain intracellular free Mg ([Mg2++]i) as observed by in vivo 31P-NMR spectroscopy. Intracellular pH (pHi) and the phosphocreatine [PCr]/[ATP] ratio also fell following a significant fall in brain [Mg2+]i). Brains of rats that exhibited strokelike events, upon death and autopsy, demonstrated continued and marked intracellular acidosis with progressive fall in the [PCr]/[ATP] ratio and elevation of inorganic phosphate (Pi) and [H+]i; these events were not accompanied by any rises in systemic arterial blood pressure. Rats pretreated with MgCl2 exhibited relatively stable brain [Mg2+]i, and essentially unchanged pHi, [PCr], [ATP], or [Pi] following alcohol administration, although such animals exhibited threefold alterations in plasma Mg2+, as measured by ion selective electrodes. These observations suggest that high alcohol ingestion can result in severe vasospasm, ischemia, and rupture of blood vessels probably as a consequence of depletion of brain [Mg2+]i, events that can be prevented by Mg2+ pretreatment.

Acute bilateral ophthalmoplegia secondary to metastatic prostatic carcinoma. Demonstration on magnetic resonance imaging

We report an unusual case of acute bilateral ophthalmoplegia secondary to bilateral cavernous sinus metastasis from prostatic adenocarcinoma. The lesion was demonstrated with magnetic resonance imaging.

In vivo proton magnetic resonance spectroscopy in a case of intracranial hydatid cyst

We performed in vivo proton magnetic resonance spectroscopy (MRS) in a patient who had an intracranial hydatid cyst. Besides lactate, alanine, and acetate, a large resonance for pyruvate was observed. These findings were further confirmed by ex vivo high-resolution NMR spectroscopy of the evacuated cyst fluid, as well as of the fluid aspirated from a cyst in the liver of the same patient. The MRS pattern appeared different from that seen in other cystic lesions of the CNS. In vivo MRS may be used as an adjunct to imaging in the diagnosis of intracranial hydatid cysts. It may also have a role in monitoring drug therapy.

Respiratory distress in newborn: treated with ventilation in a level II nursery

Fifty consecutive neonates with respiratory distress persisting beyond 6 h of age were studied during a 18 month period (total deliveries 2000/y). Twenty two neonates were managed with oxygen hood with increasing oxygen concentration, 28 with continuous positive airway pressure (CPAP) ventilation using a nasal cannula. Of these babies on CPAP, 10 were shifted to intermittent positive pressure ventilation (IPPV) on a pressure limited, time cycled ventilator (Neovent, Vickers). Babies were monitored with continuous hemoglobin oxygen saturation (SaO2), hourly blood pressure and vital charting. Radial arterial blood gas analysis (ABG) was done when feasible and especially on clinical deterioration. Oxygen (FiO2 0.95) from an oxygen concentrator was used as a source of continuous supply of oxygen. Commonest cause of respiratory distress was hyaline membrane disease (18%), followed by wet lung syndromes (14%), meconium aspiration (12%), asphyxia (12%) and septicemia (8%). In 8 babies, a lung biopsy (postmortem) was done to confirm the diagnosis. Nineteen of the 50 babies with respiratory distress died, there was a survival of 50% on CPAP and 30% on IPPV. No case of oxygen toxicity or other major complications was encountered. Even with moderate resources, neonatal ventilation in a Level II nursery is a challenging task. Babies less than 1000g require aggressive measures which is not very economical in a special care baby unit (SCBU).