Efficacy of high-dose intra-dermal hepatitis B virus vaccine in previous vaccination non-responders with chronic liver disease

BACKGROUND

Hepatitis B virus (HBV) vaccination is essential in chronic liver disease (CLD), because it can help prevent acute-on-chronic disease, which has potentially fatal complications. Unfortunately, this group has a significant proportion of HBV vaccination non-responders. A variety of intra-muscular (IM) vaccination methods have been used in an attempt to remedy this poor-response, but with limited success.

AIMS

Herein is reported the safety and efficacy of high-dose intra-dermal (ID) HBV vaccination in CLD individuals who had failed previous IM standard and boost-dosing regimens.

METHODS

Forty-eight CLD individuals, known HBcAb negative, who had failed both a three-dose schedule of 40 μg IM vaccination, and boost dosing of either 40 or 80 μg IM, were identified, of which 42 completed the vaccination course. Each received a 40 μg ID total dose (20 μg per arm) during their clinic visits until a response was documented or a maximum of three doses had been administered. HBsAb titer ≥ 10 mIU/ml was regarded as an immunologic response; the intention was to achieve an optimum response of ≥ 100 mIU/ml.

RESULTS

Twenty-nine of forty-two (69%) individuals had an immunologic response, with 15 (51%) of the responders having the optimum response. No changes in serologic data occurred. No serious dermatologic reactions were observed. No differences between those who responded and those who did not were observed with regard to the presence of cirrhosis, diabetes mellitus, or chronic kidney disease.

CONCLUSIONS

High-dose ID HBV vaccination of previous CLD non-responders to the standard IM regimen with boost dosing is both safe and efficacious, and should be considered for all such groups.

Response of vincristine, melphalan, cyclophosphamide and prednisolone in refractory multiple myeloma

In refractory and relapsing multiple, myeloma good complete response rates may be achieved by Vincristine, Melphalan, Cyclophosphamide and Prednisolone (VMCP) like regimen which is effective alternative and less expensive in developing country like Bangladesh. The study was conducted to see the response of VMCP as an alternative in relapsing or refractory multiple myeloma. The study has been carried out in the department of Haematology, Bangabandhu Sheikh Mujib Medical University from July 2004 to June, 2005. This study was conducted on refractory case of multiple myeloma, having aged between 45 to 70 years. A total of ten patients had been taken for this study group. Newly diagnosed multiple myeloma is not included in this study. All of the 10 patients were treated according to the following VMCP protocol, Vincristine 1mg IV, d1, Melphalan 6mg/m2/d p.o. d1-d7, Cyclophosphamide 120mg/m2/d p.o. d1-d7 Prednisolone 60mg/m2/d p.o. d1-d7. Cycles were repeated every 28 days for 6 cycle. Six out of ten patients with refractory multiple myeloma displayed minimal response (60%) after treatment with 6 cycle of VMCP protocol, three patients entered partial remission (30%), and one (10%) showed complete response.

Nanopillar junctions

The fabrication of nanopillar devices has been essential to the understanding and development of metallic spin electronics. This paper discusses the processes that can be used for the fabrication of such structures and the challenges in which they present, with particular emphasis on extreme sub-micrometre pillar structures suitable for the study of spin-transfer torque effects.

Digenic inheritance of an autosomal recessive hypotrichosis in two consanguineous pedigrees

Hypotrichosis is a human hereditary hair loss disorder in which affected individuals show sparse to complete absence of hair on scalp and/or on different body parts. To date, at least eight isolated autosomal recessive and dominant forms of hypotrichosis loci have been mapped on different human chromosomes, and the corresponding genes have been identified. Detailed clinical and molecular studies were undertaken of the hereditary hypotrichosis observed in the two consanguineous families (A and B) presented here. Human genome scan, using >500 highly polymorphic microsatellite markers, identified equal evidence of linkage of the hypotrichosis phenotype on chromosomes 12q21.2-q22 and 16q21-q23.1 in both the families. The novel hypotrichosis locus on chromosome 12q21.2-q22 spans 16.3 cM (17.62 Mb), flanked by markers D12S326 and D12S101. At this locus, maximum multipoint logarithm of the odds ratio (LOD) scores of 3.68 and 3.31 were obtained in families A and B, respectively. The second hypotrichosis locus on chromosome 16q21-q23.1, identified in the two families, spans 5.58 cM (8.28 Mb) and is flanked by markers D16S3031 and D16S512. Maximum multipoint LOD scores of 3.17 and 3.31 were obtained with markers mapped at this locus in families A and B, respectively. DNA sequence analysis of six candidate genes (PLEKHG7, SLC6A15, VEZT, DUSP6, KERA and KITLG), located in the linkage interval on chromosome 12q21.2-q22, failed to detect potential sequence variants in the affected individuals of the two families. However, DNA sequence analysis of CDH3 gene, located on chromosome 16q21-q23.1, detected a single base pair homozygous insertion (c.1024_1025insG and p.342insGfsX345) in exon 9 in family A and deletion of four base pair (c.1859_1862delCTCT and p.620delSfsX629) in exon 13 in family B. We described for the first time digenic inheritance of an autosomal recessive hypotrichosis phenotype in two unlinked loci on chromosomes 12q21.2-q22 and 16q21-q23.1 in two unrelated consanguineous Pakistani families.

Correlation of elevated alkaline phosphatase (ALP) and survival in metastatic castration-resistant prostate cancer (CRPC) treated with docetaxel chemotherapy: Results of SWSW Uro-oncology Group study from three U.K. centers

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Background: Treatment with docetaxel in CRPC based on the results of the TAX 327 study has been recommended by NICE guidance in UK. Paucity of UK data on any significant difference in median survival of CRPC patients receiving chemotherapy with normal or elevated ALP is a possible contributory factor to the delayed consideration of chemotherapy in CRPC. We therefore analysed differences in survival in metastatic CRPC patients with normal or elevated ALP treated with docetaxel chemotherapy in 3 cancer centres in UK with a contemporary referral population.

Methods: Survival data were collected on consecutive cases of metastatic CRPC treated with at least 1 cycle of docetaxel chemotherapy in these 3 centres. Variables analysed included: presence or absence of pain, PSADT, Gleason score, Haemoglobin, Alkaline phosphatase and number of previous lines of hormone therapy.

Results: Median overall survival in 170 eligible patients was 18.1 months (15.3-20.7) with median follow-up of 30.1 months. 84 cases had normal ALP and 86 cases had elevated ALP at time of commencing docetaxel chemotherapy. Median survival was 14.1 months (95% CI= 11.1-17.1) in the elevated ALP group and 22.2 months (95% CI= 17.5- 26.9) in the normal ALP group. The difference between group medians was significant (p<0.001). In multivariate analysis, elevated ALP was a significant prognostic factor for outcome after docetaxel chemotherapy in metastatic CRPC.

Conclusions: Regular monitoring of ALP along with PSA monitoring can be a relatively simple way of ensuring that patients with metastatic CRPC are referred for chemotherapy appropriately. To our knowledge this is the first UK data on the impact of ALP level on survival in this group of patients after docetaxel chemotherapy. It is important that decision regarding chemotherapy is based on the parameters of disease progression and regular ALP monitoring may be a relatively simple and practical way of ensuring the right timescales for referral for chemotherapy in metastatic CRPC.

[Table: see text]

Population growth, trophic level, and reproductive biology of two congeneric archer fishes (Toxotes chatareus, Hamilton 1822 and Toxotes jaculatrix, Pallas 1767) inhabiting Malaysian coastal waters

Population growth, trophic level, and some aspects of reproductive biology of two congeneric archer fish species, Toxotes chatareus and Toxotes jaculatrix, collected from Johor coastal waters, Malaysia, were studied. Growth pattern by length-weight relationship (W=aL(b)) for the sexes differed, and exhibited positive allometric growth (male, female and combined sexes of T. chatareus; female and combined sexes of T. jaculatrix) and isometric growth (male samples of T. jaculatrix only). Trophic levels of both species were analyzed based on 128 specimens. The results show that, in both species, crustaceans and insects were the most abundant prey items, and among crustaceans the red clawed crab Sesarma bidens and Formicidae family insects were the most represented taxa. The estimated mean trophic levels for T. chatareus and T. jaculatrix were 3.422+/-0.009 and 3.420+/-0.020, respectively, indicating that they are largely carnivores. Fecundity of T. chatareus ranged from 38 354 to 147 185 eggs for females with total length ranging from 14.5 to 22.5 cm and total body weight from 48.7 to 270.2 g, and T. jaculatrix 25 251 to 150 456 eggs for females with total length ranging from 12.2 to 23.0 cm and total body weight from 25.7 to 275.0 g. Differences in values of gonadosomatic and hepatosomatic indexes calculated for both species in this study may have resulted from uneven sample size ranges.

Spin-orbit strength driven crossover between intrinsic and extrinsic mechanisms of the anomalous hall effect in the epitaxial L1{0}-ordered ferromagnets FePd and FePt

We determine the composition of intrinsic as well as extrinsic contributions to the anomalous Hall effect (AHE) in the isoelectronic L1_{0} FePd and FePt alloys. We show that the AHE signal in our 30 nm thick epitaxially deposited films of FePd is mainly due to an extrinsic side jump, while in the epitaxial FePt films of the same thickness and degree of order the intrinsic contribution is dominating over the extrinsic mechanisms of the AHE. We relate this crossover to the difference in spin-orbit strength of Pt and Pd atoms and suggest that this phenomenon can be used for tuning the origins of the AHE in complex alloys.

Nonlinear giant magnetoresistance in dual spin valves

Giant magnetoresistance (GMR) arises from differential scattering of the majority and minority spin electrons by a ferromagnet (FM) so that the resistance of a heterostructure depends on the relative magnetic orientation of the FM layers within it separated by nonmagnetic spacers. Here, we show that highly nonequilibrium spin accumulation in metallic heterostructures results in a current-dependent nonlinear GMR which is not predicted within the present understanding of GMR. The behavior can be explained by allowing the scattering asymmetries in an ultrathin FM layer to be current dependent.

Development of a stress scale for pregnant women in the South Asian context: the A-Z Stress Scale

Stress in pregnancy can lead to low-birth-weight and preterm babies and to psychological consequences such as anxiety and depression during pregnancy and the puerperium. Previous scales to measure stress contain items that overlap with the symptoms of pregnancy. A stress scale was developed based on in-depth interviews with pregnant women in Pakistan. Construct validity, test-retest reliability and inter-rater reliability were carried out. Cronbach alpha was 0.82 for the 30 short-listed items, with item-total correlations of 0.2-0.8. Multidimensional scaling determined 2 dimensions: socioenvironmental hassles and chronic illnesses. This was the first scale developed for pregnant women based on stressors in a developing country in South Asia.

Structural and functional analysis of nanopillar spin electronic devices fabricated by 3D focused ion beam lithography

We discuss the fabrication of nanopillar spin electronic devices from metal multilayered heterostructures, utilizing a novel three-dimensional focused ion beam lithography process. Finite element simulation was performed to optimize the geometry of the nanopillar device and to demonstrate that current flow is perpendicular to the plane within the active region of the device. Clear zero-field current induced magnetization switching is observed in our nanopillar devices at room temperature.

Simplifying the exploration of volumetric images: development of a 3D user interface for the radiologist's workplace

Volumetric imaging (computed tomography and magnetic resonance imaging) provides increased diagnostic detail but is associated with the problem of navigation through large amounts of data. In an attempt to overcome this problem, a novel 3D navigation tool has been designed and developed that is based on an alternative input device. A 3D mouse allows for simultaneous definition of position and orientation of orthogonal or oblique multiplanar reformatted images or slabs, which are presented within a virtual 3D scene together with the volume-rendered data set and additionally as 2D images. Slabs are visualized with maximum intensity projection, average intensity projection, or standard volume rendering technique. A prototype has been implemented based on PC technology that has been tested by several radiologists. It has shown to be easily understandable and usable after a very short learning phase. Our solution may help to fully exploit the diagnostic potential of volumetric imaging by allowing for a more efficient reading process compared to currently deployed solutions based on conventional mouse and keyboard.

Effect of smoking on seminal plasma ascorbic acid in infertile and fertile males

This work aimed to assess the relationship of seminal ascorbic acid levels with smoking in infertile males. One hundred and seventy men were divided into four groups: nonobstructive azoospermia [NOA: smokers (n = 20), nonsmokers (n = 20)]; oligoasthenozoospermia [smokers (n = 30), nonsmokers (n = 20)]; asthenozoospermia [smokers (n = 20), nonsmokers (n = 20)] and normozoospermic fertile men [smokers (n = 20), nonsmokers (n = 20)]. The patients underwent medical history, clinical examination, conventional semen analysis and estimation of ascorbic acid in the seminal plasma calorimetrically. There was a significant decrease in the mean seminal plasma ascorbic acid levels in smokers versus nonsmokers in all groups (mean +/- SD; 6.03 +/- 2.18 versus 6.62 +/- 1.29, 7.81 +/- 1.98 versus 9.44 +/- 2.15, 8.09 +/- 1.98 versus 9.95 +/- 2.03, 11.32 +/- 2.15 versus 12.98 +/- 12.19 mg dl(-1) respectively). Fertile subjects, smokers or not, demonstrated significant higher seminal ascorbic acid levels than any infertile group. Seminal plasma ascorbic acid in smokers and nonsmokers was correlated significantly with sperm concentration (r = 0.59, 0.60, P < 0.001), sperm motility (r = 0.65, 0.55, P < 0.001) and negatively with sperm abnormal forms per cent (r = -0.53, -0.50, P < 0.001). Nonsignificant correlations were elicited with semen volume (r = 0.2, 0.09) or liquefaction time (r = 0.03, 0.06). It is concluded that seminal plasma ascorbic acid decreased significantly in smokers and infertile men versus nonsmokers and fertile men, and is significantly correlated with the main sperm parameters: count, motility and normal morphology. Also, cigarette smoking is associated with reduced semen main parameters that could worsen the male fertilizing potential, especially in borderline cases.

Angular dependence of domain wall resistivity in artificial magnetic domain structures

We exploit the ability to precisely control the magnetic domain structure of perpendicularly magnetized Pt/Co/Pt trilayers to fabricate artificial domain wall arrays and study their transport properties. The scaling behavior of this model system confirms the intrinsic domain wall origin of the magnetoresistance, and systematic studies using domains patterned at various angles to the current flow are excellently described by an angular-dependent resistivity tensor containing perpendicular and parallel domain wall resistivities. We find that the latter are fully consistent with Levy-Zhang theory, which allows us to estimate the ratio of minority to majority spin carrier resistivities, rho downward arrow/rho upward arrow approximately 5.5, in good agreement with thin film band structure calculations.

Efficacy of repeated high-dose hepatitis B vaccine (80 microg) in patients with chronic liver disease

Patients with chronic liver disease (CLD) respond poorly to standard hepatitis B (HBV) vaccine given as sequential 20 microg IM shots because of an overall impaired immune response. Many of these patients go on to liver transplantation and are at risk of acquiring recurrent or de novo HBV infection. To evaluate the efficacy and safety of high-dose (80 microg) IM HBV vaccination in patients with CLD who had previously failed to respond to a standard three-dose schedule of 40 microg IM vaccine given monthly. A retrospective review was undertaken at our institution of 79 patients with CLD who were treated with high-dose (80 microg) HBV vaccinations. All had previously failed a three-dose course of 40 microg HBV vaccine. An HBV vaccine response was defined as an anti-HBs titer greater than 100 mIU/ml. Liver enzymes, creatinine, age, prothrombin time, total vaccine dose, and MELD score were recorded. No adverse events were reported. Seventy-two per cent (57/79) of the subjects had an adequate response after receiving a mean total dose of 220 mug vaccine (range 80-800 microg). Twenty-eight per cent (22/79) of the subjects did not respond after receiving a mean total dose of 420 microg vaccine (range 240-720 microg). Non-responders had more severe hepatic disease defined as a higher mean total bilirubin level (p = 0.003) and a lower mean albumin level (p < 0.05). Age, prothrombin time, MELD score, and creatinine were not statistically significant between the responders and non-responders. Repeated high-dose (80 microg) HBV vaccination, in patients who do not respond to standard HBV vaccine doses, is safe and effective in the majority of patients with CLD.

Laparoscopic repair of a strangulated Bochdalek hernia

BACKGROUND

Bochdalek herniae are rare. They are usually repaired by open abdominal surgery or by a thoracic video-assisted approach. When strangulated and in a compromised patient the options are fewer.

AIM

To describe a case treated by a laparoscopic approach.

RESULTS

The procedure was technically difficult, but the patient recovered without recurrence.

CONCLUSION

Laparoscopic repair is possible even with strangulation.

The cost of allogeneic red blood cells - a systematic review

Several reports suggest that the cost of RBCs may have risen over time, but there exists very little published evidence of that. The objective was to determine whether published studies documenting cost data on RBCs suggest an increase over time and to assess the quality of cost studies. We used the terms 'cost', 'allogeneic/allogenic' and 'blood' to identify cost studies between 1966 and 2002 from Medline, ISIesource and Ingenta electronic databases. Furthermore, we manually searched a number of transfusion and health economics journals for completeness. We included studies that used an established methodology and conducted an economic evaluation using primary/secondary cost data to calculate the cost of RBCs and RBC transfusion. Studies without allogeneic RBCs as comparator were excluded. Two individuals independently reviewed the studies and included studies upon reaching a consensus. Fourteen studies qualified the selection criteria and were included in the review. Ten studies were identified from Medline, two from Ingenta, one from ISIesource and one was a conference paper. Of the 14 studies reviewed, 10 had focused on RBC transfusion and four had focused on both RBCs and RBC transfusion. Ten studies were from the US, and two each from Canada and the UK, respectively. Two studies had explicit objective of cost calculation, and others had calculated costs towards fulfilling other objectives. Most of the reviewed studies were dated and of poor quality. Despite these limitations, it appears that the cost of RBCs has increased over time in the UK, Canada and the US. More studies are needed to fully assess the trend of costs over time. Future cost studies should try to follow the economic evaluation guidelines for greater research implications.

Hemodialysis vascular access among chronic renal failure patients in Egypt

BACKGROUND

Proper choice of the vascular access plays a crucial role in dialysis outcome. The prevalence and types of vascular access have not yet been investigated in Egypt. Our work aims to study prevalence, patency rate, complications and factors affecting different types of vascular access in Egypt.

PATIENTS AND METHODS

We studied one thousand hemodialysis patients in eighteen dialysis centers in Egypt.

RESULTS

93% of the patients had natural arteriovenous access while 7% had synthetic arteriovenous grafts. The patency rate of natural fistulae was significantly higher than that of synthetic grafts (3.07 +/- 3 versus 1.5 +/- 2 years respectively). Many arteriovenous grafts were done because natural arteriovenous fistula was unsuitable or after its failure. Natural radiocephalic fistula was the most prevalent type (67.3%), with a patency rate significantly higher than all other sites (3.3 +/- 3 years). Only 10.2% of patients had a fistula created before the start of dialysis. Thrombosis rate was significantly higher in synthetic arteriovenous grafts (32.4%) than in natural arteriovenous fistulae (9.3%). Diabetes and hyperlipidemia significantly decreased the patency rate of natural arteriovenous fistula but not that of synthetic grafts. Patency of arteriovenous fistula in non-diabetics was 3.2 +/- 3.1 years versus 2 +/- 1.9 years in diabetics. Patency of arteriovenous fistula in non-hyperlipidemic patients was 3.1 +/- 3 years versus 1.5 +/- 1.6 years with hyperlipidemia. Temporary vascular access prior to permanent access was used in 90% of patients, of which femoral catheters were used in 53.6%, jugular catheters in 38% and subclavian catheters in 8.4%. The incidence of primary access failure was significantly higher in patients with a previous subclavian catheter insertion.

CONCLUSIONS

Natural arteriovenous fistula is the access of choice for hemodialysis patients in Egypt. It has higher patency rate, lower complication rate and nephrologists prefer it. Diabetes and hyperlipidemia decrease patency rate of natural arteriovenous fistula but not synthetic grafts. Subclavian catheter is better avoided due to increased incidence of primary access failure.

Ordeal of women for induced abortion in a rural area of Bangladesh

The study was carried out to document the context of induced abortion, nature of its management, and post-abortion complications in Matlab, Bangladesh. The study included all 91 cases of induced abortion that took place in the study area from July to October 1995. Information was collected from women within 60 days after the abortion. A physician carried out in-depth interviews and physical examinations of 20 randomly-selected cases. The findings depicted a complex context, within which the women had to go for an abortion. In most cases, the complete lack of use or lack of use-effectiveness of family-planning methods resulted in unwanted pregnancies. The women in desperation sought abortion services from traditional sources first. When their conditions worsened, they contacted the available modern service facilities. At times, it was too late and led to serious health consequences. Limited access to safe abortion services, together with an absence of social support, put women in a life-threatening situation. Prevention of unwanted pregnancies and access to safe abortion services are needed to improve the situation.

Local production of anti-vibrio cholerae mucosal antibody in reproductive tract tissues after cholera

To investigate whether intestinal presentation of an antigen by Vibrio cholerae, a noninvasive organism, could induce an anatomically distant mucosal immune response in reproductive tract tissues, the endocervical immune responses of women in Bangladesh were evaluated after cholera. Endocervical secretions were analyzed for secretory IgA (sIgA) antibody against the B subunit of cholera toxin (CtxB) in 9 women with cholera and 8 women with diarrhea caused by neither V. cholerae nor heat labile enterotoxin-producing Escherichia coli. Women infected with V. cholerae developed significant sIgA anti-CtxB responses in endocervical samples (P< or =.02). Antibody subtype analysis of endocervical IgA was consistent with local mucosal production (P< or =.001). Women with cholera did not develop sIgA anti-CtxB responses in serum. The ability to generate specific mucosal immune responses in reproductive tract tissues after intestinal presentation of antigen could facilitate development of vaccines effective against reproductive tract pathogens.

Radiographic and CT appearances of the major fissures

The major fissure is an important anatomic landmark in the interpretation of chest radiographs and computed tomographic (CT) scans. At radiography, the major fissures normally appear as hairlines of soft-tissue density; at conventional CT, they typically appear as lucent, hypovascular bands; and at high-resolution CT, they most often appear as sharp lines. The superolateral major fissure usually manifests as a curving edge at the upper lateral lung field with lateral opacity and medial lucency. The vertical fissure line appears as a fine, linear shadow, commencing in or near the costophrenic angle and coursing upward. The superomedial major fissure manifests as a short, obliquely oriented straight line. Progressive widening of the major fissure inferiorly manifests as a triangular area of increased opacity and represents intrafissural fat. Various inflammatory, granulomatous, neoplastic, and abnormal hemodynamic conditions involving the major fissure can affect its imaging appearance. Oblique orientation of the major fissure may complicate radiographic interpretation. The fissure may be incomplete or absent, complicating identification of various diseases. An incomplete major fissure may lead to disease spread, collateral air drift, or the "incomplete fissure sign," a sign that may, however, also be present in cases of complete fissure. Knowledge of the anatomy and normal variants of the major fissures is essential for recognizing their variable imaging appearances as well as related abnormalities.

Increased uptake of 99Tcm-ethyl cysteinate dimer in patients with brain tumours

We performed 229 99Tcm-ethyl cysteinate dimer (ECD) single photon emission tomography (SPET) studies in 185 patients with brain tumour. Increased uptake of the tracer was observed in 11 cases. In six of these 11 patients, focal intense activity was seen in the area surrounding the tumour. Five of these six patients had episodes of seizure, and ictal SPET showed further increased uptake in the area of hyperperfusion in one patient. Hyperperfusion surrounding the tumour might be related to seizure. In the remaining five patients, increased accumulation was seen in the tumour. Three of these five patients had a discrepancy between 99Tcm-ECD SPET and 201Tl SPET imaging. There could be some difference in the mechanism of accumulation in the tumour between 99Tcm-ECD and 201Tl.

Acute optic neuropathy and transverse myelopathy in patients with antiphospholipid antibody syndrome: favorable outcome after treatment with anticoagulants and glucocorticoids

We describe two patients with established antiphospholipid syndrome, who during periods of subtherapeutic anticoagulation, developed acute optic neuropathy and transverse myelopathy. Treatment with optimal anticoagulation and high dose glucocorticoids was followed by resolution of the neurologic deficits.

Tc-99m-MIBI scintimammography; SPECT versus planar imaging

This study compares single photon emission tomography (SPECT) with planar scintimammography. 16 normal, 54 benign and 80 malignant lesions were studied (total 150). 700 MBq of Tc99m-sestamibi (MIBI) was injected intravenously. Anterior supine, right and left lateral planar images were acquired in prone position at 2 hours post injection. After this a SPECT study (64 projections, 64 x 64 matrix, 30 sec/frame, anterior 180 degrees arc) was acquired in supine position. Attenuation coefficient of 0.12 and Butterworth order 5 Nyquist 0.9 filter was applied for reconstruction. A scoring system for visualization of lesions was devised with scores of 0 or 1 as negative and 2 or 3 as positive for MIBI uptake. Scores for each group of patients were added together and then compared between planar and SPECT studies.

RESULTS

Planar imaging missed 10 malignant lesions while SPECT missed only 4. Ten benign lesions showed uptake of MIBI on planar imaging while 11 showed uptake on SPECT. Cumulative scores for normal and benign groups did not show any significant difference between planar and SPECT imaging. The malignant group showed significant increase in score for SPECT. Specificity, false negative fraction and positive predictive value for planar imaging were 85.7%, 14.3% and 87.5%. These values did not show any significant difference for SPECT (84.5%, 15.5% and 87.4% respectively). Sensitivity, false negative fraction and negative predictive value for planar imaging (87.5%, 12.5% and 85.7%) was significantly different (p < 0.005) than SPECT (95%, 5% and 93.7% respectively). MIBI SPECT scintimammography improves the sensitivity, false negative fraction and negative predictive value of the planar imaging. In the absence of MIBI uptake on SPECT imaging, malignancy can be ruled out with great confidence, while only uptake should be further evaluated.

Determination of cytosolic citrulline and nitrate as indicators of nitric oxide in bladder cancer: possible association with basic fibroblast growth factor

BACKGROUND

Nitric Oxide (NO) and nitrosamines have been implicated in bladder carcinogenesis. Apart from its implication in carcinogenesis, NO contributes to the regulation of tumor angiogenesis via angiogenic peptides exemplified by basic fibroblast growth factor (bFGF).

OBJECTIVES AND METHODS

In order to examine NO pattern in normal, schistosomal, and malignant bladder cytosols, we have used a combined approach by measuring nitrate and the amino acid citrulline. The results were correlated to bFGF, which were measured in bladder cytosols by an EIA method.

RESULTS

Comparison between normal, schistosomal, and malignant bladder groups showed that patients with schistosomiasis and bladder cancer had significantly higher cytosolic nitrate, citrulline, and bFGF levels. There were no apparent correlations between these investigated parameters and tumor histologic features. The level of citrulline was strongly correlated to nitrate level and both were correlated to bFGF level in bladder cancer and schistosomiasis groups.

CONCLUSIONS

Our findings indicate that NO and bFGF were significantly elevated in schistosomiasis and bladder cancer compared to normal bladders. Moreover, the consistent association of NO with bFGF found in the present work, support the hypothesis that the angiogenic peptide bFGF may be modulated by NO and suggest a useful target in antiangiogenic therapy in bladder cancer.

Pneumothorax: a review of 146 adult cases admitted at a university teaching hospital in Pakistan

OBJECTIVE

There is a lack of data on the etiology and outcome of pneumothorax among the Pakistani population. Our aim was to review the etiology, clinical course, management and outcome of patients presenting with pneumothorax.

PATIENTS AND METHODS

All adult cases with pneumothorax admitted to a University Teaching Hospital in Karachi, between January 1992 and June 1996, were reviewed and analyzed.

RESULTS

A total of 146 patients were reviewed. Their mean age was 46.3 years (SD +/- 17.8 years) with a male to female ratio of 3.7:1. Secondary pneumothorax was the commonest type seen (45%), followed by traumatic (21%), iatrogenic (18%) and primary (16%). Tuberculosis (47%) and COPD (45%) were most common lung diseases associated with secondary pneumothorax. Pneumothorax secondary to TB presented at an earlier age than that with COPD (49.6 vs. 60.1 years). Similarly, patients with primary pneumothorax were significantly younger than patients with secondary pneumothorax (42.3 vs. 51.7 years). Rib fracture was the most common cause of traumatic pneumothorax. Coronary artery bypass grafting, transthoracic fine needle aspiration and neck vein cannulations were the leading iatrogenic causes. The commonest symptoms of pneumothorax were dyspnea (68%) and chest pain (40%). Most cases (81%) were successfully managed by intercostal tube drainage.

CONCLUSION

In our study population, secondary pneumothorax was the commonest variety seen. TB was the commonest cause of secondary pneumothorax, closely followed by COPD. Nearly 40% of pneumothorax were either traumatic or iatrogenic. Intercostal tube drainage remains the treatment of choice for pneumothorax.

Polychromatic reflectance and transmittance of a slab with a randomly rough boundary

We investigated four different approximation models for describing the polychromatic reflectance and transmittance of a slab with a randomly rough boundary while taking into account the coherent and the incoherent scattering of the rough boundary. Comparisons with experiments (an etched-silicon wafer) show that approximation models that apply a two-scale roughness to the randomly rough boundary and that take into account the coherent and the incoherent scattering yield better agreement and extend the range of validity of the approximation to shorter wavelengths.

Clinical significance of a solitary hot spot in the skull

Retrospective evaluation of bone scintigrams over the last 10 years was performed to determine the incidence of a solitary hot spot in the skull, examine its significance in patients with and without extra-skeletal malignancy, and determine if location along the suture lines is clinically significant or not. Review of the reports of bone scintigrams in 9968 patients yielded 37 (0.37%) patients with a solitary hot spot in the skull. In the group of 27 patients with extra-skeletal malignancy, the hot spot was secondary to metastasis in four patients and of a non-metastatic origin in 15. In the remaining eight patients, the cause was indeterminate. Two of the four metastatic foci were located along the suture lines. In another group of 10 patients without extra-skeletal malignancy, the cause was non-metastatic in eight patients and indeterminate in two. No significant differences between the scintigraphic features (intensity of uptake, location and relationship with sutures) of metastatic and non-metastatic foci were noted. We conclude that a solitary hot spot in the skull is rare and is predominantly benign in nature. However, in patients with known extra-skeletal malignancy, approximately 21% are secondary to a solitary bone metastasis of the skull. Location of a hot spot along the suture lines may not always be a normal variation and can represent a solitary bone metastasis.