Alternative approaches for the prevention of disability in leprosy

Cost-effective programmes for the prevention of disabilities in leprosy require active involvement of the patients and their families as well as an integrated team approach. This paper presents the views and recommendations of a group of 35 experienced leprologists who met at a workshop, reviewed the current scenario and worked out specific objectives, strategies and the reorganization required in the existing infrastructure. Three tiers of workers are suggested: village volunteer; paramedical worker; and the professionals at the base hospital. All three levels should work together at the start of a programme as well as for periodic monitoring and evaluation.

Evaluation of superficial femoral artery compromise and limb growth retardation after transfemoral artery balloon dilatations

BACKGROUND

Abnormalities of arterial pulse and limb growth after retrograde femoral arterial catheterization have been well documented. However, the magnitude of such complications after transfemoral artery balloon dilatation has not been thoroughly investigated. This study sought to evaluate the prevalence of these abnormalities in children who have undergone transfemoral artery balloon dilatation.

METHODS AND RESULTS

Data on 43 consecutive patients (1 day to 15.5 years old at the time of balloon dilatation) seen on follow-up (42 +/- 23 months) (group 1) were compared with those of 35 patients undergoing retrograde femoral arterial catheterization (group 2) and 47 control patients. Interventional ankle/control ankle blood pressure index (AAI), ratio of interventional/control lower limb length (LLI), and leg length difference (LLD) were measured. Ages and weights at study were similar in all three groups, as were the ages and weights at intervention and duration of follow-up in groups 1 and 2. The AAI was lower (P = .023) in group 1 (0.95 +/- 0.13) than in groups 2 (1.0 +/- 0.1) and 3 (1.01 +/- 0.09). The prevalence of subjects with AAI < or = 0.9 was higher (P = .003) in group 1 than in the other two groups. The LLI and LLD were similar (P > .1) in all three groups. AAI and LLD in the balloon group are not significantly associated with age and weight at intervention, duration of follow-up, or size of the balloon or balloon catheter shaft.

CONCLUSIONS

Transfemoral artery balloon dilatation procedures produce superficial femoral artery compromise, but there was no significant limb growth retardation at a 3.5-year mean follow-up, which may be related to development of collateral circulation. Study of a larger number of children at a longer follow-up interval may be necessary to further confirm these observations.

"LIMA fissure" for a tension-free IMA graft in emphysema

Tension on the mammary artery pedicle is a major concern during coronary artery bypass in asthmatic patients with emphysematous lungs. We are sharing here a simple and effective solution to this problem.

Aneurysm of the membranous ventricular septum resulting in pulmonary outflow tract obstruction in congenitally corrected transposition of the great arteries

Aneurysm of the membranous ventricular septum causing subpulmonic obstruction in patients with corrected transposition is rare but well documented. Higher left-sided (morphologic right) ventricular pressure causes protrusion of the aneurysm into the pulmonary outflow tract of the right-sided morphologic left ventricle, causing obstruction related to lack of conus and proximity of the aneurysm to subpulmonary region. Echo Doppler studies and angiography are useful in making a correct diagnosis. Surgical resection of the aneurysm along with closure of the ventricular septal defect is the treatment of choice. The prognosis is likely to be excellent.

Trends in intra-uterine growth of single live births in southern India

Trends in intra-uterine growth (IUG) of newborns from 1969-1973 to 1989-1993 were studied among rural and urban communities. Yerushalmy's five group classification of IUG was used. The percent preterm low birthweight (LBW) declined from 7 to 3 in rural and from 5 to 2 in urban areas. The percent of newborns with retardation of IUG declined from 20 to 11 in rural and from 13 to 8 in urban areas. Possible factors contributing to such changes are discussed.

Transcatheter occlusion of patent ductus arteriosus: which method to use and which ductus to close

Many devices have been developed for transcatheter occlusion of PDA. Bulkiness of the device, complexity of the procedure, and significant residual complications make the majority of the devices unsuitable for routine clinical use. Although no randomized comparative clinical trials exist, on the basis of published literature and my personal experience, coil occlusion may be best suited to close small ducts (< or = 3.5 mm) and the adjustable buttoned device may be most appropriate for large PDAs (> 3.5 mm). Clinical trials on larger patient populations than are currently available and long-term follow-up are necessary to further support these recommendations. Indications for transcatheter closure should be exactly as those used for surgical closure: PDA with audible continuous murmur with echo Doppler confirmation. The so-called silent ducts need not be closed.

Stimulated tissue repair prevents lethality in isopropanol-induced potentiation of carbon tetrachloride hepatotoxicity

Published reports on the alcohol potentiation of CCl4 toxicity indicate that in spite of enhanced hepatotoxicity there is no increase in lethality. The objective of this study was to investigate the mechanism involved in animal survival despite significantly enhanced liver injury. Male Sprague-Dawley rats (175-225 g) were treated with isopropanol (ISOP, 2.5 ml/kg, 25% aqueous solution, po) 24 hr prior to CCl4 (1 ml/kg, ip) administration. Plasma enzymes (ALT and SDH), hepatic glycogen levels, and [3H]thymidine (3H-T) incorporation into hepatonuclear DNA were measured during a time course (0-96 hr) after CCl4 administration. Liver sections were examined for histopathology and cell cycle progression by proliferating cell nuclear antigen (PCNA) immunohistochemistry. Maximum injury was observed at 36 hr in both the groups as indicated by elevated plasma enzyme levels and by histopathology. The extent of injury in the ISOP + CCl4 group was higher than that in the H2O + CCl4 group. Plasma enzyme activity returned to control levels by 60 hr, indicating recovery from injury in both groups. Maximum 3H-T incorporation occurred at 48 hr in both groups (ISOP + CCl4; vehicle + CCl4), indicating maximum stimulation of S-phase synthesis. PCNA studies revealed a corresponding stimulation of cell cycle progression. The wave of S-phase synthesis and cell cycle progression returned to control levels in the H2O + CCl4 group by 60 hr but continued up to 72 hr in the ISOP + CCl4 group. These findings support the hypothesis that in response to increased infliction of CCl4 injury by isopropanol, augmented stimulation of cell division and tissue repair restrain the progression of injury and restore hepatic structure and function, thereby allowing the rats to survive. Further, antimitotic intervention with colchicine (1 mg/kg, ip) led to decreased S-phase synthesis, followed by 60% lethality in the isopropanol-pretreated group in contrast to 40% lethality in the group receiving CCl4 alone (H2O + CCl4). These findings suggest that greater stimulation of tissue repair restrains the progression of ISOP-enhanced infliction of CCl4 liver injury and accounts for recovery from enhanced liver injury and animal survival. The findings are consistent with a two-stage model of toxicity wherein liver injury is linked by progression or regression of injury, which is governed by the extent of tissue repair to the final outcome.

The clinical significance of calculated versus measured creatinine clearance in patients with gynecologic malignancy

Measurement of creatinine clearance remains in convenient because of the need for 24-hour urine collection. Our study compared creatinine clearance calculated from serum creatinine (CC alpha) to measured creatinine clearance (MC alpha) using an unsupervised 8-hour urine collection at home. Forty-two women admitted to our gynecologic oncology service participated in this study. Twenty-six of these patients had cancer originating from the ovaries, 8 from the uterus, 7 from the cervix, and 1 from the fallopian tube. There were adequate data for 61 collections. MC alpha using unsupervised 8-hour urine collection at home correlated well with CC alpha. This calculated value may be sufficient to be used as a guide in evaluating renal function in patients with gynecologic malignancy. However, if it becomes necessary to measure creatinine clearance, our data suggest that an 8-hour collection may be used.

Origin of new leprosy cases during general surveys in relation to previous survey findings

As part of the leprosy control activities in the area of Gudiyatham Thaluk, general surveys are done once every three to five years. The percentage of examination is about 90%. An analysis of all new cases registered for treatment between 1990-94 was done to study whether these cases had been examined in the previous general survey. Of the new cases detected and registered, 566 cases (32.6%) were not examined during the previous survey. The significance of these findings in relationship to cost-effectiveness of general surveys, case-detection methodology and possible continuing of transmission of leprosy are discussed.

Feasibility and effectiveness of repeated balloon dilatation of restenosed congenital obstructions after previous balloon valvuloplasty/angioplasty

Balloon dilatation of congenital stenotic lesions of the heart and great vessels has been used for more than a decade. Varying incidence of residual obstruction or recurrence, hereafter referred to as restenosis, has been observed at follow-up. The purpose of this study was to evaluate the feasibility and effectiveness of repeated balloon dilatation of restenosed lesions after previous balloon dilatation for pulmonic (PS) and aortic (AS) stenosis and native aortic coarctation (AC). Neonates, infants, and children (n = 178) underwent balloon valvoplasty/angioplasty with reduction (p < 0.001) or peak-to-peak systolic pressure gradients from 91 +/- 41 (mean +/- SD) mm Hg to 25 +/- 19 mm Hg, from 70 +/- 20 mm Hg to 26 +/- 12 mm Hg, and from 48 +/- 17 mm Hg, to 11 +/- 9 mm Hg in patients with PS, AS, and AC, respectively. Repeated catheterization or echo-Doppler studies or both were performed from 3 months to 5 years after initial balloon dilatation. Residual gradients at follow-up were 26 +/- 26 mm Hg, 34 +/- 20 mm Hg, and 16 +/- 15 mm Hg, respectively, for PS, AS, and AC and remained significantly lower (p < 0.01) compared with gradients before the balloon dilatation. However, when results of individual patients were scrutinized, 9 (11%) of 80 patients with PS, 6 (23%) of 26 patients with AS, and 16 (27%) of 60 patients with AC had restenosis, on the basis of standard criteria. Repeated balloon dilatation was performed with reduction (p < 0.05 to < 0.001) of peak-to-peak gradients from 89 +/- 40 mm Hg to 38 +/- 20 mm Hg in 9 patients with PS, from 77 mm Hg to 13 mm Hg and 66 mm Hg to 6 mm Hg, respectively, in 2 patients with AS, and from 38 +/- 11 mm Hg to 10 +/- 6 mm Hg in 12 patients with AC. Echo-Doppler studies, 2 to 6.5 years after repeated balloon dilatation, indicated excellent results, with residual peak instantaneous Doppler gradients of 24 +/- 13 mm Hg in PS, 43 +/- 20 mm Hg in AS, and 11 +/- 6 mm Hg in AC groups, respectively. This improvement is irrespective of the cause of restenosis after initial balloon valvuloplasty/angioplasty. From this experience, we conclude that repeated balloon dilatation is feasible and effective in relieving restenosis after initial balloon valvuloplasty/angioplasty.

Transcatheter closure of atrial septal defect or patent foramen ovale with the buttoned device for prevention of recurrence of paradoxic embolism

Transcatheter occlusion of patent foramina ovalia and atrial septal defects in 10 patients with presumptive paradoxic embolic stroke using the buttoned device appears to be encouraging, with safety and efficacy demonstrated during a follow-up of up to 60 months. Anticoagulation should be continued until complete disappearance of the right-to-left atrial shunt.

Mechanism of anoxia-induced atrial natriuretic peptide release in the isolated rat atria

Our laboratory has recently shown that locally produced endothelin (ET) is involved in the atrial natriuretic peptide (ANP) response to a physical stimulus, stretch. The aim of this study was to determine if factors locally produced in the atria were involved in the ANP response to a chemical stimulus, anoxia. Reduced oxygen tension is a potent stimulus of ANP release, and our results show that, when isolated perfused atria were exposed to anoxic conditions, the ANP secretion rate increased by a maximum of 129 +/- 8% of the baseline. Exposure to anoxia caused neither an elevation in perfusate creatinine phosphokinase, a change in atrial morphology detectable by electron microscopy, nor interfered with the return toward the baseline ANP secretion rate with reoxygenation, suggesting that this response was not due to myocyte damage. When the atria were pretreated with either 3 microM BQ-123, an endothelin receptor inhibitor, or 10 microM indomethacin, a cyclooxygenase inhibitor, the ANP response to anoxia was nearly abolished. To clarify the association between ET and prostaglandins, we showed that the ANP response to 50 nM ET-1 was totally blocked at both high and low pressure by 10 microM indomethacin, but the increased contractility response to ET was unaffected. Therefore, we have concluded that the anoxia-induced ANP response is mediated by locally produced ET, which, in turn, stimulates the production of prostaglandins. Prostaglandins appear to be responsible for the increased ANP secretion rate.

Leprosy among inmates of a prison

A leprosy survey carried out in a district prison revealed a gross prevalence of 20 cases per 1000, and active prevalence of 10 cases per 1000 whereas, prevalence of leprosy in the state was 1.12 per 1000. Such prisons thus form hyperendemic pockets. The inmates are a closed community and there is a risk of cases among inmates spreading infection to others inside the prison during their sojourn there and to the community when they are released from the prison. Special efforts are required to identify and eliminate all identifiable sources of infection, especially at this point of time when we are aiming at elimination of leprosy as a public health problem.

Effect of an antimitotic agent colchicine on thioacetamide hepatotoxicity

In an earlier study we established that timely and adequate tissue repair response following the administration of a six-fold dose-range of thioacetamide (TA; 50, 150, and 300 mg/kg) prevented progression of injury and led to recovery and animal survival. Delayed and attenuated repair response after the 600 mg/kg TA dose resulted in a marked progression of injury and 100% lethality. The objective of the present study was to further scrutinize this concept in an experimental protocol in which we hypothesized that a selective ablation of the tissue repair response should lead to lethality from the nonlethal, moderately toxic doses of 150 and 300 mg/kg TA. In this study we investigated the effect of the antimitotic agent colchicine (CLC, 1 mg/kg) on the outcome of TA hepatotoxicity. Male Sprague-Dawley rats (175-225 g) were injected intraperitoneally (ip) with 150 and 300 mg/kg TA. We assessed liver injury by serum enzyme elevations and histopathology. Tissue regeneration response was measured by 3H-thymidine incorporation into hepatonuclear DNA and by proliferating cell nuclear antigen (PCNA) assay. S-Phase stimulation, as indicated by 3H-thymidine incorporation, was noted at 36 and 48 hr following the administration of 150 mg/kg TA, whereas with the 300 mg/kg TA S-phase stimulation was elicited at 48 hr following treatment. Therefore, two doses of CLC (30 hr and 42 hr, 1 mg/kg, ip) were administered to the 150 mg/kg treated group while a single dose of CLC (42 hr, 1 mg/kg, ip) was administered to the 300 mg/kg group. CLC treatment resulted in 100% lethality in both groups. Thus, CLC administration converted nonlethal doses into lethal doses. The 150 mg/kg TA dose was then chosen to further investigate the underlying mechanism. Rats treated with TA alone recovered from injury by 36-48 hr while CLC treatment resulted in a progression of injury as indicated by serum enzyme elevation and histopathology. Tissue repair, as evidenced by 3H-thymidine incorporation and PCNA studies explained this dichotomy. Antimitotic intervention with CLC resulted in a significantly diminished repair response leading to unrestrained progression of injury and lethality even from nonlethal doses. This model demonstrates the critical role of tissue repair response in determining the final outcome of toxicity.

Absence of relapse within 4 years among 34 multibacillary patients with high BIs treated for 2 years with MDT

Thirty-four multibacillary patients with a bacterial index (BI) of 3+ or more were treated with 2 years of WHO multidrug therapy (WHO/MDT). Treatment was then stopped and the patients followed for a minimum of 4 years. The rate of fall in the BI in this group without further treatment was similar to the rate of fall in the BI in an earlier group of similar patients treated with MDT until skin-smear negativity. No relapses have been seen.

Effectiveness of MDT in multibacillary leprosy

The study on the use of World Health Organization multidrug therapy (WHO/MDT) under field conditions was initiated in December 1981, and included 1067 multibacillary (MB) patients treated with two MDT regimens. The first was a THELEP-recommended regimen which consisted of 600 mg of rifampin (RFP) and 600 mg of clofazimine (CLO) given under supervision on two consecutive days monthly and 225 mg of diacetyl diaminodiphenylsulfone (DADDS) bimonthly plus dapsone (DDS) 100 mg daily unsupervised. The second regimen was the conventional MDT: patients received RFP 600 mg and CLO 300 mg supervised once a month, daily 100 mg of DDS and 50 mg of CLO unsupervised. A zero relapse rate was obtained after more than 10 years (a total of 8244 person-years) of follow up. Both regimens were well tolerated with few complications and a high acceptability, even among women. The fall in the bacterial index (BI) was 0.5 - 1.0+ in positive patients. CLO discoloration began to decrease after 3 months and disappeared within 1 year after it was discontinued. Seventy-two patients (67%) developed reactions during the treatment period; a further 12 patients developed post-treatment reactions during the surveillance period. This study vindicates MDT treatment for MB patients as recommended by WHO under field conditions.

Effects of continuous positive airway pressure on cardiac output and plasma norepinephrine in sedated pigs

Continuous positive airway pressure (CPAP) increases cardiac output (CO) in congestive heart failure (CHF). In six sedated pigs that were normovolemic (NV) and hypervolemic (HV), and seven previously instrumented pigs with pacing-induced CHF, we tested the hypothesis that this is associated with decreased total body sympathetic nerve activity (SNA). Hemodynamic variables and plasma norepinephrine level measurements were measured at baseline, CPAP 5 and 10 cm H2O, and recovery. Arterial O2 saturation was maintained at greater than or equal to 90% and PCO2 did not change. For NV baseline plasma norepinephrine level (PNE) was 97 +/- 61 pg/mL, CO 2.4 +/- .5 L/min, and pulmonary wedge pressure (Pw) 10.1 +/- 2.4 mmHg and did not change with CPAP. HV and CHF were associated with increased baseline Pw (18-21 mmHg). Baseline CO was increased with HV and unchanged with CHF. Baseline PNE was increased 4 to 5-fold with both HV and CHF. CO increased at CPAP 5 compared with baseline with both HV and CHF. However, PNE decreased with CPAP in HV, and increased with CPAP in CHF. Increased CO was always associated with decreased systemic vascular resistance. We conclude the following: (1) increased CO with CPAP can be associated with either increasing or decreasing SNA; (2) CPAP can produce increases in CO when the heart is distended whether baseline LV function is relatively normal (HV) or depressed (CHF); and (3) there are probably a number of different mechanism increasing CO with CPAP and these may vary from condition to condition.

A leprosy survey in a taluk headquarters town and the role of dermatological services and active health education in its success--a preliminary report

A report of two general surveys done in 1984 and 1987 in Gudiyatham town, is presented. The first survey covered 89.2% and the second survey 82% of the population. The new case detection rate was 3.4 per 1000. The success of the survey was due to the co-operation obtained from the public, most probably because of the intense and sustained health education, combined with leprosy services integrated with a dermatology clinic.

Radiation exposure from diagnostic radiographs in extremely low birth weight infants

OBJECTIVE

We sought to examine radiation doses received by infants of less than 750 g birth weight from radiographs.

METHODS

We examined the radiology records, including radiograph films, of all 25 surviving infants with birth weight less than 750 g admitted to our center during 1991. The standard method of neonatal radiation dose calculation was modified to consider the body size, postnatal growth, and extramedullary hematopoiesis of the extremely low birth weight infant. To determine overall radiation exposure, we calculated an effective dose equivalent, which is the sum of weighed organ dose equivalents.

RESULTS

The infants had a mean of 31 radiographys performed, including 17 chest radiographs, 5 babygrams, and 9 abdominal radiographs. The majority of chest radiographs and babygrams were performed in the first month, whereas abdominal radiographs increased during the second month of life. Total-body radiation dose and total effective dose equivalent by the standard and modified methods, respectively, for single exposures ranged from 0.01 to 0.02 millisieverts (mSv) for a chest radiograph, from 0.02 to 0.04 mSv for a babygram, and from 0.02 to 0.03 mSv for an abdominal radiograph. Surface organs icluding the skin, breast, and thyroid received the largest radiation doses. The effective dose equivalent per infant for all radiographs was 0.72 mSv according to the modified method, compared to a total-body dose of 0.40 mSv using the standard method. However, infants with chronic lung disease or necrotizing enterocolitis received up to 1.5 mSv total-body dose, including 3.3 mSv to the breast, 2.5 mSv to the thyroid, and 2.3 mSv to the testes.

CONCLUSIONS

Radiation doses received by infants of less than 750 g birth weight are small in comparison with the range of doses that form the basis of risk estimates for cancer.

Five- to nine-year follow-up results of balloon angioplasty of native aortic coarctation in infants and children

OBJECTIVES

To evaluate the usefulness of balloon angioplasty for relief of native aortic coarctation, we reviewed our experience with this procedure, with special emphasis on follow-up results.

BACKGROUND

Controversy exists with regard to the role of balloon angioplasty in the treatment of native aortic coarctation.

METHODS

During an 8.7-year period ending September 1993, 67 neonates, infants and children underwent balloon angioplasty for native aortic coarctation. A retrospective review of this experience with emphasis on long-term follow-up forms the basis of this study.

RESULTS

Balloon angioplasty produced a reduction in the peak-to-peak coarctation gradient from 46 +/- 17 (mean +/- SD) to 11 +/- 9 mm Hg (p < 0.001). No patient required immediate surgical intervention. At intermediate-term follow-up (14 +/- 11 months), catheterization (58 patients) and blood pressure (2 patients) data revealed a residual gradient of 16 +/- 15 mm Hg (p > 0.1). When individual results were scrutinized, 15 (25%) of 60 had recoarctation, defined as peak gradient > 20 mm Hg. Recoarctation was higher (p < 0.01) in neonates (5 [83%] of 6) and infants (7 [39%] of 18) than in children (3 [8%] of 36), respectively. Two infants in our early experience had surgical resection with excellent results. Three patients had no discrete narrowing but had normal arm blood pressure and had no intervention. The remaining 10 patients had repeat balloon angioplasty with reduction in peak gradient from 52 +/- 13 to 9 +/= 8 mm Hg (p < 0.001). Reexamination 31 +/- 18 months after repeat angioplasty revealed a residual gradient of 3 to 19 mm Hg (mean 11 +/- 6). Three (5%) of 58 patients who underwent follow-up angiography developed an aneurysm. Detailed evaluation of the femoral artery performed in 51 (88%) of 58 patients at follow-up catheterization revealed patency of the femoral artery in 44 (86%) of 51 patients. Femoral artery occlusion, complete in three (6%) and partial in four (8%), was observed, but all had excellent collateral flow. Blood pressure, echocardiography-Doppler ultrasound and repeat angiographic or magnetic resonance imaging data 5 to 9 years after angioplasty revealed no new aneurysms and minimal (2%) late recoarctation.

CONCLUSIONS

On the basis of these data, it is concluded that balloon angioplasty is safe and effective in the treatment of native aortic coarctation; significant incidence of recoarctation is seen in neonates and infants; repeat balloon angioplasty for recoarctation is feasible and effective; and the time has come to consider balloon angioplasty as a therapeutic procedure of choice for the treatment of native aortic coarctation.

Pupil cycle time in leprosy patients without clinically apparent ocular pathology

The pupil cycle time (PCT) was estimated in 384 leprosy patients whose eyes looked normal on clinical examination and in an equal number of healthy controls. A statistically significant increase in PCT (p < 0.05) was noticed in leprosy patients, and corroborates the view that the ocular autonomic system may be affected without any visible clinical pathology in the eye. The clinical value and application of this finding is uncertain since the difference is only a few milliseconds. Young females with leprosy showed a conspicuous lengthening of PCT for which no plausible explanation is offered. There was a general trend for the PCT to increase as the spectrum of disease moved toward the lepromatous pole and a significantly higher PCT (p < 0.01) was found among multibacillary patients compared to paucibacillary patients. Patients who had had erythema nodosum leprosum (ENL) reactions showed a higher PCT than did those who had not had ENL. Patients who had had reversal reactions showed a decrease in PCT, which may be a statistical oddity in this hospital-based study. Patients whose duration of the disease was over 10 years showed a higher PCT, while smear positivity of a patient did not alter the PCT significantly.

Atrial natriuretic peptide, oestradiol and progesterone in women undergoing spontaneous and gonadotrophin-stimulated ovulatory cycles

The objective of this study was to examine the relationship between the concentrations of oestradiol and progesterone on the one hand and atrial natriuretic peptide (ANP) concentrations on the other, during the follicular and luteal phases of spontaneous and gonadotrophin-stimulated ovulatory menstrual cycles. A total of 27 ovulatory women undergoing either a spontaneous (n = 9) or a gonadotrophin-stimulated (n = 18) cycle were selected for inclusion in this study. In comparison with spontaneous cycles, gonadotrophin-stimulated cycles had increased peak follicular oestradiol (mean +/- SE; 937 +/- 150 versus 195 +/- 18 pg/ml; P < 0.05) and midluteal progesterone (mean +/- SE; 44.0 +/- 7.4 versus 14.1 +/- 2.4 ng/ml; P < 0.05) concentrations. There were no differences in the circulating ANP concentrations between the follicular and luteal phases of the menstrual cycle. Despite the increased oestradiol and progesterone concentrations following gonadotrophin stimulation, no difference in ANP concentrations was seen between stimulated and spontaneous cycles. There was no correlation between circulating concentrations of oestradiol, progesterone (at physiological and supraphysiological concentrations) and ANP throughout the menstrual cycle.

Role of goitrogens in iodine deficiency disorders & brain development

Although iodine deficiency has primarily been implicated in the causation of goitre, the significant role played by food goitrogens in the etiology of iodine deficiency disorder (IDD) is being increasingly recognized. Impaired brain development is the major cause of concern in IDD. Detailed experimental studies were undertaken to ascertain various biochemical changes associated with developing brain in response to treatment with a goitrogens--thiocyanate. Addition of thiocyanate to food deprived of KI brought down significantly the circulating levels of thyroxine (T4) in rats. Nucleic acids and protein content in different regions of brain were significantly lowered in rat pups exposed to thiocyanate. The rate of microtubule assembly, which is detrimental for neurite growth was considerably lowered, thereby influencing both myelin deposition and synaptogenesis in developing brain. Goitrogen intake not only caused an adaptive increase in the activity of type II 5'-deiodinase, which governs availability of triiodothyronine (T3) in brain, it also increased the latter's binding to brain nuclear receptors under conditions of thiocyanate induced hypothyroid state. Addition of adequate quantities of KI mitigated thiocyanate induced alterations by restoring circulating level of thyroxine. These investigations suggest that goitrogens play a significant role in influencing biochemical events unique to developing brain.

Iodine metabolism in response to goitrogen induced altered thyroid status under conditions of moderate and high intake of iodine

Metabolic experiments in rats were undertaken to relate excretory pattern of iodine and thiocyanate, with thyroid weight and the circulating levels of thyroxine, in response to moderate and high intake of iodine and under conditions of goitrogen induced altered thyroid status. On a moderate intake of iodine (by depriving diet of KI) 25 mg of thiocyanate or substitution of 1/3rd proportion of casein based diet with dry cabbage, could significantly reduce plasma thyroxine level by 60 days. Neither body weight nor the weights of liver, kidney, heart or spleen were affected due to exposure to goitrogens. A significant increase in thyroid weight as well as higher excretion of iodine and thiocyanate were evident in goitrogen-fed rats. Presence of high amounts of KI, to a certain extent, offered protection from adverse effects of the goitrogens. Semi quantitative assessment of thyroid, indicated hypofunctioning of thyroid with follicular hyperplasia in thiocyanate fed rats. These alterations were of moderate degree in response to cabbage feeding. These results emphasize that, moderate intake of iodine, adequate to meet iodine requirement, may not ensure normal functioning of thyroid in the presence of goitrogens.

Green fluorescent fusion proteins: powerful tools for monitoring protein expression in live zebrafish embryos

The recent development of transgenic technology in zebrafish has opened an exciting new avenue in which to explore vertebrate development. However, as in other species, the inability to easily identify live transgenic fish severely limits the potential of this promising technology. To determine whether the recently described green fluorescent protein (GFP) might provide a convenient live staining method in zebrafish, we constructed a glutathione S-transferase/GFP fusion protein (GST-GFP). GST-GFP cRNA, when injected into individual blastomeres of early zebrafish embryos, resulted in the rapid development (3 hr) of easily detectable green fluorescence which persisted for up to 4 days. GFP fluorescence was restricted to progeny of the injected cell and appeared to have no adverse effects on embryonic development despite widespread expression. Our findings demonstrate that GFP fusion proteins will provide a simple yet powerful means of monitoring production of heterologous proteins in live zebrafish.

Taurine ameliorates chronic streptozocin-induced diabetic nephropathy in rats

We examined the effect of two endogenous antioxidant agents, taurine and vitamin E, on renal function in experimental diabetes. Male Sprague-Dawley rats, rendered diabetic with streptozocin (STZ), were assigned to one of the following groups: 1) untreated; 2) insulin treatment with 6 U Ultralente insulin/day in two doses; 3) taurine supplementation by 1% taurine in drinking water; and 4) vitamin E supplementation at 100 IU vitamin E/kg chow. Animals were kept for 52 wk. The survival rate was similar (70-90%) in all groups except vitamin E-treated animals, of which 84% died by 6 mo. At 52 wk, glomerular filtration rate was elevated in untreated and taurine-treated STZ rats compared with normal or insulin-treated diabetic rats. Taurine supplementation reduced total proteinuria and albuminuria by nearly 50%. This treatment also prevented glomerular hypertrophy, preserved immunohistochemical staining for type IV collagen in glomeruli, and diminished glomerulosclerosis and tubulointerstitial fibrosis in diabetic animals. The changes in renal function and structure in taurine-treated diabetic rats were associated with normalization of renal cortical malondialdehyde content, lowering of serum free Fe2+ concentration, and decreased formation of the advanced glycooxidation products, pentosidine, and fluorescence in skin collagen. Administration of the vitamin E-enriched diet exacerbated the nephropathy in STZ-diabetic rats. In addition, vitamin E supplementation increased serum free Fe2+ concentration, enhanced renal lipid peroxidation, and accelerated the accumulation of advanced glycosylation end products (AGEs) in skin collagen. We conclude that administration of taurine, but not vitamin E, to rats with STZ-diabetes ameliorates diabetic nephropathy. The beneficial effect of taurine is related to reduced renal oxidant injury with decreased lipid peroxidation and less accumulation of AGEs within the kidney.

Follow-up results of transcatheter occlusion of atrial septal defects with buttoned device

BACKGROUND

Feasibility, effectiveness and safety of transcatheter occlusion of secundum atrial septal defect (ASD) with buttoned device have been demonstrated.

OBJECTIVES

To evaluate the follow-up results of the ASD with buttoned device method to assess its long term efficacy and safety.

PATIENTS AND METHODS

Patient age at device implantation ranged from seven months to 51 years and weight ranged from 3.6 to 105 kg. Successful implantation of the device was accomplished in 20 of 22 consecutive patients (91%) seen during a 33-month period ending August 1992. Patients were divided into three groups based on the type of shunt across the ASD: group I (n = 14)--left-to-right shunt; group II (n = 5)--presumed paradoxical embolism; and group III (n = 1)--right-to-left shunt. These 20 patients were followed for 29 +/- 11 months, range 16 to 52 months. Follow-up included clinical evaluation, chest x-ray and echo-Doppler studies, and was performed two weeks, and three, six and 12 months after occlusion and yearly thereafter. Most patients received 5 to 10 mg/kg/day acetylsalicylic acid for 12 weeks following the device implantation.

RESULTS

In 14 left-to-right shunt ASD closures, the right ventricular size diminished from 2.3 +/- 0.6 to 1.7 +/- 0.3 cm immediately after closure (P < 0.01) and remained decreased (1.6 +/- 0.46 cm) at last follow-up. Paradoxical/flat septal motion was present in 11 of 14 patients (79%) before closure while such an abnormal septal motion was not present in any at follow-up. Small to trivial left-to-right shunts across the implanted device were seen in six of 14 patients (43%) immediately after closure while trivial shunts were present in three of 14 (21%) at follow-up. Small shunts became trivial and trivial shunts disappeared. None of the patients had any clinical signs of ASD and none required surgical intervention during the follow-up period. None of the five patients with cerebrovascular accident (CVA)/paradoxical embolism had recurrence of CVA. Repeat transesophageal contrast echocardiographic study with Valsalva revealed minimal right-to-left shunt in two of five patients (40%) initially, which disappeared at follow-up. The single patient with CVA secondary to atrial right-to-left shunt following previous tetralogy repair had a transient ischemic episode four months after closure and underwent surgery at the discretion of the primary cardiologist. There were no wire fractures on follow-up x-rays. None developed endocarditis.

CONCLUSIONS

These data indicate that effective ASD occlusion can be accomplished in left-to-right shunt and paradoxical embolism patients. Modification of the device to position the square-shaped patch on the right atrial side may be necessary to prevent CVA in patients with right-to-left shunts.

Early marriage among rural and urban females of south India

Data on 2972 marriages in rural areas and 1180 marriages in urban areas of North Arcot Ambedkar district of South India, during 1982-88, were analysed. The mean age at marriage of females was 18.6 in the rural and 19.6 in the urban area. The proportion of females married before attaining the legal age of 18 years was higher among the rural community (36.8%) than in the urban community (28.9%). Univariate analysis revealed an association between early age at marriage and the socioeconomic variables religion, caste, consanguinity, marital distance, spousal age difference, education and occupation of both bride and bridegroom, and socioeconomic status of the family. Multivariate analysis showed an independent relationship of marital distance and bridegroom's occupation with early age at marriage of females in the rural area alone and the bridegroom's education in the urban area alone. Consanguinity, spousal age difference and bride's education were found to be independently related with early age at marriage of females in both rural and urban areas.

Validation of risk factors in predicting recoarctation after initially successful balloon angioplasty for native aortic coarctation

Despite gratifying immediate results, significant recoarctation at follow-up has been observed after balloon angioplasty of native aortic coarctation. Risk factors for such recurrences have been identified in one of our previous studies. In this study we examined the value of these risk factors in the prediction of recoarctation after balloon angioplasty. During a 6-year period ending in September 1993, 37 infants and children aged 2 days to 15 years underwent balloon angioplasty of native coarctation with resultant reduction in coarctation gradient from 45 +/- 17 (mean +/- SD) to 12 +/- 9 mm Hg (p < 0.001). On the basis of results of 4- to 48-month follow-up catheterization in 30 children, recoarctation developed in 8 (27%) children. The data from these patients were scrutinized to identify subjects that exhibited the previously determined risk factors, namely age < 12 months, size of aortic isthmus less than two thirds the size of the ascending aorta, coarcted aortic segment < 3.5 mm before angioplasty, and coarcted segment < 6.0 mm after angioplasty. Then, thirty variables (Table I) were examined by logistic regression to identify factors responsible for recoarctation; the data from both study groups were combined for this analysis. The prevalence of recoarctation in each subgroup with a given number of risk factors is similar (p < 0.1) to that observed in the initial study identifying the risk factors. In addition, logistic regression identified age (p = 0.014), size of isthmus (p = 0.006), preangioplasty coarcted segment (p = 0.01), and postangioplasty coarcted segment (p = 0.006) as risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Identification and characterisation of sugarcane intergeneric hybrids, Saccharum officinarum x Erianthus arundinaceus, with molecular markers and DNA in situ hybridisation

Molecular markers were used to characterise sugarcane intergeneric hybrids between S. officinarum and E. arundinaceus. Very simple diagnostic tools for hybrid identification among the progeny were derived from isozyme electrophoresis and a sequence-tagged PCR. Two enzyme systems (GOT and MDH B) and PCR amplification revealing spacer-size variation in the 5s-rDNA cluster were found most convenient. Specific characterisation of the two genomic components was possible using RFLP and in situ hybridisation. The strong molecular differentiation between S. officinarum and E. arundinaceus allows the identification of numerous Erianthus-specific RFLP bands in the hybrids. Genomic DNA in situ hybridisation allows for the differentiation of the chromosomes contributed by S. officinarum and E. arundinaceus in chromosome preparations of the hybrids. In situ hybridisation with the 18s-5.8s-25s rDNA probe highlights the basic chromosome numbers in the two parental species. The potential of these techniques to monitor the Erianthus genome during the introgression process is discussed.

Prospects for elimination of leprosy in India by 2000 AD

Data regarding the trends of new-case detection rates of leprosy for India as a whole, for the State of Andhra Pradesh, and for Srikakulam district in Andhra Pradesh were generated and projected up to 2000 AD. The prevalence rate by 2000 AD was worked out based on these new -case detection rates. The projections show that at the current slowly declining trend of new-case detection, with 20% MB cases among the newly detected cases and the current mean duration of treatment, the elimination goal of leprosy by 2000 AD, could possibly be achieved at Srikakulam district level only, where the MDT project has been under implementation for over ten years, but not at the State or country levels. The achievement of elimination goal should be possible in other geographic units also if the duration of disease could be shortened to one month or less, for both paucibacillary and multibacillary types of leprosy.

Atrial natriuretic factor in gynecologic malignancy

OBJECTIVE

To determine whether plasma atrial natriuretic factor (ANF) levels are different in patients with gynecologic malignancy compared with those in healthy, nonpregnant women, and if differences do exist, whether chemotherapy plays a role.

METHODS

We compared the plasma levels of ANF in nonpregnant women free of malignancy (group 1, n = 25) and in patients with malignancy receiving at least one course of platinum-based chemotherapy (group 2, n = 32). To differentiate the contributory role of chemotherapy, another group of patients (group 3, n = 18) was studied before the initiation of chemotherapy.

RESULTS

The ANF values (mean +/- standard error [SE]) in groups 1, 2, and 3 were 7.3 +/- 0.3, 13.8 +/- 0.8, and 14.6 +/- 1.8 fmol/mL of plasma, respectively. Significant differences (P < or = .001) occurred between groups 1 and 2 and 1 and 3, but not between 2 and 3. In comparing groups 2 and 3 for a specific type of cancer, there were no significant differences. The respective values (mean +/- SE) for endometrial, ovarian, and cervical cancer before chemotherapy were 9.9 +/- 1.7, 15.05 +/- 2.6, and 18.5 +/- 4.3 fmol/mL. After chemotherapy, the values remained at 9.3 +/- 1.5, 15.03 +/- 1.06, and 14.6 +/- 2.2 fmol/mL, respectively.

CONCLUSION

Plasma ANF levels in gynecologic cancer patients were significantly higher than those in healthy, nonpregnant women. Levels were higher before chemotherapy started, thus negating the idea that chemotherapy may initiate the production and release of ANF.

Effect of occupation on menstrual cycle length: causal model

The effect of occupational stress on menstrual cycle length was studied prospectively. The hypothesis that occupational stress has a direct or indirect effect on cycle length was tested using path analysis. Twice the number of women involved in active farm, craft, or household work had significantly longer cycle lengths than sedentary beedi workers and clerks. We conclude that occupational stress has a direct effect on menstrual cycle length and that that effect is similar to the effect of exercise on cycle length. The impact of longer cycles on fertility, fertility regulation, and natural family planning methods are also discussed.

Estrogen-induced guinea pig model for uterine leiomyomas: do the ovaries protect?

A guinea pig model was used to study the hormonal control of uterine leiomyomas. Twenty female guinea pigs were divided into four groups--young, old, ovariectomized (OVX), and non-OVX animals--and were given two estradiol-17 beta (E2) silastic implants each for 3-10 mo; another four older OVX animals served as controls and received empty implants. After 3 mo, 100% (8 of 8) of the OVX animals, but none of the OVX controls, developed tumors, mainly on the uterine serosa and the abdominal wall. Electron microscopy and desmin immunostaining demonstrated that the tumors were leiomyomas. In E2-treated animals, E2 levels in serum, leiomyomas, or leiomyoma-free uterine segments rose significantly while serum progesterone (P4) was negligible. Surprisingly, only 8% (1 of 12) of the non-OVX animals developed a tumor. This apparent "ovarian protection" was transient: after 6-9 mo, 50% of the remaining non-OVX animals developed leiomyomas, but these were smaller and fewer than in OVX animals. On the basis of this model, we propose the hypothesis that some factors from the ovaries suppress leiomyoma growth in response to estrogen but that as the ovaries age this protection is diminished, allowing the clinical development of leiomyomas.

Coarctation of the aorta

Coarctation of the aorta is an important and treatable cause of secondary hypertension. The prevalence of aortic coarctation varies from 5% to 8% of all congenital heart defects. Neonates and infants, especially when they have other associated cardiac defects, may present with signs and symptoms of heart failure. Children beyond infancy are usually asymptomatic and are most often diagnosed because of a murmur or hypertension on a routine examination. Palpation of the brachial and femoral pulses simultaneously will show decreased and delayed or absent femoral pulses. On measurement of blood pressure from arms and legs, a pressure difference of more than 20 mm Hg in favor of the arms may be considered as evidence for coarctation of the aorta. The coarctation can be demonstrated on suprasternal notch two-dimensional echocardiographic views along with increased Doppler flow velocity across the coarctation site. Cardiac catheterization shows significant peak-to-peak systolic pressure gradient across the coarcted segment, and aortography demonstrates the degree and nature of the aortic narrowing. Aortic coarctation may be relieved by surgery or by balloon angioplasty; in asymptomatic patients, therapy during the ages of 2 and 5 years is suggested. Surgical relief of coarctation may be achieved by resection and end-to-end anastomosis or by subclavian flap or prosthetic path angioplasty. Although results of surgery are generally good, there are some problems with the procedure, namely, mortality, morbidity and recoarctation, particularly in neonates and young infants and development of aneurysm, paraplegia, and paradoxical hypertension. Balloon angioplasty has been used by some cardiologists with resultant relief of obstruction, but concern for development of aneurysms and arterial complications remain. Although the immediate results for surgical or balloon therapy for isolated coarctation are good, long-term prognosis is largely undetermined. Limited long-term follow-up studies suggest significantly lower survival rates compared with normal population; age at intervention and the degree and duration of hypertension before intervention may affect long-term survival.