Is total thyroidectomy justified in multinodular goitre

Role of total thyroidectomy in treatment of patients with benign diseases of thyroid gland remains controversial. The hypothesis behind the study is that total thyroidectomy can be performed in all benign thyroid diseases with equal rate of immediate and late complications compared with those of subtotal thyroidectomy. The retrospective case control study was done by reviewing the case records of patients with benign thyroid diseases involving both lobes operated during May, 2002 to September, 2004. The minimum follow-up period was 3 years. Of the 189 patients included in the study 94 underwent total thyroidectomy and 95 patients underwent subtotal thyroidectomy. There was no incidence of permanent recurrent laryngeal nerve paralysis in both groups. Temporary unilateral recurrent laryngeal nerve paralysis occurred in 3 patients (3.2%) in total thyroidectomy group and 1 (1.1%) patient in subtotal thyroidectomy group, which was not statistically significant (p = 0.307). Temporary hypocalcaemia was noted in 10 patients of total thyroidectomy group (10.6%) and 3 patients of subtotal thyroidectomy group (3.2%). Permanent hypocalcaemia was noted in 2 patients each in total thyroidectomy group and subtotal thyroidectomy group (p = 0.991). Total thyroidectomy is an acceptable alternative to subtotal thyroidectomy in benign diseases, considering the higher rate of postoperative morbidity in recurrent goitres.

Murine monoclonal anti-H as typing reagent

BACKGROUND & OBJECTIVE

The antigen H present on the surface of red cells in varying concentration, is maximum in O group red cells, but absent in Bombay phenotype individuals. This differentiation is generally detected by seed extracts of Ulex europaeus. The titre of such an extract is usually low and is subjected to batch variation. Hence, we carried out this study to raise potent murine monoclonal antibody against H antigen.

METHODS

Spleen cells of female BALB/c mice immunized with O group red cells were fused in presence of polyethylene glycol (PEG) 1500 with a mouse myeloma cell line Sp2/0 Ag14 in hypoxanthine aminopterine thymidine (HAT) selective medium and incubated at 37 degrees, 5 per cent CO(2) and 95 per cent humidity for a week.

RESULTS

The culture supernatants showing anti-H activity, were further subcloned and two clones 3E8A10 and 3E8A11 generated which showed a good potency, avidity and specificity.

INTERPRETATION & CONCLUSION

The anti-H clones thus produced indigenously provided a potent reagent in distinguishing normal O group from Bombay phenotype individuals. The unlimited availability makes this reagent cost-effective to ensure a constant supply of hybrid clones with the similar specificities.

Studies on the ABH-Iso-Agglutinins in serum, saliva and milk from mothers with "Bombay" (Oh) phenotype

Background:

ABO blood group iso-antibodies are naturally occurring antibodies found in serum and other body fluids.

Methods:

Serum, saliva and milk samples from 5 mothers identified as “Bombay” phenotype were tested for ABH-iso-antibodies by routine serological techniques.

Results:

All the five mothers showed presence of iso-antibodies in the samples tested. Higher titer values in milk than their serum were observed on subjects whose samples were collected in immediate post-partum phase as compared to those whose samples were collected after a lapse of a few months.

Conclusion:

High titer iso-agglutinins against ABH antigens were detected in milk samples besides their presence in saliva as well as serum.

Prolonged behavioral stress enhances synaptic connectivity in the basolateral amygdala

Recently identified cellular and molecular correlates of stress-induced plasticity suggest a putative link between neuronal remodeling in the amygdala and the development of anxiety-like behavior. Rodent models of immobilization stress, applied for 10 consecutive days, have been reported to enhance anxiety, and also cause dendritic elongation and spine formation in the basolateral amygdala (BLA). Paradoxically, longer exposure to stress, which is also anxiogenic, fails to affect key molecular markers of neuronal remodeling in the BLA. This has raised the possibility of homeostatic mechanisms being triggered by more prolonged stress that could potentially dampen the morphological effects of stress in the BLA. Therefore, we examined the cellular and behavioral impact of increasing the duration of stress in rats. We find that prolonged immobilization stress (PIS), spanning 21 days, caused significant enhancement in dendritic arborization of spiny BLA neurons. Spine density was also enhanced along these elongated dendrites in response to PIS. Finally, this striking increase in synaptic connectivity was accompanied by enhanced anxiety-like behavior in the elevated plus-maze. Thus, we did not detect any obvious morphological correlate of adaptive changes within the BLA that may have been activated by prolonged and repeated application of the same stressor for 21 days. These findings add to accumulating evidence that structural encoding of aversive experiences, through enhanced availability of postsynaptic dendritic surface and synaptic inputs on principal neurons of the BLA, may contribute to the affective symptoms of stress disorders.

Production of murine monoclonal anti-B

BACKGROUND & OBJECTIVE

Monoclonal antibodies against red blood cell antigens used in research and as diagnostics in India are commercially procured from western countries. Indigenously generated potent clones are not available in India. Hence, the objective of the present study was to raise potent murine monoclonal antibodies against A, B and H blood group antigens indigenously and establish a stable clone of anti-B secreting cells.

METHODS

Spleen cells of female BALB/c mice immunized with B group red blood cells were fused in presence of polyethylene glycol (PEG) 1500 with a mouse myeloma cell line Sp 2/0 Ag. 14 in hypoxanthine aminopterine thymidine (HAT) selective medium and incubated at 37 degrees C, 5 per cent CO(2) and 95 per cent humidity for a week.

RESULTS

The culture supernatant of the wells showing anti-B activity, were further subcloned and a clone 2C4D5F10 was generated which showed a good potency, avidity and specificity.

INTERPRETATION & CONCLUSION

The anti-B clones thus produced indigenously provided a useful reagent in blood group typing. The unlimited availability unlike polyclonal antisera makes this reagent more cost-effective. It also ensures a regular supply with the similar specificity.

Familial hypercholesterolemia presenting as intracranial xanthoma

A 22 years female who was diagnosed as having cholestseatoma of right ear was referred to us for medical fitness. On examination she incidentally had evidence of tuberous and tendon xanthomas. She was found to have hypercholesterolemia. On mastoid exploration a yellowish groomous mass was seen which was surrounded by foamy macrophages, suggestive of 'mastoid xanthoma'. The purpose of this case presentation is to report occurrence of such rare case and importance of early detection that will warrant treatment with proper diet and medical management. This will stabilize lesions and delay complications.

Insulin resistance as a contributor to myocardial ischaemia independent of obstructive coronary atheroma: a role for insulin sensitisation?

There is good evidence to suggest that insulin resistance and its surrogate markers are at least modest independent cardiovascular risk factors. However, as well as long term effects on atheromatous coronary disease, there is a well described correlation between markers of insulin resistance and endothelial dysfunction. In this review, the evidence for a relation between endothelial dysfunction and myocardial ischaemia is summarised. The evidence for a correlation between insulin resistance and endothelial dysfunction and the proposed cellular mechanisms are also examined. Finally, the potential role for insulin sensitising strategies is looked at and recent data examining their effects on both endothelial function and clinical symptoms is examined. In conclusion, it was found that insulin sensitising modalities have a potential role in the amelioration of angina and that randomised controlled studies are therefore warranted.

A bicarbonate anion-dependent anti-'N' MoAb

While studying the serologic characteristics of certain monoclonal blood group antibodies, we observed a hybridoma clone (5A-11E10) with anti-N-like serologic specificity that was dependent on the presence of the bicarbonate anion. The diluted cell culture supernatant preferentially agglutinated M-N+ RBCs by immediate spin. This supernatant also agglutinated M-N+ RBCs that had been treated with trypsin or sialidase (to remove N-reactivity), suggesting anti-'N' activity. Anti-'N' specificity was confirmed by the supernatant's non-reactivity with N+ RBCs treated with papain (to remove 'N' reactivity) or with ('N'-negative) M+N-U- RBCs. The requirement for bicarbonate in the MoAb's formulation was not a function of pH. Both sodium and ammonium bicarbonate supported agglutination, but neither sulfate nor carbonate was effective.

Meningitis: an unusual cause of pneumocephalus

Pneumocephalus, characterized by the presence of air in the cranium is frequently caused by trauma and surgery. Meningitis is a very rare cause of pneumocephalus. Here we report a patient who had meningitis as a cause for his pneumocephalus. This patient was diagnosed to have pneumocephalus on CT scan study and was treated with antibiotics to which he responded well, and the repeat CT scan done after two weeks showed normal study.

Hydrodynamic shear regulates the kinetics and receptor specificity of polymorphonuclear leukocyte-colon carcinoma cell adhesive interactions

The ability of tumor cells to metastasize hematogenously is regulated by their interactions with polymorphonuclear leukocytes (PMNs). However, the mechanisms mediating PMN binding to tumor cells under physiological shear forces remain largely unknown. This study was designed to characterize the molecular interactions between PMNs and tumor cells as a function of the dynamic shear environment, using two human colon adenocarcinoma cell lines (LS174T and HCT-8) as models. PMN and colon carcinoma cell suspensions, labeled with distinct fluorophores, were sheared in a cone-and-plate rheometer in the presence of the PMN activator fMLP. The size distribution and cellular composition of formed aggregates were determined by flow cytometry. PMN binding to LS174T cells was maximal at 100 s(-1) and decreased with increasing shear. At low shear (100 s(-1)) PMN CD11b alone mediates PMN-LS174T heteroaggregation. However, L-selectin, CD11a, and CD11b are all required for PMN binding to sialyl Lewis(x)-bearing LS174T cells at high shear (800 s(-1)). In contrast, sialyl Lewis(x)-low HCT-8 cells fail to aggregate with PMNs at high shear conditions, despite extensive adhesive interactions at low shear. Taken together, our data suggest that PMN L-selectin initiates LS174T cell tethering at high shear by binding to sialylated moieties on the carcinoma cell surface, whereas the subsequent involvement of CD11a and CD11b converts these transient tethers into stable adhesion. This study demonstrates that the shear environment of the vasculature modulates the dynamics and molecular constituents mediating PMN-tumor cell adhesion.

Changes in the neurosecretory cells of the brain and thoracic ganglion of male crab, Uca (celuca) lactea annulipes with respect to seasons

The change in the neurosecretory cells with males with respect to seasons was investigated. The brain is provided with three types of neurosecretory cells namely A, B and C and thoracic ganglion with four types of neurosecretory cells A, B, C and D. They vary in number and neurosecretory activity according to seasons which may be responsible for the increase in the size and development of the reproductive and associated structures.

Selectivity behavior and multianalyte detection capability of voltammetric ionophore-based plasticized polymeric membrane sensors

The current response features ofvoltammetric ion-selective polymeric membranes doped with neutral ionophores in view of practical sensor development are elucidated. The membranes are designed to extract ions only under applied external potentials and interrogated by normal-pulse voltammetry and pulsed amperometry. They contain two polarizable interfaces to avoid loss of lipophilic ions at the sample side and to maximize the available potential window. A simple theoretical model is developed that describes the observed current at the end of an uptake pulse to the applied membrane potential, which is the sum of both boundary potentials (at the sample and inner electrolyte side) and the membrane internal iR drop. The results describe how the selectivity of the resulting sensor must be dependent on the applied potential. Evidently, the role of the applied potential is akin to incorporating lipophilic cationic and anionic sites with potentiometric ionophore-based membranes, which are well known to considerably affect membrane selectivity and to define the charge type of the assessed ions. This has important implications for sensor design, as the applied cell potential can be used to tune sensor selectivity. Theory also explains the role of the inner electrolyte on sensor behavior. A maximum measuring range is expected with ions in the inner electrolyte that are difficult to extract into the membrane. This corresponds to Kihara's experimental results and contrasts to common ion-selective electrode practice, where a salt of the analyte ion is normally present in the inner electrolyte. Separate and mixed solution experiments with membranes containing the sodium-selective ionophore tert-butyl calix[4]arene tetramethyl ester and the lithium ionophore ETH 1810 agree very well with theoretical expectations. Multianalyte detection capability with a single sensing membrane is demonstrated in a selectivity-modifying pulsed amperometric detection mode, where each applied voltage yields a different practical selectivity of the sensor. The sensor is altered from being sodium to potassium selective as the magnitude of the applied potential is repetitively varied within the pulse sequence. The sensors show high long-term stability under continuous measuring conditions over 15 h.

The Pertussis Serological Potency Test. Collaborative study to evaluatereplacement of the Mouse Protection Test

The Pertussis Serological Potency Test (PSPT)--based on in vitro assessment of the humoral immune response against Bordetella pertussis--was developed as an alternative for the Mouse Protection Test (MPT). A small-scale collaborative study was carried out in five laboratories to evaluate the relevance and reliability of the PSPT. The study has been divided into three separate phases, each with its own objective. A pilot-phase study of the antibody detection assay, the 18323-whole cell ELISA (WCE), was included for training purposes. Significant differences in absorbance and antibody concentrations between the laboratories were found. In the Phase I study, the intra-assay, inter-assay and inter-laboratory precisions of the 18323-WCE were assessed. Although a precision of less than 20% was not always established and significant differences in antibody concentrations were found at random throughout the Phase I study, the ranking of the antibody concentrations corresponded well between the laboratories and should warrant a reliable potency estimation of whole cell vaccines (WCV's) in the PSPT. Phase II was a comparative study of the PSPT and the MPT to evaluate the implementation of the PSPT, to demonstrate correlation and to compare the reproducibility and reliability of both tests. The mean antibody concentrations per vaccine dose in the PSPT and the survival of mice in the MPT differed significantly within and between the laboratories. Nevertheless, the potencies of the vaccines under test estimated in both test models did not differ significantly (P>0.05). The PSPT and MPT correlated well in chi2-test of homogeneity within and between the laboratories. The potencies were similar (overall ratio=0.877), but the PSPT is more reproducible and reduces the chance of re-testing due to the smaller 95% confidence intervals. We have demonstrated that the PSPT is a valid model to estimate the potencies of pertussis WCV's from different manufacturers. Moreover, the 18323-WCE is easy to carry out and the intra-assay precision and antibody ranking warrants a reliable potency testing of pertussis WCV's in the PSPT.

Effect of fumigation and juvenile hormone on oxygen consumption of the larvae of Corcyra cephalonica (Stainton)

Reduced effect of JH-I, JH-II and JH-III on oxygen consumption of II-V instars and increased effect on the oxygen consumption of VI instar larvae suggested that control of corcyra with juvenile hormones could be brought about only when applied to just emerged VI instar larvae. Similarly fumigation of juvenile hormone treated larvae could prove beneficial only at VI instar stage. The possibility of enhancing the effect of fumigant with pretreatment of JH will be futile as even only JH treated VI instar larvae develop into abnormal individuals which die later.

Voltammetric and amperometric transduction for solvent polymeric membrane ion sensors

This paper describes basic response features of solvent polymeric membrane ion sensors with voltammetric and amperometric transduction. The model systems used here contain no ionophore for simplicity reasons. Reasonable simplifications of the theory are introduced that allow one to understand the response mechanism in view of a practical application of these sensors. It is shown that ion-sensing membranes preferentially contain no ion-exchanger properties in order to function optimally in a voltammetric mode. As with the systems studied by Kihara, both liquid-polymer interfaces of the membrane are preferably polarizable. Specifically, they contain the highly lipophilic electrolyte tetradodecylammonium tetrakis(4-chlorophenyl)borate (ETH 500) in the membrane to improve lifetime, increase the magnitude of the potential window, and prohibit exchange reactions with sample ions. An ohmic behavior that is associated with an assisted electrolyte-transfer process is observed only above a threshold potential which can be quantitatively predicted by theory. The threshold potential depends on the nature and activity of sample anions and cations in the sample and inner filling solution of the membrane electrode. Within the experimental conditions discussed in this paper, these sensors seem to measure sample ion activities, not concentrations, since the rate-limiting step is the diffusion of extracted ions away from the interface into the membrane bulk. Similarly, no effect of sample stirring on the measured current is observed. This contrasts to work done on liquid-liquid electrolyte-transfer reactions, where large diffusion coefficients in the organic phase often lead to substantial sample depletion effects. The detection of anions and cations with the same membrane is demonstrated in a cyclic voltammetric mode. Direct continuous detection of one type of anion is accomplished by pulsed amperometry to ensure a rapid, repetitive renewal of the membrane composition between measurements.

The cultural origins of western depression

Focusing on the British cultural vocabulary of guilt, fatigue, energy, stress and depression; this paper argues that such vocabularies have their own unique histories and meanings; deeply embedded, in this instance, within "white British and western European" institutions. Predicated on a western epistemology, these constructs developed in response to prevailing concerns at different periods in western history; but are now assumed to be universal natural entities that await further scientific research and investigation. The cross-cultural validity of depression as a universal disorder is therefore dubious and needs an extensive re-examination.

Humoral concepts of mental illness in India

Based on interviews with patients at three allopathic psychiatric clinics in Bombay, Bangalore and Varanasi, employing a preliminary version of the Explanatory Model Interview for Classification (EMIC) to elicit indigenous explanations of illness and patterns of prior help seeking, we discuss popular humoral theories of mental disorder. Even though most laypersons are unfamiliar with the content of the classical treatises of Ayurveda, the humoral traditions which they represent influence current perceptions. Case vignettes clarify the nature of the relationship between cultural, familial and personal factors that influence the experience of illness.