Protein kinase D regulates the fission of cell surface destined transport carriers from the trans-Golgi network

When a kinase inactive form of Protein Kinase D (PKD-K618N) was expressed in HeLa cells, it localized to the trans-Golgi network (TGN) and caused extensive tubulation. Cargo that was destined for the plasma membrane was found in PKD-K618N-containing tubes but the tubes did not detach from the TGN. As a result, the transfer of cargo from TGN to the plasma membrane was inhibited. We have also demonstrated the formation and subsequent detachment of cargo-containing tubes from the TGN in cells stably expressing low levels of PKD-K618N. Our results suggest that PKD regulates the fission from the TGN of transport carriers that are en route to the cell surface.

Pattern of cancer in Dayanand Medical College & Hospital, Ludhiana (a ten year retrospective study)

A ten year retrospective study was undertaken to ascertain the pattern and incidence of cancer in Ludhiana which is an industrial town with catchment area of Ludhiana consisting of Ludhiana distt., Sangrur, Jalandhar, Hoshiarpur, Faridkot, Ferozepur, Ropar, Kapurthala, some parts of Himachel Pradesh and Haryana. A total number of 56,565 biopsies were received for histopathological examinaiton in 10 years and 4,730 cases of cancer were diagnosed. The incidence of total malignant tumors was 8.36%. Females out numbered males in the incidence of cancer, with male to female ratio being 1:1.09. Most of the cancers were seen in the age group of 41-50 years. In females the two most common cancer sites were breast (21.07%) and cervix (19.4%) while in males hypopharynx--larynx (13.94%) and prostate (9.65%) were the most common sites of cancer.

Transurethral resection of the prostate

Transuretheral resection of prostate (TURP) is a common operation in most hospitals. The patients are elderly and usually have concomitant diseases such as diabetes, hypertension, cardiac and respiratory ailments that increase their perioperative risk. Perioperative morbidity and mortality approaches 20% and 1% respectively. Regional anesthesia, notably spinal anesthesia, offers many advantages over general anesthesia for TURP with some evidence of lower morbidity even though similar mortality rates and overall outcomes are reported for both groups. Procedure-specific complications include TURP syndrome, bladder perforation, primary fibrinolysis, bacteremia, and septicemia. All are associated with significant morbidity and mortality but amenable to early and aggressive therapeutic intervention.

Is the technically limited echocardiographic study an endangered species? endocardial border definition with native tissue harmonic imaging and Optison contrast: a review of 200 cases

OBJECTIVE

Our goal was to determine whether contrast adds diagnostic value to both fundamental and native tissue harmonic imaging (NTHI) for endocardial border definition.

METHODS

Two hundred consecutive patients who underwent stress echocardiography imaging were studied in either fundamental (n = 52) or NTHI mode (n = 148) with an Acuson Sequoia echocardiographic system. Contrast agent (Optison) was administered (0.5 to 1 mL) for enhancement of endocardial borders. Two- and 4-chamber views were analyzed before and after administration of contrast at peak stress for grading of 5 endocardial border segments. Scores from 0 to 5 were assigned to each study for all the images both before and after contrast (0 = 0 segments completely visualized; 5 = 5 segments completely visualized).

RESULTS

The use of Optison contrast significantly enhanced border definition when imaging was performed in either fundamental or NTHI mode. Addition of contrast resulted in better endocardial border definition in fundamental mode (4.1 + or - 1.0 versus 2.3 + or - 1.3, P <.001). However, in NTHI mode, the presence of contrast resulted in enhanced definition of endocardial border compared with its absence (4.8 + or - 0.5 versus 3.3 + or - 1.1, P <.001). The combination of NTHI and contrast resulted in more visualization of endocardium when compared with the combination of fundamental imaging and contrast (4.8 + or - 0.5 versus 4.1 + or - 1.0, P <.001). In addition, interobserver agreement for border detection increased from 83% in fundamental mode without contrast to 95% with the use of NTHI with Optison (P <.001).

CONCLUSION

As defined in 200 cases, the combination of NTHI with Optison contrast results in nearly complete and consistent endocardial border definition.

Paraganglionoma of extrahepatic biliary tract causing obstructive jaundice

We report a young woman with paraganglionoma arising from the extrahepatic bile duct presenting with acute obstructive jaundice. The patient underwent excision of the gall bladder and extrahepatic bile duct with the tumor, and Roux-en-Y hepaticojejunostomy. She is asymptomatic 9 months later, with normal biochemical investigations and imaging.

Histological comparison of chronic hepatitis B and C in an Indian population

Many studies have shown that steatosis, lymphoid aggregates or follicles and bile duct injury on histology are more consistently associated with chronic hepatitis C than chronic hepatitis B. We compared liver biopsies of 30 patients of chronic hepatitis B with an equal number of age matched patients with chronic hepatitis C. Steatosis, lymphoid aggregates or follicles and bile duct injury were noted in 66.6%, 36.6% and 26.6% cases respectively of chronic hepatitis B as compared to 70%, 33.3% and 30% cases respectively of chronic hepatitis C. Thus none of the features were considered distinctive of HCV infection.

Molluscum contagiosum. A case report with fine needle aspiration cytologic diagnosis and ultrastructural features

BACKGROUND

Cytomorphologic and ultrastructural features of molluscum contagiosum, a rare skin lesion of viral etiology, are presented.

CASE

A 4-month-old female was referred for fine needle aspiration cytology of papules over the back and chest wall. A Giemsa-stained preparation of whitish material aspirated from the chest wall nodule showed numerous large, intracytoplasmic, basophilic bodies that pushed the host cell nucleus to the periphery, giving a signet-ring appearance to a few cells. A cytologic diagnosis of molluscum contagiosum was suggested. On electron microscopy numerous intracytoplasmic viral particles were demonstrated, thus confirming the cytologic diagnosis.

CONCLUSION

In clinically unsuspected cases, the cytologic diagnosis of molluscum contagiosum can be suggested by demonstrating pathognomonic molluscum bodies in aspirated material.

Hemangiopericytoma in a child: a case report

Hemangiopericytoma (HPC) is a rare vascular tumour seen infrequently in the paediatric age group. It has an incidence of about 10% in children. The difficulty in assessing the malignant potential of this tumour may cause confusion to the clinician in deciding the proper line of management.

Gbetagamma-mediated regulation of Golgi organization is through the direct activation of protein kinase D

We have shown previously that the betagamma subunits of the heterotrimeric G proteins regulate the organization of the pericentriolarly localized Golgi stacks. In this report, evidence is presented that the downstream target of Gbetagamma is protein kinase D (PKD), an isoform of protein kinase C. PKD, unlike other members of this class of serine/threonine kinases, contains a pleckstrin homology (PH) domain. Our results demonstrate that Gbetagamma directly activates PKD by interacting with its PH domain. Inhibition of PKD activity through the use of pharmacological agents, synthetic peptide substrates, and, more specifically, the PH domain of PKD prevents Gbetagamma-mediated Golgi breakdown. Our findings suggest a possible mechanism by which the direct interaction of Gbetagamma with PKD regulates the dynamics of Golgi membranes and protein secretion.

Hepatic fibrogenesis using chronic arsenic ingestion: studies in a murine model

Chronic oral arsenic (As) ingestion has been alleged to cause hepatic fibrosis, non-cirrhotic portal fibrosis and cirrhosis of the liver. The present study was aimed to investigate if hepatic fibrogenesis and non-cirrhotic portal fibrosis (NCPF) is caused by arsenic. A significant increase in the hepatic protein and collagen was seen compared with controls; hepatic 4-hydroxyproline levels, indicative of fibrogenesis, were increased 4-14 folds with different dosages of arsenic compared to the controls. Hepatocellular necrosis and inflammation were negligible to mild in all the groups. None of the animals developed significant splenomegaly or features of non-cirrhotic portal hypertension. The results suggest that (i) prolonged oral arsenic ingestion in mice leads to significant hepatic fibrogenesis and collagen synthesis with minimal hepato-cellular injury; (ii) arsenic ingestion alone is unlikely to cause non-cirrhotic portal fibrosis or cirrhosis of liver. This murine model of arsenic feeding could be used for the evaluation of new antifibrotic agents for the liver.

Aetiology of chronic diarrhoea in tropical children

AIM

We studied the causes and presentations of chronic diarrhoea in post-weaned children.

METHODS

Forty seven children (6 months to 12 years) with diarrhoea of more than 2 weeks duration were recruited and subjected to detailed clinical examination and investigations.

RESULTS

Primarily on the basis of history, clinical examination and duodenal biopsy, children could be classified into 5 groups namely tropical enteropathy (46.8%), irritable bowel syndrome (10.6%), giardiasis (14.8%), celiac disease (6.8%) and non specific diarrhoea (21.8%). Children with tropical enteropathy improved with broad spectrum antimicrobial therapy, those with irritable bowel syndrome and non specific chronic diarrhoea with dietary interventions while children with celiac disease required definite withdrawal of gluten from diet.

A case of hepatocellular carcinoma associated with troublesome hypoglycemia: management by cytoreduction using percutaneous ethanol injection

Hypoglycemia is a well-known paraneoplastic manifestation of hepatocellular carcinoma. However, hypoglycemia as the first presentation is extremely uncommon. We herein report a case of HCC presenting with severe, uncontrollable hypoglycemia that was managed with percutaneous ethanol injection therapy.

The organisation of the Golgi apparatus

The past year has seen considerable progress in understanding the mechanism of COPI (coatomer protein I) vesicle docking and SNARE (soluble NSF attachment protein receptor) mediated fusion, the mechanism of cisternal growth and stacking and the regulation of Golgi architecture. The route taken by cargo proteins through the Golgi apparatus is still a matter of some dispute.

Dysembryoplastic neuroepithelial tumour

We report here a classic case of dysembryoplastic neuroepithelial tumour, which was situated in the left frontal lobe of a 13-year-old boy who presented with intractable partial complex seizures since 3 years of age. This tumour entity was first described in 1988, and has been incorporated in the 2nd edition (1993) of the WHO histological typing of CNS tumours. Fewer than 100 cases have been reported from all over the world. To our knowledge, this is the first report of this tumour from India. It is important to recognise this entity since surgery is the only means of cure and radio- or chemotherapy is unwarranted.

Nucleolar organizer regions in cirrhosis and hepatocellular carcinoma

The argyrophilic technique for staining proteins associated with nucleolar organizer regions (AgNOR's) was applied to 32 liver biopsy specimens. These included 10 normal livers, 10 cirrhosis, 10 hepatocellular carcinomas (HCC) and 2 cholangiocarcinomas. The range of the mean number of NORs per nucleus was 1.3-1.7 (95% CI: 1.4-1.6) for normal liver, 2.4-3.5 (2.8-3.2) for cirrhosis, 3.0-7.9 (3.7-5.6) for HCC and 4.0-4.2 (3.9-4.3) for cholangiocarcinoma. The difference observed was statistically significant. The AgNORs were small and discrete in normal and cirrhotic liver and relatively larger and scattered in distribution in HCC. These results indicate that both quantitative and qualitative analysis of AgNORs may be useful as an adjunct to routine haematoxylin and eosin stain to distinguish cirrhosis from HCC especially when the latter is well differentiated.

Low-dose recombinant interferon therapy in anti-HBe-positive chronic hepatitis B in Asian Indians

Approximately 15% of Indian patients with hepatitis B virus (HBV)-related chronic liver disease (CLD) have infection with precore mutant forms. These patients are likely to have an aggressive course. There are equivocal reports of success with interferon therapy of mutant infection in the West. This therapy has not been evaluated in precore mutant-related CLD in Asian Indians. Eighteen patients (mean age 38.2 +/- 12 years, M:F: 17:1) with biopsy proven CLD and precore mutant HBV infection (hepatitis B surface antige (HBsAg) positive, hepatitis B e antigen (HBeAg) negative, anti-HBe positive, HBV-DNA positive) were included. Interferon alpha 2b was given at 3 mIU on alternate days for 4 months. Serology, determination of HBV-DNA (both by dot-blot hybridization and polymerase chain reaction) and liver biopsy were repeated after completion of the therapy. Response to interferon therapy was defined as loss of HBV-DNA by dot-blot hybridization. Thirteen (72.2%) patients responded to the treatment (responders). Mean alanine aminotransferase levels (83 +/- 12 vs 55 +/- 29 IU/L, P < 0.01) and the histological activity index (15 +/- 1.4 vs 12 +/- 1.3, P < 0.01) significantly decreased in the responders compared with initial values. Serum albumin levels also improved at the end of the therapy (3.5 +/- 0.4 g/dL vs 3.8 +/- 0.4 g/dL, P = 0.07). During follow up, seven of the 13 (54%) responders relapsed; cirrhotics relapsed more often than chronic hepatitis patients (P < 0.05). All 18 patients, however, continued to be HBV-DNA positive at the end of follow up. This study concluded that: 1. Interferon therapy is beneficial, albeit to a limited extent, in HBV precore mutant-related chronic liver disease in Asian Indians. 2. It is ineffective in eliminating the mutant HBV infection, which explains the high relapse rate. 3. Prolonged low-dose interferon therapy alone or in combination with newer nucleoside analogues should be evaluated in these patients.

Tuberculosis of the gall bladder

Tuberculosis of the gall bladder is rare. We report a patient with this condition with seedlings in the umbilicus.

Ultrasound-guided fine-needle aspiration cytology diagnosis of gallbladder lesions: a study of 82 cases

Carcinoma of the gallbladder (GB) is among the five most common forms of cancers and tops the list of gastrointestinal malignancies in females of the Delhi region. Lack of specific signs and symptoms prevents early detection of GB carcinoma. However, in recent years ultrasonographically (US)-guided fine-needle aspiration (FNA) cytology has been found to be a reliable procedure for its diagnosis. The present study was carried out during a period of 5 yr (1986-1990) in 64 female and 18 male patients to find out the diagnostic utility of US-guided FNA cytology in gallbladder lesions. Ultrasonography in these 82 cases revealed a mass in the gallbladder/GB area in 74 (90.2%), a mass in the GB/pancreas in 1 (1.2%), gallstones in 32 (39.0%), and miscellaneous gallbladder lesions in 4 (4.9%). The other findings included space-occupying lesions in liver in 18 (22.0%), portal lymphadenopathy in 12 (14.6%), and infiltration in other organs in 7 (8.5%). The initial cytodiagnosis was malignancy in 48 cases, inflammatory in 12, and inadequate in 22. Following review of the smears by one of the investigators (D.K.D.), the number of malignant cases remained 48 (58.5%). There were 10 (12.2%) inflammatory and 24 (29.3%) inadequate cases. Adenocarcinoma was the most common malignancy (83.3%), followed by squamous-cell and adenosquamous carcinoma (12.5%) and small round cell tumors (4.2%). The 10 inflammatory lesions showed slight (+) to excessive (+3) neutrophilic infiltration and included one case each of xanthogranulomatous cholecystitis and a necrotizing granulomatous lesion likely to be of tuberculous etiology.

Helicobacter pylori infection in recurrent abdominal pain

OBJECTIVE

To study the relationship between Helicobacter pylori (Hp) infection and recurrent abdominal pain (RAP) and to evaluate various modalities to diagnose Hp infection.

DESIGN

Prospective case control study.

SETTING

Teaching hospital.

METHODS

Children between 3-12 years of age with RAP in whom upper gastrointestinal endoscopic examination was indicated were studied. Endoscopic biopsy specimen were collected from duodenum, antrum and esophagus. Apart from histopathological examination of biopsy material, rapid urease test (RUT) of the antral biopsy specimen and blood examination to estimate specific IgG antibodies to Hp by Indirect Solid Phase Enzyme Immunoassay was performed. The results of Hp IgG antibodies was compared with age matched controls.

RESULTS

Thirty one children with RAP were subjected to endoscopic examination and their anti Hp IgG antibodies status compared with 26 controls. Hp colonization was detected in 7 children (23%) with RAP; by RUT in 23% and antral biopsy in 16% of cases. Anti Hp IgG antibodies were also positive in almost equal proportion (19%) of controls (p = 0.757). Endoscopic examination revealed esophagitis in 16% of cases and none had evidence of gastric or duodenal erosion, ulcer or cobblestone appearance of antrum. A significant correlation of Hp was noticed with chronic antral gastritis (p = 0.002), chronic duodenitis (p = 0.02) and age > 10 years (p = 0.02). No significant correlation was noticed between Hp colonization and various socioeconomic risk factors.

CONCLUSION

Hp does not seem to be commonly associated with RAP in our patient population as Hp colonization was detected in only 23% of cases which was not significantly higher than the seroprevalence of anti Hp IgG antibodies in the controls. However, a small sample size of our study limits drawing any firm conclusions. Antral gastritis and chronic duodenitis had a significant correlation with Hp colonization. RUT was found to be a reliable diagnostic test to detect Hp.

Signaling via mitogen-activated protein kinase kinase (MEK1) is required for Golgi fragmentation during mitosis

We have developed an assay using permeabilized cells to monitor fragmentation of the Golgi complex that occurs during mitosis. Golgi stacks, in permeabilized interphase normal rat kidney (NRK) cells, upon incubation with mitotic extracts undergo extensive fragmentation, and the fragmented Golgi membranes are dispersed throughout the cytoplasm. We find that the continued presence of p34cdc2, the mitosis initiation kinase, is not necessary for Golgi fragmentation. Instead, fragmentation depends on cytosolic mitogen-activated protein kinase kinase 1 (MEK1 or MAPKK1). However, the known cytoplasmic substrates for MEK1, ERK1, and ERK2 are not required for this process. Interestingly, we find a Golgi-associated ERK, which we propose as the likely target for MEK1 in Golgi fragmentation.

Acute renal failure in the elderly: a demographic and clinical study of patients in eastern India

A total of 638 patients with acute renal failure (ARF) of diverse etiology were studied over a period of 9 years (July 1985-Dec, 1994) of which 96 (15%) patients were classified as elderly ARF with mean age of 72.5 years. Medical causes accounted for 80% of geriatric ARF while 20% patients, had ARF of surgical origin. Decreased renal perfusion resulting from gastroenteritis was the predominant (52.8%) cause of ARF in the medical group. Nephrotoxic ARF and ARF due to F. malaria were seen in 10 and 7 patients respectively. Obstructive uropathy was observed in 12 patients in surgical group and in remaining 8 patients ARF developed following various surgical procedures. ARF in association with multiorgan failure was not observed in our study. Mortality was seen in 24 patients (25%). The causes of mortality were GI bleed (6), peripheral circulatory failure (5), hyperkalemia (4) and sepsis (4). Thus medical ARF remains the major cause of acute renal failure in elderly patients in our study in contrast to ARF associated with multiorgan failure and surgery in developed countries.

The mechanism of Golgi segregation during mitosis is cell type-specific

Golgi membranes in Drosophila embryos and tissue culture cells are found as discrete units dispersed in the cytoplasm. We provide evidence that Golgi membranes do not undergo any dramatic change in their organization during the rapid mitotic divisions of the nuclei in the syncitial embryo or during cell division postcellularization. By contrast, in Drosophila tissue culture cells, the Golgi membranes undergo complete fragmentation during mitosis. Our studies show that the mechanism of Golgi partitioning during cell division is cell type-specific.