Advancing the spontaneous hypertensive rat model of attention deficit/hyperactivity disorder

To advance the spontaneous hypertensive rat (SHR) model of attention deficit/hyperactivity disorder (ADHD), experiments examined the SHR in tasks recognized to assess functioning of the prefrontal cortex or dorsal striatal. Tasks included odor-delayed win-shift (nonspatial working and reference memory), win-stay (habit learning), and attentional set-shifting (attention and behavioral flexibility). In Experiment 1, the SHR strain was compared with Wistar-Kyoto (WKY) and Wistar-Kyoto Hypertensive (WKHT) strains on the first 2 tasks. In Experiment 2, oral methylphenidate (1.5 mg/kg) and vehicle (water) were evaluated on all 3 tasks in SHR and WKY strains. Results demonstrated that the SHR made significantly more errors in the odor-delayed win-shift, win-stay, and attentional set-shifting tasks compared with the WKY. Similar performances in the WKY and WKHT indicated that deficits observed in the SHR were not related solely to hypertension. Treating the SHR with methylphenidate eliminated strain differences in all 3 tasks. These findings provide evidence that the SHR is a valid model for studying ADHD-associated neurocognitive deficits. Moreover, the current behavioral approach is appropriate to assess novel medications developed to target ADHD-associated neurocognitive deficits.

Utility of PET imaging in predicting the aggressiveness and histopathology of lymphoma

8085

Background: F (18)-fluorodeoxyglucose positron emission tomography (FDG-PET) is widely used in the staging and restaging of non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). Few studies have investigated whether the intensity of tumor FDG uptake, measured by standard uptake value (SUV), a semiquantitative measure, could differentiate between indolent and aggressive disease. The clinical utility of SUV in determining the aggressiveness of NHL and HD and in differentiating histopathological subtypes was investigated in the present study. Methods: FDG-PET studies and histopathology of patients with NHL and HD were evaluated retrospectively. Inclusion criteria include PET before any therapy or on relapse of the disease, no diagnosis of diabetes mellitus or other types of cancer and time interval of < 90 days between PET and biopsy. After reviewing the PET scans, the SUV of biopsy site were measured by drawing regions of interest. Mean ± SD of SUV was calculated for HD and various histopathological subgroups of NHL. Results: Fifty-five patients (mean age 58.1 ± 17.2 years, 30 males, 25 females, 13 patients with HD, 42 with NHL, among which 24 with aggressive and 18 with indolent NHL) were included. The mean SUV was 9.9 ± 7.8 for aggressive NHL, 4.1 ± 2.6 for indolent NHL and 11.5 ± 7.3 for HD. Mean SUV was statistically different between aggressive and indolent NHL (p < 0.001) and HD and indolent NHL (p < 0.001), but not between aggressive NHL and HD (p = 0.4). The SUV for the aggressive NHL can be subdivided further as follows: anaplastic (n =3, 15.1 ± 1.7), diffuse large cell (n=19, 9.6 ± 5.3) and follicular grade III (n=2, 8.1 ± 2.2). Indolent NHL included: mantle cell (n=1, 4.3), marginal zone (n=1, 6.3), small cleaved (n=12, 4.2 ± 3.5), low grade follicular (n=4, 3.2 ± 1.4) and small lymphocytic NHL (n=1, 2.3). Conclusions: Our study suggests that FDG- PET can distinguish aggressive from indolent lymphomas. There was a considerable overlap between HD and aggressive NHL.A SUV of seven or less indicates indolent lymphoma. PET could potentially differentiate between different histopathological subgroups of lymphomas. Future studies with greater sample size are warranted.

No significant financial relationships to disclose.

Correlation of bone marrow micrometastases with nodal status in gastrointestinal tumors

14577

Background: Presence of bone marrow micrometastases (BMM) is an important prognostic factor for patients (pts) with solid tumors. Sentinel lymph node (SLN) mapping (M) has been found to upstage pts with gastrointestinal (GI) malignancies. However, a direct correlation between the presence BMM and nodal metastases (mets) is lacking. Hence, a retrospective study was undertaken to determine the relationship between BMM and nodal status in various GI malignancies. Methods: A total of 159 consecutive pts with GI malignancies were analyzed. Of these, 6 pts with non-epithelial tumors were excluded. All pts underwent bilateral posterior-superior-iliac spine bone marrow (BM) aspiration. BM samples were examined for micrometastases by Automated Cellular Imaging System using ChromaVision Cytokeratin Detection Kit to detect cells expressing CK8 as defined by CAM 5.2 monoclonal antibody. When feasible, SLNM was performed followed by standard oncologic resection (n=105). The SLN were examined by H&E and immunohistochemical (IHC) staining. Results: A total of 153 pts were analyzed in the study. Of these 13.72% (21/153) were found to have BMM (CI 8.70–20.21, p=0.05). When analyzed by sites, the incidence of BMM was 33.3% (4/12) for stomach cancer, 9.1% (1/11) for pancreatic cancer, 12.36% (11/89) for colon cancer and 16.13% (5/31) for rectal cancer. No BMM were detected in pts with cancer of esophagus (n=7), small bowel (n=2) and liver (n=1). The BMM was positive bilaterally in 61.9% (13/21), and unilaterally in 38.1% (8/21). In pts who underwent SLNM (n=105), BMM were detected in 11.11% of SLN positive pts vs. 10.14% for SLN negative pts (p=0.87). For a subgroup of pts with colorectal cancer who underwent SLNM (n=97), BMM were detected in 9.67% of SLN positive pts vs. 9.09% for SLN negative pts (p=0.92) Conclusions: BMM did not correlate with nodal status for GI malignancies suggesting a possible different mechanism for metastases. Detection of BMM may have a significant clinical value in SLN negative pts who may benefit from adjuvant therapy.

[Table: see text]

No significant financial relationships to disclose.

Comparative analysis of bone marrow (BM) micrometastasis (M) with sentinel lymph node (SLN) status in early breast cancer (BRCa)

508

Background: While sentinel lymph node (SLN) metastasis (mets) and bone marrow (BM) micrometastases (M) provide prognostic information in breast cancer (BRCa) patients (pts), a definitive relationship between the two has not yet been proven. We hypothesize that the presence of BMM may not infer an increased risk of SLN mets due to differences in their mechanisms of spread. Methods: We conducted a 6-year retrospective study of 251 T1/T2 BRCa pts who underwent bilateral iliac crest bone marrow aspiration, SLN mapping, and either lumpectomy, partial mastectomy, modified radical mastectomy, or total mastectomy by a single surgeon. BM samples were examined for micrometastases by Automated Cellular Imaging System using Chroma Vision Cytokeratin Detection Kit to detect cells expressing CK 8 as defined by CAM 5.2 monoclonal antibody. Pts with BMM underwent repeat BM analysis after completion of adjuvant chemotherapy. Data was collected for SLN, BM, ER/PR and HER2/neu status. Results: There were 251 consecutive pts entered into the study. Of these, 27.5% (69/251) had SLN mets and 9.6% (24/251) had BMM. Of the pts with SLN mets, 11.6% (8/69) had BMM vs. 88.4% (61/69) with no BMM ( Table ). In pts with ER/PR negative (-ve) BRCa, 7.1% (2/28) had BMM vs. 92.9% (26/28) with no BMM and 25% (7/28) had SLN positive (+ve) vs. 75% (21/28) SLN -ve pts ( Table ). Of the pts with HER2/neu +ve BRCa, 13.1% (8/61) had BMM vs. 86.9% (53/61) with no BMM and 26.2% (16/61) were SLN +ve vs. 73.8% (45/61) SLN -ve pts. After completion of adjuvant chemotherapy all pts with BMM (n=24) converted to BM -ve status. Conclusions: No correlation was identified between BMM and SLN status in T1 and T2 BRCa pts. This study suggests that BMM can occur independently of SLN status. Furthermore, (-ve) ER/PR and (+ve) HER2/neu status did not have a direct correlation with either BMM or SLN mets. Pts with BMM status may benefit from adjuvant therapy. Long-term implications of BM (+ve) have to be evaluated by larger multi- center trials.

[Table: see text]

No significant financial relationships to disclose.

Comparison of two doses of ropivacaine for lumbosacral epidural analgesia in buffalo calves (Bubalus bubalis )

Six male buffalo calves aged from six to eight months and weighing 100 to 120 kg were used to evaluate the efficacy and safety of caudal epidural analgesia produced by doses of 37.5 mg (5 ml) and 75 mg (10 ml) ropivacaine (0.75 per cent). The study was completed in two phases. In phase 1, all the animals were used twice to evaluate the analgesic and clinical effects of two doses of ropivacaine. In phase 2, the animals were divided into two groups of three to evaluate the effects of two doses of ropivacaine on some haemodynamic and acid-base parameters. Signs of analgesia, as evidenced by a loss of response to pinprick stimulation, were recorded only at the tail, perineum and hindlimbs of the animals given 5 ml ropivacaine, but they extended from the tail to the thorax (T9) in the animals given 10 ml ropivacaine. The duration of analgesia was five to six hours in the animals given 5 ml ropivacaine and seven to eight hours in the animals given 10 ml ropivacaine. Animals of both groups became recumbent, but the score for ataxia was higher in the animals given 10 ml ropivacaine. The respiratory rate decreased significantly (P<0.05) below the baseline in the animals given 10 ml ropivacaine, but the rectal temperature, heart rate, mean arterial pressure, central venous pressure and acid-base and electrolyte parameters did not change significantly in either group.

Association between lumbar epidural injection and development of acute paraparesis in patients with spinal dural arteriovenous fistulas

SUMMARY

We report 3 patients with previously undiagnosed spinal dural arteriovenous fistulas (SDAVFs), who developed acute paraparesis following lumbar epidural steroid injection. MR imaging demonstrated spinal cord T2 hyperintensity, edema and/or enhancement of the conus, and intradural enlarged vascular flow voids. Spinal angiography confirmed SDAVFs arising from pedicles remote from the sites of the epidural steroid injection. Fistulas were eliminated with either endovascular or combination endovascular and open surgical approaches, with subsequent partial resolution of paraparesis.

Direct sac puncture and N-butyl cyanoacrylate embolization of medial canthal arteriovenous malformation supplied by the external carotid artery and the internal carotid artery branches

We report a periorbital arteriovenous fistula that was treated with direct sac puncture N-butyl cyanoacrylate embolization under controlled inflow and outflow. The efficacy of this technique in a periorbital lesion is discussed.

Interactions of the fucose-specific Pseudomonas aeruginosa lectin, PA-IIL, with mammalian glycoconjugates bearing polyvalent Lewisa and ABH blood group glycotopes

Pseudomonas aeruginosa Fuc > Man specific lectin, PA-IIL, is an important microbial agglutinin that might be involved in P. aeruginosa infections in humans. In order to delineate the structures of these lectin receptors, its detailed carbohydrate recognition profile was studied both by microtiter plate biotin/avidin-mediated enzyme-lectin-glycan binding assay (ELLSA) and by inhibition of the lectin-glycan interaction. Among 40 glycans tested for binding, PA-IIL reacted well with all human blood group ABH and Le(a)/Le(b) active glycoproteins (gps), but weakly or not at all with their precursor gps and N-linked gps. Among the sugar ligands tested by the inhibition assay, the Le(a) pentasaccharide lacto-N-fucopentaose II (LNFP II, Galbeta1-3[Fucalpha1-4]GlcNAcbeta1-3Galbeta1-4Glc) was the most potent one, being 10 and 38 times more active than the Le(x) pentasaccharide (LNFP III, Galbeta1-4 [Fucalpha1-3]GlcNAcbeta1-3Galbeta1-4Glc) and sialyl Le(x) (Neu5Acalpha2-3Galbeta1-4[Fucalpha1-3] GlcNAc), respectively. It was 120 times more active than Man, while Gal and GalNAc were inactive. The decreasing order of PA-IIL affinity for the oligosaccharides tested was: Le(a) pentaose > or = sialyl Le(a) tetraose > methyl alphaFuc > Fuc and Fucalpha1-2Gal (H disaccharide)>2'-fucosyllactose (H trisaccharide), Le(x) pentaose, Le(b) hexaose (LNDFH I) and gluco-analogue of Le(y) tetraose (LDFT)>H type I determinant (LNFP I)>Le(x) trisaccharide (Galbeta1-4[Fucalpha1-3]GlcNAc) > sialyl Le(x) trisaccharide >> Man >>> Gal, GalNAc, and Glc (inactive). The results presented here, in accordance with the crystal 3D structural data, imply that the combining site of PA-IIL is a small cavity-type best fitting Fucalpha1- with a specific shallow groove subsite for the remainder part of the Le(a) saccharides, and that polyvalent glycotopes enhance the reactivity. The Fuc > Man Ralstonia solanacearum lectin RSL, which resembles PA-IIL in sugar specificity, differs from it in it's better fit to the B and A followed by H oligosaccharides vs. Fuc, whereas, the second R. solanacearum lectin RS-IIL (the structural homologue of PA-IIL) binds Man > Fuc. These results provide a valuable information on PA-IIL interactions with mammalian glycoforms and the possible spectrum of attachment sites for the homing of this aggressive bacterium onto the target molecules. Such information might be useful for the antiadhesive therapy of P. aeruginosa infections.

Comparative analysis of CT-scan and PET-scan with intraoperative ultrasound (IOUS) in detecting liver metastases

3632

Background: Open, laparoscopic or percutaneous radiofrequency ablation (RFA) has been used for the surgical treatment of liver metastases (mets). However, it requires accurate preoperative (preop) localization of liver mets. CT scan and PET scan have been widely used for such preop evaluation. However, intraoperative ultrasound (IOUS) remains the gold standard. Very little data is available comparing IOUS with preop CT and/or PET scan. Thus, a retrospective study was done to compare the efficacy of IOUS with preop CT and/or PET scan in detecting the number of liver mets. Methods: A retrospective chart review was done that included all patients (pts) who underwent surgical treatment for liver mets. Data was obtained from medical records, radiology, intraop reports. Results: 53 pts including 57% men and 43% women with a median age of 62years (age range 35–80 years) were included in the study. Imaging data was available for CT, PET and IOUS in 53, 24 and 39 pts respectively. CT, PET, and IOUS detected 2.4, 1.7 and 2.6 lesions/ pt respectively. In 24 patients, both CT and PET scan report was available. Of these, the imaging study detecting the maximum number of lesions was selected for comparison of preop evaluation with IOUS. A comparison between preop imaging (CT/PET scan) vs. IOUS in these 24 pts revealed an average of 2.3 vs. 2.8 lesions/pt respectively ( Table ). When compared with preop imaging (CT/PET scan), IOUS detected additional lesions in 33% pts; fewer lesions in 17% pts and similar number of lesions in 50% pts. Comparison between CT and IOUS in 39 patients revealed 1.9 vs. 2.6 lesions/pt respectively and that between PET and IOUS in 24 patients revealed 1.7 vs. 2.8 lesions/pt respectively. Conclusions: Although CT scan and PET scan remains effective modalities for preop evaluation of liver mets, IOUS is found to be superior for planning accurate surgical treatment. Thus, the efficacy of percutaneous RFA may be limited due to inability to perform IOUS.

[Table: see text]

No significant financial relationships to disclose.

Comparative analysis of MRI vs mammography in evaluation of size, number of lesions and nodal status of breast cancer

600

Background: Breast MRI is thought to be better in evaluating patients (pts) with BrCa. Our study was to compare MRI vs mam to predict leisons and LNS in BrCa. Methods: A retrospective study of 100 consecutive pts with pathologically proven BrCa was done. All had preoperative MRI and mam. Findings were compared to the final pathologic size, used as gold standard. MRI and was done at same center and single surgeon did all surgeries. Results: Of 100 pts,MRI reported 124 lesions. MRI reported size in 107 and mam reported size in 63 lesions. In MRI detected sizes 8% had same size as pathological size, 66% were overestimated by a mean of 0.64cm and 26% were underestimated by a mean of 0.48cm. For mam lesions, 10% had same size, 34% were overestimated by a mean of 1.10cm, 57% were underestimated by a mean of 0.78 cm. Total of 25 additional lesions were found in 23 pts in same and 6 leisons in 6 pts in contralateral breast by MRI. MRI also detected enlarged axillary and intramammary LN in 15% pts, 40% were true positives(+ve) and 60% were false +ve. One pt had metastatic LN in the contralateral axilla detected by MRI and confirmed by lymphoscintogram and pathology. 3% pts had neo-adjuvant chemotherapy Conclusion: In our study mam underestimated the breast lesion size in pts significantly more than MRI, but MRI overestimated BrCa lesion size in more number of pts. The mean difference in size on MRI when compared to the pathological size is less than 1 cm, while mam overestimated by a mean of greater than 1cm. This might be particularly important for T1 and T2 lesions, where size is the most important criterion for the T-stage classification. The identification of additional lesions and enlarged LN on MRI further validates the utility of MRI.

[Table: see text]

No significant financial relationships to disclose.

Axillary lymph node metastases from papilloma of the breast

10764

Background: To report a unique case of papilloma of the breast with metastases to the axillary lymph node. Methods: Case report and review of literature. Results: 80 year old Caucasian male presented with right gynacomastia of 3 months duration. The lesion was resected. Pathology was consistent with intraductal papilloma with hyperplasia and no evidence of malignancy. Subsequently, after 2–3 weeks a mass was noted in the right axilla. This mass was resected and was found to be consistent with papilloma of the axillary lymph node and had the pathological characteristics of the original breast papilloma. Conclusion: Solitary papillomas are generally lesions of the large ducts usually located in the subareolar region of the breast. They are among the commonest cause of spontaneous nipple discharge. After resection of the primary lesion, local recurrence is fairly common. Recurrence is especially common if hyperplasia is associated with the papilloma. There is also an increased incidence of carcinoma in the affected breast. Due to the benign nature of papillomas, they do not metastasize. We did an extensive review of literature and did not find any cases of metastatic lesions from a papilloma of the breast. The underlying reason and pathogenesis for the metastases is not known.

No significant financial relationships to disclose.

A Multistate Model for the Fluorescence Response of R-Phycoerythrin

Although strong fluorescence makes the R-phycoerythrin (R-PE) proteins increasingly useful in biological and clinical assays, they are subject to nonlinear effects including transitions to collective dark states and photodegradation, which complicate quantitative applications. We report measurements of R-PE fluorescence intensity as a function of incident power, duration of illumination and temperature. Emission intensity in the band at 570 nm is proportional to incident power for low power levels. At higher incident power, the emission at 570 nm is smaller than expected from a linear dependence on power. We propose that R-PE undergoes both reversible emission cessation on a millisecond time scale attributed to transitions to a collective dark state, and irreversible photodegradation on a time scale of minutes. Singlet oxygen scavengers such as dithiothreitol and n-propyl gallate have protective effects against the latter effect but not the former. Electrophoretic analysis of irradiated solutions of R-PE indicates that significant noncovalent aggregation is correlated with photodegradation. A multistate model based on fluorescence measurements and geometric analysis is proposed for the fluorophores in R-PE. The phycobilin fluorophores are partitioned into three groups: the phycourobilins (PUB) absorbing at 490 nm, one group of phycoerythobilins (PEB) absorbing at 530 nm (PEB-530) and another group of PEB absorbing at 560 nm (PEB-560). The two processes that result in the loss of fluorescence intensity are most likely associated with the PEB-560 group.

Isolation of pathogenic Legionella species and legionella-laden amoebae in dental unit waterlines

Legionella released into the air during treatment are a potential source of infection. Water stagnation in dental unit waterlines (DUWLs) creates biofilms and promotes the proliferation of these micro-organisms. This study investigated the presence of amoeba infected with legionella, L. pneumophila and other pathogenic Legionella species in a dental teaching hospital. Water samples were collected in the morning and afternoon from 99 dental units and 16 taps connected to the municipal water supply. Samples were plated on selective media and tested for legionella using the direct immunofluorescent antibody technique and the latex agglutination test. Legionella were found in 33% of the DUWLs and in 47% of the mains taps supplying these units. Legionella-laden amoebae occurred in one mains tap sample and in 20% of DUWLs in a clinic of the teaching hospital. L. micdadei was the predominant species isolated from this clinic. L. pneumophila serogroups 2-14 predominated in the mains water, whereas L. pneumophila serogroup 1 was found in approximately half of the contaminated DUWLs and mains taps irrespective of the time of sampling. Pathogenic Legionella species seeded by municipal water into DUWLs is a potential source of legionella infection for both dental personnel and patients during prolonged dental treatment. This problem is compounded by the presence of legionella-laden amoebae which may contain levels of organism well within the infective dose. The interaction of legionella with amoebae is an important ecological factor that may significantly increase the risk of legionellosis, and thus should be given further consideration in the refinement of risk assessment models.

Oral versus high dose parenteral iron supplementation in pregnancy

OBJECTIVE

To compare the effect of daily oral iron supplementation with two injections of high dose parenteral iron.

METHOD

A total of 220 pregnant women with a singleton pregnancy and hemoglobin between 8 to 11 g% at 16-24 weeks gestation were identified and randomly divided into two groups. Group A was started on daily oral iron therapy of 100 mg of elemental iron. Group B was given 250 mg of iron sorbitol intramuscularly and repeated at an interval of 4-6 weeks. Blood indices were evaluated at the beginning of study and at 36 weeks to see the effect after iron supplementation in the two groups. The data were analyzed using SPSS software, version 10.1.

RESULTS

Definitive and comparable improvement in hemoglobin and all the blood indices (hematocrit, MCH, MCHC, MCV, Serum iron and TIBC) was observed. The absolute change in hemoglobin and hematocrit was 1.18+/-0.68 g% and 4.02+/-2.59% in oral group, 1.34+/-0.77 g% and 4.93+/-3.65% in parenteral group, respectively. Serum ferritin showed statistically significant absolute rise (10.43+/-7.92 microg/dl) after parenteral iron supplementation as compared to oral iron supplementation (9.76+/-4.78 microg/dl). Obstetric outcome was comparable in two groups.

CONCLUSION

Two treatment regimens are biologically equivalent in terms of hematological response. Two high doses of intramuscular iron can be a good substitute to meet iron requirement in pregnancy.

Spontaneous common bile duct rupture in pregnancy

This report describes how a rare condition in pregnancy can present with features resembling more common diagnoses in the unwell obstetric patient. Our patient presented in late pregnancy initially with clinical features similar to mild preeclampsia, with proteinuric hypertension, epigastric pain and mildly deranged liver function tests. She went on to develop signs of acute abdomen associated with a persistent tachycardia and hypotension; there was evidence of fetal compromise. Following resuscitation, emergency caesarean section was performed and evolved into a laparotomy. The diagnosis was not clear clinically at this stage, but a retrospective amylase sample suggested acute pancreatitis. There was no clinical evidence of biliary perforation, but ongoing clinical suspicion prompted a CT of the abdomen. This proved unhelpful and our diagnostic dilemma was only resolved by endoscopic retrograde cholangiopancreatography, which demonstrated a biliary leak. A stent was placed with subsequent improvement in the patient's condition. With anaesthetists increasingly involved in the multi-disciplinary management of acutely sick obstetric patients, our case highlights the need for every practitioner involved in such cases to assess each individual fully, and be constantly aware that the diagnosis might not be obvious.

Cardiovascular response in anemia

OBJECTIVE

To study the functional consequences of nutritional anemia by evaluating the exercise performance in these children.

METHODS

The study was conducted on 30 each of anemic and normal children of both sexes aged between 7 and 14 years. Relevant history was taken, and detailed examination was done. These children were classified according to severity of anemia based on hemoglobin estimation as mild (10-11.9 g/dl), moderate (7-9.9 g/dl) and normal (>12 g/dl). Children with severe anemia (Hb < 7g/dl), heart disease, non-nutritional anemia, acute febrile or respiratory illness were excluded. The subjects were tested on Mortara X Scribe colour stress treadmill using the modified Bruce protocol. Continuous computerised electrocardiographic analysis was done. The parameters studied included heart rate, systolic blood pressure, double product (DP = HRxSBP), ECG changes, metabolic equivalents (METS) and exercise duration. The end point of the test was a HR of 170/min (non-fatigue group) or inability to perform further (fatigue group). Statistical analysis was done by appropriate tests.

RESULTS

Fifteen children each with mild and moderate anemia and 30 age-matched controls were enrolled in the study. There was no significant difference in the resting HR, exercise duration or DP between the cases and controls. Thirty-one children reached the target HR (non-fatigue group). The end-point HR was significantly lesser among the anemic children in the fatigue group (P 0.04). The percent gain of SBP, at peak exercise (P 0.0007) and recovery SBP as percent of resting SBP (p 0.006) were significantly more in the anemic children, more so in the mildly anemic ones. Lesser METS was achieved by anemics as compared to controls (P 0.04). ECG changes occurred significantly more often in anemic children, 53.8% of those with changes being moderately anemic, the main abnormality being ST depression. None developed arrhythmia during exercise testing.

CONCLUSION

The cardiovascular response to physical exercise is compromised in children with nutritional anemia and hence these children may never attain their full potential in various school activities. Prevention of anemia should be a priority in school going children.

Haematological effect of iron supplementation in breast fed term low birth weight infants

AIMS

To determine the haematological effects of iron supplementation in predominantly breast fed term low birth weight (LBW) infants.

METHODS

Seventy three healthy term LBW (<2500 g), predominantly breast fed infants aged 50-80 days were randomised into two groups to receive either iron (3 mg/kg/day) (iron supplemented (IS) group; n = 37) or placebo drops (placebo (P) group; n = 36). Haematological parameters and anthropometry were measured at baseline and repeated after four and eight weeks.

RESULTS

A total of 62 subjects (32 in the IS group and 30 in the P group) came for the first follow up and 26 (13 in the IS group and 13 in the P group) reported for the second visit. There were no significant differences in serum ferritin and anthropometry. However, covariates (infant age, haemoglobin, and ferritin, and maternal haemoglobin) adjusted haemoglobin change was significantly higher in the IS group after four weeks (4.6 g/l; 95% CI 0.5 to 8.8) and eight weeks (8.6 g/l; 95% CI 1.8 to 15.4).

CONCLUSIONS

Iron supplementation in a therapeutic dose in term breast fed LBW infants results in a marginal increase in haemoglobin. The functional benefit of this haemoglobin rise requires further evaluation.

Gelatinous transformation of bone marrow: a study of 43 cases

Gelatinous marrow transformation (GMT) is an uncommon and poorly recognized condition characterized by deposition of seromucinous gelatinous material in the bone marrow stroma. Forty-three cases of GMT were studied in a period of 4 years. There was male preponderance. Fourteen cases were in pediatric age group (less than 12 years). Majority of patients had a preceding history of anorexia, malnutrition and chronic debility. All the patients had anemia. Bone marrow biopsy revealed focal or diffuse GMT. Bone marrow aspirate showed metachromatic dense mucoid material with a few entrapped hematopoietic cells on Giemsa staining. The gelatinous material stained with alcian blue at pH 2.5.

Gastric mucosal fibrosis: a novel explanation for dyspepsia

The etiology of functional dyspepsia has not been discerned yet which has led to inadequate treatment of this disease. It remains a common disorder with expensive and yet often ineffective therapy. We propose that the pathogenesis of this disease lies in the histological and ultrastructural changes inflicted on the gastric mucosa in chronic gastritis and fibrosis. This hypothesis, if substantiated will provide for therapy which will be based on the pathogenesis of the disease and which will be cheaper and easily available to most. It will also add impetus to the early eradication of Helicobacter pylori, which would prevent chronic gastritis and hence gastric fibrosis.

Dural sinus thrombosis presenting as unilateral lobar haematomas with mass effect: an easily misdiagnosed cause of cerebral haemorrhage

Dural sinus thrombosis has protean clinical and radiological manifestations ranging from minimal effacement of sulci with no symptoms to severe haemorrhagic infarcts associated with focal deficits, coma and even death. An uncommon form of presentation is characterized by unilateral lobar haemorrhage associated with extensive oedema and parenchymal distortion. In an acute presentation, this might resemble haemorrhage into a tumour. In delayed presentations, the haematoma, being iso- or hypodense and showing peripheral ring-like enhancement, can mimic aggressive tumours or infective processes. As this is an uncommon condition, misdiagnosis is common with the potential for mismanagement and adverse outcomes. We present five such consecutive cases that were initially misdiagnosed as other entities. Each of these cases on closer inspection show features observed on CT and MRI that should have suggested a diagnosis of dural venous sinus thrombosis. One of these cases progressed to not only extensively involve the superficial sinuses but also the deep veins, with a significant adverse outcome. The imaging features of this interesting variant of dural sinus thrombosis are reviewed. The haemodynamic basis for haemorrhage and anatomical basis for the lateralization of the lesions are discussed.

Sensorineural hearing loss following acute bacterial meningitis in non-neonates

OBJECTIVE

Sensorineural hearing loss (SNHL) is an important sequelae of acute bacterial meningitis (ABM) in children. This study was undertaken to determine the incidence of SNHL following meningitis in non-neonates and its correlation with various factors.

METHODS

Children between the ages of 1 month and 12 years with ABM admitted in a teaching hospital over a period of 18 months were enrolled. Detailed history was taken, clinical examination performed and cerebrospinal fluid analyzed at commencement of therapy, 48 hours later and at the end of treatment. On discharge brainstem evoked response audiometry (BERA) was recorded. Data were analyzed using appropriate statistical tests.

RESULTS

Out of 32 children enrolled, 9 (28.1%) developed SNHL, bilateral in 21.9% and unilateral in 6.2%. Among hearing impaired subjects, 11.2% had mild while 44.4% each had moderate and profound hearing loss. Age, presence of vomiting, altered sensorium seizures and aminoglycoside usage were not significantly different in those with and without SNHL, but the total duration of fever was (p<0.05). There was significantly higher protein content and neutrophils in the second CSF sample of those with SNHL.

CONCLUSION

There is a greater than 50% probability of the child developing SNHL if neutrophil percentage in the second CSF is 80% or more. Since the overall risk of SNHL is significant in children with meningitis, it is recommended that BERA be recorded in all, so that early intervention may be possible.

Advances in understanding the mode of action of MBT fungicide used in wood protection

Interactions between methylene bisthiocyanate (MBT) and common wood degrading fungi of Pinus radiata were investigated The minimum inhibitory concentration (MIC) of MBT was determined in yeastmalt liquid medium and on radiata pine Higher treatment concentrations of MBT were required to control fungal growth on wood than in liquid culture irrespective of the test fungus used There were significant differences between the test fungi for MIC levels of MBT on diptreated wood with the highest degree of tolerance observed for Trichoderma viride (MIC le; 064 w/v) Further experiments suggested that vapour action and diffusibility both contributed to the fungitoxicity of MBT