Identification of a mouse orthologue of the CED-6 gene of Caenorhabditis elegans

The rapid engulfment of apoptotic cells is a specialized innate immune response used by organisms to remove apoptotic cells. In mammals, several receptors that recognize apoptotic cells have been identified. Previous analysis of the engulfment gene ced-6 in Caenorhabditis elegans (C. elegans) has suggested that CED-6 is an adapter protein that participates in signal transduction pathway that mediates the specific recognition and engulfment of apoptotic cells. Here, we describe our isolation and partial characterization of a mouse cDNA, which is like an orthologue of C. elegans CED-6. PCR screening of mouse cDNA pool with primers designed from the C. elegans CED-6 cDNA sequence resulted in about 300 bp PCR product which was partially sequenced and then screened to a mouse full-length cDNA library. Thus in this study we report the identification of a novel C. elegans CED-6-like orthologue in mouse, which has probable apoptotic like function.

Cystitis cystica glandularis masquerading as a bladder tumor

A young man admitted with complaints of painless paroxysmal gross hematuria was found to have bilateral vesical masses involving the bladder base, trigone and ureteric orfices. Urine cytology and AFB were negative. Transurethral resection of the bladder mass was carried out and the histopathology suggested cystitis cystica glandularis. The literature regarding this entity has been reviewed and the differential diagnosis discussed.

Primary small cell neuroendocrine carcinoma of urinary bladder: an uncommon entity to be recognized

INTRODUCTION

To describe the clinical presentation, diagnosis and treatment outcome of neuroendocrine carcinoma of urinary bladder.

METHODS

Clinical and pathological findings of 11 patients with diagnosis of small cell neuroendocrine tumour (SCNE) of urinary bladder are reviewed between Jan. 1991 to Jan 2001. Clinical data including age, sex, presenting symptoms, clinical stage at presentation, modality of treatment and outcome were determined. Sections of the tumour were studied by immunohistochemical methods using various antibodies to determine neuroendocrine pattern.

RESULTS

Patient age ranged from 35 to 79 years (mean 60 years). The clinical presentation included, gross hematuria 6, increased urinary frequency and dysuria 3, hydroureteronephrosis with flank pain 2. 3 patients had open exploration for presumed bladder stones by suprapubic route. Undifferentiated carcinoma was the initial report in 2 and associated transitional cell carcinoma in 2 cases. Urinary cytology obtained in 4 patients showed poorly differentiated carcinoma. Immunohistochemistry showed in all cases. 7 patients had radical cystoprostatectomy with adjuvant chemotherapy and 4 patients had combination of chemotherapy and radiotherapy. The survival ranged from 6 months to 30 months (mean 16.5 months).

CONCLUSION

Primary small cell neuroendocrine carcinoma of urinary bladder is an aggressive malignancy with poor long-term outcome. Awareness of clinical presentation with free application of immunocytochemistry is emphasized to diagnose this unusual malignancy at earliest.

Efficacy and outcome of surgical intervention in patients with nephrolithiasis and chronic renal failure

AIM

To prospectively evaluate the efficacy and outcome of surgical intervention in patients with renal stones and chronic renal insufficiency.

METHODS

The study was carried out from January 1999 till January 2001. Only patients with chronic renal failure without medical renal disease were taken up for study. All patients were subjected to an ultrasound assessment of the kidney, ureter and bladder. In case of obstructed and infected systems a preliminary percutaneous nephrostomy was carried out. After correction of dyselectrolytemia, acid base imbalance and dialysis (if indicated) patients were subjected to surgical intervention (open surgery or percutaneous nephrolithotomy). ESWL was offered for stones persisting after surgery. The stone burden, composition, therapeutic procedures required to render patients stone free were assessed. The outcome of stone removal on renal function was also evaluated by serial renal dynamic scans and creatinine clearance estimations.

RESULTS

Out of 90 patients operated for staghorn or calyceal calculi, complete follow up data was available in 70. Pyelo-nephrolithotomy and percutaneous nephrolithotomy was carried out in 63 and 7 patients respectively. Out of 15 patients with residual stones ESWL was successfully performed in 9 cases. Mixed, calcium oxalate monohydrate, calcium oxalate dihydrate, and struvite stones were encountered in 48%, 14%, 17% and 21% respectively. The average pre operative serum creatinine was 4.76 (1.9-16) mg%. The maximum duration of follow up was 9 months. By the 9th post operative month the average fall in serum creatinine values was 1.53 mg/dl (32%) and the average functional improvement by renal dynamic scans stood at 20.665%. 41 patients were saved from further dialysis.

CONCLUSION

Patients with mild to moderate renal failure showed maximal improvement in renal function forestalling or reducing the need for dialysis/renal replacement therapy.

Laser endoscopic incision: a viable alternative to treat adult ureterocele

AIM

To prospectively evaluate the safety. efficacy, feasibility and outcome of Nd-Yag laser endoscopic incision in adult symptomatic patients with intravesical uretroceles.

METHODS

We present our experience with the use of Nd-Yag laser for endoscopic incision of the adult ureterocele in a group of five symptomatic adult patients.

RESULTS

All the five patients showed excellent decompression with relief from flank pain and hydronephrosis and none demonstrated a post-op vesicoureteric reflux (VUR).

CONCLUSION

Laser endoscopic management of intravesical ureteroceles is new emerging modality, which is being increasingly employed to decompress ureteroceles. Laser endoscopic incision is a precise and bloodless procedure enabling a clean accurate controlled cut through the endoscope as opposed to the traditional bugbee electrode.

Colovesical fistula an unusual complication of cytotoxic therapy in a case of non-Hodgkin's lymphoma

A 65-year old man, a known case of non-Hodgkin's lymphoma of base of the tongue and epiglottis presented with complaints of pneumaturia and faecaluria. He had received the first cycle of cytotoxic therapy (CHOP-regimen). At the end of the cycle he developed febrile neutropenia (circulating granulocyte count <1500/mm3). Cystogram showed air in the bladder area and a fistulous communication to a cavity behind the bladder. CT-scan showed air in the bladder, a fistulous communication between the sigmoid colon and bladder along with an intervening small abscess cavity. On exploration a fistulous communication between the sigmoid and bladder along with an intervening small abscess cavity was found. Resection of involved portion of sigmoid and end to end anastomosis along with a diverting colostomy was done. The bladder was closed in two layers with an omental interposition between it and the sigmoid along with a suprapubic cystostomy. The histopathology demonstrated only inflammatory response without any evidence of malignancy or diverticular disease.

Cost-reductive retroperitoneal excision of large adrenal pseudocyst: a case report and review of the literature

We report a case of a non-functioning cystic adrenal mass. It was detected on an abdominal ultrasound carried out for right flank pain in a 45-year-old lady. Biochemical parameters like 24-hour urinary free cortisol, catecholamines and serum potassium level were normal. Retroperitoneoscopic excision of the large cystic mass was done by using our cost-reductive technique as previously described. Histopathology turned out to be a pseudocyst with wall fibrosis and calcification.

Urethral stone presenting as a stop valve--a rare complication of balanitis xerotica obliterans

Balanitis xerotic obliterans (BXO) is the genital subcategory of lichen sclerosis et atrophicus. The association of BXO with urethral stone causing interruption of the urinary stream and voiding by manual displacement of the urethral stone has not been described before. We describe one such case of a young boy with BXO and urethral stone who voided by manually displacing the stone for over a year. The case is reported to emphasize the ingenuity of the patient in continuing to void for over a year despite the association of the impacted urethral stone with urethral stricture and BXO.

Pedunculated prolapsing bladder hematoma (pseudotumor) mimicking an anterior vaginal polyp--a clinical curiosity and rare complication of transurethral resection of bladder tumor

A young woman who presented with a recurrent bladder tumor was detected on follow up to be harboring a prolapsed bladder tumor at the external urinary meatus mimicking an anterior vaginal polyp. Excision and histopathological examination revealed an organized hematoma (pseudotumor). The literature regarding this clinical curiosity and its differential diagnosis is reviewed and discussed.

Transurethral resection versus open surgery for leiomyoma of urinary bladder--a report of 2 cases

The authors describe two patients with leiomyoma of the bladder who presented with bladder outlet obstruction. The results of magnetic resonance imaging are presented and their management discussed. Complete resection was curative in both patients, by enucleation in the first case and by transurethral resection in the second.

Bioequivalence assessment of rifampicin, isoniazid and pyrazinamide in a fixed dose combination of rifampicin, isoniazid, pyrazinamide and ethambutol vs. separate formulations

Depending on the patient category, tuberculosis requires treatment with 3 to 5 drugs which means that patient's compliance to therapy may not be optimal. To increase patient's adherence to treatment schedules, these drugs can be given as single drug preparations or fixed dose combinations (FDCs) of 2 or more drugs in a single formulation. However, an important issue associated with a rifampicin-containing FDC is its quality. Hence, to avoid spurious formulations entering the market, the World Health Organization and the International Union Against Tuberculosis and Lung Disease have recommended FDCs only of proven bioavailability. In this study, the relative bioavailability of rifampicin, isoniazid and pyrazinamide was assessed in a group of 14 healthy male subjects using the FDC tablet containing 4 drugs versus separate formulations at the same dose levels. The study was designed as an open, crossover trial. A total of 9 blood samples were collected over a period of 24 h. The concentration of rifampicin, its main metabolite desacetyl rifampicin, isoniazid and pyrazinamide in plasma were assessed using HPLC analysis. The pharmacokinetic parameters AUC(0-24) and Cmax were subjected to parametric and non-parametric statistical tests at 90% confidence interval. In addition, time to reach peak concentration (tmax), elimination rate constant (Kel) and terminal elimination half-life (t1/2) for each drug were also calculated. It was concluded that the FDC tablet containing 4 drugs is bioequivalent to separate rifampicin, isoniazid and pyrazinamide formulations at the same dose levels.

Mesonephroid adenocarcinoma of the bladder and urethra: a case report

Mesonephric or mesonephroid adenocarcinoma of the bladder may be a malignant form of nephrogenic adenoma or nephroid metaplasia. The lesion is rare, and to the best of our knowledge only 9 cases have been reported in the world literature. We report another case of mesonephroid adenocarcinoma of the bladder and urethra which was treated with transurethral resection and subsequent chemotherapy.

Health issues in ethnic minorities: awareness and action

A key issue in health provision is the approach to health inequalities. In the UK, black and ethnic minority populations are disadvantaged in this respect. We obtained annual/public health reports from 13 health authorities (HAs) and 22 primary care trusts/groups (PCT/Gs) serving conurbations with large black and ethnic minority populations, and examined them for mention of special health issues for these groups and the action being taken. 22 of the 35 reports referred to such issues but only 17 referred to special initiatives; the most frequently mentioned were diabetes and coronary heart disease. We recommend that HAs and PCT/Gs serving large black and ethnic minority populations state specifically in their annual reports their awareness of health-equality issues and the action being taken to address them.

Endourologic management of obstetrical ureterouterine fistula: case report and review of literature

A 32-year-old woman presented to us with complaints of paradoxical incontinence for a period of 6 months following a cesarean section for obstructed labor performed elsewhere and subsequently treated elsewhere. Clinical and urographic assessment revealed an iatrogenic ureterouterine fistula, which was successfully treated endoscopically by dilatation of the ureteral stricture and ureteroscopic double-J stenting. It had been explained to the patient, and she had given consent for, ureteroneocystostomy in the event of failure. The literature regarding the management of this rare genitourinary fistula is reviewed and discussed.

Primary squamous cell carcinoma of the prostate: a rare clinicopathological entity. Report of 2 cases and review of literature

Primary squamous cell carcinoma of the prostate is an uncommon clinicopathological entity. It differs from more common adenocarcinomas in its cell of origin, biological behavior, therapeutic response to the usual hormonal manipulation and prognosis. The review shows that squamous cell carcinoma is biologically more aggressive than adenocarcinoma. Despite the agreement on its uniqueness, a controversy exists on the exact histopathogenesis, diagnostic criteria and modality of treatment. We report on 2 patients with primary squamous cell carcinoma of the prostate. One patient presented with lower urinary tract symptoms with a hard nodular prostate on digital rectal examination, and the other with acute urinary retention on normal digital rectal examination. The evaluation revealed metastasis in the pelvic and right femur in both cases. Palliative transurethral resection of the prostate with chemotherapy (Adriamycin based) was given in both the cases. However, both the patients died at 4 and 5 months of follow-up, respectively.

Co-ordinate regulation of growth factor receptors and lipid phosphate phosphatase-1 controls cell activation by exogenous lysophosphatidate

The serum-derived lipid growth factors, lysophosphatidate (LPA) and sphingosine 1-phosphate (S1P), activate cells selectively through different members of a family of endothelial differentiation gene (EDG) receptors. Activation of EDG receptors by LPA and S1P provides a variety of signalling cascades depending upon the G-protein coupling of the different EDG receptors. This leads to chemotactic and mitogenic responses, which are important in wound healing. For example, LPA stimulates fibroblast division and S1P stimulates the chemotaxis and division of endothelial cells leading to angiogenesis. Counteracting these effects of LPA and S1P, are the actions of lipid phosphate phosphatases (LPP, or phosphatidate phosphohydrolases, Type 2). The isoform LPP-1 is expressed in the plasma membrane with its active site outside the cell. This enzyme is responsible for 'ecto-phosphatase' activity leading to the degradation of exogenous lipid phosphate mediators, particularly LPA. Expression of LPP-1 decreases cell activation by exogenous LPA. The mechanism for this is controversial and several mechanisms have been proposed. Evidence will be presented that the LPPs cross-talk with EDG and other growth factor receptors, thus, regulating the responses of the cells to lipid phosphate mediators of signal transduction.

Lovastatin treatment decreases mononuclear cell infiltration into the CNS of Lewis rats with experimental allergic encephalomyelitis

Mononuclear cell infiltration into the CNS and induction of inflammatory cytokines and iNOS in diseases like multiple sclerosis (MS) and experimental allergic encephalomyelitis (EAE) have been implicated in subsequent disease pathogenesis and progression. We report that Lovastatin treatment blocks the clinical disease and induction of inflammatory cytokines and iNOS in spinal cords of MBP induced EAE rats. A significant number of the infiltrating cells in CNS were ED1+ cells of monocyte/macrophage lineage. To understand the mechanism of efficacy of Lovastatin against EAE, we examined the effect of Lovastatin on the transmigration of mononuclear cells into EAE spinal cord. The data presented here documents that Lovastatin treatment attenuates the transmigration of mononuclear cells possibly by down regulating the expression of LFA-1, a ligand for ICAM, in endothelial-leukocyte interaction. These results indicate that Lovastatin treatment prevents infiltration by mononuclear cells into the CNS of rats induced for EAE, thereby lessening the histological changes and clinical signs and thus ameliorating the disease. These observations indicate that Lovastatin treatment may be of therapeutic value against inflammatory disease process associated with infiltration of activated mononuclear cells into the tissue.

Severely encrusted polyurethane ureteral stents: management and analysis of potential risk factors

OBJECTIVES

To review the management of heavily encrusted and stuck JJ ureteral stents. We report our experience and review current published reports in managing heavily encrusted and stuck JJ stents, the guidelines for management, and the prevention of such problems.

METHODS

We reviewed our stent records from January 1994 to December 2000 and analyzed our stent complications and their final outcome. Fifteen patients had heavily encrusted and stuck stents. Of these, 14 were encountered in patients with a sizable stone burden (400 to 650 mm(2)) and 1 occurred in a patient with malignant ureteral obstruction. Sandwich combinations of multiple extracorporeal shock wave lithotripsy/traction and endourologic procedures were used to render them stone and stent free. The stent was examined and the encrustation was analyzed by x-ray crystallography.

RESULTS

Of 15 patients, 13 were available for evaluations; 1 patient was lost to follow-up and 1 patient died. The average stone burden was 625 mm(2). The encrustation was localized to the upper end in eight and to the lower and upper end in three. In 4 cases, the entire stent was encrusted, and the lumen was occluded in 12. All 13 patients with stuck, fragmented, and encrusted stents were rendered stone and stent free; 2 of the 13 had clinically insignificant residual stones (less than 2 mm). Calcium phosphate and monohydrate stones were the most commonly encountered stone encrustations.

CONCLUSIONS

Stent encrustation is one of the most serious complications of polyurethane JJ stents. Multimodal endourology should form the cornerstone of therapy for heavily encrusted stuck stents. It is important to maintain an efficient computerized stent log under the direct supervision of a physician. Patients with probable risk factors should be monitored even more frequently to avoid mishaps and morbidity.

Minimally invasive retroperitoneoscopic live donor nephrectomy: point of technique

SUMMARY

As the worldwide demand for donor kidneys soars, kidney donation via less invasive and minimally invasive laparoscopic techniques is emerging rapidly as a new and viable option to traditional, open-surgical harvesting techniques. Generally, this method of donation has been feasible by using the transperitoneal approach, but, more recently, it also has been accomplished through retroperitoneal access. The authors describe their modified, cost-reductive technique of live retroperitoneoscopic donor nephrectomy and its very good results. Laparoscopic donor nephrectomy appears to be promising; it reduces donor pain and suffering while maintaining excellent graft results.

Age of seizure onset in adults with Down's syndrome

In a cohort of 68 adults (35 males and 33 females) with Down's syndrome aged 29-83 years, a history of seizures was found in 26.5%. The overall mean age of onset of seizures was 37 years, males (22 years) being significantly younger than females (51 years). The age of onset was bimodally distributed, with the first peak occurring in the first two decades, and a late-onset peak occurring in the fifth and sixth decades. A strong association between Alzheimer's disease and seizures was confirmed. Of those with a history of seizures, those aged over 45 years were significantly more likely to develop Alzheimer's disease than those younger than 45. It is suggested that late-onset epilepsy in Down's syndrome is associated with Alzheimer's disease, while early-onset epilepsy is associated with an absence of dementia.

Arsenite-induced multiple antibiotic resistance phenotype in environmental isolates of Yersinia enterocolitica

Minimal inhibitory concentrations (MICs) of five antibiotics namely amikacin, gentamicin, tetracycline, ciprofloxacin, and nitrofurantoin for pork isolates of Yersinia enterocolitica increased two- to eightfold after bacteria were grown in the presence of 5 mm arsenite. For Y. enterocolitica isolates obtained from wastewater (sewage effluents), an unequivocal increase in MICs was seen with amikacin and gentamicin. No change was discernible in the outer-membrane proteins after isolates were grown in the presence of arsenite.

Recurrent urethral hairball and stone in a hypospadiac: management and prevention

A 32-year-old perineal hypospadiac man presented with recurrent urethral hair growth, stone, and stricture with a history of multiple urethroplasties. He was treated by urethrolithotomy, internal urethrotomy, laser epilation of the hair-bearing urethral graft, closure of the fistula, and chemical depilation of the neourethral hair. A dilute solution of thioglycolate was prophylactically instilled into the neourethra at intervals of 3 months to ensure complete tricholysis and to prevent recurrent hair growth in the future.

Impact of power index, hydroureteronephrosis, stone size, and composition on the efficacy of in situ boosted ESWL for primary proximal ureteral calculi

OBJECTIVES

The efficacy, safety, feasibility, and outcome of in situ treatment applied to select proximal ureteral calculi was assessed and analyzed with a view to avoiding auxiliary interventions and providing high clearance rates in the shortest possible time. We studied the impact of several clinically important variables, including power index, degree of hydroureteronephrosis (HDUN), stone size, and composition on the efficacy of sequential in situ boosted extracorporeal shock wave lithotripsy (ESWL) in a select group. The power index requirement for the in situ boosted protocol and the impact of the stone size/composition, degree of HDUN, and clearance rates were also analyzed.

METHODS

An in situ (no instrumentation) boosted protocol was applied to 130 primary unimpacted proximal ureteral calculi with no prior intervention. A typical session with the Siemens Lithostar Plus comprised 3000 shock waves, in installments of 500, deployed at a power setting of 1 to 4 kV with a gradual stepwise escalation. Sequential boosted additional sessions of ESWL were administered on days 2, 7, and 14, tailored to the degree of fragmentation, clearance status, and amount of residual stone bulk. Several parameters (shock waves, kilovolts used, fluoroscopy time, number of sessions, stone size, composition, fragmentation, clearance, and HDUN) were recorded and the results analyzed statistically.

RESULTS

The results were excellent in 83.8%, with a mean duration to complete clearance of 11.3 days. In situ ESWL failed in 7.69%, and the auxiliary intervention rate was 10.7%. Pre-ESWL HDUN was present in 78.3%, the mean power index was 184.6/session/case, and the average stone burden was 8.9 mm(2). Calcium oxalate monohydrate was the most common stone (56%). Renal colic was the most common side effect observed. The power index, fragmentation at the first session, and stone size were found to be the most favorable significant variables affecting stone clearance. The degree of HDUN, number of sessions, and stone composition did not significantly impact the clearance rates.

CONCLUSIONS

In situ boosted ESWL should be the first-line therapeutic modality in select unimpacted primary proximal ureteral stones.

Ethnic minority health. Restricted access

A survey of health authorities and primary care groups with high ethnic minority populations in England showed HAs were further advanced in addressing the special needs of ethnic minorities than PCGs. More than three-quarters of HAs cited initiatives for ethnic minorities compared with only 36 per cent of PCGs. Only a minority of organisations reported schemes to address health inequalities. Commissioning organisations covering large communities of people from ethnic minorities should do more to address their special health needs.

Endothelin as a therapeutic target in the treatment of cardiovascular disease

Endothelins, a family of peptides derived from the vascular endothelium and smooth muscle cells possess vasoconstrictor and mitogenic properties. By acting predominantly in a paracrine fashion, these peptides activate specific receptors and have protean effects in normal and diseased organ systems. The wide distribution of these receptors in various tissues mediate the multiplicity of physiologic actions attributed to endothelins. Much of our understanding about endothelins has come from the development of an array of receptor-specific and mixed receptor antagonists. Based on the promising results from animal studies, active research and drug development programs are under way to investigate the clinical potential of endothelin antagonism for treatment of cardiovascular disease.

Proboscis lateralis of nose

A rare case of congenital malformation of the nose that was successfully corrected surgically is reported.

Retroperitoneoscopic ureterolysis and reconstruction of retrocaval ureter

We report a case of circumcaval ureter in a symptomatic young man who was managed successfully by retroperitoneoscopic ureterolysis and ureteroureteral reconstruction using three-port technique.

Transcutaneous oxygen tension in patients with calciphylaxis

Calciphylaxis is a severe complication of chronic renal failure, confined almost exclusively to patients on dialysis therapy. Histological characteristics of calciphylaxis include small-vessel calcifications of skin, subcutaneous tissue, and visceral organs. These vascular changes promote tissue ischemia that often results in tissue necrosis. In this study, we investigated the extent of skin ischemia in patients with calciphylaxis by means of transcutaneous oxygen tension (TCPO(2)) measurement, a noninvasive test that accurately assesses skin oxygenation. TCPO(2) levels were measured in 21 patients with calciphylaxis and 21 age- and sex-matched patients without evidence of calciphylaxis (controls). TCPO(2) levels were measured bilaterally at the chest, anterior abdomen, and upper thigh while patients breathed room air and after a 30-minute exposure to 100% fraction of inspired oxygen (FIO(2)). Compared with controls, patients with calciphylaxis showed significantly lower TCPO(2) levels at each body region. In both controls and patients with calciphylaxis, lower TCPO(2) levels correlated with increased weight and use of hemodialysis. No correlation with serum parathyroid hormone (PTH), serum calcium, or serum phosphorus values was present, although 39% of the patients with calciphylaxis had markedly elevated PTH values (sixfold greater than normal; >300 pg/dL). Low TCPO(2) levels in patients with calciphylaxis were documented in body regions with and without skin lesions. In patients with calciphylaxis, extremely low TCPO(2) values (</=30 mm Hg while patients breathed room air) were present in 62% of the body regions with skin lesions and 26% of the body regions without lesions. Room-air TCPO(2) levels </=30 mm Hg were present in only 0.8% of the body regions of control patients. TCPO(2) levels obtained while patients breathed 100% FIO(2) remained lower in patients with calciphylaxis than in controls. In conclusion, TCPO(2) levels are abnormally low in patients with calciphylaxis, indicating that severe and diffuse skin ischemia exists, even at areas free of skin lesions. Low TCPO(2) values did not substantially increase with 100% FIO(2) in many patients with calciphylaxis, suggesting a fixed insufficiency of the skin vessels. This study shows that TCPO(2) measurements may allow rapid and noninvasive screening for skin ischemia before the development of skin lesions in patients with calciphylaxis.

Lipid phosphate phosphatase-1 dephosphorylates exogenous lysophosphatidate and thereby attenuates its effects on cell signalling

The serum-derived phospholipid growth factor, lysophosphatidate (LPA), activates cells through a family of G-protein-coupled EDG receptors. The present article examines the role of lipid phosphate phosphatase-1 (LPP-1, or phosphatidate phosphate 2A) in regulating cell activation by LPA. Overexpressing LPP-1 approximately doubled the rate of dephosphorylation of exogenous LPA by Rat2 fibroblasts. The amount of LPA dephosphorylation was restricted to less than 10% of the total exogenous LPA. Over-expression of LPP-1 attenuated cell activation as indicated by diminished responses including cAMP, Ca2+, activation of phospholipase D and ERK, DNA synthesis and cell division. LPP-1 therefore provides a novel level of regulation for controlling cell signalling by exogenous LPA.

Mycotic abdominal aortic aneurysm: a fatal sequel to concomitant prostatic and renal aspergillosis. Case report and review of the literature

We report the first case of aspergillus mycotic aneurysm as a sequel to concomitant prostatic and renal aspergillosis. The patient had undergone left nephrectomy and transurethral resection of prostate for aspergillus infection one year ago. He again presented with LUTS and backache and clinical examination showed visible pulsations in the epigastrium. CT-scan abdomen showed a pseudoaneurysm of the abdominal aorta. The aneurysm was repaired in situ with homografting and omental wrap. However, the patient succumbed to septicemia on the tenth postoperative day. Adjunctive surgery is usually essential as medical management alone has been unsatisfactory. It is imperative that these cases should be followed closely to detect the disease recurrence and complications at the earliest.

Pharmacokinetic study of paclitaxel as a 3-hour infusion in an Indian population: 135 mg/m2 vs. 175 mg/m2

The objective of this clinical study was to determine the pharmacokinetic parameters of paclitaxel at doses of 135 and 175 mg/m2 when given as a 3-hour infusion in an Indian population. Twelve cancer patients of both sexes participated in the study and a parallel experimental design was adopted for the assignment of doses to patients. A solid phase extraction technique was used for sample clean-up followed by a reversed phase HPLC assay for the analysis of paclitaxel in plasma samples. Pharmacokinetic parameters such as Cmax, AUC0-infinity, T1/2 beta, AUMC0-infinity, VSS, VZ and CLT were determined by a compartment model-independent method using a PCNONLIN package. Teff and AUCeff were also calculated and compared at the two doses by considering a plasma concentration of > or = 0.05 microM as threshold. The mean Cmax and AUC0-infinity values were 2.57 microM and 12.06 microM at the 135 mg/m2 dose level while at the 175 mg/m2 dose the values increased to 4.96 microM and 9.52 microM.h/l, respectively. It was found that the 135 mg/m2 dose resulted in greater mean CLT and VSS values than the 175 mg/m2 dose. The disposition of paclitaxel was found to be nonlinear and the pertinent pharmacokinetic parameters were comparable to those from previous clinical studies. It was concluded from the present study that further clinical trials of paclitaxel alone or in combination with other drugs should be undertaken cautiously, taking into consideration its nonlinear pharmacokinetics which necessitate proper adjustment of the infusion schedule and/or dose to avoid any adverse consequences to the patient.

Endotoxin-induced alterations of lipid and fatty acid compositions in rat liver peroxisomes

The structure/function of peroxisomal lipids in rat liver treated with a sublethal dose of endotoxin, a lipopolysaccharide (LPS), was investigated. Peroxisomes isolated from LPS-treated rat liver had remarkable alterations in lipid content compared with saline treated control liver peroxisomes. Cholesterol and phospholipids (PL) decreased significantly by 28.7% and 50.8%, respectively, leading to the change in the ratio of cholesterol/phospholipids (control 0.081 versus LPS 0.118, P < 0.001). A quantitative analysis from LPS-treated rat liver peroxisomes showed a general decrease in all classes of PL. No such alterations were observed in lipid content of other subcellular organelles. The peroxisomal fatty acid composition in LPS-treated animals was also altered. An analysis of fatty acid composition in PL and phosphatidylcholine from LPS-treated peroxisomes showed an increase in arachidonic acid (C20:4) and docosahexaenoic acid (C22:6). Very long chain (VLC) fatty acids (> C22:0) were also found increased in all classes of lipids in LPS-treated peroxisomes. Gadolinium chloride (GAD) mediated inactivation of Kupffer cells (KC) normalized cholesterol/PL ratio in LPS-treated peroxisomes. Collectively, the results indicate that the peroxisome metabolism of lipids and fatty acids is specifically altered in endotoxin-treated rat liver and at least part of the alterations may be mediated by factors released by KC.

Inducible nitric oxide synthase in the central nervous system of patients with X-adrenoleukodystrophy

X-Adrenoleukodystrophy (X-ALD) is an inherited peroxisomal disorder of deficient catabolism of very long-chain (VLC) fatty acids with resulting neuroinflammatory demyelinating disease. Our recent documentation of nitric oxide (NO)-mediated increase in VLC fatty acid levels in glial cells and demonstration of greater increase of VLC fatty acids levels in the inflammatory region (plaque) of X-ALD brain as compared to the normal-looking region away from the plaque prompted us to investigate the possible involvement of NO in the pathophysiology of X-ALD. Herein we provide evidence of the expression of inducible nitric oxide synthase (iNOS) in the CNS of X-ALD patients. In situ hybridization demonstrated that iNOS mRNA was present in brain tissues from X-ALD patients but not in normal controls. Double-labeling immunofluorescence studies using cell-specific markers confirmed that iNOS-expressing cells in the CNS of X-ALD were astrocytes and microglia/macrophages. Finally, antibodies against nitrotyrosine strongly immunoreacted with tissues from the center of the plaque region of X-ALD brains suggesting the presence of the NO reaction product nitrotyrosine in the CNS of X-ALD. Taken together, these results demonstrate that iNOS is expressed in the brains of patients with X-ALD and may contribute to the pathogenesis of the disease.

Evaluation of rifampicin bioequivalence in fixed-dose combinations using the WHO/IUATLD recommended protocol

For an accurate assessment of rifampicin bioequivalence from fixed-dose combinations (FDCs), and to reduce the time and cost constraints associated with bioequivalence studies, the World Health Organization and the International Union Against Tuberculosis and Lung Disease have developed a simplified screening protocol. This study was undertaken with the objective of testing the applicability of this protocol for all types of FDCs. Data were obtained for volunteers common to three studies, and pharmacokinetic parameters were evaluated by different statistical tests. From the results, it has been demonstrated that the simplified screening protocol is suitable for evaluating the bioequivalence of rifampicin in all the types of FDCs available on the market.

Increased vascular adrenergic vasoconstriction and decreased vasodilation in blacks. Additive mechanisms leading to enhanced vascular reactivity

Blood pressure reactivity is enhanced in young black subjects through mechanisms that are poorly understood. We compared alpha-adrenergic-mediated vasoconstrictor and ss-adrenergic vasodilator sensitivity and their relation to sympathetic activity in blacks and whites. Ten healthy black (age, 29.9+/-2.4 years) and 10 white (age, 28.3+/-1.9 years) men were studied. Forearm blood flow was measured with strain-gauge plethysmography after the intrabrachial artery administration of phenylephrine (1.25 to 20 microgram/min) and isoproterenol (60 and 400 ng/min) after application of lower-body negative pressure and after a cold pressor test. Forearm and systemic norepinephrine spillover were measured with a radioisotope dilution technique. alpha-Adrenergic vasoconstriction was markedly increased (ANOVA P=0.008) and ss-adrenergic vasodilation decreased (ANOVA P=0.02) in blacks. Phenylephrine (10 microgram/min) decreased forearm blood flow by 58.0+/-2.5% in blacks but only by 26.6+/-6.0% in whites (P<0.001). Vasoconstrictor response to endogenous norepinephrine, stimulated by a cold pressor test, resulted in a higher forearm vascular resistance in blacks than in whites (107.3+/-13 versus 64.8+/-13 mm Hg. mL(-)(1). 100 mL(-)(1), P=0.03). There were no significant ethnic differences in basal or stimulated forearm or systemic norepinephrine spillover. Increased vasoconstrictor and decreased vasodilator responses in blacks were not correlated. Increased sympathetically mediated vascular tone caused by enhanced vasoconstriction and attenuated vasodilation, effects that would be additive, and not increased sympathetic activity could enhance vascular reactivity and may play a role in the pathogenesis of hypertension in blacks.

Innate antiviral defenses in body fluids and tissues

Innate, non-specific, resistance mechanisms are important barriers to pathogens, particularly delaying virus multiplication at the onset of infections. These innate defense mechanisms include a series of mechanical barriers, pre-existing inhibitory molecules, and cellular responses with antimicrobial activity. The antiviral activities of these innate inhibitors reside in a variety of partly characterized substances. This review presents the innate antiviral inhibitors in cell cultures, urine, serum, the gastrointestinal tract, the nervous system, tissues of crustaceans, and saliva. Medical adaptation of the innate antiviral defense mechanisms may be useful for prevention and treatment of viral infections.

Bioequivalence of rifampicin when administered as a fixed-dose combined formulation of four drugs versus separate formulations

A bioequivalence study of the antitubercular drug rifampicin in a four-drug combination (rifampicin, isoniazid, pyrazinamide and ethambutol) and separate formulations of the drugs at the same dose levels was carried out in a group of 22 healthy male volunteers. The investigation was designed as an open crossover study. The drugs were administered once in individual formulations and once in a fixed-dose combination. The WHO-approved protocol was followed according to which six blood samples were collected over a period of 8 h for each volunteer and each experimental session. Pooled urine samples were also collected during the study. Rifampicin and desacetyl rifampicin concentrations in both plasma and urine samples were assessed. Various pharmacokinetic parameters such as AUC0-8 h, Cmax and Tmax were calculated for both rifampicin and desacetyl rifampicin. The results indicated that combined (the four-drug combination) and separate formulations are bioequivalent for rifampicin.

Identification of the pathway of alpha-oxidation of cerebronic acid in peroxisomes

Cerebronic acid (2-hydroxytetracosanoic acid), an alpha-hydroxy very long-chain fatty acid (VLCFA) and a component of cerebrosides and sulfatides, is unique to nervous tissues. Studies were carried out to identify the pathway and the subcellular site involved in the oxidation of cerebronic acid. The results from these studies revealed that cerebronic acid was catabolized by alpha-oxidation to CO2 and tricosanoic acid (23:0). Studies with subcellular fractions indicated that cerebronic acid was alpha-oxidized in fractions having particulate bound catalase and enzyme systems for the beta-oxidation of VLCFA (e.g., lignoceric acid), suggesting peroxisomes as the subcellular organelle responsible for alpha-oxidation of cerebronic acid. Etomoxir, an inhibitor of mitochondrial fatty acid oxidation, had no effect on cerebronic acid alpha-oxidation. Further, cerebronic acid oxidation was found to be dependent on the presence of NAD+ but not FAD, NADPH, ATP, Mg2+, or CoASH. Intraorganellar localization studies indicated that the enzyme system for the alpha-oxidation of cerebronic acid was associated with the peroxisomal limiting membranes. Studies on cultured fibroblasts from normal subjects and patients with peroxisomal disorders indicated an impairment of alpha-oxidation of cerebronic acid in cell lines that lack peroxisomes [e.g., Zellweger syndrome (ZS)]. On the other hand, alpha-oxidation of cerebronic acid was found to be normal in cell lines from X-linked adrenoleukodystrophy, adult Refsum disease, and rhizomelic chondrodysplasia punctata. Our results clearly demonstrate that alpha-oxidation of alpha-hydroxy VLCFA (cerebronic acid) is a peroxisomal function and that this oxidation is impaired in ZS. Furthermore, this alpha-oxidation enzyme system is distinct from the one for the alpha-oxidation of beta-carbon branched-chain fatty acids (e.g., phytanic acid).

Maternal and cord plasma selenium levels in full-term neonates

Selenium is a part of the enzyme glutathione peroxidase and has an important role in the prevention of oxygen free radical injury. Hence good selenium nutrition is of special relevance to the neonate. The present study evaluated plasma selenium levels in cord plasma of 82 full term, appropriate for gestational age babies and their mothers at delivery. The plasma selenium levels in babies were 54.17 +/- 1.34 ppb which was significantly lower than 70.63 +/- 1.62 ppb seen in their mothers. Anemic mothers with a Hb < 8 g/dl had a plasma selenium level (60.74 +/- 4.57 ppb) which was lower than those with a Hb > 8 g/dl i.e. 74.19 +/- 2.17 ppb. Maternal age, parity, literacy and socio-economic status did not affect the plasma selenium levels.

The characterization of phospholipase D in FRTL-5 thyroid cells

We previously demonstrated that TSH activates phospholipase D (PLD) in Fischer rat thyroid line (FRTL)-5 cells. To date, two types of mammalian phosphatidylcholine-specific PLD cDNAs, designated as PLD-1 and PLD-2, have been cloned. The present study determined the PLD isoform composition in FRTL-5 thyroid cells and which isoform is regulated by TSH. PLD-1 is activated by small molecular weight G-proteins, such as ADP-ribosylation factor (ARF) and RhoA family members, while PLD-2 is relatively independent of such stimuli. We established the presence of PLD-1 and PLD-2 by Western blot analysis and compared PLD activity in cytosol, membranes and combined fractions in the presence and absence of GTPgammaS. The membrane fraction showed very little activity in the absence of GTPgammaS, but this activity increased approximately 5-fold (P<0.05, ANOVA) in the presence of GTPgammaS. Maximal PLD activity was seen with the combination of membrane plus cytosolic fractions (which contained ARF and RhoA) where the addition of GTPgammaS increased PLD activity approximately 8-fold (P<0.05, ANOVA). To determine the relative activities of PLD-1 and PLD-2 in FRTL-5 thyroid cells, cell-free PLD assays were performed in the presence of GTPgammaS or GDPbetaS with varying concentrations of phosphatidylinositol 4,5-bisphosphate (PIP(2)). PLD-2 contributed only approximately 19% of the total amount of PLD activity in the membranes and PLD-1 was the predominant PLD isoform. TSH stimulated PLD-1 activity by up to 2. 3-fold over control values (P<0.01, ANOVA). To establish the dependence of PLD-1 on small molecular weight G-proteins, the translocations of ARF and RhoA to the membrane fractions was determined after stimulation by TSH. Both ARF and RhoA were maximally translocated to the membrane fraction after 10 min incubation with 100 microU/ml TSH by approximately 1.7- and 2.3-fold over control values, respectively (P<0.02 and P<0.03, ANOVA). It is concluded that TSH stimulates PLD-1 activity in FRTL-5 thyroid cells and this is accompanied by the translocation of ARF and RhoA to the membrane fraction.

Lipid phosphate phosphatase-1 and Ca2+ control lysophosphatidate signaling through EDG-2 receptors

The serum-derived phospholipid growth factor, lysophosphatidate (LPA), activates cells through the EDG family of G protein-coupled receptors. The present study investigated mechanisms by which dephosphorylation of exogenous LPA by lipid phosphate phosphatase-1 (LPP-1) controls cell signaling. Overexpressing LPP-1 decreased the net specific cell association of LPA with Rat2 fibroblasts by approximately 50% at 37 degrees C when less than 10% of LPA was dephosphorylated. This attenuated cell activation as indicated by diminished responses, including cAMP, Ca(2+), activation of phospholipase D and ERK, DNA synthesis, and cell division. Conversely, decreasing LPP-1 expression increased net LPA association, ERK stimulation, and DNA synthesis. Whereas changing LPP-1 expression did not alter the apparent K(d) and B(max) for LPA binding at 4 degrees C, increasing Ca(2+) from 0 to 50 micrometer increased the K(d) from 40 to 900 nm. Decreasing extracellular Ca(2+) from 1.8 mm to 10 micrometer increased LPA binding by 20-fold, shifting the threshold for ERK activation to the nanomolar range. Hence the Ca(2+) dependence of the apparent K(d) values explains the long-standing discrepancy of why micromolar LPA is often needed to activate cells at physiological Ca(2+) levels. In addition, the work demonstrates that LPP-1 can regulate specific LPA association with cells without significantly depleting bulk LPA concentrations in the extracellular medium. This identifies a novel mechanism for controlling EDG-2 receptor activation.

The role of tear physiology in ocular surface temperature

PURPOSE

To determine whether the more rapid cooling of the tear film in dry eyes is related to other tear film parameters, a battery of tear physiology tests was performed on dry eye patients and control subjects.

METHODS

Tear evaporation rate was measured with a modified Servomed (vapour pressure) evaporimeter and ocular temperature with an NEC San-ei 6T62 Thermo Tracer in 9 patients diagnosed as having dry eye and in 13 healthy control subjects. Variability in temperature across the ocular surface was described by the temperature variation factor (TVF). Lipid layer structure and tear film stability were assessed with the Keeler Tearscope and tear osmolality was measured by freezing point depression nanolitre osmometry.

RESULTS

The data were explored by principal component analysis. The subjects with and without dry eye could be separated into two distinct groups entirely on the basis of their tear physiology. Dry eye patients exhibited higher tear evaporation rates, osmolalities and TVF, lower tear film stabilities and poorer-quality lipid layers than the control subjects. A significant linear relationship was found to exist between tear evaporation rate and TVF for all subjects (R2 = 0.242, p = 0.024).

CONCLUSIONS

Rapid cooling of the tear film in dry eyes appears to be related to the reduced stability of the tears and the increased rate of evaporation. The higher latent heat of vaporisation, associated with the increased evaporation in dry eyes, may account for the increased rate of cooling of the tear film in this condition.

Interleukin-10 and interleukin-13 inhibit proinflammatory cytokine-induced ceramide production through the activation of phosphatidylinositol 3-kinase

Ceramide produced by hydrolysis of plasma membrane sphingomyelin (SM) in different cells including brain cells in response to proinflammatory cytokines [tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta)] plays an important role in coordinating cellular responses to stress, growth suppression, and apoptosis. The present study underlines the importance of IL-10 and IL-13, cytokines with potent antiinflammatory properties, in inhibiting the proinflammatory cytokine (TNF-alpha and IL-1beta)-mediated degradation of SM to ceramide in rat primary astrocytes. Treatment of rat primary astrocytes with TNF-alpha or IL-1beta led to rapid degradation of SM to ceramide, whereas IL-10 and IL-13 by themselves were unable to induce the degradation of SM to ceramide. Interestingly, both IL-10 and IL-13 prevented proinflammatory cytokine-induced degradation of SM to ceramide. Both IL-10 and IL-13 caused rapid activation of phosphatidylinositol (PI) 3-kinase, and inhibition of that kinase activity by wortmannin and LY294002 potently blocked the inhibitory effect of IL-10 and IL-13 on proinflammatory cytokine-mediated induction of ceramide production. This study suggests that the inhibition of proinflammatory cytokine-mediated degradation of SM to ceramide by IL-10 and IL-13 is mediated through the activation of PI 3-kinase. As ceramide induces apoptosis and IL-10 and IL-13 inhibit the induction of ceramide production, we examined the effect of IL-10 and IL-13 on proinflammatory cytokine-mediated apoptosis. Inhibition of TNF-alpha-induced apoptosis by IL-10 and IL-13 suggests that the antiapoptotic nature of IL-10 and IL-13 is probably due to the inhibition of ceramide production.

Marjolin's ulcer of the suprapubic cystostomy site infiltrating the urinary bladder: a rare occurrence

We report a case of a 40-year-old man who had presented with a spontaneous suprapubic urinary leak from a well-healed suprapubic cystostomy tract scar, 20 years following a successful scrotal tube substitution urethroplasty done for a post-traumatic urethral stricture. Preoperative contrast studies suggested a recurrent bulbomembranous urethral stricture. Excision biopsy of the suprapubic fistulous tract revealed scar cancer infiltrating the bladder wall. Of 3 similar cases reported in the past, only 1 had bladder involvement. Ours is the second such case with bladder involvement.