Predicting the severity of relapsing-remitting MS: The contribution of cross-sectional and short-term follow-up MRI data

Background and objective: Predicting the long-term clinical course of multiple sclerosis (MS) is difficult on clinical grounds. Recent studies have suggested magnetic resonance imaging (MRI) metrics to be helpful. We wanted to confirm this.

Methods: Contactable individuals ( N = 84) from an initial 99 patients with relapsing–remitting MS (RRMS) who had undergone careful baseline and 2-year follow-up examinations including MRI were reassessed after a mean of 10.8 ± 2.7 years. We investigated using multivariate linear regression analyses if clinical and MRI data obtained at the prior time-points and the rates of change in morphologic variables over a mean observational period of 2.5 years could have served to predict a patient’s MS severity score (MSSS) 11 years later. Conversion to secondary progressive MS (SPMS) was a further outcome variable.

Results: In univariate analyses, the ‘black hole ratio’ (BHR) at baseline ( p = 0.017, beta = 0.148) and at first follow-up ( p = 0.007, beta = −0.154) was the only MRI parameter showing a significant correlation with the MSSS. In a multiple regression model, the independent predictive value of imaging variables became statistically non-significant and the latest MSSS was predicted primarily by the baseline EDSS ( r2 = 0.28; p < 0.001). The BHR at baseline explained 9.4% of variance of conversion to SPMS ( p = 0.033). Over the observational period the MSSS remained stable in patients remaining RRMS, but increased in converters to SPMS from 4.0 to 6.4.

Conclusions: We failed to confirm a clear independent contribution of cross-sectional and short-term follow-up MRI data for the prediction of the long-term clinical course of MS. The MSSS is not a stable indicator of disease severity but may increase in converters to SPMS.

Lesion probability mapping to explain clinical deficits and cognitive performance in multiple sclerosis

BACKGROUND

Lesion dissemination in time and space represents a key feature and diagnostic marker of multiple sclerosis (MS). The correlation between magnetic resonance imaging (MRI) lesion load and disability is only modest, however. Strategic lesion location might at least partially account for this 'clinico-radiologic paradox'.

OBJECTIVES

Here we used a non-parametric permutation-based approach to map lesion location probability based on MS lesions identified on T2-weighted MRI. We studied 121 patients with clinically isolated syndrome, relapsing-remitting or secondary progressive MS and correlated these maps to assessments of neurologic and cognitive functions.

RESULTS

The Expanded Disability Status Scale correlated with bilateral periventricular lesion location (LL), and sensory and coordination functional system deficits correlated with lesion accumulation in distinct anatomically plausible regions, i.e. thalamus and middle cerebellar peduncule. Regarding cognitive performance, decreased verbal fluency correlated with left parietal LL comprising the putative superior longitudinal fascicle. Delayed spatial recall correlated with _amygdalar, _left frontal and parietal LL. Delayed selective reminding correlated with bilateral frontal and temporal LL. However, only part of the spectrum of cognitive and neurological problems encountered in our cohort could be explained by specific lesion location.

CONCLUSIONS

Lesion probability mapping supports the association of specific lesion locations with symptom development in MS, but only to limited extent.

Cognitive impairment in relation to MRI metrics in patients with clinically isolated syndrome

Background: Cognitive deficits are frequent in multiple sclerosis (MS) and have been associated with morphologic brain changes. Less information exists on their extent and relation to MRI findings in clinically isolated syndrome (CIS). It is also unclear if structural changes as detected by magnetization transfer (MT) imaging may provide an additional explanation for cognitive dysfunction.

Objective: To analyse the extent of cognitive deficits and their relation to MRI metrics including MT imaging in CIS compared to relapsing-remitting MS (RRMS).

Methods: Forty-four CIS and 80 RRMS patients underwent the Brief Repeatable Battery of Neuropsychological Tests (BRB-N) and a 3 T MRI scan.

Results: BRB-N subtests revealed similar results in CIS and RRMS. Impaired mental processing speed was most prevalent in both groups (CIS 13.6%; RRMS 16.3%) and thus served for correlation with MRI metrics. Using stepwise linear regression analyses, the strongest predictor for decreased mental processing speed was normalized cortex volume ( p < 0.001) followed by T2-lesion load ( p < 0.05) in RRMS, whereas cortical MT ratio was the only MRI parameter associated with decreased mental processing speed in CIS ( p < 0.005).

Conclusion: Cognitive dysfunction occurs in CIS in a pattern similar to RRMS, with impaired mental processing speed being most prevalent. Cortical MT-ratio changes may be an early sign for tissue changes related to impaired mental processing speed in CIS while this association shifts to increased signs of cortical atrophy and lesion load in RRMS.

Morphometry of purkinje cell body of cerebellum in bangladeshi cadaver

This cross sectional descriptive study was performed by examining 30 (thirty) relatively fresh cerebellum. Out of them 20 postmortem human cerebellum collected from Bangladeshi cadavers of both sexes (male 10 and female 10) age ranging from 5 to 60 years and 10 cerebellums from caesarian section of dead fetuses of both sexes (male 6 and female 4) age ranging from 34 weeks to 41 weeks. Specimen containing cerebellum was collected from dead bodies autopsied on different dates from April'2009 to September'2009 at the autopsy laboratory of department of Forensic Medicine and Gynaecology and Obstetrics of Mymensingh Medical College, Mymensingh. Samples were collected by using nonprobability sampling technique. The collected sample was grouped in to three age groups like Group A (34 to 41 weeks of gestation), Group B (5 to 30 years) and Group C (31 to 60 years) and two sex groups (male and female). Ten cerebellums were studied from each age group for this histological study. Sections were processed following standard histological procedure and were stained with Hematoxylin and Eosin stain. Slides were examined under 15X40 magnifications and measurement of vertical and transverse diameter of the cell body were taken with the help of ocular micrometer. In this study, the mean difference of mean vertical and transverse diameter of Purkinje cell body between Groups A & B and Groups A & C was statistically highly significant (p<0.001) but differences between Groups B & C was statistically significant only in case of transverse diameter.

Risk stratification in young patients with channelopathies

Identifying the young patient at risk of malignant arrhythmias and sudden cardiac death remains a challenge. It is increasingly recognised that sudden death, syncope and aborted cardiac arrest at a young age in patients with a structurally normal heart may be the result of various ion channel disorders - the channelopathies. The approach to risk stratification involves a combination of the clinical presentation, taken in conjunction with the family history, genetic testing, invasive electrophysiological studies or other provocative tests where appropriate and feasible. A logical approach to risk stratification in some of the commoner channelopathies seen in paediatric practice is presented.

Morphometric study of vocal fold of different sexes of Bangladeshi cadaver

The larynx is an organ of respiration and phonation. Larynx or Voice box is well developed in humans. The sound made by a human being using the vocal folds for talking, singing, laughing, crying, screaming etc. Pitch of the sound depends on the length, tension and mass of the vocal folds. This cross sectional descriptive type of study was done to see the length of the vocal folds and to establish the difference between sexes of adult Bangladeshi people. A total of 29 human larynges of adult age group ranging from 17 to 60 years in the both sexes were collected by purposive sampling during routine postmortem examination at the autopsy laboratory of Department of Forensic Medicine of Mymensingh Medical College, from October 2008 to March 2009. The mean length of vocal fold was measured and significance differences of the dimension between male and female were observed. In the present study observed finding was compared with those of other researchers. In male the mean(+/-SD) length of vocal fold was 23.12(+/-4.06) mm. In female the mean(+/-SD) length of vocal fold was 18.50(+/-2.39) mm. In statistical analysis, difference between male and female values was calculated by using Students (Unpaired) 't' test. The present study revealed that the value was greater in male than in female group and this difference was statistically significant (p<0.01).

Complexity analysis of the uterine electromyography

In respect to the main goal of our ongoing work for predicting preterm birth, we analyze in this paper the complexity of the uterine electromyography (EMG) by using the sample entropy (SampEn) algorithm. By considering recent methodological developments, we measure the SampEn over multiple scales using the wavelet packet decomposition method. The results obtained from the analyzed data indicate that SampEn decreases along pregnancy. Furthermore, we demonstrate that the computed SampEn parameter may discriminate between the two classes (pregnancy/labor). The results are supported by statistical analysis using t-test indicating good statistical significance with a confidence level of 95%. A surrogate data test is also performed to investigate the nature of the underlying dynamics of our experimental data. The results are very promising for monitoring pregnancy and detecting labor to help identify preterm labor.

Lymphedema-distichiasis syndrome without FOXC2 mutation: evidence for chromosome 16 duplication upstream of FOXC2

A patient with the classical phenotype of Lymphedema-Distichiasis syndrome (OMIM 153400) is described who showed no mutations in the sequence of FOXC2. Accordingly, a Gene Chip 250k array analysis was undertaken with dense SNP genotyping of the genomic region surrounding the FOXC2 locus on Chromosome 16 followed by copy number evaluation by real time PCR. The latter assay showed evidence of a duplicated region 5' of FOXC2 that could be causative for the patient's striking phenotype, which included both distichiasis and a hyperplastic refluxing lymphatic vascular and lymph node phenotype associated with pubertal onset lymphedema, scoliosis and strabismus.

Sexual attitudes and their relation to cervical intraepithelial neoplasia in Maiduguri, Nigeria

Five hundred randomly selected sexually active women attending antenatal, postnatal, family planning and gynaecological clinics in the Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, had questionnaires administered on their sexual attitudes/ behaviour and their 'pap'smears taken for cytological assessment. The aim was to identify any significant association between sexual attitudes/behaviour and cervical intraepithelial neoplasia (CIN) for the purpose of targeting the population most at risk. Ninety-one women had varying degrees of CIN, a prevalence rate of 18.2%. However, multiple sexual partners was the only factor incriminated to significantly increase the risk of occurrence of CIN. Targeting women with multiple sexual partners may help in directing limited screening resources to those more likely to be positive.

Knowledge and attitude to cervical cancer screening among women in Maiduguri, Nigeria

Five hundred women were studied to determine their knowledge of cervical cancer. Less than 10% of the women were aware of the disease or its symptoms. Even fewer were aware of cytological screening, the good results obtained in the premalignant stage and early invasive stages of the disease. Simple explanation showed a good recall at 4-6 weeks. At that time women would accept screening and understood its importance. This study shows clearly that education must precede a screening programme if it is to succeed.

Study of prenatal and postnatal development of spleen of Gallus Domesticus (deshi chicken)

Spleen is one of the secondary or peripheral lymphoid organs along with cecal tonsils in birds. The growth of the spleen of Gallus Domesticus (deshi chicken) from prenatal embryonic day fifteen (ED15) to postnatal day ninety (D90) were studied. In macroscopic study it was found that the shape of the spleen was rounded with slightly flattened from side to side at its middle part at prenatal period (ED15, ED18) and becomes rounded at postnatal stages of the deshi chicken (D90). Regarding position it lies close to the right side of the junction between proventriculus and gizzard and was similar in prenatal and postnatal stages. The result of the present study revealed that the mean diameter and weight of the spleen in deshi chicken gradually increases with increase of age, which were 2.00+/-0.136mm and 0.007+/-0.00gm respectively at ED15 stage and it reaches upto 10.40+/-0.331mm and .303+/-0.004gm respectively at day 90 (D90). It was observed that the differences of diameter & weight of the spleen between different ages were statistically significant (p<0.01). Histologically the spleen was surrounded by thin capsule in prenatal life, which gradually becomes thicker in postnatal life. The splenic pulps were not differentiated into white and red pulp on 15th day of embryonic life (ED15) but they were gradually differentiated into white and red pulp in the late prenatal (ED18) and postnatal period. The growth and development of spleen at each stage of the study period were found to be significantly high. Present study indicates that chicken splenic cell population, structure and function were similar to human spleen histologically. It was also found that the chicken embryo allows easy experimental access to all the stages of the splenic development, so the present study will be helpful for experimentation on lymphoid organs and to understand pathophysiology of immunological diseases of human.

Morphological study of levator glandulae thyroidea in Bangladeshi cadaver

The study was done to see the incidence of levator glandulae thyroidea including its association with pyramidal lobe and its morphological variation regarding its craniocaudal attachment in Bangladeshi people. Sixty postmortem tissue blocks containing thyroid gland and its neighbouring structures were collected from 48 male and 12 female cadavers of different age groups and fixed in 10% formol-saline solution. Gross and fine dissection was carried out to study the incidence of levator glandulae thyroidea, its attachment and its association with pyramidal lobe. In the present study, observed findings were compared with those of Western and Bangladeshi researchers. It was evident that, in the present study, in 43.33% cases levator glandulae thyroidea was present. Among them 84.65% was associated with the pyramidal lobe and in all of these cases it extended from the apex of the pyramidal lobe to hyoid bone. In most of the cases (92%) of this study the levator glandulae thyroideae were cranially found to attach with hyoid bone. Only four muscles those were not associated with pyramidal lobe arise from isthmus. Two of them cranially attached with hyoid bone and remaining two levator glandulae thyroideae cranially was found to be attached with the corresponding oblique line of thyroid cartilage.

Measurement of different external dimensions of the heart in adult Bangladeshi cadaver

The cross sectional descriptive study was carried out to determine the gross morphological parameters regarding heart to establish a racial characteristic of Bangladeshi adult population. To fulfill this aim, different external dimensions of the heart in Bangladeshi adult people of both sexes were measured and compared with the findings of other researchers of Bangladesh and western countries. A total fifty normal human hearts from both sexes were collected during routine postmortem examination in autopsy laboratory of Forensic medicine department of Mymensingh Medical College, Mymensingh on different dates from August 2003 to April 2004. The age at death of cadavers was ranged from 20 to 60 years. The mean weight, length, breadth and antero-posterior diameter were measured and the following values were found. In male the mean (+/-SD) weight was 247.92(+/-40.26) gm, mean (+/-SD) length was 10.5(+/-0.62) cm, mean (+/-SD) breadth was 8.51(+/-0.61) cm and mean (+/-SD) antero-posterior diameter was 5.86(+/-0.63) cm. In female the mean (+/-SD) weight was 164.29(+/-33.56) gm, mean (+/-SD) length was 9.2(+/-0.89) cm, mean (+/-SD) breadth was 7.67(+/-0.61) cm and mean (+/-SD) antero-posterior diameter was 5.47(+/-0.55) cm. In statistical analysis, difference between male and female values was calculated by using students 't' test. The present study revealed that the values were always greater in male than in female group, though statistically there was no significant difference (p>0.05) between them.

Quantitative assessment of brain iron by R2* relaxometry in patients with clinically isolated syndrome and relapsing–remitting multiple sclerosis

Background

Increased iron deposition has been implicated in the pathophysiology of multiple sclerosis (MS), based on visual analysis of signal reduction on T2-weighted images. R2* relaxometry allows to assess brain iron accumulation quantitatively.

Objective

To investigate regional brain iron deposition in patients with a clinically isolated syndrome (CIS) or relapsing–remitting MS (RRMS) and its associations with demographical, clinical, and conventional magnetic resonance imaging (MRI) parameters.

Methods

We studied 69 patients (CIS, n = 32; RRMS, n = 37) with 3T MRI and analyzed regional R2* relaxation rates and their correlations with age, disease duration, disability, T2 lesion load, and normalized brain volumes.

Results

Basal ganglia R2* relaxation rates increased in parallel with age ( r = 0.3–0.6; P < 0.01) and were significantly higher in RRMS than in CIS ( P < 0.05). Using multivariate linear regression analysis, the rate of putaminal iron deposition was independently predicted by the patients’ age, disease duration, and gray matter atrophy.

Conclusions

Quantitative assessment by R2* relaxometry suggests increased iron deposition in the basal ganglia of MS patients, which is associated with disease duration and brain atrophy. This technique together with long-term follow-up thus appears suited to clarify whether regional iron accumulation contributes to MS morbidity or merely reflects an epiphenomenon.

Tremelimumab in combination with exemestane as novel immunotherapy for patients with advanced breast cancer

3034

Background: Tremelimumab (CP-675, 206) is a fully human IgG2 anti-CTLA4 monoclonal antibody (mAb) with single-agent antitumor activity presumed to be related to immune stimulation following blockade of CTLA4. Here, we conducted a phase I, open-label, dose-escalation trial of the combination of tremelimumab and exemestane in patients (pts) with advanced hormone receptor (or unknown receptor status if prior response with hormone therapy) breast cancer. Methods: Twenty-five pts with ER+ and/or PR+ breast cancer and 1 pt with unknown receptor status who had relapsed after treatment for advanced disease were enrolled. Pts received escalating doses of tremelimumab (3 to 10 mg/kg) delivered either every 28 days (Q28D) or every 90 days (Q90D) in combination with continuous exemestane (25 mg/day). Primary endpoints were assessment of safety and determination of recommended phase II dose. Tumor response evaluation per RECIST was a secondary endpoint. Results: Overall, 65 cycles of tremelimumab were administered in combination with exemestane. Pts received 3 mg/kg tremelimumab Q28D (n=6), 6 mg/kg tremelimumab Q28D (n=1), 6 mg/kg tremelimumab Q90D (n=13), or 10 mg/kg Q90D (n=6). No pharmacokinetic interaction between tremelimumab and exemestane was observed. Dose-limiting toxicities included transient serum transaminase elevation in cycle 1 (grade 3 in 1 pt) and diarrhea in cycle 1 (grade 3 in 3 pts, 1 of whom was hospitalized with steroid-refractory diarrhea and given anti-tumor necrosis factor-α mAb, infliximab) and cycle 2 (grade 3 in 1 pt). One pt developed grade 2 autoimmune thyroiditis requiring chronic hormone replacement. Other toxicities included constipation (n=6), fatigue (n=8), and rash (n=9). The MTD was 6 mg/kg Q90D. For pts receiving ≥2 cycles of therapy, best response was stable disease in 8 pts lasting 3 to 14 months (median 8 months); no pts had objective responses. Conclusions: MTD of tremelimumab in combination with exemestane is estimated at 6 mg/kg Q90D, which is lower than the single-agent dose of 15 mg/kg Q90D used in phase II and III trials in pts with melanoma or colorectal cancer. This may suggest that there is a biological interaction between tremelimumab and exemestane.

[Table: see text]

Functional pathway mapping of human glioblastoma multiforme and brain metastases for patient tailored therapy

2076

Background: Genome scanning analysis of human glioblastoma multiforme (GBM) has suggested that this form of cancer is a protein pathway disease. Since genomic analysis cannot directly predict protein activation, analysis of protein pathway activation is required. With the current focus on targeted translational therapeutic modalities, a functional understanding of the GBM signaling repertoire is critical, and yet largely unknown. Methods: Twelve tumors were included in this study: 10 GBMs (9 primary, 1 recurrent) and two brain metastases (1 breast and 1 lung). Pure tumor cell populations were obtained from fixed frozen tissue sections using Laser Capture Microdissection. Protein pathway mapping was performed using Reverse Phase Protein Microarrays (RPMA) whereby the activation of 85 key signaling proteins was quantitatively measured at once. Unsupervised and supervised analysis was used to explore pathway activation. Results: Unsupervised hierarchical clustering of all tumors in the study set revealed largely patient-specific signaling portraits yet also identified distinct pathway subsets. The two metastatic tumors clustered separately and distinctly from the GBMs. The GBM specimens clustered according to pathway activity. Statistical analysis demonstrated significant correlations between certain phosphorylated endpoints detected and overall survival. Phosphorylation of cofilin (S3) was associated with shorter survival time, while Stat1 (Y701) and Shc (Y317) phosphorylation were both positively correlated with longer overall survival. Conclusions: This study represents the most comprehensive proteomic analysis of human GBM pathway mapping to date. Since certain pathway biomarkers are themselves being targeted by current investigational therapies, the ability to map pathway activation and identify critical pathway biomarkers can lead to targeted therapeutics tailored to each patient's tumor. The ability to segregate short from long-term survivors according to protein pathway activation is promising.

[Table: see text]

Morphology of sighs and their role in the control of breathing in preterm infants, term infants and adults

BACKGROUND

Although there is evidence that sighs are important to restore lung volume, the factors responsible for inducing a sigh and the effects of sighs on the stability of the respiratory system remain unclear.

OBJECTIVE

To compare newborn with adult sigh morphology in order to better understand the physiological mechanisms that induce sighs and the role sighs play on the control of breathing in infants.

DESIGN/METHODS

We measured respiratory variables during control, the pre-sigh, the sigh, and the post-sigh period during quiet and REM sleep in 10 preterm infants, 10 term infants and 10 adults using a flow-through system.

RESULTS

No significant differences were observed in any of the respiratory variables between the pre-sigh and the control breaths in any of the subjects in any of the two sleep states, suggesting that indices of respiratory drive are not predictive of an impending sigh. Sighs were relatively larger in infants than in adults and had a characteristic biphasic inspiratory flow observed almost exclusively in infants. While post-sigh ventilation was usually increased in adults, it was usually decreased in infants due to the presence of apneas.

CONCLUSIONS

The established indexes of respiratory drive are not predictive of an impeding sigh. When compared with control breaths, sighs are much larger in preterm and term infants than in adults. These big augmented breaths in infants are often followed by apnea and hypoventilation likely secondary to the increased activity of the peripheral chemoreceptors present in neonates.

Selenium intoxication with selenite broth resulting in acute renal failure and severe gastritis

Selenium (Se) is an essential trace element in human and animal nutrition. It is also widely utilized in industrial processes. Reports of acute selenium toxicity in humans are rare. We report a case of a 23-year-old female who consumed about 100 mL of liquid selenite broth and presented with severe nausea, vomiting, abdominal pain, hematemesis and acute renal failure (ARF). The serum selenium level was significantly increased. Gastro-duodenoscopy revealed severe corrosive gastritis. Renal biopsy showed features of acute tubular necrosis (ATN), affecting primarily the proximal tubules. The patient was managed with gastric lavage, blood transfusions, infusion of fresh frozen plasma (FFP) and platelet concentrates and hemo-dialysis. The patient was discharged five weeks after admission and her renal functions recovered completely by eight weeks after admission. She continues to be on regular follow-up for any possible sequelae of mucosal corrosive damage. This case highlights a case of selenium intoxication from selenite broth resulting in ARF and corrosive gastritis. The recovery was complete.

Relationship of uterine artery with ureter

The study was done to see the relationship of right and left uterine artery with corresponding ureter. Their distance from lateral border of uterus and site of crossing in relation to internal os in Bangladeshi female were observed. Sixty post mortem specimens containing uterus, uterine tube, ureter and surrounding structures were collected from cadavers of different age groups and fixed in 10% formol saline solution. Gross and fine dissections were carried out to study the relationship and distance of uterine artery where it crosses the corresponding ureter and the site of crossing in relation to internal os. In the present study our findings were compared with those of the standard text books. In this study, there were no variations regarding relations of right and left uterine artery with corresponding ureter. In all cases of all age groups, ureters were found to cross the uterine artery anteriorly on both sides. Site of crossing of uterine artery of both sides with ureter at the level of internal os was 50% in 2-12 years (Group A) 20.45% in 13-45 years (Group B) and 12.50% in 46-80 years (Group C) age group. Below the level of the os was found in remaining cases except one which crosses above the level of the os in group B. In this study mean distance of uterine artery where it crosses the ureter from lateral border of uterus was more on right side in all age groups, which was 1.67 cm, 2.30 cm and 2.11 cm in age Group A, B & C respectively.

Histomorphological study of lymphoid follicle of vermiform appendix

The study was done to find out the number of lymphoid follicle of vermiform appendix in Bangladeshi people and to increase the knowledge regarding variational anatomy in our population. Total 40 fresh appendixes were collected for histological study of different age and sex during postmortem examination in the autopsy laboratory of Forensic department of Mymensingh Medical College. This cross sectional descriptive study was done by convenient sampling technique. For convenience of differentiating the number of lymphoid follicle of vermiform appendix in relation to age and sex, findings were classified in four groups, up to 20 years, 21 to 35 years, 36 to 55 years and 56 to 70 years. In the present study the number of lymphoid follicle were highest in group A, mean were (5.40+/-1.30) and lowest in group D where mean were (1.05+/-0.35). In male mean were 3.16 and in female mean were 2.86. Diameter of the lymphoid follicle in group A was highest (40.14+/-2.66) and lowest in group D (0.24+/-1.35). Number of germinal centre are highest in group B (2.20 +/- 0.45) and lowest in group D (0.00 +/- 0.00).

Stem cells in pediatric heart failure

Pediatric heart failure could be a target for regenerative therapy. Stem cell-based therapy has the potential to provide functional cardiomyocytes. Whereas adult stem cells have shown no or only minimal therapeutic benefit in adults with no evidence of transdifferentiation, embryonic stem cells can differentiate to any cell type, including cardiomyocytes. However, ethical concerns and immunological problems are associated with embryonic stem cells derived from the inner cell mass of blastocysts. Recently, somatic cells could be reprogrammed to a pluripotent state (i.e. induced pluripotent stem cells) with the help of transcription factors. This technique removes ethical and probably also immunological concerns. Nevertheless extensive experimental research will be necessary before cell replacement strategies become clinically applicable. Because the underlying pathophysiology differs significantly with age, caution is warranted extrapolating data obtained in experimental models of cardiac ischemia and clinical studies in adults to the pediatric population. Pediatric heart failure has a good prognosis if causal therapy is possible. However, some forms of congenital heart disease and especially dilated cardiomyopathy still have limited therapeutic options. Almost half of children with symptomatic cardiomyopathy receive a transplant or die within two years. The authors will review the relevant stem cell sources for cell-based treatments. And, given the differences of the underlying diseases between adult and pediatric patients with heart failure, it is contemplated which condition of pediatric patients with heart failure is most likely to benefit and which cell type would be appropriate.

An anatomical study on pyramidal lobe of thyroid gland in Bangladeshi people

The study was done to see the incidence of pyramidal lobe of thyroid gland including its position, attachment, length and incidence of its association with levator glandulae thyroidae in Bangladeshi population. Sixty postmortem tissue blocks containing thyroid gland and its related neighbouring structures were collected from 48 male and 12 female cadavers of different age groups and fixed in 10% formol-saline solution. Gross and fine dissection was carried out to study the incidence of presence of pyramidal lobe, its attachments, length, breadth and association with levator gladulae thyroidae. In the present study, findings were compared with those of Western and Bangladeshi researchers. It was evident that, fifty percent of the thyroids possesses pyramidal lobe. Incidence was more in male (52.1%) than in female (41.7%). It also appeared from the observations that, this lobe was commonly situated on the left side. In the majority of cases (56.66%), base of the pyramidal lobes were attached to the upper border of the isthmus with or without encroachment on the adjacent part of the left lobe. The range of length and breadth of the pyramidal lobe was from 1.8 to 35mm and 1.3 to 19mm respectively. In 73.33% cases, pyramidal lobe was associated with levator glandulae thyroideae and in only 26.66% cases pyramidal lobe was found independently.

Higher diagnostic accuracy with the ThinPrep method in a simulated intraoperative environment

OBJECTIVE

To compare the accuracy of intraoperative fine needle aspiration cytology samples prepared by the ThinPrep method to conventional cytological methods. Specimen adequacy and turn around time (TAT) were also assessed.

METHODS

Fifty consecutive fresh tumours submitted for histological analysis were aspirated and each prepared as follows: (i) direct smear with H&E stain, (ii) direct smear with Pap stain, (iii) ThinPrep slide with H&E stain, and (iv) ThinPrep slide with Pap stain. The slides were randomly distributed to three cytopathologists for interpretation. The quality of the preparation, the diagnosis and the time needed for interpretation were recorded.

RESULTS

Accuracy was measured as the percentage of absolute agreement between the cytological and the histopathological diagnoses of the lesions. Histologically, there were 43 malignant and six benign lesions and one atypical lipoma. The TAT began when the slides/cytolyte specimens arrived at the lab and ended with the pathologist's diagnosis.

CONCLUSIONS

In terms of accuracy and specimen adequacy, ThinPrep slides with Pap stain is the best procedure. This advantage however is offset by the longer testing time.

Retinal injury as an early manifestation of posttransplant thrombotic microangiopathy: recovery with plasma exchanges and conversion to sirolimus--case report and review of the literature

Thrombotic microangiopathy (TMA) remains a serious event. We report a case of occurrence of TMA in the immediate postoperative period after a living-related renal transplantation. A distinguished feature of the case was major, early involvement of the retina with marked by decreased visual acuity along with thrombocytopenia and renal functional impairment. The syndrome was reversible with plasma exchange and conversion from tacrolimus to sirolimus. The patient's renal function is excellent at 11 months after transplantation. Decreased visual acuity and cotton wool exudates may be the first manifestation of posttransplant TMA.

Compliance der morphologisch unauffälligen Aorta bei Jugendlichen mit Marfan Syndrom: Vergleich von MR-Messungen der aortalen Dehnbarkeit und der Pulswellengeschwindigkeit

PURPOSE

To compare the aortic compliance of the normal-sized aorta of adolescents with Marfan syndrome and healthy controls using MR measurements of the aortic distensibility and pulse wave velocity.

MATERIALS AND METHODS

Fourteen patients (median age: 15 years) and 11 healthy subjects (23 [12 - 32] years) were examined at 1.5 T. The MR protocol included 2D steady-state free precession (SSFP)-CINE MRI of the aortic distensibility and PC-MRI of the pulse wave velocity. All measurements were positioned perpendicular to the descending aorta at the level of the diaphragm for assessing the changes in the aortic cross-sectional areas and additionally above and below this plane for assessing the pulse wave velocity. In addition contrast-enhanced 3D-MR angiography was performed in adolescents with Marfan syndrome to exclude morphologic changes and to prove normal-sized aorta.

RESULTS

Compared with control subjects, adolescents with Marfan syndrome had significantly decreased distensibility and significantly increased pulse wave velocity (chi (2)-test, p = 0.0002) using an age-related non-linear regression analysis. The related aortic compliance was significantly decreased (chi (2)-test, p = 0.0002). There was a good correlation between the two methods (r = 0.86). A low intraobserver variability was found for both methods (< or = 2 %).

CONCLUSIONS

MRI allows detecting abnormal elastic aortic wall properties already in the normal-sized aorta of adolescents with Marfan syndrome. Monitoring of these properties could be relevant for evaluating disease onset and progression. MRI has the potential value of compliance measurements for the follow-up and to guide therapy indications.

Morphological study of parathyroid in relation to thyroid gland of Bangladeshi people

The morphological study was done to see the number and location of parathyroid glands in relation to thyroid gland of Bangladeshi people to increase the knowledge regarding variational anatomy in our population. Sixty post mortem tissue block containing thyroid and parathyroids along with surrounding structures were collected from 48 male and 12 female cadavers of different age groups and fixed in 10% formol saline solution. Gross and fine dissections were carried out to study the topographic relationship and number of parathyroid glands in relation to thyroid gland. In the present study, findings were compared with the findings of Western and Bangladeshi researchers. In the present study, the so-called typical number of parathyroid glands that is 2 pairs per person (in relation to thyroid gland) was externally visible only in fifty percent (50%) of cases. According to this study, middle third of posterior border of thyroid gland lodged most of the glands (60-65%).

Evaluation of stentangioplasty in university cardiac center

In this ongoing prospective study conducted in University Cardiac Center, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2004 to January 2006. Fifty (50) patients (mean age 56+/-7.2 years) underwent stentangioplasty were evaluated. The study group of 50 patients consisted of 42 (84%) men and 08 (16%) women. The aim of this study was to evaluate in-hospital success, failure and complications during the procedures. About risk factors 19(38%) had hypertension, 13(26%) were smoker, 11(22%) suffered from diabetes mellitus, 05(10%) had family history of ischaemic heart disease. Average left ventricular ejection fraction was 54+/-7. Target vessel percutaneous coronary angioplasty (PTCA) were done in 61 vessel, intracoronary stent implanted in 58 vessels, direct stenting were done in 35 cases, failed PTCA were in 03(6%) cases and two had dissection. The native vessels had a mean reference diameter of 2.91 mm and their luminal diameter increased significantly after percutaneous coronary intervention (PCI). All the patients were discharged by one to three days of the procedure with improvement of their clinical condition. In conclusion, intracoronary stent deployment in coronary artery stenosis following balloon angioplasty is a valid and beneficial strategy with good in-hospital results.

Changes of placental diameter thickness and cotyledon in eclampsia

The study was done to see the changes of placental diameter, thickness and number of cotyledons in eclapmsia. A total 45 placenta, 25 from eclamptic mother and 20 from normal pregnant mother were collected from Gynaecology and Obstetric department of Mymensingh Medical College and Hospital (MMCH). Study was done in Anatomy department of Mymensingh Medical College (MMC). Macroscopic study of the formol saline fixed placentas revealed that, compared to the controls there was trend of less placental diameter in eclamptic group(p=0.0004). Cotyledon number was found to be significantly less in eclampsia (p=0.0001). However there was no significant difference in placental thickness in eclamptic placenta than that of normal group. Statistical significance of difference between two groups was calculated by using Students "t" test. A difference between the two groups was considered to be significant when p<0.005. The morphological changes in placenta are possibly due to reduced uteroplacental blood flow in eclampsia.

Donor Gender Balance in a Living-Related Kidney Transplantation Program in Oman

It has been observed in several Eastern and Western countries that there is a gender imbalance among kidney donors. In the international experience, approximately 65% of live kidney donors have been women. We retrospectively studied the distribution of female and male donors or recipients among living kidney transplantations performed from 1980 to 2005, namely 198 Omani recipients of living-related kidney transplantations. To examine cultural influences, transplantations performed or expatriates were excluded from the study. For the whole period, 98 out of 198 donors (49.5%) were women. The number of female recipients 75 of 198 (38%) versus males were 123 (62%) recipients. We then subdivided the period into three intervals: 1980 to 1990, 1991 to 2000, and 2001 to 2005. The numbers of female donors for these three periods were 29 of 64 (45%), 42 of 89 (47%), and 27 of 45 (60%), respectively. There was a persistent preponderance of male recipients ranging from 58% to 66% during these periods. We concluded that there was no gender imbalance for kidney donors. Nevertheless, there was a male preponderance in the recipient group.

Complete Regression of Cutaneous B-Cell Lymphoma in a Renal Transplant Patient After Conversion From Cyclosporin to Sirolimus

Posttransplant lymphoproliferative disease remains a serious morbidity. Herein we have reported a case of complete regression of a biopsy-proven B-cell lymphoma that occurred in the posttransplant period. A 48-year-old man received a living donor renal transplant for end-stage renal disease due to undetermined etiology. His initial immunosuppression consisted of corticosteroid, mycophenolate mofetil, and cyclosporin. The patient developed severe pneumonia within the first 2 months after transplantation due to Acineotobacter, fungus, and cytomegalovirus infections. He experienced a complete recovery and was discharged for regional follow-up. Four months after discharge, he was referred again because of presence of two nodules on his trunk. A biopsy of the nodules revealed B-cell lymphoma. Cyclosporin was stopped and he was converted to sirolimus. The lesions regressed progressively and completely within 7 weeks. The patient remains well without clinical relapses at 19 months after conversion. Renal functions remained stable. We postulated that the antincoplastic properties of sirolimus may have played an active part in the positive outcome.

Histomorphometric study of thyroid gland of Bangladeshi people

To study the histomorphological features of thyroid gland of Bangladeshi people in different age groups, thirty postmortem thyroid glands were collected and fixed in Bouin's fluid. For histological examination specimens were processed and stained following standard procedure and studied under low and high magnifications. Diameter of thyroid follicle and number of follicles per square millimeter were measured. Values were noted in a tabulated form and analyzed by SPSS program and findings were compared with the other studies of Western and Bangladeshi researchers and of standard textbooks. In this study it was observed that diameter of follicles were widely variable. The highest mean diameter of the follicles was found in 19 to 45 years age group and thyroids of this age group had fewer follicles per unit area of thyroid section than the two other groups. This difference was statistically significant with above 45 years age group (p=.001) and upto 18 years age group (p=.01) of the study. It was observed that all these findings of this geographical area were conformed to the findings of the other studies.

Pain as the presenting symptom of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)

Numerous clinical forms of CIDP have been described, but pain is generally considered a rare or secondary sign. We describe here the clinical, electrophysiological and neuropathological characteristics of five patients with CIDP and pain as the main presenting symptom, and their course with treatment. Between January 2003 and December 2004, we selected five patients with prominent or isolated pain among 27 patients diagnosed with CIDP. All patients were subjected to clinical and electrophysiological examinations, and had a complete laboratory work up to exclude other causes of neuropathy. In view of the atypical clinical presentation, all five patients underwent nerve biopsy. There were two men and three women. The mean age at onset of neuropathy was 70+/-7.39 years. All patients initially presented with pain in the lower limbs associated with modest motor impairment (1 case), distal paresthesia (4 cases), cramps (1 case) and fatigue (2 cases). CSF was normal in three cases. On electrophysiological examination, three patients had nerve conduction abnormalities with subtle or clear signs of demyelination: three (case 1, 2 and 4) fulfilled the criteria of Rotta et al. and two (case 2 and 4) the criteria of both Nicolas et al and the INCAT group. Patients were all given symptomatic treatment and four patients received an immunomodulatory treatment, which was constantly effective. Pain may be a major and disabling symptom in patients with CIDP, so this diagnosis has to be considered in patients referred for a painful polyneuropathy. Moreover, immunomodulatory treatment has to be considered in such patients as symptomatic therapy may be ineffective.

An unsupervised classification method of uterine electromyography signals using wavelet decomposition

The purpose of this study is to classify the uterine contractions in the electromyography (EMG) signal. As the frequency content of the contraction changes from one woman to another and during the pregnancy, wavelet decomposition is used to extract the parameters of each contraction, and an unsupervised statistical classification method based on Fisher test is used to classify events. A principal component analysis projection is then used to evidence the groups resulting from this classification. Results show that uterine contractions may be classified into independent groups according to their frequency content.

A morphological and morphometric study of the right ventricular papillary muscles of autopsied heart of Bangladeshi people

Fifty formalin-fixed hearts from thirty nine male and eleven female Bangladeshis aged 20 to 70 years and without any known cardiac disorder were used in the present study. In right ventricle, there was a single anterior papillary muscle in 92% cases. The posterior papillary muscle was double in 32% and single in 28% cases. The septal papillary muscle was single in 46% cases while in 30% cases it was absent. The different between males and females in the total number of papillary muscles was statistically non significant. In the right ventricle, the anterior papillary muscles were the longest and the septal papillary muscles were the shortest.

Are they spherules of ovarian cystic teratoma or daughter cysts of echinococcosis?

Teratoma is a germ cell tumour which accounts for approximately 15-20 % of all ovarian cancers. The tumour is possibly derived from ectodermal differentiation of totipotent cells or mitotic germ cells. We present a case of a 37-year-old female patient with multiple spherical structures floating in a large pelvic-abdominal cystic mass seen on sonographic images. A giant echinococcal cyst gravid with its daughters was the presumed preoperative sonographic diagnosis. The patient underwent excision of the lesion, and the pathological diagnosis was teratoma. The striking feature of multiple spherical structures in the cyst was caused by multiple spherules of a mature ovarian cystic teratoma which were representing numerous mobile sebaceous cysts and desquamative keratin formations.