Esophageal duplication cyst causing unilateral hyperinflation of the lung in a neonate

Esophageal duplication cysts are rare congenital anomalies. Frequently asymptomatic, they may cause respiratory distress and feeding difficulties in infants. Unilateral hyperinflation of the lung due to compression of the bronchus by the cyst is rare. We report a case of a 4-day-old male neonate presenting with respiratory distress who had an esophageal duplication cyst causing obstructive hyperinflation of the right lung. The nature of the cyst was confirmed after surgery.

Apolipoprotein E in temporal lobe epilepsy: a case-control study

PURPOSE

To investigate the relationship of apolipoprotein E (apoE) genotype, plasma levels of apoE and lipids in temporal lobe epilepsy (TLE) patients in Asian Indians. Status of plasma levels of Apo E in epilepsy patients has not been reported till date.

METHODS

ApoE gene polymorphism was analyzed in 58 patients with temporal lobe epilepsy (TLE) and 57 age and sex approximated controls using Polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP). Levels of plasma apoE and lipids were measured using ELISA and enzymatic kits respectively.

RESULTS

The distribution of ApoE genotype in epilepsy patients and controls was comparable. Higher levels of plasma ApoE were observed in TLE patients as compared to controls (p=0.0001). Individuals with plasma levels of apoE > 190 mg/L were at 20 times higher odds (95%CI=2.46-163.34, p=0.005), while those with levels of apoE between 150-190 mg/L were at 4.9 times higher odds (95% CI=1.85-13.9, p=0.001), to develop TLE.

CONCLUSIONS

We have observed for the first time, high levels of plasma apoE in epilepsy patients. The findings of this case-control study suggest that apolipoprotein E may play an important role in epilepsy.

Bronchopulmonary foregut malformation in association with diaphragmatic eventration

Bronchopulmonary foregut malformations are uncommon anomalies, and their association with diaphragmatic eventration is rare. This report presents 2 cases with this association. Embryologically, a simultaneous disturbance in the development of pulmonary vessels and developing esophagotracheal septum may explain the etiopathogenesis of this association. Abnormal budding along the developing foregut tube may lead to foregut cysts. In both cases, the bronchopulmonary foregut malformations were excised, and the diaphragm was repaired. The results of surgery were gratifying in both cases.

The clinical value of combining maternal serum screening and uterine artery Doppler in prediction of adverse pregnancy outcome

Uterine artery Doppler waveform analysis is not offered in routine antenatal care in the UK. The aim of this study is to evaluate a policy of offering uterine artery Doppler ultrasound, in the setting of a District General Hospital, to women who are judged to be at high risk of adverse pregnancy outcome, based on their mid-trimester biochemical serum screening. Data from 73 cases with abnormal serum screening were collected and analysed. Abnormal outcome occurred in 11 cases (16%) including two perinatal deaths. The positive predictive value of adverse outcome was 13% for abnormal serum screening, 26% for human chorionic gonadotropin (hCG) >3 multiples of the median (MOM) and 8% for alfa-fetoprotein (AFP) >2.5 MOM. A total of 56 cases of the study group had uterine artery Doppler at 22 weeks' gestation. Evaluation of the performance of uterine artery Doppler in prediction of adverse pregnancy outcome revealed a sensitivity of 43%, specificity of 70%, a positive predictive value (PPV) of 18% and a negative predictive value (NPV) of 89%. When the presence of diastolic notch was taken to define a positive result the sensitivity remained unchanged, however the specificity, PPV and NPV improved to 91%, 43% and 91%, respectively. In conclusion, the combination of serum markers and abnormal uterine artery Doppler ultrasound improves the identification of women at risk of subsequent pregnancy complications. Raised serum hCG has a better predictive value for adverse pregnancy outcome as opposed to raised serum AFP. In the absence of diastolic notch, the accuracy of abnormal uterine artery Doppler ultrasound is markedly reduced.

Anorectal malformations and their impact on survival

OBJECTIVE

To evaluate the incidence, types and the effect on outcome of associated anomalies in neonates with anorectal malformations (ARM).

METHODS

This retrospective study was carried out on all neonates with ARM admitted to the neonatal surgical intensive care unit (NSICU) from 1998 through 2003.

RESULTS

Of the 754 neonates admitted to the NSICU during the study period of 6 years, there were 124 (16.4%) neonates with anorectal malformations. Of these 110 were included in the study. 73 % were male and 27% female. 86% of these were high ARM (HARM) while only 14% were low ARM (LARM). Associated anomalies were seen in 68% of patients. The incidence was 72% for HARM and 50% for LARM. The major associated anomalies consisted of esophageal (13%), gastrointestinal (GIT) (11%), genitourinary (GUT) (32%), skeletal (26%), cardiac (33%) and miscellaneous 26%. The overall survival rate was 84% (82% for HARM and 94% for LARM). The survival among those with associated esophageal anomalies was 43%, GIT 67%, GUT 80%, cardiac 61%, skeletal 76% and miscellaneous 79% respectively. This difference in survival was significant only for those with esophageal (p=0.004) and cardiac anomalies (p=0.0026). The survival rates among those with one, two or more than two organ systems involved with associated anomalies were 88%, 82% and 58% respectively. This difference was significant only for more than two organ systems involvement (p=0.003).

CONCLUSION

Associated anomalies are common in neonates with ARM, the incidence being similar for HARM and LARM. The survival depends upon the number and severity of associated anomalies both in patients with LARM and HARM. Neonates with more number of organ systems involved have a poorer survival specially when associated with esophageal and cardiac anomalies. All neonates with ARM merit a meticulous search for associated anomalies so that the management can be tailored for each baby.

Exposure to high fluoride concentration in drinking water will affect spermatogenesis and steroidogenesis in male albino rats

Sodium fluoride (NaF) administered orally to adult male rats at a dose level of 4.5 ppm and 9.0 ppm for 75 days caused significant decrease in the body weight, brain index and testicular index. A significant decrease in sperm count, sperm motility, sperm viability and sperm function (HOS positive) with increased sperm abnormalities was also observed in NaF-exposed male rats. The activity levels of testicular steroidogenic marker enzymes 3beta-hydroxysteroid dehydrogenase (3beta-HSD) and 17beta-hydroxysteroid dehydrogenase (17beta-HSD) were significantly decreased in NaF-treated rats indicating decreased steroidogenesis and in turn spermatogenesis in rats exposed to NaF.

Active inflammatory bowel disease and coronary artery dissection

The case of a young woman with flare-up of Crohn's disease, who had an acute myocardial infarction due to the spontaneous dissection of the left anterior descending coronary artery, is reported. The literature on this rare condition is reviewed and a mechanism postulated for spontaneous coronary artery dissection in inflammatory bowel disease.

Prepubertal unilateral spermatic vessel ligation decreases haploid cell population of ipsilateral testis postpubertally in rats

DNA flow cytometry is a sensitive and rapid technique to evaluate the germ cell maturation of testis. The haploid cell population of testis specifically denotes testicular maturation. High ligation of spermatic vessels (HLSV) and low ligation of spermatic vessels (LLSV) have been described in the surgical treatment of high undescended testis. Estimation of germ cell population of testis after these maneuvers has not been performed so far by DNA flow cytometry; hence this study was designed. Thirty male rats, aged 30 days, were randomized into three groups. Group I underwent sham surgery; group II underwent unilateral HLSV-ligation and division of main spermatic vessels, similar to the Fowler-Stephens technique; and group III underwent unilateral LLSV-ligation and division of main spermatic vessels close to the testis, similar to the Koff and Sethi technique. Thirty days later, the ipsilateral testes were harvested, and haploid, diploid, and tetraploid cells were counted by DNA flow cytometry. The mean (+/-SD) percentage of the haploid cell population was 68.7+/-4.8, 49.3+/-6.5, and 50.8+/-6.4 in groups I, II, and III, respectively. There was a significant (p<0.05) decrease in haploid cell population between groups I and II and between groups I and III. However, there was no significant difference between groups II and III. In conclusion, prepubertal HLSV as well as LLSV decreases the haploid cell population of ipsilateral testis in rats. LLSV has no advantage over HLSV.

Apoptosis and cell removal in the cryptorchid rat testis

In order to determine that apoptosis is responsible for large-scale germ cell elimination, we analyzed cells from cryptorchid testes both in histological sections and among those isolated in vitro. Apoptotic testicular cells during 3 to 7 days were only 8 to 30%, reaching a maximum of 80% by the end of 15 days of cryptorchidism. A similar trend was also observed with the number of dead cells. The process of large-scale germ cell removal in the initial stages was facilitated by the formation of multinucleated giant cells, which stained negative for apoptosis. Increase in oxidative stress and decrease in intratesticular testosterone was also observed. The above findings indicate that large-scale germ cell removal, at least during initial stages of cryptorchidism is not solely as a result of apoptosis. Declined intra testicular testosterone, elevated temperature and high oxidative stress following cryptorchidism probably affect cell viability and trigger a fast pace cell removal through giant cell formation.