Sickle cell morbidity profile in Omani children

In order to define the morbidity profile of sickle cell disease in Omani children, we analysed data on 97 children (53 boys, 44 girls) aged < or = 12 years admitted under our care in a regional referral hospital between July 1999 and June 2000. Ninety of them had sickle cell anaemia (HbSS disease) and seven had sickle cell thalassaemia (beta zero). Their mean (SD) steady-state Hb was 7.9 (1.2), range 6-10 g/dl. They were admitted on 316 occasions during the 12-month period. The number of admissions per child ranged from one to 12 (mean 3.3). Vaso-occlusive crises were the main reason for admission (83%), followed by severe anaemia (12%) and infections (4%). During the study period, 31% received blood transfusions. Weight faltering was very common, 68% falling below the 5th percentile of the National Center for Health Statistics reference curves compared with 28% of age- and sex-matched non-sicklers (p < 0.001). Other complications included hypersplenism (four), ischaemic necrosis of the femoral head (two), and one case each of acute chest syndrome, acute splenic sequestration, cholelithiasis and pathological fracture of a lumbar vertebra. Overall, 71% of the children had moderately severe or severe disease. This pattern seems to be attributable, at least in part, to meteorological and genetic factors. The severe morbidity profile reported in this study underscores the need to continue the search for optimal management modalities, including the often emotion-laden issue of prevention.

Hydroxyapatite particles are capable of inducing osteoclast formation

Hydroxyapatite (HA) coatings have been used to improve implant fixation by promoting bone formation around the prosthesis. A macrophage response to HA particulates has been noted around loosened HA-coated prostheses. As biomaterial wear particle-associated macrophages are known to be capable of differentiating into osteoclasts that are capable of bone resorption, we examined whether particulate HA could similarly induce macrophage-osteoclast differentiation. HA-associated macrophages were isolated from granulomas, formed by subcutaneous implantation of HA, and co-cultured with UMR 106 osteoblast-like cells in the presence of 1,25-dihydroxyvitamin D(3) for up to 14 days on glass coverslips and bone slices. HA-associated macrophage-osteoclast differentiation was evidenced by the formation of numerous multinucleated tartrate resistant acid phosphatase (TRAP)-positive cells which formed lacunar resorption pits on bone slices. Polymethylmethacrylate (PMMA) particle-associated macrophages, isolated from subcutaneous PMMA-containing granulomas, caused significantly more osteoclast formation and bone resorption than HA-associated macrophages. These results indicate that macrophages responding to HA particles are capable of osteoclast differentiation. They also suggest that particles derived from uncemented (HA-coated) implants are likely to induce less osteoclast formation and osteolysis than cemented implants.

Histological and microbiological findings in non-infected and infected revision arthroplasty tissues. The OSIRIS Collaborative Study Group. Oxford Skeletal Infection Research and Intervention Service

An assessment of clinical and laboratory findings is generally required to distinguish between septic and aseptic loosening of a hip implant. In order to evaluate the diagnostic utility of histological and microbiological investigative techniques to differentiate between these two conditions, we analysed their results in 617 patients with hip implant loosening. Histology and microbiology study confirmed the clinical diagnosis of septic loosening in approximately 98% and 89%. respectively. The clinical diagnosis of aseptic loosening was confirmed by histology in 99% of cases. In all but 2 of 81 cases of septic loosening, in which an organism was isolated on microbiological culture, the histological diagnosis of septic loosening was made on the basis of the degree of the acute inflammatory infiltrate (i.e. the presence of 1 or more neutrophil polymorphs per high power field (x 400) on average after examination of at least 10 high power fields) in periprosthetic tissues. In 10 patients for whom there was a strong clinical suspicion of septic loosening but no organisms were isolated on microbiological culture, the histological findings, using the above criteria, were in keeping with the clinical diagnosis of septic loosening. As almost 11% of cases of septic loosening would not have been diagnosed by microbiological investigation alone, our findings indicate that histological examination of periprosthetic tissues should form part of the investigative protocol to distinguish between aseptic and septic loosening.

Electronic structure and properties of transition metal-benzene complexes

A comprehensive theoretical study of the geometries, energetics, and electronic structure of neutral and charged 3d transition metal atoms (M) interacting with benzene molecules (Bz) is carried out using density functional theory and generalized gradient approximation for the exchange-correlation potential. The variation of the metal-benzene distances, dissociation energies, ionization potentials, electron affinities, and spin multiplicities across the 3d series in MBz complexes differs qualitatively from those in M(Bz)(2). For example, the stability of Cr(Bz)(2) is enhanced over that of CrBz by almost a factor of 30. On the other hand, the magnetic moment of Cr(Bz)(2) is completely quenched although CrBz has the highest magnetic moment, namely 6 mu(B), in the 3d metal-benzene series. In multidecker complexes involving V(2)(Bz)(3) and Fe(2)(Bz)(3), the metal atoms are found to couple antiferromagnetically. In addition, their dissociation energies and ionization potentials are reduced from those in corresponding M(Bz)(2) complexes. All of these results agree well with available experimental data and demonstrate the important role the organic support can play on the properties of metal atoms/clusters.

Clinical profile and prognosis of Addison's disease in India

BACKGROUND

The clinical presentation of primary adrenocortical insufficiency (Addison's disease) in India may differ from that in developed countries. We therefore studied the clinical profile and prognosis of Addison's disease, with special reference to patients with tuberculous infection. We also evaluated the utility of various clinical parameters in differentiating tuberculous from idiopathic Addison's disease.

METHODS

In a retrospective and prospective study, 45 consecutive patients of Addison's disease (20 patients with tuberculous aetiology) were studied for their clinical features, autoantibody profile (adrenal cytoplasmic, thyroid microsomal and gastric parietal cell antibodies) and prognosis.

RESULTS

A tuberculous aetiology was present in 47% of the patients and of these, 85% had enlargement of one or both adrenal glands. While patients with tuberculous Addison's disease had a higher prevalence of extra-adrenal tuberculosis (55% v. 9%, p = 0.001), a lower frequency of adrenal cytoplasmic antibodies (17% v. 50%, p = 0.03) and parietal cell or thyroid microsomal antibodies (11% v. 55%, p = 0.004), a considerable overlap was observed. Despite adverse circumstances, during a mean follow up of 3.3 years, only 2 (5%) patients died, neither of whom had tuberculous involvement. Five (13%) patients suffered from one or more episodes of Addisonian crises, though none of these resulted in mortality.

CONCLUSION

Tuberculosis remains an important cause of Addison's disease in India. The presence of extra-adrenal tuberculosis, or lack of adrenal cytoplasmic antibodies, does not, with certainty, differentiate between a tuberculous and idiopathic aetiology. The prognosis of Addison's disease was good despite unfavourable circumstances.

Seminal toxicity of nickel sulfate in mice

Young male albino mice of Swiss strain were exposed to nickel by oral route of 20 mg nickel sulfate/kg body weight for 5 d/wk for 6 mo. A decrease in normal (testosterone-dependent) proteinuria was shown, and morphological examination of the seminal vesicles revealed a lower weight and smaller size as well as a histological indication of lower secretory activity of the epithelium compared to controls. The findings are consistent with a theory implying a decreased testosterone activity in nickel-treated animals.

Pharmacokinetics of ICG and HPPH-car for the detection of normal and tumor tissue using fluorescence, near-infrared reflectance imaging: a case study

We present in vivo fluorescent, near-infrared (NIR), reflectance images of indocyanine green (ICG) and carotene-conjugated 2-devinyl-2-(1-hexyloxyethyl) pyropheophorbide (HPPH-car) to discriminate spontaneous canine adenocarcinoma from normal mammary tissue. Following intravenous administration of 1.0 mg kg-1 ICG or 0.3 mg kg-1 HPPH-car into the canine, a 25 mW, 778 nm or 70 mW, 660 nm laser diode beam, expanded by a diverging lens to approximately 4 cm in diameter, illuminated the surface of the mammary tissue. Successfully propagating to the tissue surface, ICG or HPPH-car fluorescence generated from within the tissue was collected by an image-intensified, charge-coupled device camera fitted with an 830 or 710 nm bandpass interference filter. Upon collecting time-dependent fluorescence images at the tissue surface overlying both normal and diseased tissue volumes, and fitting these images to a pharmacokinetic model describing the uptake (wash-in) and release (wash-out) of fluorescent dye, the pharmacokinetics of fluorescent dye was spatially determined. Mapping the fluorescence intensity owing to ICG indicates that the dye acts as a blood pool or blood persistent agent, for the model parameters show no difference in the ICG uptake rates between normal and diseased tissue regions. The wash-out of ICG was delayed for up to 72 h after intravenous injection in tissue volumes associated with disease, because ICG fluorescence was still detected in the diseased tissue 72 h after injection. In contrast, HPPH-car pharmacokinetics illustrated active uptake into diseased tissues, perhaps owing to the overexpression of LDL receptors associated with the malignant cells. HPPH-car fluorescence was not discernable after 24 h. This work illustrates the ability to monitor the pharmacokinetic delivery of NIR fluorescent dyes within tissue volumes as great as 0.5-1 cm from the tissue surface in order to differentiate normal from diseased tissue volumes on the basis of parameters obtained from the pharmacokinetic models.

Sweet's syndrome and Pneumocystis carinii pneumonia: two sequelae of low-dose cytosine arabinoside therapy in a patient with acute myeloid leukemia

Cytosine arabinoside in low dose is sometimes employed for treating acute myeloid leukaemia. We report here a case of acute myeloid leukemia, treated with low-dose cytosine arabinoside, who developed acute febrile neutrophilic dermatosis and Pneumocystis carinii pneumonia after attainment of remission. A direct effect of cytosine arabinoside on neutrophil function and an immunosuppressive potential in lower doses could be speculated.

Fine needle aspiration cytology in xanthogranulomatous cholecystitis, gallbladder adenocarcinoma and coexistent lesions

OBJECTIVE

To evaluate the diagnostic efficacy of fine needle aspiration cytology (FNAC) in gallbladder mass lesions and to explore the possibility of overlooking malignancy in coexistent adenocarcinoma with xanthogranulomatous cholecystitis (XGC) on fine needle aspiration smears.

STUDY DESIGN

In a retrospective, seven-year study, ultrasound-guided needle aspirates from 25 histologically proven cases of gallbladder adenocarcinoma, 11 cases of gallbladder adenocarcinoma associated with XGC and 20 cases of XGC were evaluated for the presence of mesotheliumlike, foam, inflammatory and multinucleate giant cells; pink, granular background; bile; and degenerated cells, along with atypical or frankly malignant cells. Detailed clinical findings were retrieved from the records.

RESULTS

The overall sensitivity of detecting carcinoma was 90.63% and specificity 94.74%. The sensitivity of detecting malignancy was 80% when adenocarcinoma was associated with XGC.

CONCLUSION

FNAC plays an important role in making the preoperative diagnosis of adenocarcinoma, XGC and coexistent lesions. The probability of detecting malignancy is greater than with XGC in coexistent lesions. Thus, a preoperative FNAC diagnosis would help in determining the urgency of treatment and in planning for the surgical procedure in gallbladder lesions.

Pharmacokinetics of ICG and HPPH-car for the detection of normal and tumor tissue using fluorescence, near-infrared reflectance imaging: a case study

We present in vivo fluorescent, near-infrared (NIR), reflectance images of indocyanine green (ICG) and carotene-conjugated 2-devinyl-2-(1-hexyloxyethyl) pyropheophorbide (HPPH-car) to discriminate spontaneous canine adenocarcinoma from normal mammary tissue. Following intravenous administration of 1.0 mg kg-1 ICG or 0.3 mg kg-1 HPPH-car into the canine, a 25 mW, 778 nm or 70 mW, 660 nm laser diode beam, expanded by a diverging lens to approximately 4 cm in diameter, illuminated the surface of the mammary tissue. Successfully propagating to the tissue surface, ICG or HPPH-car fluorescence generated from within the tissue was collected by an image-intensified, charge-coupled device camera fitted with an 830 or 710 nm bandpass interference filter. Upon collecting time-dependent fluorescence images at the tissue surface overlying both normal and diseased tissue volumes, and fitting these images to a pharmacokinetic model describing the uptake (wash-in) and release (wash-out) of fluorescent dye, the pharmacokinetics of fluorescent dye was spatially determined. Mapping the fluorescence intensity owing to ICG indicates that the dye acts as a blood pool or blood persistent agent, for the model parameters show no difference in the ICG uptake rates between normal and diseased tissue regions. The wash-out of ICG was delayed for up to 72 h after intravenous injection in tissue volumes associated with disease, because ICG fluorescence was still detected in the diseased tissue 72 h after injection. In contrast, HPPH-car pharmacokinetics illustrated active uptake into diseased tissues, perhaps owing to the overexpression of LDL receptors associated with the malignant cells. HPPH-car fluorescence was not discernable after 24 h. This work illustrates the ability to monitor the pharmacokinetic delivery of NIR fluorescent dyes within tissue volumes as great as 0.5-1 cm from the tissue surface in order to differentiate normal from diseased tissue volumes on the basis of parameters obtained from the pharmacokinetic models.

Extradural meningioma en-plaque of the cervical cord

A rare case of cervical extradural en-plaque meningothelial meningioma is reported. The magnetic resonance imaging revealed an extradural sheet of tumor encasing the cervical cord from anterior, posterior and right lateral aspects and emerging from the right C3-4 intervertebral foramina. Though a differential diagnosis of lymphoma and tubercular granulation tissue were considered, its isointense intensity patterns on T1 and T2 weighted images and the intratumoral calcification on intrathecal contrast computed tomographic scan suggested a meningioma. At surgery, the lesion was fibrous, avascular and densely adherent to the dura. The radiological features and management options of the lesion are discussed.

Spectral light quality affects protein profile of Synechococcus sp. PCC 7942: a comparative 2-dimensional gel electrophoresis (2-DGE) analysis

We report here a comparative analysis of the effect of blue (450 nm), red (660 nm), and white light (400-700 nm) on the protein profile of cyanobacteria Synechococcus sp. PCC 7942. In vivo labeling of cells with [(35)S] methionine and their subsequent analysis by two-dimensional gel electrophoresis (2-DGE) showed that eight polypeptides were unique to dark adapted cells, ten were blue light specific, and four were specifically induced in red light. The results show that Synechococcus sp. respond to various light treatments rapidly and synthesize new polypeptides in dark and blue/red light.

Male reproductive effect of nickel sulphate in mice

Nickel sulphate was administered orally to adult male mice at dose level of 5 and 10 mg/kg body weight (5 days per week) for 35 days. There was no change in body weight. However a significant decrease in absolute and organ-to-body weight ratios of testes, epididymides, seminal vesicles and prostate gland was observed. The sperm abnormality, associated with decrease in sperm motility and sperm count was also observed. Significant alterations in the activities of marker testicular enzymes, viz. sorbitol dehydrogenase (decreases), lactate dehydrogenase (increases) and gamma-glutamyl transpeptidase (increases) associated with histopathological changes in testes, epididymides and seminal vesicles, were also observed. Accumulation of nickel in testes, epididymides and seminal vesicles was also observed. The study reveals that the oral exposure to nickel may affect the histology of testes, epididymides, seminal vesicles and sperms morphology. These testicular and spermatotoxic changes may be responsible for observed male mediated developmental toxic effects.

Pyoderma gangrenosum. A diagnosis not to be missed

We describe a case of pyoderma gangrenosum which presented with severe wound breakdown after elective hip replacement. The patient was treated successfully with minimal wound debridement and steroids. This diagnosis should always be considered when confronted with an enlarging painful skin lesion which does not grow organisms when cultured and fails to respond to antibiotic therapy, especially if there are similar lesions in other sites. In patients who have a past history of pyoderma gangrenosum, prophylactic steroids may be indicated at the time of surgery or may be required early in the postoperative period.

Correlation of cell counts and indices in testicular FNAC with histology in male infertility

OBJECTIVE

To evaluate the value of percentage cell counts and cell indices in testicular fine needle aspiration cytology (FNAC) in male infertility and their correlation with histologic categories as seen in open testicular biopsies.

STUDY DESIGN

Differential cell counts were performed, and cell indices, including spermatic index, Sertoli cell index and sperm-Sertoli cell index, were calculated in testicular fine needle aspiration (FNA) smears in 30 azoospermic males whose open testicular biopsies were classified as normal spermatogenesis in 10 cases, maturation arrest in 5, hypospermatogenesis in 6, Sertoli cell only syndrome in 5 and tubular/peritubular sclerosis in 4.

RESULTS

In normal spermatogenesis, FNA smears showed up to 40% Sertoli cells, and spermatozoa were the predominant spermatogenetic cell type. There was a progressive increase in Sertoli cell percentage and Sertoli cell index and reduction in spermatozon percentage, spermatic index and sperm-Sertoli cell index with increasing severity of reduction in spermatogenesis in different histologic categories. The differences between mean counts and indices in normal spermatogenesis and other histologic categories were statistically significant (P < .01).

CONCLUSION

The percent cell counts and cell indices in testicular FNAC correlate with histologic categories and are useful in evaluating male infertility.

Relative frequencies of G and P types among rotaviruses from Indian diarrheic cow and buffalo calves

While an increasing number of studies suggest that there is a high prevalence of rotaviruses with P8[11], a typical P type of bovine rotavirus (BRV), among human neonates or infants in India, no data are available on the distribution of G and P types of Indian BRVs. Thus, fecal specimens were collected from cow and buffalo calves under 1 month of age on organized dairy farms in India during the period between 1994 and 1997, and 36 rotavirus-positive specimens were used to determine the relative frequencies of the G and P types of Indian BRVs. As to the G type, G10 was predominant (83%), followed by G6 (6%). The majority (94%) of BRVs had P8[11], and only one isolate possessed P6[1]. The most common combination of G and P types was G10P8[11] (81%), followed by G6P6[1] (3%) and G6P8[11] (3%). The high prevalence of BRVs possessing P8[11] VP4s strongly supports the hypothesis that BRVs may cross the host species barrier and circulate among neonates in India.

Recombinant feline leukemia virus (FeLV) variants establish a limited infection with altered cell tropism in specific-pathogen-free cats in the absence of FeLV subgroup A helper virus

Feline leukemia virus subgroup B (FeLV-B) is commonly associated with feline lymphosarcoma and arises through recombination between endogenous retroviral elements inherited in the cat genome and corresponding regions of the envelope (env) gene from FeLV subgroup A (FeLV-A). In vivo infectivity for FeLV-B is thought to be inefficient in the absence of FeLV-A. Proposed FeLV-A helper functions include enhanced replication efficiency, immune evasion, and replication rescue for defective FeLV-B virions. In vitro analysis of the recombinant FeLV-B-like viruses (rFeLVs) employed in this study confirmed these viruses were replication competent prior to their use in an in vivo study without FeLV-A helper virus. Eight specific-pathogen-free kittens were inoculated with the rFeLVs alone. Subsequent hematology and histology results were within normal limits, however, in the absence of detectable viremia, virus expression, or significant seroconversion, rFeLV proviral DNA was detected in bone marrow tissue of 4/4 (100%) cats at 45 weeks postinoculation (pi), indicating these rFeLVs established a limited but persistent infection in the absence of FeLV-A. Altered cell tropism was also noted. Focal infection was seen in T-cell areas of the splenic follicles in 3/4 (75%) rFeLV-infected cats analyzed, while an FeLV-A-infected cat showed focal infection in B-cell areas of the splenic follicles. Nucleotide sequence analysis of the surface glycoprotein portion of the rFeLV env gene amplified from bone marrow tissue collected at 45 weeks pi showed no sequence alterations from the original rFeLV inocula.

Endosonographic, endoscopic, and histologic evaluation of alterations in the rectal venous system in patients with portal hypertension

BACKGROUND

Colorectal varices and congestive rectopathy or colopathy have been erratically reported in patients with portal hypertension. The clinical importance of these entities has not been described. We assessed the changes in the venous system of the rectum by endoscopy and rectal endosonography (EUS). We also assessed the role of factors such as etiology of portal hypertension, grade of esophageal varices, sclerotherapy, and liver disease severity on the occurrence of these vascular changes.

METHODS

We studied changes in the venous system of the rectum using endoscopy and EUS in 60 patients with portal hypertension (cirrhotic 41, noncirrhotic 19). Ten patients with irritable bowel syndrome and 6 patients with hemorrhoids served as controls. Rectal varices were classified as tortuous, nodular, and tumorous. Corresponding appearances on rectal EUS were classified as single or discrete multiple, multiple, and innumerable submucosal veins, respectively. Evidence of congestive rectopathy was also recorded.

RESULTS

Prevalence of rectal varices was 43.3% on endoscopy (73% tortuous, 19% nodular, and 8% tumorous) and 75% on EUS (p < 0.0005). The latter showed corresponding appearances of submucosal veins in 25 of 26 patients and detected submucosal veins not identified at endoscopy in 19 other patients. Congestive rectopathy was found in 38.3% of patients. Multiple small dilated vessels in the submucosa were seen in 23.3% patients on rectal EUS. The development of these vascular changes was significantly influenced by sclerotherapy, but not by higher grade of esophageal varices, the etiology of portal hypertension, or severity of liver disease.

CONCLUSIONS

Changes in the rectal venous system are common, with rectal EUS being superior to endoscopy in detecting early, as well as florid, changes.

An assessment of the histological criteria used to diagnose infection in hip revision arthroplasty tissues

AIM

To characterise the number and nature of the inflammatory cells seen in cases of septic or aseptic loosening of hip arthroplasty, and to establish reliable histological criteria to distinguish between these two conditions.

METHODS

Histological examination of paraffin sections of periprosthetic tissues (pseudocapsule, femoral and acetabular pseudomembranes) of 523 cases of aseptic loosening and 79 cases of microbiology culture proven septic loosening. The cellular composition of the inflammatory cell infiltrate was determined semiquantitatively.

RESULTS

The finding of a 2+ or greater neutrophil polymorph infiltrate (one or more cells per high power field (x400) on average after examination of 10 fields) in arthroplasty tissues correlated strongly with the microbiological diagnosis of septic loosening: diagnostic sensitivity 100%, specificity 97%, accuracy 99%, positive predictive value 92%, negative predictive value 100%. The finding of a 3+ neutrophil polymorph infiltrate (five or more cells on average per high power field) had a diagnostic sensitivity of 72%, specificity 100%, accuracy 98%, positive predictive value 100%, and negative predictive value 97%. In some cases of septic loosening the finding of a heavy lymphocytic and plasma cell infiltrate was of low diagnostic sensitivity. A neutrophil polymorph infiltrate (generally less than one cell per 10 high power fields) was also seen in cases of aseptic loosening.

CONCLUSIONS

The presence of 2+ or more (more than one neutrophil polymorph per high power field (x400) on average after examination of at least 10 high power fields) in periprosthetic tissues provides the most sensitive and accurate histopathological criterion for distinguishing between septic and aseptic loosening of hip arthroplasty.

Multiple lymphomatous polyposis presenting as inflammatory bowel disease

Multiple lymphomatous polyposis is a rare manifestation of primary gastrointestinal lymphoma characterized by polypoidal masses involving several segments of the gastrointestinal tract. We report a case who initially presented with features resembling inflammatory bowel disease.

Facial expressions of emotions and schizophrenia: a review

It is generally agreed that schizophrenia patients show a markedly reduced ability to perceive and express facial emotions. Previous studies have shown, however, that such deficits are emotion-specific in schizophrenia and not generalized. Three kinds of studies were examined: decoding studies dealing with schizophrenia patients' ability to perceive universally recognized facial expressions of emotions, encoding studies dealing with schizophrenia patients' ability to express certain facial emotions, and studies of subjective reactions of patients' sensitivity toward universally recognized facial expressions of emotions. A review of these studies shows that schizophrenia patients, despite a general impairment of perception or expression of facial emotions, are highly sensitive to certain negative emotions of fear and anger. These observations are discussed in the light of hemispheric theory, which accounts for a generalized performance deficit, and social-cognitive theory, which accounts for an emotion-specific deficit in schizophrenia.

Does autopsy of antenatally diagnosed malformed foetuses aid genetic counselling?

BACKGROUND

Many pregnancies are terminated because of ultrasonographic diagnosis of malformation in the foetus. A detailed foetal autopsy is needed to arrive at a definite diagnosis on the basis of which genetic counselling can be provided.

METHODS

Sixty-one foetuses, terminated because of antenatal diagnosis of congenital malformations by ultrasound, were autopsied. The ultrasound diagnosis was compared with the diagnosis reached after autopsy.

RESULTS

In 31 cases (51%) the autopsy provided additional findings. In 21 cases (34.4%), the autopsy changed the primary diagnosis. The revised diagnosis led to a change in the risk of recurrence in 18 cases (29.5%).

CONCLUSION

Genetic counselling depending solely on ultrasonographic foetal diagnosis may be erroneous. For appropriate genetic counselling, a detailed foetal examination should be carried out after termination in cases with ultrasonographically detected congenital malformations.

Nasoethmoid schwannoma with intracranial extension. Case report and review of literature

Schwannomas are very rare in the nose and paranasal sinuses; their presence both intra-and extracranially is still rarer. Here we present a case of nasoethmoid schwannoma with intracranial extension into anterior cranial fossa. Clinical, radiological, pathological and operative findings are discussed and the literature is reviewed. We recommend bifrontal craniotomy for removal of intracranial and nasoethmoid extensions of this tumor.

Membranous glomerulonephritis in association with ulcerative colitis

Glomerulonephritis is a rare association of ulcerative colitis. We report a patient with ulcerative colitis who developed proteinuria due to membranous glomerulonephritis which responded to colectomy.

Osteoclastic differentiation by mononuclear phagocytes containing biomaterial particles

Aseptic loosening of implant components is a common and important complication of both cemented and uncemented prosthetic joint replacements. Wear particles derived from organic polymer and metal implant biomaterials are commonly found within macrophages and macrophage polykaryons in the fibrous membrane between loose implant components and the host bone undergoing resorption. In order to determine whether biomaterial particle-containing, foreign-body macrophages may contribute to periprosthetic bone resorption, we cultured murine monocytes that had phagocytosed particles of biomaterials commonly employed in bone implant surgery [polymethylmethacrylate (PMMA), ultra-high molecular weight polyethylene (PE), titanium and chromium-cobalt] on bone slices and glass coverslips with UMR 106 osteoblast-like stromal cells in the presence of 1,25-dihydroxy-vitamin D3. Under these conditions, all biomaterial particle-containing, foreign-body macrophages differentiated into osteoclastic cells, i.e. tartrate-resistant acid phosphatase (TRAP)-positive multinucleated cells capable of extensive lacunar bone resorption. This study shows that particle phagocytosis by macrophages does not abrogate the ability of these cells to undergo osteoclast differentiation. These findings emphasise the importance of the foreign-body macrophage response to biomaterial wear particles in the pathogenesis of aseptic loosening.

Tuberculous Addison's disease: lack of normalization of adrenocortical function after anti-tuberculous chemotherapy

OBJECTIVE

Tuberculosis of the adrenal glands is a common cause of Addison's disease in developing countries. We conducted a study to determine if treatment of such patients with modern anti-tuberculous chemotherapy would lead to an improvement in plasma cortisol and aldosterone levels.

DESIGN

Prospective study.

PATIENTS

5 patients with Addison's disease secondary to tuberculosis.

MEASUREMENTS

Basal and ACTH stimulated plasma cortisol and aldosterone levels were measured prior to instituting anti-tuberculous chemotherapy, as well as one month after its conclusion. Four patients were again studied over the next 2-5 years.

RESULTS

Peak plasma cortisol levels prior to treatment were markedly reduced (range, < 14-110 mumol/l). There was no improvement one month (< 14-143 mumol/l) or 2-5 years (< 14-69 mumol/l) after completing anti-tuberculous chemotherapy. Peak plasma aldosterone at diagnosis was < 56-210 pmol/l; it was undetectable in 4 patients. No improvement was observed one month (< 56-210 pmol/l), or 2-5 years (< 56-389 pmol/l) after stopping anti-tuberculous chemotherapy. Plasma aldosterone levels at both these time points were far lower than those in control subjects (median 736 pmol/l, 560-1512 pmol/l; p < 0.01). One patient had an increase in peak aldosterone from < 56 pmol/l to 389 pmol/l, though peak cortisol actually declined in this subject (from 110 mumol/l to 69 mumol/l).

CONCLUSIONS

Treatment of tuberculous Addison's disease with anti-tuberculous chemotherapy does not lead to normalization of ACTH stimulated plasma cortisol or aldosterone levels during the 2-5 year period of study. However, prolonged follow up with regular adrenal function tests is warranted in all such patients.

Association of hepatitis E virus with an outbreak of hepatitis at a military training camp in Nepal

From 29 January 1995 to 15 March 1995, an outbreak of hepatitis occurred among 692 soldiers at an isolated training camp 25 km east of Kathmandu. Thirty-two cases occurred approximately 8 weeks after arrival of soldiers at the camp. To determine the etiology of the outbreak, patient sera were examined for evidence of infection with hepatitis A, B, C, and E viruses using commercially available enzyme-linked immunosorbent assay (ELISA) kits. The polymerase chain reaction (PCR) was used to detect hepatitis E virus (HEV) RNA. Evidence of recent infection (IgM to HEV and/or HEV RNA) was found in all but two patients, whereas none had evidence of recent infection with hepatitis A, B, or C viruses. Therefore, the outbreak was attributed to HEV. Fecally contaminated drinking water was suspected as the source of the outbreak. To determine the extent of HEV infections among those without clinical hepatitis, sera from the remaining soldiers were examined for markers of HEV infection. Evidence of past infection (IgG to HEV in the absence of IgM or HEV RNA) was found among 204 soldiers (prevalence = 30%), leaving 488 individuals susceptible to infection at the onset of the outbreak. Evidence of recent infection was found among another 83 individuals. We conclude that most exposed, susceptible soldiers sustained HEV infection without experiencing overt hepatitis. If the levels of virus inoculum and prior immunity in this population were typical, inapparent infection may be the usual adult response to virus exposure in an endemic area.

Effect of some essential oils on microorganisms

The essential oils tested viz., Cardiaca Oil, Mentha Oil, Artemisia Oil and Geranium Oil against pathogenic bacterial and fungal strains. Significant activity of all oils was found against all microorganisms. All the four oils showed a higher inhibition against all the microorganisms, except S. epidermidis at different level of concentrations used (1000 ppm and 500 ppm). It is clearly indicated that inhibition activity increased approximately 1 to 2 folds at 1000 ppm concentration as compared to 500 ppm. S. epidermidis has shown resistant towards all the oils at both the concentration while M. smegmatis and S. mutans have shown higher inhibition as compared to S. epidermidis.

The role of MRI in the diagnosis of occult hip fractures

Undisplaced fractures of the hip can occasionally be difficult to diagnose on radiographs. We performed MRI scans on 33 patients who had post-traumatic painful hips but negative radiographs. Forty per cent of the patients had sustained a fractured neck of femur, 15 per cent had sustained an intertrochanteric fracture and 11 per cent had sustained other fractures around the hip; in one patient a tumour was demonstrated. No fracture was seen in 30 per cent of the patients scanned. MRI is well tolerated by elderly patients in pain, does not involve ionising radiation and provides early and accurate diagnosis in patients with X-ray negative post-traumatic hip pain.

Processing of facial expressions of emotion and alexithymia

OBJECTIVE

The primary objective was to examine emotional responsiveness in alexithymia.

DESIGN

A quasi-experimental design was followed with the alexithymia variable being manipulated by subject stratification based on Toronto Alexithymia Scale-20-H.

METHOD

Alexithymics (N = 12) and non-alexithymics (N = 12) were asked to match, label and verbally describe photographs displaying facial emotions along with TAT card II.

RESULTS

Alexithymics did not differ from non-alexithymics in emotional matching and labelling tasks but had significant difficulty in verbally describing emotional expressions as evident by less duration of utterance, greater response latency and increased linguistic-type speech disruptions. Speech disruptions did not produce a group difference for TAT card II.

CONCLUSION

Such difficulty in alexithymics may be associated with their inability to use emotional words in the appropriate context.

UVB-induced photodamage to phycobilisomes of Synechococcus sp. PCC 7942

The effect of UVB irradiation on the phycobilisomes (PBSs) of Synechococcus sp. PCC 7942 cells was studied. The sucrose density-gradient-isolated PBSs from in vivo UVB-treated (280-320 nm) cells showed a strong decrease in beta-phycocyanin (beta PC) and alpha-phycocyanin (alpha PC) polypeptides, in addition to a decrease in the linker polypeptides LCM 75 (linker connecting the core to the thylakoid membranes), LR 33 (linker in the rod structure), LRC 31.5 (linker connecting the rod to the core) and LRC 29. In vitro UVB treatment of gradient-isolated intact PBSs for 1 h had no effect on any of the constituent polypeptides, and only after 2 h was a degradation of LCM 75 and LR 33 and a decrease in beta PC evident. Further investigation of phycobiliproteins (4 h of UVB irradiation) using polyclonal antibody directed against purified whole PBSs revealed that, in vivo, there was a gradual decline in the levels of LCM 75, LR 33, LRC 31.5, LRC 29, beta PC and alpha PC.

RNA profile and structural protein analysis of rotaviruses isolated from diarrhoeal calves in India

Two isolates of group A rotaviruses (CR129 and CR156) were isolated from faecal samples of diarrhoeal calves reared in two dairy farms at Hisar (Haryana, India) by using MA-104 cell lines. These isolates were compared with three standard reference bovine rotaviruses, UK, NCDV and B223, to reveal differences, if any, in their genome and protein migration profiles. The migration of RNA segment 4 of CR129 was slower than that of NCDV, but faster than that of UK. Segment 10 of CR156 moved faster than that of the reference viruses. The segments 2 and 3 co-migrated in CR129, but resolved separately in CR156. Five protein bands of size 116-120 KD (VP1), 95 KD (VP2), 90 KD (VP3/VP4), 44 KD (VP6) and 34 KD (VP7) were detected by protein analysis. No significant difference was observed in the protein profile of these two bovine rotavirus isolates by immunoblotting. However, VP1 was of approximately 116 KD size in the two isolates, compared to 120 KD in the reference strains. These findings indicate that these rotaviruses isolated from diarrhoeic Indian calves differed from the 3 reference strains.

Xanthogranulomatous cholecystitis. Fine needle aspiration cytology in 17 cases

OBJECTIVE

To establish morphologic features of xanthogranulomatous cholecystitis (XGC) on fine needle aspiration cytology (FNAC).

STUDY DESIGN

In a retrospective, five-year study, ultrasound-guided fine needle aspirates from 17 cases of histologically proven XGC were examined for the presence of histiocytes, foam cells, inflammatory cells, multinucleate giant cells, bile, cholesterol crystals, degenerate cells, normal columnar epithelial cells, capillary endothelial cells and a pink granular background.

RESULTS

The presence of histiocytes, foam cells, multinucleate giant cells, bile and a mixed population of inflammatory cells in varying proportions on a background of pink, granular debris was characteristic of XGC. However, pleomorphism in reactive histiocytes can occasionally raise the suspicion of malignancy, necessitating a comprehensive evaluation of the overall cytologic findings.

CONCLUSION

XGC has characteristic cytologic features that can be used to differentiate it from malignancy, which XGC can mimic clinically and radiologically. Preoperative FNAC in such cases would help to guide the surgeon toward a correct surgical approach.

Finger printing of Mycobacterium tuberculosis in patients with intracranial tuberculomas by using in vivo, ex vivo, and in vitro magnetic resonance spectroscopy

In vivo, ex vivo, and in vitro proton magnetic resonance spectroscopy was performed in 12 patients with intracranial tuberculomas with an aim of detecting the biochemical constituents of Mycobacterium tuberculosis in a granuloma. One dimensional (1D) single pulse and spin-echo sequences and 2D correlative spectroscopy were used for the ex vivo study to confirm the resonances seen on in vivo study. Spectroscopic studies of the perchloric acid and lipid extract of granuloma and M. tuberculosis were performed to look for similarity of resonance. In vivo study showed the presence of lipids at 0.9, 1.3, 2.0, 2.8 ppm, and phosphoserine at 3.7 ppm. All these resonances were confirmed on ex vivo study. In addition, distinct resonances of serine and phenolic lipids were seen on ex vivo and in vitro study of tuberculous granuloma, which have not been observed in other intracranial tumors. Lipid extract of granuloma and M. tuberculosis showed phenolic lipids at 7.1 and 7.4 ppm, a constituent of the cell wall of the bacteria in a tuberculoma. It appears that it may be possible to finger print the biochemicals of the cell wall of M. tuberculosis in a tuberculous granuloma and thus may help in detection and diagnosis of such lesions.

Endoscopic, histologic and microbiologic evaluation of upper abdominal pain with special reference to Helicobacter pylori infection

OBJECTIVE

To study children with significant upper abdominal pain of unidentifiable etiology and evaluate: (a) the relationship of pain to inflammatory esophago-gastro-duodenal lesions and Helicobacter pylori (HP) infection, and (b) the response to specific therapy.

DESIGN

Prospective study.

SETTING

Pediatric section of a tertiary referral gastroenterology center.

SUBJECTS

Thirty three consecutive children with significant upper abdominal pain [mean age 9.9 +/- 2.7, range 4-15 years; 20 males] were subjected to upper gastrointestinal tract endoscopy and antral mucosal biopsies obtained for rapid urease test (RUT), Gram's staining of impression/crush smears and culture for HP and histologic examination. Patients with HP gastritis were treated with triple therapy, colloidal bismuth subcitrate, amoxycillin and metronidazole, for two weeks. At 8 weeks from the initiation of therapy, patients were re-evaluated for symptoms and HP eradication by repeat endoscopy and antral biopsies. Patients with esophagitis, gastritis and duodenitis without HP infection were treated with ranitidine for 6 weeks. All the patients were followed up for 6 months.

RESULTS

Histology revealed antral gastritis in 28/33 (85%) patients. HP infection was present in 12/28 (43%) patients with antral gastritis. Symptomatic improvement with triple therapy was observed in 10/12 (83%) patients with HP gastritis and eradication of HP in 5/7. Improvement on ranitidine therapy was observed in 12/16 (75%) patients with HP negative gastritis. On follow-up, no patient with initial improvement with therapy had relapse of symptoms.

CONCLUSION

Symptomatic children with HP related gastritis should be treated with triple therapy and HP negative gastritis with H2-receptor antagonist.

Bilateral transfer deficit in schizophrenia: a trait marker

Schizophrenic patients who had shown improvement over a 6-week treatment period were tested for their bilateral transfer of skill with a mirror-drawing task. Compared with first degree relatives and normal control subjects, patients showed a significant deficit in bilateral transfer of skills in terms of response accuracy both before and after treatment. These findings indicate that the deficit is an enduring functional loss in schizophrenia.