Bangladesh national drug policy: an example for the Third World?

The need and the lack of resources of the Third World poor urgently demands the elimination of 'luxury' drugs. The innocent victims can only be safe if these do not find their way on to the market. A National Drug Policy based on the ED Concept is essential for the developing countries and BNDP may provide a helpful model.

Computed tomography appearance of the thymus and anterior mediastinum in active Cushing's syndrome

Computed tomography (CT) evaluation of the thymus and anterior mediastinum is an important aspect of the investigation of patients with ACTH-dependent Cushing's syndrome in order to exclude an ACTH-secreting carcinoid tumor. We have reviewed the CT imaging of the thymus and anterior mediastinum in a series of 85 patients (55 females; median age 41, range 7-77 yr) with active Cushing's syndrome as there are few data on the range of appearances in hypercortisolemic states. One patient had a thymic carcinoid tumor (24 x 18 mm). Of the others, 28/84 (33%) patients showed thymic remnant tissue, consisting of either nodule(s) at least 5 mm diameter (n = 21, mean diameters 12.5 +/- 5 x 9.6 +/- 4 mm), or triangular bilobed glands (n = 7, mean thickness of the body, right and left limbs 25 +/- 7, 14 +/- 3, and 12 +/- 5 mm). Thymic involution appeared in 56/84 (67%) patients, ranging from small nodule(s) of less than 5mm diameter to linear soft tissue strands and complete fatty replacement. Patients with thymic remnant tissue were younger than those with thymic involution (P < 0.05). The thymic carcinoid tumor could be distinguished from remnant tissue on the basis of age and size. The presence of anterior mediastinal nodule(s) in hypercortisolemia need not imply the presence of a thymic carcinoid tumor, although in older patients this should arouse suspicion.

The structure and function of periodontal ligament cells in acellular cementum in rat molars

To elucidate the structure and function of periodontal ligament cells at the periodontal ligament-cementum interface in advanced acellular cementogenesis, the cervical regions of molars in rats aged 6 weeks were observed by light and electron microscopy. The light and transmission electron microscopy showed the periodontal ligament cells to be elongated between dense, well-developed principal fibers. The transmission and scanning electron microscopy showed that these cells extended wing-like projections from the lateral surface, forming cylindrical compartments surrounding the principal fibers. In addition, finger-like projections extended toward the cementum from the cementum-facing ends. The main results suggest the following: at the periodontal ligament-cementum interface, the periodontal ligament cells maintain the architecture of the principal fibers by means of extracellular compartments. The arrangement of finger-like projections results in the formation of acellular cementum containing only Sharpey's fibers as a fibrous component.

Immunological studies on DNA-lysine photoadduct

Calf thymus native DNA was covalently linked with lysine by irradiation with 254 nm light. Thermal melting studies indicated a decrease of 16 degrees C in the Tm of DNA-lysine photoadduct over native DNA. The decrease in Tm was dependent of irradiation dose. The photoadduct was found to be a potent immunogen in experimental animal. Thymine-lysine photoconjugate in DNA-lysine photo-monoadduct appears to be the major immunodominant portion. A strong recognition of DNA-lysine photoadduct was observed with anti-DNA autoantibodies found in the sera of patients with SLE. Thymine-lysine conjugate in DNA-lysine photo-monoadduct appears to provide an immunodominant epitope(s) for SLE autoantibody recognition. The results suggests for the possible involvement of DNA-lysine photoadduct or similar modified structure(s) as a potential trigger for anti-DNA autoantibody production.

Inhibition of platelet function by recombinant soluble ecto-ADPase/CD39

Excessive platelet accumulation and recruitment, leading to vessel occlusion at sites of vascular injury, present major therapeutic challenges in cardiovascular medicine. Endothelial cell CD39, an ecto-enzyme with ADPase and ATPase activities, rapidly metabolizes ATP and ADP released from activated platelets, thereby abolishing recruitment. Therefore, a soluble form of CD39, retaining nucleotidase activities, would constitute a novel antithrombotic agent. We designed a recombinant, soluble form of human CD39, and isolated it from conditioned media from transiently transfected COS-1 cells and from stably transfected Chinese hamster ovary (CHO) cells. Conditioned medium from CHO cells grown under serum-free conditions was subjected to anti-CD39 immunoaffinity column chromatography, yielding a single approximately 66-kD protein with ATPase and ADPase activities. Purified soluble CD39 blocked ADP-induced platelet aggregation in vitro, and inhibited collagen-induced platelet reactivity. Kinetic analyses indicated that, while soluble CD39 had a Km for ADP of 5.9 microM and for ATP of 2.1 microM, the specificity constant kcat/Km was the same for both substrates. Intravenously administered soluble CD39 remained active in mice for an extended period of time, with an elimination phase half-life of almost 2 d. The data indicate that soluble CD39 is a potential therapeutic agent for inhibition of platelet-mediated thrombotic diatheses.

Renal carcinoma presenting as cardiac tamponade: a case report and review of literature

Pericardial involvement in an advanced malignancy is common but malignancy presenting as cardiac tamponade is rather uncommon. Review of English literature using Medline CD ROM revealed 131 cases since 1935, who have presented with this life threatening emergency. Lung is the most common primary site followed by lymphomas and leukemias. We report a case of transitional cell carcinoma of kidney presenting as cardiac tamponade. Such a presentation of transitional cell carcinoma of kidney has never been reported.

Ethnic differences in correlates of microalbuminuria in NIDDM. The role of the acute-phase response

OBJECTIVE

To investigate whether microalbuminuria is associated with markers of the acute-phase response in NIDDM and whether there are ethnic differences in this association among the three main racial groups in Malaysia.

RESEARCH DESIGN AND METHODS

NIDDM patients of Chinese, Indian, and Malay origin attending a diabetic clinic in Kuala Lumpur, Malaysia, were matched for age, sex, diabetes duration, and glycemic control (n = 34 in each group). Urinary albumin-to-creatinine ratio was measured in an early morning urine sample. Biochemical measurements included markers of the acute-phase response: serum sialic acid, triglyceride, and (lowered) HDL cholesterol.

RESULTS

The frequency of microalbuminuria did not differ among the Chinese, Indian, and Malay patients (44, 41, and 47%, respectively). In Chinese patients, those with microalbuminuria had evidence of an augmented acute-phase response, with higher serum sialic acid and triglyceride and lower HDL cholesterol levels; and urinary albumin-to-creatinine ratio was correlated with serum sialic acid and triglyceride. The acute-phase response markers were not different in Indians, with microalbuminuria being high in even the normoalbuminuric Indians; only the mean arterial blood pressure was correlated with urinary albumin-to-creatinine ratio in the Indians. Malay NIDDM subjects had an association of microalbuminuria with acute-phase markers, but this was weaker than in the Chinese subjects.

CONCLUSIONS

Microalbuminuria is associated with an acute-phase response in Chinese NIDDM patients in Malaysia, as previously found in Caucasian NIDDM subjects. Elevated urinary albumin excretion has different correlates in other racial groups, such as those originating from the Indian subcontinent. The acute-phase response may have an etiological role in microalbuminuria.

Cold stress facilitates calcium mobilization from bone in an ovariectomized rat model of osteoporosis

In an ovariectomized rat model of osteoporosis, the effects of cold stress on intestinal Ca2+ transference and rate of bone turnover were evaluated. In the ovariectomized rats, a significant reduction in intestinal transference of Ca2+ was associated with decreased activities of intestinal mucosal enzymes, alkaline phosphatase (AP), and calcium ATPase (Ca2+-ATPase) in all the different segments of small intestine in a descending gradient. The development of a high rate of bone turnover and osteoporosis in these animals was confirmed by significant alteration in plasma AP activity and calcium (Ca) level, urinary excretion of Ca and phosphate, and Ca : creatinine ratio. Cold stress in this model, apart from its unique influence in elevating plasma corticosterone and thyroid hormone level, enhanced all the above referred parameters studied in connection with intestinal transference of Ca2+, bone turnover rate, and osteoporosis. The results of this study emphasize that cold stress may have a positive influence on bone loss for an early development of hypogonadal osteoporosis in rats.

Blood glucose and ischemic brain damage

The effect of hyperglycemia on ischemic brain damage was studied in a rat model of incomplete ischemia. Incomplete ischemia was produced by permanent occlusion of one (either left or right) common carotid artery (CCA). Hyperglycemia was induced by intraperitoneal injection of 50% glucose, and same volume of physiological saline was injected in the controls 40 min before CCA ligation. Serum glucose level, at the time of vessel ligation, was 33.3 mMol/L. After CCA ligation, the rats were allowed to wake up and survive for upto 1 month. Perfusion-fixed brains were embedded in paraffin, subserially sectioned, and stained with haematoxylin-eosin/cresyl violet. Brain from sham-operated animals showed no damage neurons. Only mild neuronal damage was observed in saline pre-treated rats in CA1 area. Histological examination 24 h after CCA occlusion revealed ischemic neuronal cell damage to be more extensive in hyperglycemic rats. Neuronal damage was found in the major brain structures vulnerable to several insults. Some of those damaged neurons recovered well, but presence of some damaged neurons at 1 month of recovery suggesting delayed recovery. The results indicate that increased blood glucose level (hyperglycemia) during brain ischemia exaggerates structural alterations and leads to delay in recovery.

Low HIV and high STD among commercial sex workers in a brothel in Bangladesh: scope for prevention of larger epidemic

The present study documents the first systematic assessment of a brothel in Bangladesh in terms of sexually transmitted disease (STD) and human immunodeficiency virus (HIV). A cross sectional study was undertaken on brothel-based commercial sex workers (CSWs) selected systematic random sampling to assess the prevalence of STDs and HIV among CSWs in a brothel setting. Two hundred and ninety-six CSWs were selected from a brothel with a population of 593 women. Following informed consent, endocervical and blood samples were obtained for the diagnosis of genital chlamydia, gonorrhoea, HIV and syphilis respectively. In addition, another 170 consecutive blood samples were collected from the total CSW population for HIV tests. All blood samples for HIV testing were made anonymous by removing patient identifiers before testing. Endocervical specimens were tested by polymerase chain reaction (PCR) for the diagnosis of genital chlamydia and gonorrhoea. Syphilis and HIV infections were diagnosed by serology. One hundred and sixty-nine (57.1%) of the women were Treponema pallidum haemagglutination (TPHA)-positive, 20 (6.8%) of the women were Venereal Disease Research Laboratory (VDRL)-positive at a greater than 1:8 dilution. Eighty-two (28%) of the women were found to be infected either by gonorrhoea or chlamydia. No HIV antibody was found in any of the 466 blood samples. A high prevalence of STDs and low prevalence of HIV in the CSWs in Bangladesh suggest potential for the rapid spread of HIV once it is introduced in this high-risk population. The opportunity to control STD and HIV infection in this population should not be missed, in order to prevent a large epidemic in the future.

A double-blind trial of fluoxetine in pathologic skin picking

BACKGROUND

Our objective was to determine the efficacy of fluoxetine in the treatment of pathologic skin picking in a double-blind, placebo-controlled, parallel trial.

METHOD

Twenty-one adults with chronic pathologic skin picking agreed to participate and received 10 weeks of placebo or fluoxetine with a flexible dosing schedule up to 80 mg/day. Three skin-picking measures were employed: the Clinical Global Impression-Improvement (CGI-I) scale, the Skin Picking Treatment Scale (SPTS), and a visual analog scale of self-rated change (VAS). In addition, depression, anxiety, and obsessions-compulsions were rated using the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), the Spielberger State-Trait Anxiety Inventory (STAI), and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for the duration of the study.

RESULTS

Seventeen subjects (6 treated with fluoxetine and 11 treated with placebo) completed the trial, at a mean fluoxetine dose of 55 mg/day. Fluoxetine was significantly superior to placebo in the treatment of skin picking according to two of the three measures for the completer analysis and to one of the three measures for the intent-to-treat analysis. Neither baseline level nor change in depression, anxiety, or obsessive-compulsive symptoms was significantly related to change in skin picking.

CONCLUSION

This first controlled trial of the treatment of pathologic skin picking suggests that fluoxetine may be of therapeutic benefit. Larger controlled studies are warranted.

Clinical, radiological and pathological features of patients with Rathke's cleft cysts: tumors that may recur

Rathke's cleft cysts are cystic sellar and suprasellar lesions, characteristically lined by a single layer of ciliated cuboidal or columnar epithelium. In contrast, craniopharyngiomass, which are also cystic sellar and suprasellar lesions, are characteristically lined by stratified squamous epithelium with keratinization on a layer of connective tissue. The usual management recommended for Rathke's cleft cysts is simple surgical drainage with partial excision of the cyst wall. Recurrences of these cysts reportedly have been very rare. This retrospective study presents the details of 12 patients (6 females; median age 30 yr, range 21-58 yr) with Rathke's cleft cyst, referred to our department over a 15-yr period (1981-1996), an unusual feature being the recurrence of 4 (33%) of these lesions. Clinical, endocrine, radiological, surgical (10 transsphenoidal; 2 transcranial), and pathological details were recorded. Nine out of 12 patients (75%) were symptomatic; visual symptoms were the commonest, and 8 had visual field defects. The median duration of symptoms was 12 months (range 3-24 months). Three patients (25%) had panhypopituitarism, 2 of whom also had diabetes insipidus (17%). The cysts varied in size from 6 mm to 50 mm, 1 being entirely suprasellar. There were no pathognomonic clinical or radiological features to differentiate them from other pituitary lesions, although the presence of diabetes insipidus in 2 patients suggested that the lesion was not a pituitary adenoma. A definite histological diagnosis was possible in 8 patients; in 4, the diagnosis was presumptive. The median duration of follow-up was 30 months (1-168 months). Four patients (33%) showed reexpansion at 3, 6, 48, and 48 months after initial surgery, 3 of whom were symptomatic and required repeat surgery. Two of these patients were given postoperative external beam pituitary radiotherapy. Apparent recurrence of Rathke's cleft cysts after initially successful surgery in our series was higher than suggested by previous reports, and thus, long-term follow-up with pituitary imaging and neuroophthalmological assessment is essential. There are no specific characteristics of the cyst that predict recurrence. Ideal management of these cysts is unclear, but aspiration, followed by extensive excision of the cyst wall when possible, seems to be the best initial option. For recurrent symptomatic tumors, surgical resection is the treatment of choice. Considering the high recurrence rate with residual structural and functional dysfunction, the role of radiotherapy in preventing recurrence of these cysts needs careful evaluation with a larger study with a longer follow-up period.

Effects of anodal polarization on protein kinase Cγ (PKCγ) in the rat brain

An anodal direct current of 0.3 microA or 30.0 microA was unilaterally applied for 30 min or 3 hr to the surface of the sensorimotor cortex of rats, and the effects of anodal polarization on protein kinase C (PKCgamma) activity were examined. The brains were processed by means of immunocytochemistry using the monoclonal antibody 36G9 raised against purified PKCgamma. In sham-operated animals, PKCgamma-like-immunoreactivity (PKCgamma LI) was noted in neuronal cytoplasm, as well as in processes in the cerebral cortex and in the hippocampus. Anodal polarization with 3.0 miroA for 30 min resulted in a pronounced increase in the number of PKCgamma-like-positive neurons in accordance with the intensity of immunostaining in the cerebral cortex, and an increase in the polarized hemispheres was highlighted by repeated applications of the currents. Polarization with 0.3 microA for 3 hr also increased the PKCgamma LI, but 0.3 microA for 30 min or 30.0 microA for any duration had no effects. The effect of polarization on PKCgamma activity, as evaluated by the intensity of immunostaining and the number of neurons, began to increase 1 h after polarization, peaked at 3 hr and thereafter decreased to the control levels by 72 hr. These results indicated the involvement of the gamma-isoform of PKC in the neurochemical mechanism of long-standing central and behavioral changes induced by anodal polarization.

The endothelial cell ecto-ADPase responsible for inhibition of platelet function is CD39

We previously demonstrated that when platelets are in motion and in proximity to endothelial cells, they become unresponsive to agonists (Marcus, A.J., L.B. Safier, K.A. Hajjar, H.L. Ullman, N. Islam, M.J. Broekman, and A.M. Eiroa. 1991. J. Clin. Invest. 88:1690-1696). This inhibition is due to an ecto-ADPase on the surface of endothelial cells which metabolizes ADP released from activated platelets, resulting in blockade of the aggregation response. Human umbilical vein endothelial cells (HUVEC) ADPase was biochemically classified as an E-type ATP-diphosphohydrolase. The endothelial ecto-ADPase is herein identified as CD39, a molecule originally characterized as a lymphoid surface antigen. All HUVEC ecto-ADPase activity was immunoprecipitated by monoclonal antibodies to CD39. Surface localization of HUVEC CD39 was established by confocal microscopy and flow cytometric analyses. Transfection of COS cells with human CD39 resulted in both ecto-ADPase activity as well as surface expression of CD39. PCR analyses of cDNA obtained from HUVEC mRNA and recombinant human CD39 revealed products of the same size, and of identical sequence. Northern blot analyses demonstrated that HUVEC express the same sized transcripts for CD39 as MP-1 cells (from which CD39 was originally cloned). We established the role of CD39 as a prime endothelial thromboregulator by demonstrating that CD39-transfected COS cells acquired the ability to inhibit ADP-induced aggregation in platelet-rich plasma. The identification of HUVEC ADPase/CD39 as a constitutively expressed potent inhibitor of platelet reactivity offers new prospects for antithrombotic therapeusis.

Nephrogenic adenoma of the ureter--a case report

We present a case of nephrogenic adenoma, a rare benign lesion arising from the ureter. Histologically, it showed the formation of epithelial lined tubules resembling the renal tubules. Special Stain demonstrated the presence of intraluminal PAS-positive materials.

The status of lower-limb amputation in Bangladesh: a 6-year review

We conducted a review of 450 single lower-limb amputations performed in our hospital in Bangladesh between July 1982 and June 1987. The incidence of amputation in the specific area of 1000000 inhabitants covered by the hospital was 0.75/10(3) per year. The indications for amputation were: limb ischemia in 366 patients (81%), traumatic crush injury in 45 (10%), diabetes-associated complications in 20 (5%), severe limb infection in 10 (2%), and neoplasm growth in 10 (2%). The ratio of above-knee (AK) to below-knee (BK) amputation was 1:65, and 36 patients (8%) required reamputation, 22 of whom had undergone BK amputation previously. Thus, the number of patients with a final amputation at AK level was 302 (67%). The operative mortality was 21% and the uncomplicated primary wound healing rate was 89% within the survivors. Among the 355 patients who survived the amputation, 265 (75%) were given a prosthesis, 50 (14%) refused a prosthesis, and the remaining 40 (11%) were unfit for a prosthesis. Rehabilitation was successful in 44% of the AK and 86% of the BK amputees. In conclusion, when amputation is inevitable, maximum consideration should be given to the type of surgery performed to avoid rehabilitation failure.

Reversibility of furazolidone-induced changes in testes and secondary sex characters of White Leghorn cockerels

Furazolidone (Fz) was fed to 4 groups of cockerels 15 w of age at 0, 400, 800 and 1200 mg/kg feed for 3 w and then was withdrawn for another 3 w. In a second experiment conducted simultaneously cockerels were fed these same Fz levels for 6 w and then were withdrawn from Fz feed for 4 w. In both experiments, 800 and 1200 mg Fz/kg feed resulted in decreases in comb and wattle size and in the weight of testes. The testes had smaller seminiferous tubule diameters and increased relative and decreased absolute volumes of interstitium. Spermatogenesis was not observed in cockerels fed 800 and 1200 mg Fz/kg feed. Withdrawal of Fz resulted in increased comb and wattle size, weight of testes and diameter of the seminiferous tubules. There was also an increase in absolute volume of interstitium along with decreased relative interstitium volume. Spermatogenesis was restored.

Antisense and sense poly(A)-RNAs from the Xenopus laevis pyruvate dehydrogenase gene loci are regulated with message production during embryogenesis

The structure and temporal expression of two Xenopus cDNAs encoding the beta subunit of pyruvate dehydrogenase (XPdhE1 beta) have been determined. XPdhE1 beta was 88% homologous to mature human PdhE1 beta, but the putative N-terminal mitochondrial signal peptide was poorly conserved. Zygotic expression of XPdhE1 beta mRNA was detected at neural tube closure and increased until stage 40. RT-PCR cloning identified a short homology to a protein kinase open reading frame within the 3' non-coding sequence of the XPdhE1 beta cDNAs. This homology, which occurred on the antisense cDNA strand, was shown by strand specific RT-PCR to be transcribed in vivo as part of an antisense RNA. Northern analysis showed that this RNA formed part of an abundant and heterogeneous population of antisense and sense poly(A)-RNAs transcribed from the XPdhE1 beta loci and coordinately regulated with message production.

Catalytic and non-catalytic forms of the neurotrophin receptor xTrkB mRNA are expressed in a pseudo-segmental manner within the early Xenopus central nervous system

The induction of anterior-posterior and medio-lateral patterning within the Xenopus neural plate leads to the rapid establishment of a functional nervous system. Here we describe two Xenopus TrkB neurotrophin receptor genes which are expressed in discrete sets of neuroblasts during this developmental process. The xTrkB mRNAs encode both catalytic and non-catalytic receptors and exhibit membrane-spanning-domain proximal splicing. Expression begins at neural tube closure within the trigeminal ganglion and within the Rohon-Beard neurons of the dorsal spinal cord, providing an excellent dorsal marker of early neural tube patterning. Expression occurs later in the facial ganglia and possibly within the Kolmer-Agduhr neurons. The predominant xTrkB transcripts within the trigeminal and Rohon-Beard neurons and the exclusive early transcripts of the facial ganglia encode C-terminally truncated non-catalytic receptors. Such Trk mRNAs have previously been observed in rodents. However, our observations suggest that they may play a specific role during early development. Anterior-posterior segmentation of the neural tube occurs rostrally within the prospective brain, but previous studies have suggested that segmentation does not extend caudally into the spinal cord. We show that the xTrkB positive Rohon-Beard neurons of the spinal cord do in fact display clear segmental groupings soon after neural tube closure. This is consistent with a role for segmentation in the anterior-posterior patterning of the trunk central nervous system.

Cardiac malignant lymphoma in severe combine immunodeficient mice

Extranodal malignant lymphomas are known to occur with increased frequency in patients with human immunodeficiency virus infection. Although cardiac malignant lymphomas are rare, recently an increasing number of patients with acquired immune deficiency syndrome (AIDS) and cardiac lymphoma have been reported. To clarify the relationship between AIDS and cardiac lymphomas, we used 60 severe combine immunodeficient (SCID) mice as animal models in whom five different types of human lymphoma cell lines were injected. Primary lymphomas at the site of cell line injection developed within 14-30 days in 58 mice. Cardiac malignant lymphoma was detected in 10 cases (17%), among which tumour was macroscopically evident in 2. Tumour was present on the pericardial aspects of the heart extending into the myocardium in most cases, but no intracavitary lesion was observed. In one case, obstructive features were marked near the root of the great vessels by direct pressure of the growth. This study indicates that lymphomas have a predilection to invade the heart in immunocompromised conditions.