Age and sex related variations in corpus callosal morphology

There is no unanimity in literature on sexual dimorphism or on age related morphophometric changes in the Corpus Callosum (CC). For comprehensive data 44 preserved human brains (22 male and 22 female) and 30 MRI scans from North-west Indian population were studied. Morphometric measurements of the CC and its subregions were taken at the midsagittal level in both the groups and subjected to statistical analysis. The only CC parameters which showed sexual dimorphism were (a) larger CC length in males in the MRI group, (b) the distance between the splenium and superior colliculus was more in males in preserved brains and (c) The distance between the genu and the fornix was more in older males than older females. Age related changes included (a) In males the distance between the genu and the fornix (in both the groups) was more in the older age group while the maximum width of the anterior half of the CC body was more in the younger age group (preserved brains) and (b) In females the height of the CC and the minimum width of the CC were more in the older females (preserved brains). No sexual dimorphism was observed in most of the CC parameters studied, including the splenium. Age related thinning of the anterior half of the CC in males could possibly be related to atrophic brain changes more common in males than females.

Post-operative radiotherapy for Ewing sarcoma: when, how and how much?

Postoperative radiotherapy in Ewing family of tumors has undergone continuous evolution over the last few decades to establish its role in the combined modality management of these tumors. The process of evolution is still far from over. This review analyzes the evidence from major multi-institutional prospective trials as well as large retrospective institutional series in Ewing tumors to determine the current standards and controversies in postoperative radiation. The indications of PORT, radiation dose-fractionation, timing, target volumes and treatment planning, as well as the late effects are reviewed. A summary of evidence based consensus is presented and unresolved aspects are discussed. Pediatr Blood Cancer 2008;51:575-580. (c) 2008 Wiley-Liss, Inc.

Development of an Exposure System for the Toxicological Evaluation of Particles Derived from Coal-Fired Power Plants

To investigate the toxicity of particles originating from coal-fired power plants it is necessary to consider the effects of both primary particles and secondary components formed in the air through atmospheric reactions. This report describes a new exposure system that can be used to expose animals to both directly emitted particles and to secondary particles. The system consists of three main components. The first is a sampling system to continuously collect and dilute power plant stack emissions. The second is a reaction laboratory that contains reaction chambers to simulate atmospheric reactions. The following atmospheric reactions were simulated: (1) the oxidation of sulfur dioxide to form sulfuric acid, (2) the neutralization of sulfuric acid by ammonia, and (3) the reaction of alpha-pinene with ozone to form secondary organic aerosol. Using these chambers with the diluted emissions, different typical atmospheric scenarios can be simulated. The final component is a mobile toxicology laboratory where animals are exposed to the resulting test aerosols. We report here the characteristics of the test aerosol exposures obtained at a coal-fired electric power plant. Particle exposures were characterized for concentrations of mass, elements, elemental carbon, organic species, inorganic ions, strong acidity, particle number, and size distributions. Mass concentrations ranged from a few micrograms per cubic meter for a scenario of primary emissions only, to about 250 microg m(-3) for the most complex scenario. We show that the different scenarios produced a large variation in the composition of the test aerosol, thus potentially changing the toxicity of the emissions.

Development and Evaluation of a Photochemical Chamber to Examine the Toxicity of Coal-Fired Power Plant Emissions

When investigating the toxicity of individual particle sources, it is important to consider the contribution of both primary and secondary particles. In this article, we present the design of a new photochemical chamber that can be used to form secondary sulfuric acid particles from diluted coal-fired power plant emissions. The chamber is a relatively small, well-mixed flow reactor that can fit in a mobile reaction laboratory. It produces high concentrations of hydroxyl radical (OH) from the photolysis of ozone (O3) in the presence of water vapor. Two chambers were built and tested. A pilot chamber was tested in the laboratory, using mixtures of NO and SO2 in air, at concentrations that are approximately 100 times lower than those in power plant stack emissions. This chamber was able to oxidize about 20% of the SO2, thereby producing 1350 microg m(-3) of H2SO4 particles. Further tests showed that increasing O3 concentrations and residence time increased the H2SO4 production. A field chamber was built subsequently and used in a toxicological study. Diluted coal-fired power plant emissions were introduced in the chamber. Over 19 days of exposure, the chamber, on average, converted 17% of the supplied SO2 emissions and produced an average of 350 microg m(-3) of H2SO4 particles. Particle losses were determined for the pilot chamber, using artificial particles whose size ranged from 50 to 1000 nm. The determined losses ranged from 21 to 42%, with no trend between the amount of particle loss and particle size. Losses for the field chamber, estimated using model calculations, were found to be similar to those of the pilot chamber.

IL-1 and iNOS gene expression and NO synthesis in the superior region of meniscal explants are dependent on the magnitude of compressive strains

OBJECTIVE

Partial meniscectomy is known to cause osteoarthritis (OA) of the underlying cartilage as well as alter the load on the remaining meniscus. Removal of 30-60% of the medial meniscus increases compressive strains from a maximum of approximately 10% to almost 20%. The goal of this study is to determine if meniscal cells produce catabolic molecules in response to the altered loading that results from a partial meniscectomy.

METHOD

Relative changes in gene expression of interleukin-1 (IL-1), inducible nitric oxide synthase (iNOS) and subsequent changes in the concentration of nitric oxide (NO) released by meniscal tissue in response to compression were measured. Porcine meniscal explants were dynamically compressed for 2 h at 1 Hz to simulate physiological stimulation at either 10% strain or 0.05 MPa stress. Additional explants were pathologically stimulated to either 0% strain, 20% strain or, 0.1 MPa stress.

RESULTS

iNOS and IL-1 gene expression and NO release into the surrounding media were increased at 20% compressive strain compared to other conditions. Pathological unloading (0% compressive strain) of meniscal explants did not significantly change expression of IL-1 or iNOS genes, but did result in an increased amount of NO released compared to physiological strain of 10%.

CONCLUSION

These data suggest that meniscectomies which reduce the surface area of the meniscus by 30-60% will increase the catabolic activity of the meniscus which may contribute to the progression of OA.

Radiation recall dermatitis with gatifloxacin: a review of literature

Radiation recall dermatitis (RRD) is a hypersensitivity skin reaction at the previously irradiated site after the administration of certain pharmacologic agent, which recovers on stopping the medication. RRD is a well-recognized phenomenon with the use of chemotherapeutic agents; however, only a few cases have been reported with noncytotoxic antibiotics, despite their common use in patients with cancer. We report here a case of RRD with the use of gatifloxacin and describe the time dose factors of radiation exposure, characteristics of skin reactions, management and response and our reasons to label this case as RRD. We also discuss published work regarding proposed mechanisms, histological features, radiation dose threshold and response to rechallange with the RRD-triggering drug. If RRD is to be characterized unequivocally, all the potential areas of confusion must be clarified like radiosensitization, nonhealing of acute reactions and skin-related adverse effects of the RRD-triggering drug. With the same objective, we further discussed radiosensitization and photosensitizing potential of fluoroquinolones. Gatifloxacin, although devoid of photosensitivity reactions, may cause idiosyncratic hypersensitivity reaction to cause RRD and should be considered as a potential cause of RRD. Given the potential severity of the reaction and increasing use of gatifloxacin, it is important to be aware of this phenomenon.

Encouraging experience of concomitant Temozolomide with radiotherapy followed by adjuvant Temozolomide in newly diagnosed glioblastoma multiforme: single institution experience

The purpose of this study was to report our experience with concomitant and adjuvant temozolomide (TMZ) with radiotherapy in patients with newly diagnosed glioblastoma multiforme (GBM). Forty-two newly diagnosed histopathologically proven patients with GBM underwent maximal safe resection followed by external radiotherapy to a total dose of 60 Gy in 30 fractions over 6 weeks along with concomitant oral TMZ (75 mg/m2) daily followed by adjuvant TMZ for 5 days every 28 days for six cycles (150 mg/m2 for the first cycle and 200 mg/m2 for rest of the cycles). Patients were monitored clinicoradiologically as per standard practice. Patients were 13-69 years of age with a median age of 49.5 years (31 males, 11 females). Fifty per cent of patients underwent a gross total resection of tumour, 43% had partial resection, and 7% an open or stereotactic biopsy only. 53% of the patients had a post-operative Karnofsky Performance Score (KPS) of 60-80%. All patients received concomitant radiation and TMZ with 74% of the patients completing six cycles of adjuvant TMZ. At a median follow-up of 12.5 months, the 1- and 2-year survival was 67 and 29%, respectively. The median overall and progression-free survival was 16.4 and 14.9 months respectively. Patients with pretreatment KPS of >80% had significantly better overall survival as compared with those having KPS<or=80% (median survival 22.12 vs. 11.97 months; p=0.026). Treatment was generally well tolerated with 9% of patients developing grade 3 anaemia, 2% grade 3 leucopoenia, and 7% patients grade 3 or 4 thrombocytopenia respectively during the treatment. At last follow-up, among the surviving patients, 30% had a maintained KPS greater than 90%. Concomitant radiotherapy and TMZ followed by adjuvant TMZ prolongs survival in patients with glioblastoma multiforme and is well tolerated in our patient population.

Case report: Second primary small cell carcinoma of the trachea in a breast cancer survivor: a case report and literature review

Small cell carcinoma of the trachea is a rare entity and only a few cases have been described, none as a second malignant neoplasm. This is the first report of a metachronous second primary of the trachea with small cell histology in a breast cancer survivor. A 25-year-old woman was diagnosed initially with an infiltrating ductal carcinoma of the breast, and was treated with modified radical mastectomy followed by adjuvant chemo-radiotherapy. 10 years later, she presented with breathlessness and central airway obstruction. Bronchoscopy revealed an intraluminal lesion in the proximal trachea, which was reported as small cell carcinoma on biopsy. There was no evidence of loco-regional recurrence of the previously treated breast cancer. Whole-body positron emission tomography did not show any distant metastases. As it was a small cell carcinoma, she was treated with concurrent chemo-radiotherapy and remains loco-regionally controlled. Decision-making in such instances should take into account prior treatment and needs to be individualized. There is a need for increased awareness amongst primary care physicians regarding second malignant neoplasms in the long-term follow-up of breast cancer patients treated with radiation and chemotherapeutic agents that have carcinogenic potential.

Comparison of two schedules (previous evening versus same morning) of bowel preparation for colonoscopy

BACKGROUND AND AIMS

Evening preparation for colonoscopy is often unsatisfactory and inconvenient. We performed this study to compare the efficacy of bowel preparation at two different timings: previous evening and same morning and to compare the loss of working hours and sleep between these groups.

PATIENTS AND METHODS

In this prospective, investigator blinded, randomized trial, 201 patients were enrolled from February to June 2005. Patients aged between 18 to 80 years needing colonoscopy were included. Patients with prior bowel surgery, suspected bowel obstruction or contraindications to phosphate preparation were excluded. Patients received a phosphate based preparation on the previous evening or morning of the procedure. The endoscopist and an observer scored bowel preparation using the Ottawa and Aronchick scales. Using the Ottawa scale right, middle and left colon were separately assessed. Loss of sleep and working hours were noted.

RESULTS

One hundred and two patients received morning preparation and 99 patients received preparation on the previous evening. There was no significant difference in bowel preparation in both the groups using the Ottawa ( P = 0.87) or Aronchick ( P = 0.22) scales. Bowel preparation for right colon was significantly better in the morning group ( P = 0.008). More working hours were lost in the evening group (7.99 vs 10.17, P< 0.001). Sleep was disturbed in 15 patients in morning group and in 42 patients in evening group ( P< 0.001).

CONCLUSION

Both preparations had similar efficacy. Right side preparation was significantly better in the morning group. Evening preparation was associated with loss of more working hours and sleep.

Acute effects of naltrexone and GBR 12909 on ethanol drinking-in-the-dark in C57BL/6J mice

RATIONALE

Recently, a simple procedure was described, drinking in the dark (DID), in which C57BL/6J mice self-administer ethanol to the point of intoxication. The test consists of replacing the water with 20% ethanol in the home cage for 2 or 4 h early during the dark phase of the light/dark cycle.

OBJECTIVES

To determine whether the model displays predictive validity with naltrexone, and whether opioid or dopaminergic mechanisms mediate excessive drinking in the model.

MATERIALS AND METHODS

Naltrexone or GBR 12909 were administered via intraperitoneal injections immediately before offering ethanol solutions, plain tap water, or 10% sugar water to male C57BL/6J mice, and consumption was monitored over a 2- or 4-h period using the DID procedure.

RESULTS

Naltrexone (0.5, 1, or 2 mg/kg) dose dependently decreased ethanol drinking but these same doses had no significant effect on the consumption of plain water or 10% sugar water. GBR 12909 (5, 10, and 20 mg/kg) dose dependently reduced the consumption of ethanol and sugar water but had no effect on plain water drinking.

CONCLUSIONS

The DID model demonstrates predictive validity. Both opioid and dopamine signaling are involved in ethanol drinking to intoxication. Different physiological pathways mediate high ethanol drinking as compared to water or sugar water drinking in DID. DID may be a useful screening tool to find new alcoholism medications and to discover genetic and neurobiological mechanisms relevant to the human disorder.

Celiac crisis with hypokalemic paralysis in a young lady

Celiac crisis presents as severe acute diarrhea with life-threatening metabolic derangement in a patient with celiac disease. We report a 30-year-old lady who was admitted with one-month history of worsening small bowel-type diarrhea. She developed acute quadriparesis due to refractory hypokalemia. Celiac disease was diagnosed on the basis of positive serology and histological features. She improved with aggressive correction of hypokalemia and gluten-free diet. Celiac crisis is a rare presentation of this heterogeneous disease in adulthood.

Primary malignant melanoma of right colon

We report a 62-year-old lady who presented with abdominal lump and neurological deficit. Investigations showed ascending colon mass, subcutaneous nodule and right parietal lobe lesion. Histology and immunohistochemistry were suggestive of malignant melanoma. The search for primary site was negative.

Should early cancers of the oral tongue be kept under surveillance after wide excision alone? A prospective study

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Background: The treatment of the clinically N0 neck in early stage oral tongue cancer remains controversial. Several clinico-pathologic criteria that can reliably identify an increased risk of occult metastases in the neck have been proposed. Our aim was to assess the impact of elective neck dissection (END) on outcome and correlate it with clinico-pathologic criteria for patient selection for surveillance. Methods: Patients with early stage cancer of the oral tongue (T1–2, N0) after undergoing wide excision with or without END were prospectively kept under observation. Patients having adverse histological features necessitating adjuvant radiotherapy were excluded. All patients gave informed consent and were closely followed. Relapsers were offered appropriate salvage therapy. The primary end-point for our prospective phase II study was the impact of END on relapse-free survival (RFS) with an estimated sample size of 50 patients. Overall survival (OS) was a secondary endpoint. Results: Fifty three eligible patients were consecutively accrued on the trial after surgery. Forty eight patients underwent per oral wide excision, with only 5 requiring a neck approach. Twenty two patients underwent upfront END. Twenty four patients relapsed (23 of which had some loco-regional component). The risk of neck recurrence in patients whose necks were not dissected electively was significantly higher than in patients treated with END (55% vs 9% respectively, p = 0.0016). The 3-year RFS (69.1% vs 40.9%, p = 0.008) and OS (87.2% vs 42.6%, p = 0.0228) was significantly better for patients treated with END. Conclusions: Regional recurrences are the most important cause of failure after wide excision alone. END which achieves excellent disease control in the neck and significantly improves RFS and OS should be considered routine for early stage oral tongue cancer.

No significant financial relationships to disclose.

Radical Radiotherapy in Head and Neck Squamous Cell Carcinoma: An Analysis of Prognostic and Therapeutic Factors

AIMS

Head and neck squamous cell carcinoma (HNSCC) continues to be a leading cancer in developing countries. Definitive radiation therapy either primary or as postoperative adjuvant is offered to most patients. We aimed to identify prognostic and therapeutic factors that affect locoregional control and survival in patients undergoing radical radiotherapy for head and neck squamous cell cancers.

MATERIALS AND METHODS

A retrospective analysis of 568 previously untreated patients with squamous head and neck cancers, who received radical radiotherapy between 1990 and 1996, using local control, locoregional control and disease-free survival (DFS) as outcome measures.

RESULTS

With a median follow-up of 18 months for living patients, the 5-year local control, locoregional control and DFS for all 568 patients were 53%, 45% and 41%, respectively, for all stages combined. The 5-year local control, locoregional control and DFS as per the American Joint Committee on Cancer stage grouping were 78%, 70% and 70%; 64%, 59% and 57%; 51%, 42% and 37%; and 40%, 27% and 22% from stages I to IV, respectively, with highly significant P values. Patients receiving higher doses (> or = 66 Gy) had a significantly better outcome compared with lower doses. The 5-year local control (59% vs 48%, P = 0.0015), locoregional control (47% vs 41%; P = 0.0043) and DFS (44% vs 37%; P = 0.0099) were significantly better in patients receiving > or = 66 Gy. Site of primary also affected outcome significantly, with oral cavity lesions faring badly.

CONCLUSION

Tumour stage remains the most important factor affecting outcome in radical radiotherapy of HNSCC. A definite dose-response relationship exists with higher total doses, leading to better local control, locoregional control and DFS in all stages. Site of primary affects outcome too, with laryngeal primaries doing well and oral cavity cancers faring the worst.

Cytomegalovirus involving gastric antrum in immunocompromised hosts: a report of 5 cases

Cytomegalovirus infection, which is common in immunosuppressed patients, only rarely affects the stomach, especially the gastric antrum. We report five patients with cytomegalovirus infection of the stomach with antral involvement. Of these, four had undergone renal transplant and one had HIV infection. All patients presented with upper gastrointestinal symptoms that did not respond to proton pump inhibitors and prokinetic drugs. In addition, all had systemic symptoms. Diagnosis was made at upper GI endoscopy and biopsy, and ganciclovir treatment led to improvement.

Splenic metastases from cervical carcinoma: a case report

Splenic metastasis from squamous cell carcinoma of the uterine cervix is an unusual event in the natural history of the disease. The authors report one such uncommon occurrence in a 41-year-old female who presented initially with cervical carcinoma (stage IIB) and was treated with radical radiotherapy with concurrent weekly chemotherapy. Following a disease-free interval of less than a year, she developed hepatosplenic metastases despite being locally controlled. The literature relevant to the report is also discussed. This report reaffirms the notion that splenic metastases from cervical carcinoma are rare events but can occur as part of widespread dissemination.

Stereotactic radiosurgery for brain oligometastases: good for some, better for all?

Brain metastasis is the commonest central nervous system neoplasm affecting 25% patients with cancer. Recursive Partitioning Analysis (RPA) is a reliable prognostic index for patients with brain metastases. In patients with oligometastases and good performance status, decision-making regarding stereotactic radiosurgery (SRS) boost, following whole brain radiation therapy (WBRT), is guided by patient preference, access to radiosurgical facility and institutional policy. Published data for this review was identified by a systematic search of MEDLINE, CANCERLIT and EMBASE databases from 1990 until the present date and was restricted to the English language using appropriate search terms. All three identified randomized controlled trials consistently showed that radiosurgery improves intracranial local control (Level I evidence). Survival benefit, however, is limited to a selected subset of patients (RPA class 1) only. More importantly, patients receiving SRS have significantly better performance scores and decreased steroid requirements resulting in improved health-related quality-of-life (HRQoL). There is no head-to-head comparison of radiosurgery with neurosurgery in resectable single metastasis. SRS is associated with an improvement in outcome. A trial of radiosurgery versus neurosurgery should be attempted to define better the role of SRS in resectable single metastasis. Formal HRQoL assessments should be incorporated as primary end points in future prospective trials.

Ultrasonographic changes in malignant neck nodes during radiotherapy in head and neck squamous carcinoma

Limited information is available about the sonomorphological changes in metastatic neck nodes during radiotherapy. The aim of this study was to evaluate the pattern of sonomorphological changes in metastatic neck nodes with radiotherapy. The study population consisted of 16 consecutive patients planned for radical radiotherapy to the head and neck. All patients were subjected to four ultrasound examinations: before therapy, at 46 Gy, at the conclusion of radiation and at first follow up. A total of 59 ultrasound examinations were performed on 16 patients. The difference between the mean number of nodes detected per patient before (10.6) and after (7.8) radiation was significant (P = 0.05). Sixteen nodes were categorized as malignant at first sonography, half of which reverted back to normal by the end of radiation. Changes in the sonomorphology of malignant cervical lymph nodes occur with radiotherapy with more that half demonstrating reversion to normal pattern. Future studies correlating this with histopathology should be considered.

Development and performance evaluation of a high-volume ultrafine particle concentrator for inhalation toxicological studies

This article presents the development and performance evaluation of a high-volume ultrafine particle concentrator. The ultrafine particle concentrator consists of several units, including a size-selective inlet; a condensational growth unit; a series of two virtual impactors (concentrators); a thermal size restoration device; an air cooler; and a size-selective outlet. Ambient ultrafine particles are condensationally grown to supermicrometer sizes and then are concentrated by a factor of 40 to 50 using a two-stage virtual impactor. Subsequently, ultrafine particle size distribution is restored, using a thermal method. The Harvard ultrafine concentrated ambient particle system (HUCAPS) delivers 58 lpm of concentrated aerosol that can be used for in vivo or in vitro inhalation toxicological studies. Overall, pressure drop through the system is only 2.2 kPa, which is adequately low for inhalation toxicological exposure tests. The performance of this system was evaluated using single-component artificial aerosols with a variety of physicochemical properties as well as ambient air. These experiments showed that for an optimum supersaturation ratio of 3.0, all ultrafine particles grow and get concentrated by about the same enrichment factor, regardless of their composition and surface properties.

Hemoglobin E-beta thalassemia: factors affecting phenotype

The phenotype of E-beta-thalassemia is affected by several genetic factors. The aim of this study was to analyze severity of E-beta-thalassemia and correlate with HbE, HbF, E/F ratios, beta-mutation and Xmn I polymorphism. Thirty cases of E-beta-thalassemia (23 with childhood onset) were studied. HbE levels were quantitated by HPLC. Xmn1 polymorphism and beta-mutations were studied by PCR-RFLP and ARMS respectively. Commonest features were pallor (100%), splenomegaly (74%), and hepatomegaly (65%), 43% (10/23) were on regular transfusions at diagnosis. One case presented with paraplegia. Patients heterozygous for Xmn I polymorphism (+/-) had later onset (>3 yrs) compared to homozygous (-/-) absence (0.5-2.8 yrs). Most (69.6%) showed beta-mutation IVS 1-5 (G-->C). Negative correlation was found between age of onset and HbE. Thus, presentation is similar to previously reported Thai cases. Heterozygosity of Xmn I polymorphism also delays disease onset. Early diagnosis facilitates appropriate management and prenatal diagnosis.

Spontaneously developing autoantibody to factor VIII in an elderly woman: diagnostic and therapeutic challenges

An elderly woman with a continuously bleeding small wound was investigated for the presence of antibodies to FVIII using activated partial time-based screening and confirmatory tests. A late acting coagulation factor inhibitor was detected. The same was characterised to be a low titre antibody against FVIII (5.2 Bethesda units). Cryoprecipitate infusions, corticosteroids and topical desmopressin were unsuccessful in controlling the bleeding. Addition of cyclophosphamide brought about stoppage of bleeding and disappearance of the autoantibody.

Consolidation radiation after complete remission in Hodgkin's disease following six cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy: is there a need?

PURPOSE

Combined modality treatment using multidrug chemotherapy (CTh) and radiotherapy (RT) is currently considered the standard of care in early stage Hodgkin's disease. Its role in advanced stages, however, continues to be debated. This study was aimed at evaluating the role of consolidation radiation in patients achieving a complete remission after six cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy using event-free survival (EFS) and overall survival (OS) as primary end points.

PATIENTS AND METHODS

Two hundred and fifty-one patients with Hodgkin's disease attending the lymphoma clinic at the Tata Memorial Hospital (Mumbai, India) from 1993 to 1996 received induction chemotherapy with six cycles of ABVD after initial staging evaluation. A total of 179 of 251 patients (71%) achieved a complete remission after six cycles of ABVD chemotherapy and constituted the randomized population. Patients were randomly assigned to receive either consolidation radiation or no further therapy.

RESULTS

With a median follow-up of 63 months, the 8-year EFS and OS in the CTh-alone arm were 76% and 89%, respectively, as compared with 88% and 100% in the CTh+RT arm (P =.01; P =.002). Addition of RT improved EFS and OS in patients with age < 15 years (P =.02; P =.04), B symptoms (P =.03; P =.006), advanced stage (P =.03; P =.006), and bulky disease (P =.04; P =.19).

CONCLUSION

Our study suggests that the addition of consolidation radiation helps improve the EFS and OS in patients achieving a complete remission after six cycles of ABVD chemotherapy, particularly in the younger age group and in patients with B symptoms and bulky and advanced disease.

Development of a high-volume concentrated ambient particles system (CAPS) for human and animal inhalation toxicological studies

A two-stage, high-volume, ambient particle concentrator was developed and characterized. This versatile system, depending on its operational parameters, can be used to fractionate and concentrate particles in three size ranges (PM(10-2.5), PM(10-1), PM(2.5-1)). The performance of this concentrated ambient particle system (CAPS), as well as its individual virtual impaction stages, was investigated as a function of several parameters, including minor-to-total flow ratios and acceleration nozzle Reynolds number. During these laboratory tests, performance parameters such as concentration enrichment factor (CF), particle losses, collection efficiency curves, cutpoint, and pressure drop were measured. The main objective of these investigations was to optimize the ability of the system to concentrate ambient PM(2.5-10) and PM(1-10) particles. PM(2.5-10) particles were concentrated by a factor of 70 to 150. The flow rate of the concentrated aerosol can range between 12.5 and 50 LPM (L/min). Other features of the system include relatively low-pressure drops in the major and minor flows, low particle losses, and a compact design. Performance evaluation of the system also confirmed that separation and concentration of the PM(2.5-10) particles occurred without any significant distortion of the size distribution, during the concentration process. Similar results were obtained for the PM(1-10) size range. For this size range, concentration enrichment was 70 times, and again, no particle size distribution distortion was observed. The overall performance of this versatile system makes it suitable for inhalation toxicological studies.

Development and laboratory performance evaluation of a personal cascade impactor

This paper presents the design and laboratory evaluation of a personal cascade impactor. The system is compact, lightweight, and uses a single battery-operated sampling pump. It operates at a flow rate of 5 L/min and consists of four impaction stages, each equipped with slit-shaped acceleration nozzles, and a backup filter. The impactor was calibrated using polydisperse particles. The 50% cut points of the four stages were 9.6, 2.6, 1.0, and 0.5 microm, respectively. The backup filter is placed downstream of the fourth stage and is used to collect the particles with an aerodynamic diameter smaller than 0.5 microm (dp < 0.5 microm). The major feature of this novel sampler is its ability not only to fractionate the particles with an aerodynamic diameter smaller than 10 microm to the various size fractions, but also to collect them onto relatively small polyurethane foam substrates without using adhesives. Although the impaction substrates are not coated with adhesives such as grease or mineral oil, particle bounce and re-entrainment losses were found to be insignificant. Interstage losses of particles smaller than 0.5 microm were less than 10%; for fine particles, less than 5%; and for coarse particles, less than 12%. The pressure drop across the four stages and the backup filter were 0.015 kPa (0.153 cm H2O),0.025 kPa (0.255 cm H2O), 0.274 kPa (2.794 cm H2O), 0.323 kPa (3.294 cm H2O), and 0.370 kPa (3.773 cm H2O), respectively. Particles can be easily recovered from the foam substrates using aqueous extraction.

Bioactivation of nitroglycerin and vasomotor response to nitric oxide are impaired in cirrhotic rat livers

Nitroglycerin (NTG), a nitric oxide (NO) donor, has been shown to reduce portal pressure in cirrhotic patients. Using the in situ perfusion of normal and cirrhotic rat livers, we compared the vascular relaxation induced by either NTG or the spontaneous nitric oxide donor S-nitroso-N-acetylpenicillamine (SNAP). Normal and cirrhotic livers were perfused (40 mL/min, 37 degrees C) with Krebs' solution in a recirculating system. After preconstriction with methoxamine (10(-4) mol/L), a dose-response study was performed using 6 cumulative doses of NTG or SNAP (10(-7) to 3 x 10(-5) mol/L). NO(x) (NO(-)(2) + NO(-)(2) production in the perfusate was measured by chemiluminescence. Cirrhotic livers exhibited lower vasorelaxant responses, compared with normal livers, to both NTG (P <.0001) and SNAP (P =.0020). In normal livers, NTG and SNAP induced similar vasorelaxant responses (P =.44). In cirrhotic livers, NTG induced less vasorelaxation than SNAP (P <.0001). In the presence of NTG (P =.0045), but not SNAP (P =.99), NO(x) production in experiments with cirrhotic livers was lower than in experiments with normal livers. In conclusion, in cirrhotic rat livers, the vasorelaxant response to NTG is impaired owing to both a decreased metabolism of this NO donor and an inability of the hepatic vasculature to respond to NO.

Two signals are better than one: border cell migration in Drosophila

Recent studies of border cell migration during Drosophila oogenesis demonstrate that the EGFR and PDGFR signaling pathways act in a partially redundant manner to guide this process. Evidence presented shows that PDGFR signaling directs border cell migration via Rac and the Rac activator Mbc/CED-5/Dock180.

Neuronal nicotinic acetylcholine receptor alpha3 subunit protein in rat brain and sympathetic ganglion measured using a subunit-specific antibody: regional and ontogenic expression

A synthetic peptide corresponding to the C-terminus of the alpha 3 subunit of the rat neuronal nicotinic acetylcholine receptor (nAChR) was used to generate a rabbit polyclonal alpha 3 antibody. The specificity of this antibody was characterized by immunoblotting, immunohistochemical and immunoprecipitation techniques. Using this antibody, the relative densities of the alpha 3 subunit were quantitatively determined in different brain regions and in superior cervical ganglion (SCG). Among these regions, SCG, interpeduncular nucleus (IPN) and pineal gland showed the highest levels of alpha 3 protein expression. Habenula and superior colliculi had intermediate levels of expression. Low levels were found in cerebral cortex, hippocampus and cerebellum. The ontogenic profile of the alpha 3 subunit in the SCG was also determined. The alpha 3 protein level is low at postnatal day (P 1), but increases rapidly during the first seven postnatal days. This level then plateaus and remains stable through postnatal day 35. These findings suggest that neuronal nAChRs containing the alpha 3 subunit participate in important roles in specific regions of the rat brain and the SCG.

Helicobacter pylori-related gastric outlet obstruction: is there a role for medical treatment?

The role of Helicobacter pylori in the pathogenesis of duodenal and gastric ulcer and ulcer recurrence is widely known. Bleeding, perforation, and gastric outlet obstruction represent the most serious, potentially life-threatening complications of ulcer disease. At present, the effect of H. pylori eradication on complicated ulcer disease has not been fully established. Case reports exist on the resolution of gastric outlet obstruction after eradication of H. pylori. We report the first case of H. pylori-related gastric outlet obstruction successfully treated with parenteral antibiotics.

Local arterial vasoconstriction induced by octreotide in patients with cirrhosis

Peripheral vasodilation initiates the hyperdynamic circulation in cirrhosis. Somatostatin and its analogues, such as octreotide, have a vasoconstrictive effect in cirrhotic patients and experimental animals with portal hypertension. The exact mechanism of octreotide-induced vasoconstriction remains unknown. To investigate whether octreotide produces vasoconstriction through suppression of vasodilatory peptides, such as glucagon, or through a local effect, we evaluated the effect of an intra-arterial dose on forearm blood flow (FBF), while measuring systemic glucagon levels. FBF was measured in 10 cirrhotic patients by venous occlusion plethysmography. The brachial artery of the nondominant arm was catheterized, and vasoactive drugs were administered: methacholine 4 microg/min; octreotide 20 microg/h, and octreotide 20 microg/h + methacholine 4 microg/min. Each infusion, lasting 5 minutes, was followed by saline for washout. FBF was measured in both arms during the last minute of each infusion and at the end of washout, with the uninfused arm acting as the control. Nitrates and nitrites, octreotide, and glucagon blood levels were determined at baseline and after each infusion. Percent change in flow (%triangle up) was obtained by comparing the flow during drug administration to that during the preceding saline infusion. Saline infusion did not alter FBF, but octreotide infusion resulted in a 34% +/- 7.7 (P <.005) reduction in FBF in the infused arm. FBF in the control arm was unchanged despite a significant decrease in systemic glucagon levels. Methacholine infusion increased FBF around 300%, which was not altered by the concomitant infusion of octreotide. Octreotide has a local vasoconstrictive effect that seems nitric oxide (NO)-independent. Octreotide probably has a facilitating effect over vasoconstrictors increased in chronic liver diseases.

Hypopharyngeal perforation from a swallowed fork: a brief report and comment

Hypopharyngeal perforations are usually seen as a complication of endotracheal intubation by less experienced physicians in emergency situations. The site most commonly perforated is the pharynx, posterior to the cricopharyngeal muscle; the second most common site is the pyriform sinus. We report here an unusual cause of hypopharyngeal perforation from a swallowed plastic fork in a psychiatric patient.

Low-dose midazolam sedation: an option for patients undergoing serial hepatic venous pressure measurements

The hepatic venous pressure gradient (HVPG) is becoming increasingly used clinically. It is useful in the differential diagnosis of portal hypertension and provides a prognostic index in cirrhotic patients. Performance of serial measurements has been shown to be useful in guiding pharmacological therapy of portal hypertension and variceal hemorrhage. The technique is safe to perform; however, many patients are anxious and reluctant to undergo serial measurements. The effects of sedatives on portal pressure measurements have not yet been defined. The objective of this study was to evaluate the effects of midazolam on the HVPG. Twenty patients with compensated cirrhosis were included in this prospective, double-blind study. The HVPG was determined by subtracting the free hepatic venous pressure (FHVP) from the wedged hepatic venous pressure (WHVP). Patients were randomized to receive either placebo, 0.02 mg/kg midazolam, or 0.03 mg/kg midazolam, administered intravenously over 3 minutes. Immediately after drug administration and every 3 minutes thereafter, for a total of 30 or 40 minutes, measurements were repeated. Three hours later, patients were asked to state whether the sedative affected their state of comfort/relaxation. The effects of both doses of midazolam on HVPG did not differ significantly from those of placebo. Furthermore, neither dose of midazolam induced significant changes in HVPG as compared with baseline values. However, higher-dose midazolam (0.03 mg/kg) was associated with significant reductions in FHVP from baseline and a tendency for a reduction in WHVP. Both doses significantly increased patient comfort and relaxation during the test. Midazolam, used at a dose of 0.02 mg/kg, is effective in increasing patient comfort and relaxation during hepatic venous pressure measurements, without significantly affecting pressures (HVPG, WHVP, or FHVP). It is therefore an acceptable option for patients undergoing serial hepatic venous pressure measurements.

Surgery in India

Surgical practice in India is mostly managed by the central and state governments and is totally government financed, offering free medical aid. However, with the economic growth and affluence of the middle-class population in urban areas, more and more hospitals, nursing homes, and clinics managed by the private sector are arising in cities and towns. Privately owned hospitals are built and managed by large industrial houses and trusts. It is essential, according to government directives, for these hospitals to have certain numbers of general beds that will provide for the economically weaker sections of the population. Medical insurance is popular amongst the urban population; in addition to well-established insurance companies, many new medical service reimbursement organizations are forming. Surgical care standards are uniformly high in the larger teaching institutions and hospitals run by the private sector in major cities in India, in which superspecialty surgical care that meets worldwide standards is available in addition to general surgical care. These hospitals are manned by surgeons holding master's degrees in general surgery, superspecialties, and subspecialties. In the hospitals and dispensaries in rural areas, only basic surgical facilities are available; for major surgical procedures, the patients are referred to the closest urban hospitals. Therefore, the government of India is placing more and more emphasis on building hospitals that offer better surgical facilities away from the cities and towns. A diploma course in surgery is run by the National Board of Surgery, and these diplomates are encouraged to practice more in rural areas and small hospitals. Economic constraints and the population explosion are the biggest hurdles to progress in surgical care, teaching, and research activities. With the advancement in education and growth of the economy, more and more multinationals are walking into the field of medical care, which is proving to be a great boon and providing a rapid increase in the health care expansion in this country. The World Health Organization and the World Bank are providing considerable aid for disease prevention, health care provision, and research activities.

Temperature sensitivity of the keratin cytoskeleton and delayed spreading of keratinocyte lines derived from EBS patients

Point mutations in the keratin intermediate filament genes for keratin 5 or keratin 14 are known to cause hereditary skin blistering disorders such as epidermolysis bullosa simplex, in which epidermal keratinocytes are extremely fragile and the skin blisters on mild trauma. We show that in 2 phenotypically diverse cases of epidermolysis bullosa simplex, the keratin mutations result in a thermoinstability of the intermediate filament cytoskeleton which can be reproducibly demonstrated even in the presence of tissue culture-induced keratins and in conditions where filament fragility is not otherwise obvious. SV40-T antigen and HPV16 (E6--E7) immortalised keratinocyte cell lines were examined, established from control and epidermolysis bullosa simplex-affected individuals with either severe (Dowling-Meara) or mild (Weber-Cockayne) forms of the disease. In standard tissue culture conditions no significant and consistent abnormality of the keratin cytoskeleton could be demonstrated. However after thermal stress a reduced stability of the keratin filaments was demonstrable in the epidermolysis bullosa simplex cell lines, with filaments breaking into aggregates similar to those seen in skin from EBS patients. These aggregates were maximal at 15 minutes after heat shock and the filament network structure was substantially reversed by 60 minutes. Differences were also seen in the cells during respreading after replating: cells containing mutant keratins were slower to respread than controls and fine aggregates were seen at the cell margins in the Dowling-Meara derived cell line. Such delays in restoring the normal intermediate filament network after physiological processes involving cytoskeleton remodelling may render the cells vulnerable to cytolysis in vivo if physically challenged during this time window. The steady reduction in the mitotic index of the epidermis during the first few years of life could then explain the clinical improvement which is frequently observed in growing children.

Effects of intracervical injection of hyaluronidase in primigravidae during labour

A study was conducted on 75 primigravidae in labour of which 50 were injected with intracervical injection of hyaluronidase and 25 were taken as control. Labour could be accelerated and shortened by an average of 1.95 hours (p < .01) after intracervical injection of hyaluronidase. Its effect was insignificant on the latent phase of labour while it significantly shortened the active phase of labour by 2.09 hours (p < .001). Its effect on maximum rate of cervical dilatation (0.85 cm/hour) was also found to be statistically significant ie, p < .001. Hyaluronidase had no effect on uterine contractions, duration of 2nd and 3rd stages of labour and on involution of the uterus. There was no incidence of cervical tear in any of the cases.