Dermatofibrosarcoma protuberans of the jejunum

We report a 55-year-old man with recurrent bleeding from the small intestine. Preoperative investigations suggested it to be a small intestine tumor. The resected specimen was diagnosed at histology as dermatofibrosarcoma protuberans of the small bowel.

Histological changes to palatal and paratubal muscles in oral submucous fibrosis

Oral submucous fibrosis (OSMF) is prevalent in the Indian subcontinent. In a large number of patients conductive deafness due to eustachian tube dysfunction has been found. The present study was, therefore, planned to assess the histopathological changes in palatal and paratubal muscles in oral submucous fibrosis. Incisional biopsy from the soft palate was taken in clinically proven cases of OSMF. In most of the cases, signs of chronic inflammation and fibrosis were seen in the submucosa. Dysplasia was noticed in seven (13.2 per cent) patients. Degenerative changes in palatal/paratubal muscles were found in the form of loss of cross striations in seven (13.2 per cent), oedematous muscle fibres in five (9.4 per cent) and atrophy in five (9.4 per cent) cases. It was concluded that there was definite involvement of palatal and paratubal muscles in OSMF. This could explain the eustachian tube dysfunction in these patients.

Endometrial protection from tamoxifen-stimulated changes by a levonorgestrel-releasing intrauterine system: a randomised controlled trial

INTRODUCTION

Tamoxifen is currently the most commonly used adjuvant treatment for breast cancer, however, it frequently causes episodes of unscheduled uterine bleeding, which could be associated with proliferative changes of the endometrium, or even endometrial cancer. We aimed to assess whether a levonorgestrel intrauterine system could modulate the uterine responses to tamoxifen. We also aimed to assess women's tolerance of the screening procedures, the insertion, removal, and potential side-effects of the device.

METHODS

We did a randomised controlled trial, in which postmenopausal women who had had at least 1 year of adjuvant tamoxifen treatment and who were undergoing regular follow-up for breast cancer were randomly assigned to either endometrial surveillance alone, or endometrial surveillance before and after insertion of the levonorgestrel intrauterine system for 12 months. We assessed tolerance of the surveillance procedures and the device with visual analogue scales.

FINDINGS

Baseline assessment showed only benign uterine changes in all women (n=122). Hysteroscopic assessment indicated a uniform decidual response (confirmed histologically in 40 of 41 cases) in all women fitted with the intrauterine system; there were no new polyps in these women and 13% had fewer fibroids than in controls. Both screening procedures and device were well tolerated. There was an excess of bleeding in the women fitted with intrauterine systems but this resolved to a baseline similar to those receiving surveillance only.

INTERPRETATION

The levonorgestrel-releasing intrauterine system had a protective action against the uterine effects of tamoxifen. The effectiveness of this device in preventing uterine changes in the endometrium needs to be assessed in the context of decreasing the need for repeated investigations of postmenopausal bleeding in women taking tamoxifen.

Expression of Bacillus circulans Teri-42 xylanase gene in Bacillus subtilis

The xylanase gene of Bacillus circulans Teri-42 was cloned in both B. subtilis and Escherichia coli. The enzyme activity was almost 87% higher in B. subtilis (pBA7) than in E. coli (pAQ4). No cellulase activity was detected in the clones, B. subtilis (pBA7) and E. coli (pAQ4). Approximately 1120 U (80%) of the xylanase was secreted extracellularly by the clone B. subtilis (pBA7) as compared to 79 U (88%) excreted in E. coli (pAQ4). In B. subtilis (pBA7) the optimal xylanase activity was at pH 7.0 and 50 degrees C, which was the same as that of the parent B. circulans Teri-42. The recombinant xylanase in B. subtilis was more stable at higher temperatures than the parent B. circulans Teri-42. Purification of xylanase from the clone B. subtilis (pBA7) showed a 71 kDa polypeptide similar to that observed in B. circulans Teri-42.

Molecular basis of vitamin E action. Tocotrienol potently inhibits glutamate-induced pp60(c-Src) kinase activation and death of HT4 neuronal cells

HT4 hippocampal neuronal cells were studied to compare the efficacy of tocopherols and tocotrienol to protect against glutamate-induced death. Tocotrienols were more effective than alpha-tocopherol in preventing glutamate-induced death. Uptake of tocotrienols from the culture medium was more efficient compared with that of alpha-tocopherol. Vitamin E molecules have potent antioxidant properties. Results show that at low concentrations, tocotrienols may have protected cells by an antioxidant-independent mechanism. Examination of signal transduction pathways revealed that protein tyrosine phosphorylation processes played a central role in the execution of death. Activation of pp60(c-Src) kinase and phosphorylation of ERK were observed in response to glutamate treatment. Nanomolar amounts of alpha-tocotrienol, but not alpha-tocopherol, blocked glutamate-induced death by suppressing glutamate-induced early activation of c-Src kinase. Overexpression of kinase-active c-Src sensitized cells to glutamate-induced death. Tocotrienol treatment prevented death of Src-overexpressing cells treated with glutamate. alpha-Tocotrienol did not influence activity of recombinant c-Src kinase suggesting that its mechanism of action may include regulation of SH domains. This study provides first evidence describing the molecular basis of tocotrienol action. At a concentration 4-10-fold lower than levels detected in plasma of supplemented humans, tocotrienol regulated unique signal transduction processes that were not sensitive to comparable concentrations of tocopherol.

Comorbidity in juvenile obsessive-compulsive disorder: a report from India

OBJECTIVE

Using minimal exclusion criteria, to assess systematically the psychiatric comorbidity in children and adolescents with obsessive-compulsive disorder (OCD) and compare the findings with those of previous studies.

METHOD

Fifty-four children and adolescents who satisfied DSM-III-R criteria for OCD were assessed using a structured interview schedule, the Children's version of the Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and the questionnaire for tic disorders. All 54 subjects were recruited from the Child and Adolescent Psychiatry (CAP) services of the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, South India. Diagnoses were determined consensually after a review of all the available data.

RESULTS

Comorbidity was found in 69% of the sample: 22% were diagnosed with disruptive disorders; 20% met criteria for mood disorders; 19% had anxiety disorders; and 17% had tic disorders. Only 1 subject had bipolar disorder, and none had psychosis. The rates for individual diagnoses--in particular, the rates for disruptive disorders, bipolar disorder, and psychosis--were considerably lower than those reported in previous studies.

CONCLUSIONS

Patterns of comorbidity in this study differed from those previously reported. Novel patterns of comorbidity with disruptive disorders, bipolar disorder, and psychosis reported in a few recent studies were not replicated in this study. These differences are probably due to different ascertainment methods. Comorbidity needs to be assessed in large epidemiological samples before definite associations can be made between certain comorbid disorders and juvenile OCD.

Use of hypertonic saline in the treatment of severe refractory posttraumatic intracranial hypertension in pediatric traumatic brain injury

OBJECTIVES

To evaluate the effect of prolonged infusion of 3% hypertonic saline (514 mEq/L) and sustained hypernatremia on refractory intracranial hypertension in pediatric traumatic brain injury patients.

DESIGN

A prospective study.

SETTING

A 24-bed Pediatric Intensive Care Unit (Level III) at Children's Hospital.

PATIENTS

We present ten children with increased intracranial pressure (ICP) resistant to conventional therapy (head elevation at 30 degrees, normothermia, sedation, paralysis and analgesia, osmolar therapy with mannitol, loop diuretic, external ventricular drainage in five patients), controlled hyperventilation (Pco2, 28-35 mm Hg), and barbiturate coma. We continuously monitored ICP, cerebral perfusion pressure (CPP), mean arterial pressure, central venous pressure, serum sodium concentrations, serum osmolarity, and serum creatinine.

INTERVENTIONS

A continuous infusion of 3% saline on a sliding scale was used to achieve a target serum sodium level that would maintain ICP <20 mm Hg once the conventional therapy and barbiturate coma as outlined above failed to control intracranial hypertension.

MEASUREMENTS AND MAIN RESULTS

The mean duration of treatment with 3% saline was 7.6 days (range, 4-18 days). The mean highest serum sodium was 170.7 mEq/L (range, 157-187 mEq/L). The mean highest serum osmolarity was 364.8 mosm/L (range, 330-431 mosm/L). The mean highest serum creatinine was 1.31 mg/dL (range, 0.4-5.0 mg/dL). There was a steady increase in serum sodium versus time zero that reached statistical significance at 24, 48, and 72 hrs (p < .01). There was a statistically significant decrease in ICP spike frequency at 6, 12, 24, 48, and 72 hrs (p < .01). There was a statistically significant increase in CPP versus time zero at 6, 12, 24, 48, and 72 hrs (p < .01). There was a statistically significant increase in serum osmolarity versus time zero at 12 hrs (p < .05) and at 24, 48, and 72 hrs (p < .01). Two patients developed acute renal failure and required continuous veno-venous hemodialysis; these were concurrent with an episode of sepsis and multisystem organ dysfunction. Both recovered full renal function with no electrolyte abnormalities at the time of discharge.

CONCLUSION

An increase in serum sodium concentration significantly decreases ICP and increases CPP. Hypertonic saline is an effective agent to increase serum sodium concentrations. Sustained hypernatremia and hyperosmolarity are safely tolerated in pediatric patients with traumatic brain injury. Controlled trials are needed before recommendation of widespread use.

Prolonged hypernatremia controls elevated intracranial pressure in head-injured pediatric patients

OBJECTIVE

To determine the effects continuous infusions of hypertonic saline (3% NaCl) on intracranial pressure (ICP) control and describe the physiologic effects of hypertonic saline administered to closed head injury children.

DESIGN

Retrospective chart review.

SETTINGS

Pediatric intensive care unit of a children's hospital.

PATIENTS

Sixty-eight children with closed head injury.

INTERVENTIONS

Intravenous infusion of 3% hypertonic saline to increase serum sodium to levels necessary to reduce ICP < or =20 mm Hg.

MEASUREMENTS AND MAIN RESULTS

The patients enrolled had similar Injury Severity Scores. Treatment effectively lowered ICP in these patients and ICP was under good control a majority of the time. Only three patients (4%) died of uncontrolled elevation of ICP. No adverse effects of supraphysiologic hyperosmolarity such as renal failure, pulmonary edema, or central pontine demyelination, were noted.

CONCLUSIONS

Hypertonic saline administration to children with closed head injury appears to be a promising therapy for control of cerebral edema. Further controlled trials are required to determine the optimal duration of treatment before widespread use is advocated.

Vitamin E regulates changes in tissue antioxidants induced by fish oil and acute exercise

PURPOSE

Prooxidant effects of fish oil supplementation could unfavorably affect the cardiovascular benefits of fish oil. We tested the effects of 8 wk vitamin E cosupplementation with fish oil on antioxidant defenses at rest and in response to exhaustive exercise in rats.

METHODS

Rats (N = 80) were divided into fish oil, fish oil and vitamin E (FOVE), soy oil, and soy oil and vitamin E (SOVE) supplemented groups. For the vitamin E supplemented rats, corresponding groups (FOVE-Ex and SOVE-Ex) performed an acute bout of exhaustive exercise after the supplementation period.

RESULTS

Fish oil supplementation increased the activity of catalase, glutathione peroxidase, and glutathione-S-transferase in the liver and red gastrocnemius (RG) muscle. Fish oil decreased liver total glutathione (TGSH) levels. Vitamin E supplementation decreased antioxidant enzyme activities to levels at or near those in SOVE in a tissue specific pattern. Vitamin E increased TGSH in liver, heart, and RG. Regression analysis showed TGSH to be a negative determinant of protein oxidative damage as measured by protein carbonyl levels in both liver and RG. Catalase activity was associated with liver lipid peroxidation as measured by thiobarbituric acid-reacting substances. The exercise-induced decrease in hepatic TGSH tended to be less in FOVE versus SOVE. Exhaustive exercise also modulated tissue antioxidant enzymes.

CONCLUSIONS

Vitamin E supplementation markedly decreased fish oil induced antioxidant enzyme activities in all tissues. Sparing of glutathione may be an important mechanism by which vitamin E decreased tissue protein oxidative damage.

Cysticercosis of the optic nerve

Cysticercosis of the optic nerve has been reported only twice in the literature. A case of optic nerve cysticercosis in a 50-year-old woman with atypical optic neuritis is reported. Computerized tomography showed a thickened left optic nerve with a ring-enhancing lesion containing an eccentric nodule. An enzyme-linked immunosorbent assay test for cysticercosis further established the diagnosis. The patient was treated with oral prednisolone and albendazole, with no improvement in vision.

Subacute sclerosing panencephalitis presenting as optic neuritis

Subacute sclerosing panencephalitis (SSPE) is a rare progressive neurologic disease affecting both grey and white matter of the brain in children and young adults. One such case which involved the visual system is described here.

Role of computed tomography in spinal trauma

Twenty patients admitted for spinal trauma were studied with computed tomography (CT) scan. All the patients had initial routine plain radiographs in the anteroposterior and lateral views. Ten patients sustained injury due to fall from height, 7 suffered road side accident, 2 had injury due to fall of weight on back and one suffered due to slip on floor. Twelve patients had injury at multiple levels. Twenty-four vertebral bodies were involved in 20 patients, 10 had fracture of posterior elements only. Neurological deficit occurred in 16 patients. CT scan provided more information than plain radiography, which missed vertebral body fracture in 2 out of 24 instances and spinal canal compromise in 7 out of 12 patients. CT scan detected posterior element injuries better and in greater detail in all cases.

Hippocampal field CA1 interneuronal nociceptive responses: modulation by medial septal region and morphine

A majority (24/32) of the extracellularly recorded dorsal hippocampus field CA1 putative GABAergic interneurons were excited in conjunction with theta activation on formalin injection (5%, 0.05 ml, s.c. into right hind-paw) in urethane (1.0 g/kg, i.p.)-anaesthetized rats. An increase in activity was observed to the 10th minute (n=24) and also at later time-periods at which a few of the neurons were recorded following injection of formalin. The mean peak increase in activity within 5 min of formalin injection was 6.43+/-0.81 Hz over the average background activity for these neurons (6.46+/-1.04 Hz). Of 24 neurons, 14 exhibited an increase in activity which was rhythmically modulated with theta. With a concurrent administration of formalin and morphine (5 mg/kg, i.p.), the presumed interneurons recorded displayed an initial increase in discharge rate (mean peak increase within 5 min of 6.95+/-1.10 Hz) which then declined with a decrease in theta activity. The effect of concurrent morphine was naloxone reversible. Morphine administration alone resulted in an immediate decrease in the interneuronal firing rate. In presence of the medial septal region lesions, formalin did not evoke an excitation of intemeurons or theta activation. Further, such lesions prevented the decrease in intemeuron activity to morphine administration. The above data are consistent with the notion that (i) the field CA1 interneurons participate in a noxious stimulus-induced and medial septal region mediated pyramidal cell suppression, and (ii) morphine affects CA1 nociceptive responses partly in a fashion consistent with the effect of the drug on septohippocampal neural network processing.

Multiple foreign bodies in the tracheobronchial tree

Inhaled foreign bodies in respiratory tract are usually single. Multiple foreign bodies in the tracheobronchial tree are extremly rare. A nine-month-old infant with four pieces of belelnut in right bronchus is reported and its management is discussed.

An assessment of the Standardized Assessment of Personality as a screening instrument for the International Personality Disorder Examination: a comparison of informant and patient assessment for personality disorder

BACKGROUND

The International Personality Disorder Examination (IPDE) has been developed as a standardized interview for personality disorders. While it has good psychometric properties, its length makes it difficult to use in the community in population research, particularly outside psychiatric settings. The informant-based Standard Assessment of Personality (SAP), which has been in use since 1981, could serve as a valid screen to detect likely personality disordered individuals who would then receive a definitive diagnosis by IPDE. This study aimed to compare the two instruments in their capacity to detect personality disorder according to ICD-10 taxonomy and to estimate the efficiency of the use of the two together in a case-finding exercise.

METHOD

Ninety psychiatric out-patients in Bangalore, India, were assessed for personality disorder using the two methods. Assessment was conducted by a pair of trained interviewers in random order and by random allocation to interviewer.

RESULTS

Overall agreement between the two instruments in the detection of ICD-10 personality disorder was modest (kappa = 0.4). The level of agreement varied according to personality category, ranging from kappa 0.66 (dependent) to kappa 0.09 (dyssocial). The SAP proved to have a high negative predictive value (97%) for IPDE as the gold standard, suggesting its potential as a screen in samples where the expected prevalence of personality disorder is low.

CONCLUSION

A two-stage approach to epidemiological studies of personality disorder may be practicable.

Cytokine-induced glucose uptake in skeletal muscle: redox regulation and the role of alpha-lipoic acid

In L6 myotubes, glucose uptake stimulated by interferon (IFN)-gamma or lipopolysaccharides (LPS) and a combination of LPS, IFN-gamma, and tumor necrosis factor (TNF)-alpha was inhibited by the antioxidant pyrrolidinedithiocarbamate and potentiated in reduced glutathione (GSH)-deficient cells. Also, the stimulatory effect of LPS and IFN-gamma individually, and of a combination of LPS, IFN-gamma, and TNF-alpha, on glucose uptake was associated with an increased level of intracellular oxidants (dichlorofluorescein assay) and loss of intracellular GSH. Study of the individual effects of LPS, IFN-gamma, and TNF-alpha as well as of a combination of the three activators provided evidence against a role of nitric oxide in mediating the stimulatory effect of the above-mentioned agents on glucose uptake. We also observed that the insulin-mimetic nutrient alpha-lipoic acid (LA; R-enantiomer) is able to stimulate glucose uptake in cytokine-treated cells that are insulin resistant. This study shows that cytokine-induced glucose uptake in skeletal muscle cells is redox sensitive and that, under conditions of acute infection that is accompanied with insulin resistance, LA may have therapeutic implications in restoring glucose availability in tissues such as the skeletal muscle.

A study of platelet serotonin receptor in mania

BACKGROUND

Serotonergic (5-HT) dysfunction has been hypothesized in mania; however platelet studies on the 5-HT uptake rate and the 5-HT transporter have revealed inconsistent results. To the best of our knowledge no studies have been conducted on the 5-HT2 receptor status in mania.

METHODS

We determined density (Bmax) and dissociation constant (Kd) of 5-HT2 receptors in the platelets of 29 normal control and 29 manic subjects using 125I-ketanserin as the binding radioligand. The manic patients were assessed for the same after 14 days of treatment with lithium (n = 14) and after return to premorbid levels of functioning (n = 5).

RESULTS

There were no significant differences in the Bmax (3.51 +/- 3.04 vs. 3.14 +/- 3.44 fmol/mg protein, p = ms) values between normal control and manic subjects. In comparison to the baseline values Bmax at day 14 (3.49 +/- 3.68 vs. 2.18 +/- 1.90 fmol/mg protein, p = ns) and following recovery (1.17 +/- 0.85 vs. 1.29 +/- 1.13 fmol/mg protein, p = ns) did not show any significant difference.

CONCLUSIONS

Our findings preliminarily suggest that the platelet 5-HT2 receptor is neither a state marker nor a trait marker in mania; however studies on the 5-HT2 receptor using positron-emission tomography ligands will help in conclusively ruling out the involvement of this receptor in mania.

Alpha-lipoic acid supplementation: tissue glutathione homeostasis at rest and after exercise

Antioxidant nutrients have demonstrated potential in protecting against exercise-induced oxidative stress. alpha-Lipoic acid (LA) is a proglutathione dietary supplement that is known to strengthen the antioxidant network. We studied the effect of intragastric LA supplementation (150 mg/kg, 8 wk) on tissue LA levels, glutathione metabolism, and lipid peroxidation in rats at rest and after exhaustive treadmill exercise. LA supplementation increased the level of free LA in the red gastrocnemius muscle and increased total glutathione levels in the liver and blood. The exercise-induced decrease in heart glutathione S-transferase activity was prevented by LA supplementation. Exhaustive exercise significantly increased thiobarbituric acid-reactive substance levels in the liver and red gastrocnemius muscle. LA supplementation protected against oxidative lipid damage in the heart, liver, and red gastrocnemius muscle. This study reports that orally supplemented LA is able to favorably influence tissue antioxidant defenses and counteract lipid peroxidation at rest and in response to exercise.