Intestinal Myiasis in a Malaysian Patient Caused by Larvae of Clogmia albipunctatus (Diptera: Psychodidae)

We report a case of human intestinal myiasis in a 41-yr-old female patient presented at a clinic in Seri Kembangan, Selangor, Malaysia. Larvae passed out in the patient's feces were sent to the Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. DNA barcoding confirmed the second case of intestinal myiasis in Malaysia involving the larvae of Clogmia albipunctatus (Duckhouse) (Diptera: Psychodidae). We review reported cases of myiasis and discuss the present case of intestinal myiasis in an urban patient.

Psychiatric training in primary care medicine residency programs. A national survey

The authors conducted a national survey to investigate the current status of psychiatric training in primary care/internal medicine residencies. Fifty-four residency training directors completed and returned the survey. The survey results show that an average of 99 hours (69.5 hours clinical plus 29.8 hours didactics) is devoted to psychiatric training during the 3 years of primary care/internal medicine residency training. Responding residency training directors indicated that psychiatric training is important (an average of 7 out of 10 on a 10-point rating scale), and 63% of respondents indicated that more training in psychiatry is needed.

Body fat and fat distribution by anthropometry and the response to high-fat cholesterol-containing diet in monkeys

Considerable variability exists among individuals in the response of plasma cholesterol to changes in dietary fat and cholesterol, and obesity is one variable reported to affect this response. This study was performed to determine the relationship between body fat and changes in plasma cholesterol in cynomolgus monkeys fed a high-fat cholesterol-containing diet for 12 months. The animals gained significant body weight (body mass index increased from 30.5 +/- 0.5 to 35.7 +/- 2.8 kg/m2) and skinfold parameters of body fat increased as well. Total cholesterol increased from 109 +/- 4 to 390 +/- 25 mg/dl (P < 0.001), and there were also significant increases in LDL- and HDL-cholesterol and triglyceride. While there was very little relationship between body fat and plasma lipids before the diet, after 12 months, there were significant negative correlations between total and LDL-cholesterol and anthropometric measures of body fat (r ranged from -0.37 to -0.55, P < 0.01). The correlations were not affected when the effects of baseline body mass index and serum cholesterol and total food intake were controlled by partial correlation analysis. In this sample of animals, the acquisition of greater body fat appeared to protect against rises in cholesterol in response to consumption of a high-fat cholesterol-containing diet.

Very early aortic responses during atherosclerosis induction in rabbits: measurement by duplex ultrasound. I. Non-invasive study of aortic hyperresponsiveness to serotonin

We report the use of a non-invasive ultrasound method to visualize and measure changes in serotonin reactivity of the abdominal aorta during the early stages of atherosclerosis development. Studies were performed at 0, 4, 8, and 14 weeks in New Zealand white rabbits fed a diet enriched with 0.5% cholesterol. Change in systolic vessel diameter at each examination was compared with changes in rabbits fed a control diet or rabbits on a diet enriched with cholesterol plus a concentrated marine lipid. After 4 weeks on the diets, the abdominal aortae of rabbit fed the cholesterol-rich diet displayed an enhanced vasoconstriction to serotonin (P less than 0.01). The enhanced vasoconstriction was observed prior to visible morphologic changes, and progressed when restudied at succeeding examinations. Morphologic abnormalities became evident at 8 weeks in cholesterol-fed animals. Dietary supplementation with marine lipid, rich in polyunsaturated fatty acids, diminished the effect of the atherogenic diet on aortic vasoconstriction.

Prediction of angiographic change in native human coronary arteries and aortocoronary bypass grafts. Lipid and nonlipid factors

A within-group risk factor analysis was conducted to predict angiographic change in the Cholesterol Lowering Atherosclerosis Study, a randomized, placebo-controlled trial of colestipol plus niacin therapy in men with previous coronary bypass surgery. Global angiographic change, including both native coronary arteries and bypass grafts after 2 treatment years, was the end point. Risk factors included on-trial clinical measures, plasma lipids, lipoproteins, and apolipoproteins. Univariate analysis indicated that risk factors previously observed by others in epidemiologic investigation of ischemic heart disease--total cholesterol, LDL cholesterol, non-HDL cholesterol, triglycerides, apolipoprotein B, and diastolic blood pressure--had significant effects in the placebo-treated group. Univariate analysis indicated significant effects of apolipoprotein C-III in drug- and placebo-treated groups. Multivariate analysis indicated the predominant risk factor predicting the probability of global coronary progression was non-HDL cholesterol in placebo-treated subjects and the content of apolipoprotein C-III in high density lipoproteins of drug-treated subjects. Both drug- and placebo-treated group findings point to an important role for triglyceride-rich lipoproteins in progression and regression of human atherosclerosis.

Quantitative ultrasound pulsation study in human carotid artery disease

Pulsation in the human carotid artery during two complete cardiac cycles was studied by using computer digitized video-frames from B-mode ultrasound images. Eight patients with identifiable atherosclerotic lesions in the common carotid immediately proximal to the bulb area were studied. Diameter, strain, and elastic modulus were compared between lesion site and an adjacent reference segment 1 or 2 cm proximal to the bulb. As controls, nine patients without identifiable lesions were analyzed. The results indicate a significantly wider diameter (p less than 0.01) at the proximal reference site in patients with lesions as compared to comparable segments in control patients. The strain was significantly lower (p less than 0.05), whereas the elastic modulus was significantly higher (p less than 0.05), at the lesion site as compared to the proximal reference sites in patients with lesions. These results may indicate that an initial dilation of the carotid artery followed by loss of wall flexibility may be associated with atherosclerotic lesion formation.

Morphologic and immunocytochemical study of young dogs with diabetes mellitus associated with pancreatic islet hypoplasia

In 11 dogs (7 males, 4 females; 10 purebred, 1 mixed breed), diagnosed as having diabetes mellitus before the age of 6 months, the pancreas was evaluated histologically; in 6, the pancreas also was examined by use of electron microscopy and/or immunocytochemical methods. Each dog was placed in 1 of 3 groups (A through C) on the basis of pancreatic histopathologic findings: Group A (n = 3)--no recognizable islets, but the pancreas in 2 dogs contained scattered endocrine cells detectable by use of immunoperoxidase staining or electron microscopy; Group B (n = 4)--no recognizable islets, but the pancreas had severe vacuolation of ducts and acini, as well as acinar atrophy; Group C (n = 4)--scant shrunken islets; 1 pancreas had reduced numbers of recognizable islets, hydropic beta-cell vacuolation attributable to glycogen deposition, and islet and nonislet endocrine cells in expected proportions. Insulitis was not observed in any pancreas, although scattered lymphocytes were seen in the pancreatic interstitial fibrous tissue of 3 dogs. Histologic pancreatic lesions in these young dogs were distinct from those of type-I (insulin-dependent) diabetes mellitus in human beings, as well as from those of diabetes mellitus in aged dogs, but were similar to those described in other young diabetic dogs. This uncommon syndrome is distinct from commonly recognized canine diabetes mellitus, on the basis of age of onset, predisposition for purebred dogs, lack of predisposing endocrinopathies or obesity, and pancreatic histologic features. The cause(s) is unknown, but is related to pancreatic endocrine hypoplasia and not to insulitis or to exocrine pancreatic inflammation. The term pancreatic islet hypoplasia is chosen as best describing this disorder.

Alterations in serum thyroid hormonal indices with colestipol-niacin therapy

A serial blood-lipid-lowering study at the University of Southern California yielded unexpected findings on routine thyroid function monitoring. After 1 year of combined colestipol and niacin therapy, patients had reduced total serum thyroxine (T4) levels and increased triiodothyronine uptake ratios, an indicator of apparent decreases in thyroxine-binding globulin levels. Calculation of the free T4 index partially but not completely corrected for the apparent decrease in thyroxine-binding globulin, as determined by a relatively small decrease in the free T4 index compared with a large decrease in T4. Sequential sampling, using three separate methods, showed reduced thyroxine-binding globulin levels. The mechanism for these changes is unknown, but the fact that these patients were essentially euthyroid needs emphasis because the use of combined colestipol and niacin therapy is becoming more widespread.

Autopsy calibration of carotid artery B-mode ultrasound imaging: effects of pressure on residual lumen size

The accuracy of B-mode ultrasound (9 MHz) vascular imaging was studied on seven carotid arteries obtained at autopsy. Parallel cross-sectional images on five serial planes of each artery were compared with readings on corresponding sections of silicone rubber replicas of the vessel lumens and with histologic sections. A close correlation between ultrasound and cast measurements was observed (r = 0.88, p less than 0.01), and both corresponded well with histologic measurements. Longitudinal ultrasound views of the arteries were employed to determine changes of normal vessel diameter (maximum lumen diameter) and residual lumen diameter with increasing arterial pressure. In the specimens studied, compression of lesions occurred in addition to circumferential vessel enlargement, and the rate of compression of lesions exceeded that of circumferential vessel diameter enlargement.

Combined therapy of niacin, colestipol, and fat-controlled diet in men with coronary bypass. Effect on blood lipids and apolipoproteins

The effects of colestipol (30 grams/day), niacin (7.3 grams/day), and diet on blood lipids and apolipoproteins after one year of therapy are reported. Men selected on the basis of previous coronary artery bypass surgery were randomly assigned to drug or control treatments in an angiographic study of atherosclerosis progression and regression. In 14 men, drugs and diet produced the following changes: Baseline total cholesterol 245 mg/dl, triglyceride 189 mg/dl, and LDL cholesterol 164 mg/dl were decreased by 73 mg/dl (29%), 83 mg/dl (41%) and 69 mg/dl (40%) respectively. Baseline HDL cholesterol, 44 mg/dl was increased 13 mg/dl (33%). Baseline apolipoprotein B, 124 mg/dl and apolipoprotein C-III (heparin precipitate) 5.6 mg/dl were decreased 40 mg/dl (31%) and 2.4 mg/dl (41%) respectively. All these changes are significant, p less than 0.01. Apolipoprotein A-I and apolipoprotein C-III (heparin supernate) were not significantly changed. In the controls, placebo and diet produced no significant decrease in blood lipid or lipoproteins, with the exception that baseline apolipoprotein B, 111 mg/dl increased 18 mg/dl (12%), p less than 0.05.

Work in progress: common carotid artery contours reconstructed in three dimensions from parallel ultrasonic images

Three-dimensional sonograms of the common carotid artery were obtained using a device which takes images in parallel planes. Tests in phantoms simulating atherosclerotic vessels the same size as the common carotid artery indicated that the coefficient of variation of a single luminal measurement was 2-5%.

Insulin kinetics in juvenile canine diabetics after glucose loading

Glucose and insulin kinetics were studied in 4 juvenile canine diabetics and 6 healthy controls. Diabetic dogs were glucose intolerant with delayed insulin response after glucose challenge. Total insulin secretion was near that of the controls, but was inadequate when compared with corresponding plasma glucose concentrations.

Velocity and attenuation of sound in arterial tissues

The velocity and attenuation of sound has been determined for freshly excised human and canine arterial tissues using a time delay spectrometer (TDS) technique. Frequency was swept from 0 to 10 MHz with data being taken in the range from 2 to 10 MHz. The velocity was determined using a comparison of the time delay for the received signal between a water path and a sample tissue of measured thickness. The velocity of sound was measured for various pathologies and related to biochemical assays of tissue. It was found to increase with increasing ultrasound attenuation of the tissue. The velocity was shown to increase with increased collagen, C, expressed as a percentage of wet weight of the tissue, [V = 17.8* C + 1561 m/s at 37 degrees C, r = 0.77] but was strongly dependent on tissue cholesterol or low levels of calcium. For highly calcified lesions, the velocity of sound was found to be approximately 2000 m/s at 37 degrees C.

Abnormal insulin secretion in adult canines

Insulin secretion after intravenous administration of glucose was studied in fourteen dogs, twelve of which were four years of age or older. Based on several characteristics of insulin secretion kinetics, normal and impaired insulin responses were defined in the experimental subjects. Among those, five exhibited a marked depression of the initial stage of insulin release which was followed by a stage of relative hyperinsulinemia. Similarities between canine and human insulin secretion patterns were noted, and the potential usefulness of the procedure for the early detection of canine diabetes mellitus discussed.

Abnormal serum lipid patterns in primary renal allograft recipients

The blood lipids profile was determined in 59 patients with successful primary renal allografts, who were followed for an average period of 31.8 months (range, 6 to 80 months). Elevated levels of cholesterol (greater than 250 mg/100 ml) were found in 51% of the patients, elevated levels of triglycerides were found in 56%, and elevated levels of phospholipids in all but one of the patients who were studied (45 of 46). Correlation analysis revealed significant relationships among the systolic blood pressure with total cholesterol (r equals 0.36, P less than 0.01), triglycerides (r equals 0.56, p is less than 0.001), and phospholipids (r equals 0.40, P is less than 0.001). No significant correlations were found between the lipid levels and daily prednisone dosage or with the duration of the period following transplantation. The most significant finding in our study was an elevation of serum phospholipid level--a pattern unreported previously in transplant recipients but which has been reported to be associated with hepatic derangement in nontransplant population. Of 32 patients who had elevated levels of serum phospholipids, the liver function tests were abnormal in 22 patients (69%).

Lipids in silicone rubber valve prostheses after human implantation

Fourteen prosthetic valves were obtained from human recipients at autopsy or valve replacement surgery. The silicone rubber poppets were extracted with lipid solvent and examined by thin-layer chromatography, infrared absorption spectroscopy, and phosphorus analysis. The significant findings were: (1) No phospholipid was present in any of the valves; neither was there any protein. (2) The relative content of cholesterol, cholesteryl ester, fatty acid, and triglyceride varied widely. (3) Residual uncured silicone polymers were found in all valves; in one patient these appeared to combine with lipid and form a component with unusual chromatographic behavior.