Hyperthyroxinemia with a non-suppressed TSH: how to confidently reach a diagnosis in this clinical conundrum

Disorders of thyroid function are among the commonest referrals to endocrinology. While interpretation of thyroid function testing is usually straightforward, accurate interpretation becomes significantly more challenging when the parameters do not behave as would be expected in normal negative feedback. In such cases, uncertainty regarding further investigation and management arises. An important abnormal pattern encountered in clinical practice is that of high normal or raised free thyroxine (fT4) with inappropriately non-suppressed or elevated thyroid-stimulating hormone (TSH). In this short review using two clinical vignettes, we examine the diagnostic approach in such cases. A diagnostic algorithm is proposed to ensure that a definitive diagnosis is reached in these challenging cases.

Allyl piperidine-1-carbodiothioate and benzyl 1H-imidazole 1 carbodithioate: two potential agents to combat against mycobacteria

AIMS

The emergence of multidrug resistant strains of Mycobacterium tuberculosis has made tuberculosis more difficult to manage clinically. With the aim of obtaining new and effective anti-mycobacterial agent(s), this study investigated the anti-mycobacterial activity of several imidazole and piperidine derivatives.

METHODS AND RESULTS

Towards obtaining new anti-mycobacterial agents, Mycobacterium smegmatis cells were treated with different compounds for their growth inhibitory activity. Among these, benzyl 1H-imidazole-1-carbodithioate and allyl piperidine-1-carbodiothioate exhibited better inhibition than the others. Thereafter, anti-biofilm property of these two was examined by treating M. smegmatis with these agents before and after the formation of biofilm. The result showed that both the compounds at their sublethal dose inhibited the formation of biofilm as well as dispersed preformed biofilm. Consistently, they augmented the activity of isoniazid or rifampicin against biofilm-encapsulated cells. MTT assay was performed to examine the toxic effects of this combinatorial therapy on different cell lines. Results exhibited a low cytotoxicity for this combinatorial treatment. The activity of these two was also verified against dormant mycobacterial cells and was found to be effective.

CONCLUSION

The present study identified two compounds that exhibited anti-mycobacterial activities against both planktonic and dormant cells. These two also exhibited anti-biofilm activity at their sublethal dose and augmented the activity of isoniazid and rifampicin against biofilm encapsulated cells.

SIGNIFICANCE AND IMPACT OF THE STUDY

The current study provides two new agents that have the potential to be used in anti-mycobacterial therapy and may help in public health management.

Cytohistological correlation in pituitary tumor and immunological assessment with the help of Ki-67

Background:

Tumors of the pituitary gland and sellar region represent approximately 10–15% of all brain tumors. Pituitary adenoma (PA), the most common pathology of the pituitary gland, can be effectively subclassified only with the help of immunohistochemistry (IHC). This is important and needed for individual patient management.

Aims and Objectives:

The objective of the study was to analyze the importance of intraoperative imprint smear cytology and correlating with final histopathological diagnosis. Furthermore, to classify the different types of PA with the help of IHC, prolactin (PRL), adrenocorticotropic hormone (ACTH), and growth hormone (GH) and to predict the benign, atypical, or malignant nature of the tumor with the help of prognostic marker Ki-67.

Materials and Methods:

A prospective study was done in 34 cases. The patients whose pituitary gland samples are referred from the endocrine and the neurosurgery department to the pathology department for histopathological examinations were selected. We have studied the clinical features, radiology and touch imprint cytology, histopathology, and IHC with the help of PRL, ACTH, GH, and Ki-67 of PA over 2 years.

Results:

In our study, we had 32 cases of PA of 34 cases over a span of 2 years. We have seen that there is a correlation between cytological and histological diagnosis of the subtypes of PA in 62% cases, and the Kappa statistics show a moderate extent of agreement (Kappa - 0.320, 95% confidence interval = 0.031–0.609). Ki-67 when compared to the radiological grading showed a high degree of comparability (Chi-square test: P < 0.001). All cases with invasion had a higher Ki-67. On using the Fisher's exact test, we found that the Ki-67 expression with GH-producing adenomas and ACTH-producing adenomas was comparable (P = 1.000) while in PRL-producing adenomas too this was not significant (P = 0.269).

Conclusion:

PA can be effectively classified with the help of IHC. Intraoperative cytology is important in diagnosing PA, but histopathology remains the gold standard in diagnosing and differentiating PA from other pathologies of the pituitary gland. The radiological grading together with immunological classification and the prognostic markers of Ki-67 is important in deciding the benign or atypical nature of the adenomas thus helping in better patient management.

Kinesin-II recruits Armadillo and Dishevelled for Wingless signaling in Drosophila

Wingless (Wg)/Wnt signaling is fundamental in metazoan development. Armadillo (Arm)/β-catenin and Dishevelled (Dsh) are key components of Wnt signal transduction. Recent studies suggest that intracellular trafficking of Wnt signaling components is important, but underlying mechanisms are not well known. Here, we show that Klp64D, the Drosophila homolog of Kif3A kinesin II subunit, is required for Wg signaling by regulating Arm during wing development. Mutations in klp64D or RNAi cause wing notching and loss of Wg target gene expression. The wing notching phenotype by Klp64D knockdown is suppressed by activated Arm but not by Dsh, suggesting that Klp64D is required for Arm function. Furthermore, klp64D and arm mutants show synergistic genetic interaction. Consistent with this genetic interaction, Klp64D directly binds to the Arm repeat domain of Arm and can recruit Dsh in the presence of Arm. Overexpression of Klp64D mutated in the motor domain causes dominant wing notching, indicating the importance of the motor activity. Klp64D shows subcellular localization to intracellular vesicles overlapping with Arm and Dsh. In klp64D mutants, Arm is abnormally accumulated in vesicular structures including Golgi, suggesting that intracellular trafficking of Arm is affected. Human KIF3A can also bind β-catenin and rescue klp64D RNAi phenotypes. Taken together, we propose that Klp64D is essential for Wg signaling by trafficking of Arm via the formation of a conserved complex with Arm.

A delay-diffusion model of marine plankton ecosystem exhibiting cyclic nature of blooms

The cyclic nature of blooms is a very interesting characteristic of marine plankton ecosystem. Release of toxins by some phytoplanktons has an important role on planktonic interactions and hence on regulating the blooms. A mathematical model describing the phytoplankton-zooplankton interaction with these characteristics is studied. The time needed for liberation of toxins by phytoplanktons is considered. To account for the spatial heterogeneity of an aquatic environment, diffusivity of different plankton populations is also incorporated into the system. Stability and bifurcation behaviour of different steady states are analysed.

Effects of deterministic and random refuge in a prey-predator model with parasite infection

Most natural ecosystem populations suffer from various infectious diseases and the resulting host-pathogen dynamics is dependent on host's characteristics. On the other hand, empirical evidences show that for most host pathogen systems, a part of the host population always forms a refuge. To study the role of refuge on the host-pathogen interaction, we study a predator-prey-pathogen model where the susceptible and the infected prey can undergo refugia of constant size to evade predator attack. The stability aspects of the model system is investigated from a local and global perspective. The study reveals that the refuge sizes for the susceptible and the infected prey are the key parameters that control possible predator extinction as well as species co-existence. Next we perform a global study of the model system using Lyapunov functions and show the existence of a global attractor. Finally we perform a stochastic extension of the basic model to study the phenomenon of random refuge arising from various intrinsic, habitat-related and environmental factors. The stochastic model is analyzed for exponential mean square stability. Numerical study of the stochastic model shows that increasing the refuge rates has a stabilizing effect on the stochastic dynamics.

Postoperative intussusception following repair of eventration of diaphragm--two case reports

Two patients of postoperative intestinal obstruction following repair of eventration of diaphragm, subsequently diagnosed as postoperative intussusception managed successfully, are reported. Absence of common features of intussusception led to delay in the diagnosis. Rarity of this phenomenon and incidentally two consecutive cases of postoperative intussusception occurring after repair of eventration of diaphragm prompted to report these two cases.

Congenital duodenal obstruction with preduodenal portal vein and situs inversus totalis: report of two cases and literature review

Preduodenal portal vein is a rare congenital anomaly that causes high intestinal obstruction. The authors report two interesting cases of preduodenal portal vein that were diagnosed as having congenital duodenal obstruction. As there is a high potential for surgical risk, this anomaly is of special interest to the surgeon and should be kept in mind. Here, we discuss the clinical presentation, diagnosis and management along with a review of the literature.

Pyloric and antral strictures following corrosive acid ingestion: A report of four cases

This study reports four children who developed complete stricture of pylorus and antrum of the stomach following accidental ingestion of corrosive agent (toilet cleaner).

Simultaneous presentation of type 1 diabetes and Graves' disease

The association between type 1 diabetes mellitus and autoimmune thyroid disease is well documented in the literature. Both can coexist although one endocrinopathy usually precedes the other. The simultaneous new onset of both diseases is rarely seen. Hyperthyroidism can precipitate and complicate the management of diabetic ketoacidosis by masking its classical clinical features. Persistent tachycardia after correction of acidosis and dehydration, may be the only suggestion of another coexisting illness such as thyrotoxicosis. We describe the case of a previously healthy woman who developed new onset type 1 diabetes mellitus and Graves' disease, and presented with diabetic ketoacidosis.

Kinesin II is required for cell survival and adherens junction positioning in Drosophila photoreceptors

Photoreceptor morphogenesis requires specific and coordinated localization of junctional markers at different stages of development. Here, we provide evidence that Drosophila Klp64D, a homolog of Kif3A motor subunit of the heterotrimeric Kinesin II complex, is essential for viability of developing photoreceptors and localization of junctional proteins. Genetic analysis of mutant clones shows that absence of Klp64D protein in early larval eye disc does not affect initial differentiation, but results in abnormal nuclear position in differentiating photoreceptors. These cells eventually die in the pupal stage, indicating klp64D's role in cell viability. The function of Klp64D protein is cell type specific because the p35 cell death inhibitor can rescue cell death in cone cells but not photoreceptors. In contrast to early induction of mutant clones, late induction during third instar larval stage just prior to pupation allows survival of single- or few-celled clones of klp64D mutant cells. Analysis of these lately induced clones shows that Klp64D function is essential for Bazooka (Par-3 homolog) and Armadillo localization to the adherens junction (AJ) in pupal photoreceptors. These findings suggest that Kinesin II complex plays a cell type-specific function in the localization of AJ and cell polarity proteins in the developing retina, thereby contributing to photoreceptor morphogenesis.

Gastric teratoma in a female infant

Gastric teratoma is a rare lesion seen most often in male infants. This patient, aged one year, female was having a massive benign gastric teratoma. The size of the tumour was 22 cm x 10 cm x 8 cm and weighted 2.250 kg making it one of the largest gastric teratoma. The tumour was removed by surgery. Histopathology revealed presence of all 3 elements in the form of skin, cartilage, fibrofatty tissue, blood vessels and gland with tall columnar epithelium. Postoperative period was uneventful.

Outcome of colostomy closure with different skin closure techniques in a developing country

BACKGROUND

Colostomy site, which is a potentially contaminated wound, is traditionally closed with interrupted skin stitches and placement of intraperitoneal or parietal or both drains; often with poor cosmetic outcome in our country. This study aims at prospective evaluation of colostomy closure wounds by different techniques.

PATIENTS AND METHODS

This study was carried out in all infants and children with colostomy (for different pathologies) admitted for colostomy closure in our institute from August 1, 2006 to February 29, 2008. Patients were divided into two groups: Group A with colostomy closure without any drain and subcuticular skin closure and Group B with colostomy closure with both intraperitoneal and parietal drain and interrupted skin closure. Patient's details, including age, sex, body weight, diagnosis, preoperative bowel preparation, peroperative antibiotics, postoperative wound infection, anastomotic leaks, duration of hospitalisation and postoperative follow-up for wound assessment, were recorded. By the end of February 2008, 151 cases of colostomy closure were recorded, 70 in Group A and 81 in Group B.

RESULTS

Statistical analysis of the data showed no statistically significant difference in wound infection and anastomotic leak between the two groups. On postoperative follow-up, wound assessment showed significantly better cosmesis in the no drain subcuticular group.

CONCLUSION

This study shows that closing colostomies without any drain and subcuticular skin closure does not result in any increased incidence of wound infection and has better cosmetic results.

Emergency separation of a xipho-omphalopagus twin in a developing country

Female conjoined twins (thoraco-omphalopagus) were delivered by emergency caesarean section in a private nursing home. On examination, one of the twins was dead and was threatening the survival of the surviving twin (twin A). An emergency separation was performed to salvage the surviving twin.

Metastatic breast cancer deluding as a papular skin rash

Dermatological metastases from internal malignancies are relatively less common than other sites. We describe an interesting case of an elderly lady who initially presented with symptomatic normocytic anaemia, and then developed a widespread papular rash over a period of ten days. The rash was found to be metastatic breast cancer.

A prospective observational clinical study involving an alternative cancer treatment, psorinum therapy, in treating stomach, gallbladder, pancreas, and liver cancers

3050

Background: The prospective observational clinical study was conducted to know the efficacy of an alternative cancer treatment, ‘psorinum therapy,‘ in treating liver, gall bladder, pancreatic, and stomach cancers. The primary outcome measures of the study were (1) to assess the radiological tumor response; (2) to assess how many participants survived at least 1 year, 2 years, 3 years, 4 years, and finally, 5 years after the beginning of the study. The secondary outcome measure of the study was to assess the side effects of the investigational anti-cancer drug (psorinum) if any. Methods: The drug psorinum (an alcoholic extract of scabies, scrub, slough, and pus cells) was administered orally at 0.01ml-0.02 ml/Kg body weight as a single dose in empty stomach per day and ongoing to all the participants along with allopathic and homeopathic supportive cares. Results: 158 histopathology or cytopathology proved participants (42 of stomach, 40 of gallbladder, 44 of pancreas, and 32 of liver cancers) were included in the final analysis at the end of the study. According to the AJCC/UICC TNM staging system, 7 (4.43%) of them diagnosed at stage II, 39 (24.68%) of them diagnosed at late stage II or early stage III and 112 (70.87%) of them diagnosed at late stage III or stage IV. According to the RECIST criteria, complete tumor response occurred in 28 (17.72%) cases and partial tumor response occurred in 56 (35.44%) cases. 126 (79.75%) of them survived at least 1 year, 99 (62.66%) of them survived at least 2 years, 87 (55.06%) of them survived at least 3 years, 76 (48.10%) of them survived at least 4 years, and 62 (39.24%) of them survived at least 5 years. These participants did not receive any other conventional or investigational cancer treatments. The participants report no side effects from the drug psorinum. Conclusions: Psorinum therapy is effective in treating stomach, gallbladder, pancreas, and liver cancers. Double-blinded randomized controlled clinical trial should be done for further investigation of this alternative cancer treatment.

No significant financial relationships to disclose.

Acquired tracheo-oesophageal fistula: a case report

This is a case report of a girl aged 4 years who presented with repeated attacks of chocking and dysphagia. She was diagnosed to be having an acquired tracheo- oesophageal fistula caused by fish bone impaction. She was treated successfully. In this report, the literature was reviewed of this rare condition.

Modeling the precision and robustness of Hunchback border during Drosophila embryonic development

During anterior-posterior axis specification in the Drosophila embryo, the Hunchback (Hb) protein forms a sharp boundary at the mid-point of the embryo with great positional precision. While Bicoid (Bcd) is a known upstream regulator for hb expression, there is evidence to suggest that Hb effectively filters out "noisy" data received from varied Bcd gradients. We use mathematical models to explore simple regulatory networks which filter out such noise to produce a precise Hb boundary. We find that in addition to Bcd and Hb, at least one freely evolving protein is necessary. An automated search yields a number of examples of three-protein networks exhibiting the desired precision. In all such networks, Hb diffuses much slower than the third protein. In addition, the action of Hb on the third protein is the opposite of the action of the third protein on hb (i.e. if Hb activates the third protein, then the third protein inhibits hb expression, and vice versa). Most of the discovered systems satisfy the known biological properties, that Bcd activates hb, and that Hb activates its own expression. We find that all network topologies satisfying these constraints arise among the networks exhibiting the desired precision. Investigating the dynamics of these networks, we find that under a general class of non-uniform initial conditions, Bcd can be eliminated from the system and the spatiotemporal evolution of these two proteins alone is sufficient to recapture the dynamics. We hypothesize that Bcd is needed only to spatially disturb the gradient of the third protein, and then becomes unnecessary in the further evolution of the Hb border. This provides a possible explanation as to why the Hb dynamics are robust under perturbations of the Bcd gradient. Under this hypothesis, other proteins would be able to assume the role of Bcd in our simulations (possibly in the case of evolutionary divergences or a redundancy in the process), with the only constraint that they act to positively regulate hb.

Par-1 and PP2A: Yin-Yang of Bazooka localization

Apical basal cell polarity is a fundamental feature of all epithelial cells. Identification of the genes involved in the polarization of epithelial cells has begun to reveal the mechanisms underlying the establishment and maintenance of cell polarity. An important issue is to understand the molecular basis for localization of cell polarity proteins in the context of the developing organism. Bazooka (Baz, Drosophila homolog of Par-3) plays a crucial role in organizing cell polarity in several different tissues. In the ovarian follicle epithelium, Par-1 protein kinase regulates Baz localization to the apical cell cortex by excluding phosphorylated Baz from the lateral region. In photoreceptor cells of retinal epithelium, Baz is targeted to the adherens junction (AJ) instead of the apical domain. Our study suggests that in photoreceptors, Par-1 blocks the localization of Baz to AJ whereas protein phosphatase 2A (PP2A) promotes Baz localization by antagonizing the Par-1 effects. In this extra view, we provide a brief overview and perspective of our findings on the antagonistic function of Par-1 and PP2A in Baz localization during photoreceptor morphogenesis.

Antagonistic functions of Par-1 kinase and protein phosphatase 2A are required for localization of Bazooka and photoreceptor morphogenesis in Drosophila

Establishment and maintenance of apical basal cell polarity are essential for epithelial morphogenesis and have been studied extensively using the Drosophila eye as a model system. Bazooka (Baz), a component of the Par-6 complex, plays important roles in cell polarity in diverse cell types including the photoreceptor cells. In ovarian follicle cells, localization of Baz at the apical region is regulated by Par-1 protein kinase. In contrast, Baz in photoreceptor cells is targeted to adherens junctions (AJs). To examine the regulatory pathways responsible for Baz localization in photoreceptor cells, we studied the effects of Par-1 on Baz localization in the pupal retina. Loss of Par-1 impairs the maintenance of AJ markers including Baz and apical polarity proteins of photoreceptor cells but not the establishment of cell polarity. In contrast, overexpression of Par-1 or Baz causes severe mislocalization of junctional and apical markers, resulting in abnormal cell polarity. However, flies with similar overexpression of kinase-inactive mutant Par-1 or unphosphorylatable mutant Baz protein show relatively normal photoreceptor development. These results suggest that dephosphorylation of Baz at the Par-1 phosphorylation sites is essential for proper Baz localization. We also show that the inhibition of protein phosphatase 2A (PP2A) mimics the polarity defects caused by Par-1 overexpression. Furthermore, Par-1 gain-of-function phenotypes are strongly enhanced by reduced PP2A function. Thus, we propose that antagonism between PP2A and Par-1 plays a key role in Baz localization at AJ in photoreceptor morphogenesis.

Assessment of noise level in Burdwan town, West Bengal

Cities and towns of the world are now facing enormous rise of noise pollution problem due to very high population rise, transport congestion and associated commercial and industrial activities. Burdwan, a district headquarter (100 km away from Kolkata) is one such town where noise pollution is very frequent. In order to assess noise level, noise data were collected from various places of the town by sound level meter with a duration of 30 minutes/location during specified time like 6.00 am, 10.00 am, 1.00 pm, 4.00 pm and 6.00 pm. Most of the monitoring places either belongs to silence category or commercial category areas. From the tabulated data, it was found that sound level lies within the range of 64-85 dB or above in different time at different places. The locations that belong to the silence zone have the noise level up to 90 dB. Statistically noise level in all these zones differ significantly at their peak hours. Noise pollution adversely affects our environment as well as human beings. Sound causes both pathological and psychological disorders in human beings. Implementation of rules and regulations under section 20, 21J, 41, 68(I), 70, 90, 111A of Environment Protection Act, 1986 and of course various technological methods and public awareness are very essential to check noise pollution in Burdwan town.

Modeling the Role of Diffusion Coefficients on Turing Instability in a Reaction-diffusion Prey-predator System

The paper is concerned with the effect of variable dispersal rates on Turing instability of a non-Lotka-Volterra reaction-diffusion system. In ecological applications, the dispersal rates of different species tends to oscillate in time. This oscillation is modeled by temporal variation in the diffusion coefficient with large as well as small periodicity. The case of large periodicity is analyzed using the theory of Floquet multipliers and that of the small periodicity by using Hill's equation. The effect of such variation on the resulting Turing space is studied. A comparative analysis of the Turing spaces with constant diffusivity and variable diffusivities is performed. Numerical simulations are carried out to support analytical findings.

A comparison of glycaemic and metabolic control over time among South Asian and European patients with Type 2 diabetes: results from follow-up in a routine diabetes clinic

AIMS

Although South Asians have a higher prevalence of diabetes which develops at a younger age, data on change in metabolic parameters post-diagnosis are relatively sparse. We therefore wished to determine whether South Asians with diabetes had similar or greater year-on-year deterioration in metabolic parameters compared with Europeans.

METHODS

We analysed longitudinal change in metabolic parameters [glycated haemoglobin (HbA(1c)), blood pressure, body mass index (BMI), lipids] among South Asian (n = 210) and European (n = 1557) patients consecutively attending the same diabetes clinic over a mean period of 5.3 years.

RESULTS

South Asians were younger than Europeans at first recorded diagnosis of diabetes (mean age 45.9 vs. 57.3 years, P < 0.001) and had significantly lower ( approximately 1.2 units) BMI and blood pressure. Mean HbA(1c) was not different across ethnic groups at first visit, but with time glycaemic control was worse in South Asians than Europeans, with average deterioration 1.31% (= 0.23%/year) in Asians vs. 0.82% (0.16%/year) in Europeans, P = 0.003. This ethnic difference in mean change in HbA(1c) persisted after adjustment for age, sex, baseline HbA(1c), and weight change in linear regression analysis (beta = 0.46, 95% CI 0.24-0.69, P < 0.001), and with additional adjustment for time to referral and duration of diabetes (P = 0.01). Moreover, South Asians had significantly smaller improvements in blood pressure (P < 0.001) and cholesterol (P = 0.044) over the follow-up period in keeping with fewer prescriptions of anti-hypertensive agents and lipid-lowering agents.

CONCLUSIONS

These data suggest the need to be more aggressive in the management of diabetes and related risk factors in South Asians.

Normoglycaemia in acute renal failure--a difficult diagnosis of diabetes

We report diagnostic difficulties in a case of diabetes mellitus presenting as acute on chronic renal failure with normoglycaemia. A renal biopsy indicated diabetic nephropathy; she developed hyperglycaemia following the institution of haemodialysis. It is important to remember that diabetic patients may have normal blood glucose concentrations in renal failure. In a patient with undiagnosed diabetes mellitus presenting with acute on chronic renal failure, choice of diagnostic biochemical test for diabetes may be difficult.

DNA sequence variation and haplotype structure of the ICAM1 and TNF genes in 12 ethnic groups of India reveal patterns of importance in designing association studies

We have examined the patterns of DNA sequence variation in and around the genes coding for ICAM1 and TNF, which play functional and correlated roles in inflammatory processes and immune cell responses, in 12 diverse ethnic groups of India. We aimed to (a) quantify the nature and extent of the variation, and (b) analyse the observed patterns of variation in relation to population history and ethnic background. At the ICAM1 and TNF loci, respectively, the total numbers of SNPs that were detected were 28 and 12. Many of these SNPs are not shared across ethnic groups and are unreported in the dbSNP or TSC databases, including two fairly common non-synonymous SNPs at positions 13487 and 13542 in the ICAM1 gene. Conversely, the TNF-376A SNP that is reported to be associated with susceptibility to malaria was not found in our study populations, even though some of the populations inhabit malaria endemic areas. Wide between-population variation in the frequencies of shared SNPs and coefficients of linkage disequilibrium have been observed. These findings have profound implications in case-control association studies.

Computer simulation of leachate quality by recirculation in a sanitary landfill bioreactor

Sanitary Landfills are the most widely used method of solid waste disposal around the world. Modern sanitary landfills are designed with impervious liners, and leachate collection, removal, and treatment systems to minimize the potential for groundwater contamination. Leachate recycle through the landfill is an effective method of leachate treatment, and to enhance solid waste stabilization. A mathematical model is developed to simulate the release of contaminants from solid wastes, and their movement into the percolating liquid. Two differential equations are used that express the mass balance of the contaminants in the percolating water and those in the solid wastes. These simultaneous linear differential equations are solved numerically using a fourth-order Runge-Kutta algorithm with many physical and process parameters. The model results are used to estimate the active life of landfill with and without leachate recirculation. Such information is valuable in the operation, maintenance, and closure plan of a sanitary landfill.

Pancreatic lesions in von Hippel-Lindau disease

OBJECTIVE

Von Hippel-Lindau disease is an inherited neoplasia syndrome. The main endocrine manifestations are phaeochromocytoma and paraganglioma. The presence of pancreatic disease has also been variably reported. This study was undertaken to describe the prevalence, nature, natural history and clinical associations of pancreatic lesions in von Hippel-Lindau disease.

PATIENTS AND DESIGN

A retrospective analysis of the case notes of 17 consecutive patients. Average duration of follow-up was 5.5 years. Clinical, biochemical, genetic and radiological testing was routinely performed.

RESULTS

Eleven (64.7%) patients had pancreatic lesions either on computed tomography or magnetic resonance imaging. Serous microcystic adenomas and multiple cysts were the commonest findings, but solid lesions were also found. The commonest clinical association was diabetes mellitus in patients with extensive serous microcystic adenomas. None of the pancreatic lesions showed evidence of biochemical function. All patients with pancreatic lesions also had renal lesions. Mutations were found at several points in the gene and there was no apparent association between pancreatic lesions and a particular mutation.

CONCLUSIONS

Pancreatic lesions are very common in von Hippel-Lindau disease and all patients had coexisting renal lesions. The main clinical correlate was diabetes mellitus, but otherwise the lesions were clinically and biochemically silent.

Obstetric morbidity and socio-demographic factors in rural West Bengal, India

The impact of selected socio-demographic factors on reported obstetric morbidity during antepartum and postpartum periods was studied through a cross-sectional retrospective survey carried out in rural areas of three districts of West Bengal, India. During their most recent live births, 56.6% of mothers reported at least one morbid condition. Mothers with higher levels of education reported fewer overall problems. Factors such as age and pregnancy order affect obstetric morbidity differently in different religious groups. More mothers reported postpartum than antepartum problems, and very few sought treatment. The present study provides an insight into various factors affecting obstetric morbidity in a developing country.

Oxaloacetate synthesis in the methanarchaeon Methanosarcina barkeri: pyruvate carboxylase genes and a putative Escherichia coli-type bifunctional biotin protein ligase gene (bpl/birA) exhibit a unique organization

Evidence is presented that, in Methanosarcina barkeri oxaloacetate synthesis, an essential and major CO(2) fixation reaction is catalyzed by an apparent alpha(4)beta(4)-type acetyl coenzyme A-independent pyruvate carboxylase (PYC), composed of 64.2-kDa biotinylated and 52.9-kDa ATP-binding subunits. The purified enzyme was most active at 70 degrees C, insensitive to aspartate and glutamate, mildly inhibited by alpha-ketoglutarate, and severely inhibited by ATP, ADP, and excess Mg(2+). It showed negative cooperativity towards bicarbonate at 70 degrees C but not at 37 degrees C. The organism expressed holo-PYC without an external supply of biotin and, thus, synthesized biotin. pycA, pycB, and a putative bpl gene formed a novel operon-like arrangement. Unlike other archaeal homologs, the putative biotin protein ligases (BPLs) of M. barkeri and the closely related euryarchaeon Archaeoglobus fulgidus appeared to be of the Escherichia coli-type (bifunctional, with two activities: BirA or a repressor of the biotin operon and BPL). We found the element Tyr(Phe)ProX(5)Phe(Tyr) to be fully conserved in biotin-dependent enzymes; it might function as the hinge for their "swinging arms."

Clinical appraisal of Ascaris lumbricoides, with special reference to surgical complications

Over a period of 4 years (January 1993-December 1997), 509 patients were treated for abdominal colic with or without intestinal obstruction and a history of passage of adult roundworms either in the stool or in vomitus. All patients were below the age of 10 years, the youngest 6 months old, and were treated successfully with antispasmodics and normal saline enemas. When the pain subsided, an anthelminthic drug was given. Of 209 patients admitted to the hospital, 105 responded to conservative management and 104 (50%) required surgical intervention. The procedures included squeezing out of worms, resection and anastomosis, and treatment of other pathologies like acute appendicitis, tubercular stricture of the small intenstine, etc. Five patients died in the postoperative period due to various complications. There were no deaths among those treated by conservative management. Early recognition of the condition can prevent serious surgical complications and morbidity.