Multifocal Serpiginoid Choroiditis Due to Mycobacterium Mageritense following Laparoscopic Hysterectomy in an Immunocompetent Host

PURPOSE

To report nontubercular choroiditis, caused by Mycobacterium mageritense isolated using MALDI-TOF MS, following laparoscopic hysterectomy in an immunocompetent patient.

CASE REPORT

A 42-year-old female presented with gradual, painless diminution of vision in the right eye for six weeks. She had undergone laparoscopic hysterectomy two months back. BCVA was 2/60 OD. Clinical presentation and imaging all pointed to a diagnosis of serpiginous-like choroiditis. Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) had led to isolation of Mycobacterium mageritense. Patient was treated with systemic antibiotics. At 3 months follow up, BCVA improved to 6/60; fundus showed healed choroiditis and chorioretinal thinning.

CONCLUSION

Atypical mycobacterial infections associated with laparoscopic surgeries can rarely lead to debilitating systemic bacteremia resulting in profound visual impairment. The importance of timely diagnosis using specific and sophisticated methods such as MALDI-TOF MS as well as maintaining aseptic precautions perioperatively during major surgeries cannot be overemphasized.

Central retinal vein occlusion post ChAdOx1 nCoV-19 vaccination - can it be explained by the two-hit hypothesis?

PURPOSE

To report a case of central retinal vein occlusion (CRVO) seven days following the first dose of ChAdOx1 nCoV-19 vaccine and propose a hypothesis for the possible underlying pathogenesis.

OBSERVATION

A 31-year-old male presented with CRVO with cystoid macular edema, one week after receiving his first ChAdOx1 nCoV-19 vaccine dose. Apart from mild hyperhomocysteinemia, no major thrombophilic or systemic risk factors were found. Anti-platelet factor 4 antibodies, specific for vaccine-induced immune thrombotic thrombocytopenia, were also negative. However, he tested strongly positive (> 250 U/mL) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG spike antibodies, 2 weeks post the first dose - suggestive of a prior subclinical infection.

CONCLUSION

COVID-19 is known to be associated with an altered host one-carbon metabolism resulting in hyperhomocysteinemia. We hypothesize that a prior subclinical infection with COVID-19, the first hit, may have led to hyperhomocysteinemia in our patient and vaccination must have been the second hit that triggered the thrombotic event. Further studies, including correlation of thrombotic complications with IgG antibody titres post-vaccination, are essential in order to better understand the pathogenesis of such events.

Regression of choroidal metastasis from breast carcinoma with palbociclib

Background

Uveal metastasis is reported to be the most common intraocular malignancy. The most common site of origin of ocular metastases in females is the breast. In some cases, uveal metastatic lesions respond to systemic chemotherapy. We report a case of a patient who developed choroidal metastasis, while on endocrine therapy with selective estrogen receptor modulator (SERM), tamoxifen, for estrogen receptor (ER) positive, progesterone receptor (PR) positive and (human epidermal growth factor receptor 2) HER2 negative primary breast carcinoma, which then regressed following systemic chemotherapy with palbociclib.

Case description

An 83-year-old female, with a history of modified radical mastectomy, chemotherapy and radiation therapy for infiltrating duct carcinoma of the breast, presented with a choroidal metastatic lesion in the left eye along with liver and lung metastases, 3 years after the primary carcinoma was treated. At the time of presentation, she was on tamoxifen. The choroidal tumor showed regression after the introduction of palbociclib, a cyclin-dependent kinase 4/6 (CDK4/6) inhibitor.

Conclusion

This report highlights the use of palbociclib, in the palliative treatment of choroidal metastasis from primary breast cancer. The use of chemotherapy for choroidal metastasis can help avoid external beam radiation therapy and its concurrent side effects. Although there are a few reports involving the use of palbociclib for metastatic breast carcinoma, all of those have been in conjunction with and/or following non-response to other treatment modalities. Ours is the first report wherein palbociclib has been used as the first-line palliative chemotherapy and helped in regression of choroidal metastasis.

ADULT-ONSET CYSTIC HYGROMA IN AXILLA: A RARE CASE REPORT FROM INDIA AND LITERATURE REVIEW

Background. Cystic hygroma (CH), occurs in 1/6000 live births and in 90% of cases develops in age less than 2 years old. They are mainly located in cervicofacial region. Adult-onset CH is very rare. Objective. The aim of this study is to review literature to discuss the clinical presentation, diagnosis, and treatment of CH in adults through a case report of unilocular CH in the axillary region in an adult male from India. Methods. A first case report of unilocular CH in axillary region in an adult male from India is being investigated. Results. Here we report a case of unilocular CH in the axillary region in a 49-year-old male with a 14x16x8 cm cystic swelling in left axilla with a history of aspiration failure. Contrast-enhanced MRI (CEMRI) showed well-defined thin walled, unilocular cystic lesion which appeared hyperintense on T2 & STIR and hypointense on T1W1 and showed thin peripheral rim of enhancement on post contrast images. The patient underwent surgical excision and the diagnosis of a pathological CH was established. His postoperative recovery was uneventful and had no evidence of recurrence. Conclusion. Due to rarity of adult-onset unilocular CH in axilla, its evaluation for prompt diagnosis and definitive treatment to prevent recurrence and complications is urgent. Furthermore, this is the first reported case from India which has been successfully managed at a peripheral hospital in Northeast-India and our report of this case contributes to the evidences supporting the role of CH in a differential diagnosis for masses in the adult axilla, especially in acute phase with no predisposing factors.

Study of Change in Physico-Chemical Parameters by Treatment of Sludge from Common Effluent Treatment Plant (CETP) with Earthworms

One of the most vital problems of environmental protection concern is that of solid waste disposal. This problem continues to grow with the growth of population and the development of industries. The Common Effluent Treatment Plant (CETP) already establishes itself as a service to society at large, contributing towards a cleaner environment. However, the inappropriate disposal of CETP’s hazardous sludge can cause serious environmental problems. The sludge if sent for landfilling may cause groundwater contamination, changing the soil fertility parameters as well. The research presented here is carried out to explore the ability of an epigeic earthworm Eudrilus eugeniae to transform the sludge produced from CETP into a value-added product i.e., vermicompost. In this study, six samples of feed mixture were used with different ratios of CETP sludge, cow dung, and sawdust. Physico-chemical parameters such as pH, Electrical Conductivity (EC), Volatile Solids (VS), Total Nitrogen (TN), Nitrate Nitrogen (NO3--N), Ammonium Nitrogen (NH4+-N) were characterized to analyze the quality of the compost formed. All these parameters are in the agreement with recommended standards of mature compost. The result shows that vermicomposting technique when used, epigeic earthworm Eudrilus eugeniae can work as a favorable alternative solution for the disposal of CETP sludge.

Relapsing neuromyelitis optica in an adolescent girl

Early differentiation of neuromyelitis optica spectrum disorder (NMO-SD) from multiple sclerosis (MS) is of paramount importance as NMO-SD (especially relapsing variant) has more severe morbidity than MS. We describe a case of an adolescent girl who presented with repeated episodes of optic neuritis over a period of 4 years with normal brain MRI scans. She was treated initially as relapsing remitting MS, before showing clinical evidence of transverse myelitis (TM), and eventually being diagnosed as NMO-SD. Pulse intravenous methyl prednisolone along with immunosuppressive therapy led to remission of her disease. However, delay in diagnosis as NMO-SD led to visual disability in the left eye. Therefore, in young patients with recurrent optic neuritis and normal brain MRI, it may be prudent to get spinal MRI done to look for TM, even when asymptomatic. In addition, we should keep a low threshold for requesting aquaporin-4 antibody testing in these patients.

Influence of Storage Temperature on Orthodontic Elastics

Introduction: Orthodontic elastics are a very significant tool in orthodontics, as it is the most commonly used force delivering unit. Temperature plays a key role in the amount of force that elastics are able to produce. Hence, there is a need to evaluate the influence of storage temperature on the properties of orthodontic elastics before its clinical use. Aim: To evaluate the influence of different storage temperature of latex orthodontic elastics. Materials and Methods: This cross-sectional study was conducted at Sathyabama Dental College and Hospital, Chennai, in November 2019. Sample of 40 latex orthodontic elastics (TP Orthodontics, medium force, standard size of 3/16′′) were divided into four groups with 10 elastics each, based on their storage temperature and stored in closed plastic packages. Group 1 was kept as a Control group and Group 2, Group 3 and Group 4 were stored in three Incubators under the specified storage temperatures such as 26-28°C, 4-8°C, 37°C respectively. The elastics were stretched and their forces measured in six progressive increases of 100% of their inner diameter, starting at a level of 100% stretching, with the Universal Testing Machine, Instron. The samples were also tested for Maximum Stress (MPa), Maximum Force (N), Maximum Elongation (%) and Break Distance (mm). Data were analysed using Statistical Package for the Social Science (SPSS) software version 16.0, one-way Analysis of Variance (ANOVA) and post-hoc test. Results: On evaluating the stress at 100%, 200%, 300%, 400%, 500%, 600% of strain, there was no statistically significant difference between the groups. Maximum Stress MPa was found to be 24.12±3.32, 25.12±3.42, 23.3±3.41, 23.97±3.50 for group1, group 2, group 3 and group 4 respectively. Maximum Elongation (%) was found to be 1369.0±25.108, 1364.0±23.190, 1359.0±35.103, 1363.0±34.657 for group 1, group 2, group 3 and group 4, respectively. Break Distance (mm) was found to be 68.48±1.267, 68.28±1.267, 67.87±1.77 and 68.19±1.727 for group1, group 2, group 3 and group 4, respectively. And none of the parameters tested showed statistical significance between the four groups. Conclusion: Latex elastics may be stored under any of the conditions tested in the present study over a period of one month, since different storage temperatures over a period of one month did not interfere in their mechanical properties.

High-content screening assay-based discovery of paullones as novel podocyte-protective agents

Podocyte dysfunction and loss is an early event and a hallmark of proteinuric kidney diseases. A podocyte's normal function is maintained via its unique cellular architecture that relies on an intracellular network of filaments, including filamentous actin (F-actin) and microtubules, that provides mechanical support. Damage to this filamentous network leads to changes in cellular morphology and results in podocyte injury, dysfunction, and death. Conversely, stabilization of this network protects podocytes and ameliorates proteinuria. This suggests that stabilization of podocyte architecture via its filamentous network could be a key therapeutic strategy for proteinuric kidney diseases. However, development of podocyte-directed therapeutics, especially those that target the cell's filamentous network, is still lacking, partly because of unavailability of appropriate cellular assays for use in a drug discovery environment. Here, we describe a new high-content screening-based methodology and its implementation on podocytes to identify paullone derivatives as a novel group of podocyte-protective compounds. We find that three compounds, i.e., kenpaullone, 1-azakenpaullone, and alsterpaullone, dose dependently protect podocytes from puromycin aminonucleoside (PAN)-mediated injury in vitro by reducing PAN-induced changes in both the filamentous actin and microtubules, with alsterpaullone providing maximal protection. Mechanistic studies further show that alsterpaullone suppressed PAN-induced activation of signaling downstream of GSK3β and p38 mitogen-activated protein kinase. In vivo it reduced ADR-induced glomerular injury in a zebrafish model. Together, these results identify paullone derivatives as novel podocyte-protective agents for future therapeutic development.

Transport and pharmacodynamics of albitiazolium, an antimalarial drug candidate

BACKGROUND AND PURPOSE

Choline analogues, a new type of antimalarials, exert potent in vitro and in vivo antimalarial activity. This has given rise to albitiazolium, which is currently in phase II clinical trials to cure severe malaria. Here we dissected its mechanism of action step by step from choline entry into the infected erythrocyte to its effect on phosphatidylcholine (PC) biosynthesis.

EXPERIMENTAL APPROACH

We biochemically unravelled the transport and enzymatic steps that mediate de novo synthesis of PC and elucidated how albitiazolium enters the intracellular parasites and affects the PC biosynthesis.

KEY RESULTS

Choline entry into Plasmodium falciparum-infected erythrocytes is achieved both by the remnant erythrocyte choline carrier and by parasite-induced new permeability pathways (NPP), while parasite entry involves a poly-specific cation transporter. Albitiazolium specifically prevented choline incorporation into its end-product PC, and its antimalarial activity was strongly antagonized by choline. Albitiazolium entered the infected erythrocyte mainly via a furosemide-sensitive NPP and was transported into the parasite by a poly-specific cation carrier. Albitiazolium competitively inhibited choline entry via the parasite-derived cation transporter and also, at a much higher concentration, affected each of the three enzymes conducting de novo synthesis of PC.

CONCLUSIONS AND IMPLICATIONS

Inhibition of choline entry into the parasite appears to be the primary mechanism by which albitiazolium exerts its potent antimalarial effect. However, the pharmacological response to albitiazolium involves molecular interactions with different steps of the de novo PC biosynthesis pathway, which would help to delay the development of resistance to this drug.

Transcatheter closure of patent ductus arteriosus: report of the first case in Nigeria

BACKGROUND

Since the first report on device closure of patent ductus arteriosus (PDA) by Porstmann et al in 1967, the procedure has gained wide acceptance and has been used all over the world, including parts of Africa. The advantages when compared to surgical closure include shorter procedure time and hospital stay and no scar being left. This mode of treatment was not available in Nigeria prior to this with patients having to travel abroad to benefit.

PATIENT AND METHOD

Cardiac catheterisation laboratory became available in Lagos, Nigeria in 2009 and in October 2010, the laboratory collaborated with Lagos State University College of Medicine (LASUCOM) and Lagos State University Teaching Hospital (LASUTH), to perform a device closure on a 3-year old girl with PDA who had presented to LASUTH with heart failure at the age of 6 months. To the best of our knowledge, this is the first time the procedure has been performed in Nigeria

RESULTS

The patient made a successful recovery and is haemodynamically stable, on no medications.

CONCLUSION

Device closure of PDA is now safe and available in Nigeria.

Single-step endoscopic ultrasonography-guided drainage of peripancreatic fluid collections with a single self-expandable metal stent and standard linear echoendoscope

Endoscopic ultrasonography (EUS)-guided drainage of peripancreatic fluid collections (PFCs) is a well described alternative to surgery or percutaneous drainage. However, it is limited by the requirement for a large working channel that allows multiple plastic stent placement, which is only commercially available on therapeutic linear echoendoscopes. Herein, we describe the drainage of PFCs with a single self-expandable metal stent (SEMS) using a single-step technique and standard linear echoendoscope. Seven cases were identified during a retrospective chart review, and included all patients who had undergone EUS-guided drainage of PFCs during a 6-month period. The mean age was 46 years (range 25 - 70 years) and all patients were symptomatic. The mean diameter of PFCs was 8 cm (range 4.1 - 12.5 cm). Previous percutaneous drainage had failed in three patients. A total of 10 PFCs were drained. Three patients had two cysts drained by the same stent and one patient had two separate procedures to drain two distinct cysts. The SEMS was in place for a mean of 13 weeks (range 4 - 34 weeks). Successful placement of SEMS was achieved in all seven cases. Patients were followed for a mean of 18 weeks (range 7 - 35 weeks), and symptom improvement was achieved in all cases. Complete resolution of PFC was achieved in 9 /10 cysts. No complications were encountered. Single-step EUS-guided drainage of PFCs using a single 10-mm SEMS and a standard linear echoendoscope appears to be a feasible endoscopic technique with excellent technical and clinical success rates.

Cardiac mucormycosis with T-cell immunodeficiency

We present a case of a 2 year old apparently healthy child who presented with fever and mass on the mitral valve. Excision histopathology of the mass revealed mucormycosis. After 4 months, she had CNS embolisation with recurrence of cardiac lesion when investigations revealed associated T-cell immunodeficiency.

Pulmonary hyalinizing granuloma with ureteric fibrosis: A case report and review of relevant literature

A 52-year-old, asymptomatic patient presented with bilateral lung nodules on chest radiograph. She was diagnosed to have "pulmonary hyalinizing granuloma" on an open lung biopsy. We review the clinical features of this rare disease.

Parachute tricuspid valve

Parachute abnormality of mitral valve frequently occurs with left sided obstructive lesions though occasionally may occur as an isolated lesion. Symptoms depend upon the severity of stenosis and associated lesions. Parachute abnormality of the tricuspid valve has rarely been reported and its association with left to right shunts has not been described so far.

Perventricular device closure of muscular ventricular septal defects on the beating heart

This report describes our initial experience with intraoperative device closure of muscular ventricular septal defects under echocardiographic guidance without cardiopulmonary bypass in two patients.

Clinical profile of neonatal sepsis

INTRODUCTION

Neonatal Sepsis is a major cause of mortality and morbidity in newborns both in developed and developing countries.

OBJECTIVE

This study was to analyse the symptoms and sign of Neonatal Sepsis.

MATERIALS AND METHODS

Retrospective hospital based study the date was collected from patient record files of two years (Jan. 2001-Dec.2002).

RESULT

106 Neonates with suspected sepsis were studied out of which 30 were culture positive. The most common organism was E. coli and the most common clinical presentation was the respiratory distress and letharginess.

CONCLUSION

Infection in Neonate is an important cause of mortality and morbidity especially in low birth babies.

Case report: Aneurysmal bone cyst of the ethmoid bone

Aneurysmal bone cysts (ABCs) are benign, slow growing expansile lesions usually found in long bones or vertebrae. Plain radiography reveals expansion of bone and cortical thinning. MRI may assist in diagnosis by virtue of its ability to demonstrate blood-fluid levels, which is a characteristic finding in these lesions. Very few cases of ABC of the paranasal sinuses have been reported in the literature. We present MRI findings of ABC of the ethmoid sinus in a 19-year-old male.

Early treatment of skeletal Class III: a case report

Skeletal class III malocclusion is a growth related facial deformity which increases if left untreated. Skeletal class III malocclusion should be corrected as soon one recognises the initial signs. Mixed dentition period is the time of greatest opportunity for occlusal guidance and growth modulation. A case of skeletal class III malocclusion in mixed dentition is presented, which was treated with a Delaire face mask therapy to modulate the craniofacial growth and to achieve a balanced profile.

Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up

OBJECTIVES

The aim of this study was to evaluate the use of endovascular stents in native and recurrent coarctation of the aorta (CoA).

BACKGROUND

Stents have been used successfully in various locations. Their use in CoA can be an alternative to surgery or balloon angioplasty (BA).

METHODS

Thirty-four patients with CoA (13 native and 21 re-coarctation after surgery or BA) with a mean age of 16 +/- 8 years (range 4 to 36 years) underwent attempted stent implantation between 1993 and 1999. Successful outcome was defined as peak systolic pressure gradient after stent implantation < 20 mm Hg.

RESULTS

Stents were implanted in 33/34 patients, and successful outcome occurred in 32/33 patients. Peak systolic pressure gradient decreased from 32 +/- 12 mm Hg to 4 +/- 11 mm Hg (p < 0.001). Coarctation site to descending aorta diameter ratio increased from 0.46 +/- 0.16 to 0.92 +/- 0.16 (p < 0.001). Two patients underwent successful stent re-dilation 16 and 21 months after initial implantation. Six patients (18%) developed complications, including two patients who underwent surgery. Follow-up for 29 +/- 17 months (range: 5 to 81 months) demonstrated no evidence of re-coarctation, aneurysm formation, stent displacement or fracture. Systolic blood pressure (SBP) decreased from 136 +/- 21 mm Hg before stent placement to 122 +/- 19 mm Hg at follow-up (p = 0.002). The SBP gradient decreased from 39 +/- 18 mm Hg to 4 +/- 6 mm Hg, and peak Doppler gradient decreased from 51 +/- 26 mm Hg to 13 +/- 11 mm Hg at follow-up (p < 0.001).

CONCLUSIONS

Intravascular stent placement for native and recurrent CoA has excellent results in the short and intermediate terms. Long-term outcome remains to be evaluated.

Coronary risk and dyslipidemia in type 2 diabetic patients

OBJECTIVES

A prospective study was carried out to find out the percentage of dyslipidemia in type 2 diabetics, to study the pattern of dyslipidemia, categorize the levels of LDL, HDL and triglycerides into higher, borderline and lower risk of developing coronary heart disease in type 2 diabetics and to compare the lipid profile with non-diabetics.

MATERIAL AND METHODS

Five hundred patients of type 2 diabetes mellitus and 150 age, sex and BMI matched non-diabetic healthy individuals were studied. The labelling of dyslipidemia and the categorization of risk for developing coronary heart disease (CHD) was done according to the guidelines of American Diabetes Association (ADA, 1998).

RESULTS

Dyslpidemia was present in 89% of diabetic patients with LDL hyperlipoproteinemia (LDL > 100 mg%) in 76%, HDL dyslipidemia (HDL < 35 mg%) in 58%, hypertriglyceridemia (TG > 200 mg%) in 22% patients. On analysing CHD risk based on lipid profile, it was revealed that in LDL moiety 48% fell in higher risk of CHD (LDL > 130 mg%), 28% in borderline risk (LDL 100-130 mg%) and 24% (LDL < 100 mg%) in lower risk. For HDL 18.5% fell in higher risk (HDL < 35 mg%) and TG only 0.5% fell in higher risk (TG > 400 mg%). The lipid profile was significantly altered in diabetic patients as compared to non diabetics.

CONCLUSIONS

The major concern which our study highlights is the high percentage of LDL dyslipidemia majority of whom fell in higher risk of developing CHD. Triglyceride and HDL levels were of lesser significance when newer ADA (1998) criteria for dyslipidemia were applied.

Serum insulin assay: an important therapeutic tool in management of freshly diagnosed type 2 diabetes mellitus

OBJECTIVES

The study was performed to see that, whether metabolic control and response to treatment in freshly diagnosed patients of type 2 diabetes mellitus is affected by primary pathology (hyperinsulinemia/inappropriate insulin secretion).

METHODS

One hundred and eight freshly diagnosed patients of type 2 diabetes mellitus with age range from 30-65 years were followed for a period of three months. The blood glucose, serum triglyceride, and serum insulin levels were determined in each patient. Patients were found to have either higher or normal to low serum insulin values at fasting, and accordingly patients were distributed into two groups; group one (normal to low initial fasting serum insulin level i.e. < or = 30 microU/ml) and group two (high fasting serum insulin level i.e. > or = 30 microU/ml). Each group was further divided into two subgroups A and B. Subgroup A was treated with glipizide and B with metformin.

RESULTS

Diabetic patients who had fasting hyperinsulinemia (n = 53, 100%) had blood pressure > or = 140/90 at the time of presentation. Patients who had fasting serum insulin within normal range only 30% (n = 17) had hypertension. Patients of group one had good recovery from hyperglycemia and reduction in triglyceride values when treated with sulphonylurea (subgroup A) as compared to patients treated with biguanide (subgroup B). On the contrary patients of group two showed poor glycemic control, increase in blood pressure and rise in serum triglyceride titre when treated with sulphonylurea (subgroup A) while in the same group biguanide effectively produced euglycemia with normalization of blood pressure and decrease in triglyceride levels (subgroup B).

CONCLUSION

Assessment of initial serum insulin levels is helpful guide to decide about the type of oral hypoglycemic agent to be used in freshly diagnosed patients to type 2 diabetes mellitus.

Pulmonary thrombosis, homocysteinemia, and reperfusion edema in an adolescent

Deep vein thrombosis, pulmonary embolism, and pulmonary thrombosis in situ are rare in childhood and adolescence [1,2]. Unfortunately, these diagnoses may be unsuspected in a pediatric patient with dyspnea and chest pain. This article illustrates the diagnostic and therapeutic challenges that arose from unrecognized chronic thrombotic disease in an adolescent.

Role of losartan therapy in the management of diabetic hypertension

The management of diabetic hypertension requires meticulous selection of agents in the antihypertension armamentorium. There may be several associated factors to be considered while treating a hypertensive diabetic. These include hyperglycemia, dyslipidemia, proteinuria, left ventricular hypertrophy and heart failure to name a few. Losartan is the first of a new class of agents in the list of antihypertensive drugs. By its selective angiotension II receptor (subtype AT1) blocking action it is postulated to bring about a more complete inhibition of the renin-angiotensin system. Thus, it might produce all the benefits of angiotensin converting enzyme (ACE) inhibitor therapy with the freedom from cough so commonly seen with the use of ACE inhibitors. This review attempts to analyze the possible benefits of losartan therapy in diabetes.

Maxillary expansion--an interceptive modality in mixed dentition

Maxillary expansion is a very useful procedure for arch length augmentation, posterior crossbite treatment and removing cross arch interferences. Removable appliances are in the realm of a pedodontist and general dentist. However, one should be aware of the problems arising at an early age of the child, should be able to properly diagnose the condition and if required, a timely referral to a specialist is also expected.

Insulin secretory response in healthy adult offspring of hypertensive parents

OBJECTIVES

The present study was done to observe the insulin secretory response in healthy adult offspring of normotensive and hypertensive parents as the etiology of essential hypertension is largely treated as unknown.

METHODS

The insulin secretary response was observed in 20 healthy adult offspring of normotensive parents (Group I) and 25 healthy adult offspring of hypertensive parents (Group II). The mean serum insulin levels were assessed at fasting, 30, 60, 90 and 120 minutes after 75 grams of oral glucose load in both groups.

RESULTS

The mean serum insulin levels in fasting state was higher in group II (32.40 +/- 18.59) than group I (17.90 +/- 11.98) (p < 0.01). After 30 minutes mean serum insulin levels were higher in group II than group I (88.00 +/- 56.04, 40.5 +/- 15.15 respectively, p < 0.001). There was no statistically significant difference after 60, 90 and 120 minutes of oral glucose load (p > 0.05).

CONCLUSIONS

Our observations suggest that the insulin secretory response in fasting and 30 minutes after oral glucose load was earliest metabolic abnormality in subjects at high risk for developing hypertension i.e. offspring of hypertensive parents.

Balloon angioplasty of postsurgical recoarctation in infants: the risk of restenosis and long-term follow-up

OBJECTIVES

This study was undertaken to evaluate the long-term results of balloon angioplasty (BA) for postsurgical recoarctation in infants.

BACKGROUND

Balloon angioplasty is a well-accepted modality for the treatment of recoarctation. However, infants remain a group of concern because of their size, risk for complications and the potential for restenosis with growth. Age <12 months has been determined to be a risk factor for the development of recoarctation after angioplasty for native coarctation. Although studies on postsurgical coarctation have found no relationship between age at angioplasty and the development of recoarctation, few studies specifically addressing infants have been performed.

METHODS

Clinical, echocardiographic, hemodynamic and angiographic data on 22 consecutive children <1 year of age who underwent BA between 1986 and 1996 were reviewed.

RESULTS

A successful result, defined as a postprocedure gradient of < or =20 mm Hg, was achieved in 20 of 22 (91%) infants with a reduction in the systolic peak pressure gradient from 48 +/- 27 to 9 +/- 10 mm Hg (p < 0.001) and an increase in coarctation diameter from 2.7 +/- 1.1 to 5.2 +/- 1.5 mm (p < 0.001). At long-term follow-up of a median of 56 months (0.6 to 12 years), the restenosis rate after an initial optimal result was 16% (3 of 19). Five (24%) infants required reintervention (2 initially unsuccessful; 3 recoarctation), with a success rate of 95% after two procedures. Suboptimal long-term outcome correlated with a lower infant weight.

CONCLUSIONS

Balloon angioplasty can be safely performed in infants, with good long-term results. The risk of restenosis is low and can be successfully managed with repeat angioplasty.

Fungal diseases of the paranasal sinuses

Fungal diseases of the paranasal sinuses can be categorized into the invasive and noninvasive varieties. The invasive form has been classified as acute fulminant fungal sinusitis, granulomatous invasive fungal sinusitis, and chronic invasive fungal sinusitis. The noninvasive form can be classified as the fungus ball and the allergic fungal sinusitis. The following review discusses the various types of fungal sinusitis with a special emphasis on the CT and MR imaging features.

Hallux valgus and hallux rigidus: MRI findings

The purpose of this article is to describe the MR findings of Hallux Valgus (HV) and Hallux Rigidus (HR). Twenty-four patients (11 with HV, 4 with HR, and 9 with both HV and HR) were studied at 1.5 Tesla MRI. Two separate observers evaluated the first ray blindly for the following signs: sesamoid position, sesamoid proliferation, hypertrophy of the median eminence, presence of a lateral facet, presence of an adventitial bursa, shape of the first metatarsal head, relative length of the first metatarsal, joint space loss, osteophytes (dorsalor lateral), marrow edema, geodes, subchondral sclerosis, intra-articular ossicle, and pes planus. The most common findings observed in HV were a hypertrophic medial eminence (95%), sesamoid proliferation (90%) and adventitial bursitis (70%). The most common findings observed in HR were osteophytes (77% and 69%), geodes, and marrow edema. We conclude that traditional routine radiograph signs of HV and HR may be applied to MR images.

Blinded evaluation of reverse transcriptase-polymerase chain reaction prostate-specific antigen peripheral blood assay for molecular staging of prostate cancer

OBJECTIVES

The reverse transcriptase-polymerase chain reaction (RT-PCR)-prostate-specific antigen (PSA) assay to detect presumed occult micrometastatic prostate cancer has been controversial, and this molecular staging has been thought to be clinically useful by some groups but not others.

METHODS

We used a sensitive nested RT-PCR assay with specific primers derived from the PSA sequence and a very stringent two-step PCR protocol with denaturing temperature of 94 degrees C annealing and extension temperature of 68 degrees C. This method enabled us to detect PSA-expressing LNCaP prostate cancer (PC) cells as low as one cell of 10 million lymphocytes (1/10(7)). Ninety-six patients with PC were studied, including 85 before radical prostatectomy (RP), and 22 controls, including healthy men and women and men with benign prostatic hyperplasia.

RESULTS

In 85 patients undergoing RP, a minimum of two independent RT-PCR-PSA assays detected circulating prostate cells preoperatively in 27 patients (31.8%). Of 12 patients with locally advanced or advanced stage cancer, RT-PCR-PSA was positive in 5 (41.7%); of the 22 controls, no patient was RT-PCR-PSA positive. In 10 randomly selected cases, the RT-PCR product was confirmed as PSA by DNA sequencing. Of the 27 patients undergoing RP who were RT-PCR positive, 11 (40.7%) had non-organ-confined disease (pT3a or greater), and of the 58 patients who were RT-PCR negative, 32 (55.2%) had non-organ-confined disease. Patients with RT-PCR positive results also had lower margin positivity (9 of 27, 33.3%) than did patients with RT-PCR negative results (21 of 58, 36.2%). Finally, at a mean follow-up of 25.7 months, 5 (18.5%) of 27 RT-PCR positive patients had recurrence (PSA) compared with 14 (24.1%) of 58 RT-PCR negative patients.

CONCLUSIONS

On the basis of this blinded study, RT-PCR for PSA-expressing cells in 85 patients before RP is not related to clinical stage, age, race, grade, Gleason sum, serum PSA or prostatic acid phosphatase, tumor volume, or tumor multifocality. RT-PCR positivity did not predict pathologic stage or early PSA recurrence. A standardized RT-PCR assay needs to be developed to account for interlaboratory discrepancies.

Recent advances in interventional pediatric cardiovascular disease

Transcatheter therapy in children with congenital or acquired heart disease is a challenging, innovative, and constantly evolving field. In this article we review the various "nonsurgical" techniques that are currently available, with a discussion of their applications and an update on the recent advances in the field of interventional cardiology.

Beta-amyloid augments platelet aggregation: reduced activity of familial angiopathy-associated mutants

The beta-amyloid (A beta) peptide is present both in serum and in platelets, however it is unclear whether A beta plays a role in platelet function. We have now investigated the effects of soluble A beta on platelet function and have found that low levels (0.1-1 nM) of soluble A beta augment ADP-dependent platelet aggregation and translocation of focal adhesion kinase to the platelet cytoskeleton. Addition of A beta to gel-filtered platelets along with concentrations of adenosine diphosphate (ADP) producing submaximal aggregation responses increased the aggregation response by over 2-fold depending on the ADP:A beta ratios. The structure activity requirements for A beta activity showed intriguing constraints. Only full length A beta has significant activity. Truncated A beta peptides, such as A beta(1-16) or A beta(25-35), or reverse A beta(40-1) all show little or no activity. We also examined the activity of mutant A beta peptides, corresponding with the APP(692A-G) and APP(693E-Q) (at A beta21 and A beta22, respectively) which are found in familial Alzheimer's disease and hereditary cerebral hemorrhagic amyloidosis, Dutch type (HCHWA-D), and found that these peptides showed little or no activity. These results suggest that A beta interacts with platelets in a highly specific manner and may play a role in regulating platelet function.

Transcatheter closure of an anomalous venous connection by a novel method

Left superior vena cavae draining to the left atrium have traditionally been treated with surgical ligation. Advances in cardiac catheterization have made transcatheter closure a viable alternative to surgery. We report on an innovative method using a Greenfield filter and Gianturco coils for closure of a persistent left superior vena cava.

Recent advances in interventional pediatric cardiovascular disease

Transcatheter therapy in children with congenital or acquired heart disease is a challenging, innovative, and constantly evolving field. In this article we review the various "nonsurgical" techniques that are currently available, with a discussion of their applications and an update on the recent advances in the field of interventional cardiology.

Single coronary artery complicating stent implantation for homograft stenosis in tetralogy of Fallot

Successful stent implantation for conduit stenosis has been described; however, this procedure may be complicated by compression of adjacent structures during expansion. We report on a rare case of a single right coronary artery system complicating stent implantation for relief of homograft stenosis in tetralogy of Fallot.

Plasminogen activators augment endothelial cell organization in vitro by two distinct pathways

Endothelial cell differentiation into capillary structures is a complex process that requires the concerted effects of several extracellular matrix proteases, including plasminogen activators. Here, the role of tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA) was evaluated in an in vitro model of endothelial morphogenesis involving organization of human umbilical vein endothelial cells into tubular structures when they are cultured on the basement membrane preparation, Matrigel. Both uPA and tPA were detected in HUVEC cultures on Matrigel, and inhibitors of plasminogen activators or of serine proteases decreased the extent of the tube network formed by the cells. The decrease resulting from serine protease inhibitors was additive to that from matrix metalloproteinase inhibitors which have previously been shown to decrease tube formation in this model, suggesting that the two classes of proteases modulate tube formation by distinct mechanisms. Plasminogen activator inhibitor (PAI)-1 decreased tube formation by 50% when added up to 4.5 h after the initiation of an 18 h assay and caused 25% inhibition when added 9.5 h after culture initiation, indicating that the effects of plasminogen activators are not limited to an early event in the differentiation process. Steady-state expression of mRNA for uPA increased during the first several hours of culture on Matrigel, further supporting a role for PA activity throughout the process of tube formation. These findings suggested that PAs may affect multiple events during tube-forming activity. A fucosylated peptide comprising the amino-terminal domain of uPA that binds to the uPA receptor (uPAR) but lacking proteolytic activity enhanced tube formation. In contrast, a defucosylated form of the same peptide had no effect. Since fucosylation of this fragment has been shown to be essential in other models of cell stimulation by uPA-uPAR interaction, these data support the hypothesis that uPA enhances endothelial morphogenesis both through proteolytic activity and via uPAR occupancy. Plasminogen activators could facilitate angiogenesis in vivo.