An antenatal diagnosis: Congenital high airway obstruction.

Congenital high airway obstruction (CHAOS) is a rare lethal fetal malformation characterised by obstruction to the fetal upper airway, which can be partial or complete. Antenatal diagnosis of CHAOS is important due to recent management options. Diagnosis is made with secondary changes such as hyperechoic enlarged lungs resulting in mediastinal compression, ascites, hydrops, flattened or everted diaphragms and dilated distal airways. We reported a case of CHAOS, antenatally on ultrasonography (USG) at 20 weeks of gestation.

Primary tubercular abscess of the breast--an unusual entity.

Primary breast tuberculosis manifested as abscess is a rare entity. We are reporting a case of primary breast tuberculosis, which presented as breast abscess. Abscess was drained and tissue sent for histopathology. To our surprise, diagnosis came as breast tuberculosis. Aspiration cytology was not done, as it is not a routine test for abscess cases. Patient was put on anti- tubercular drugs. In the follow-up of 6 months, she was asymptomatic and advised to continue medicine.

Outbreak of meningococcal disease in and around New Delhi, India, 2005-2006: a report from a tertiary care hospital.

The first of several cases of meningococcal meningitis was reported in April 2005, in New Delhi, India. Subsequent to this the Government declared an outbreak, which persisted for two periods, from April-July 2005 and January-March 2006. The National Institute of Communicable Diseases (NICD) recommended using WHO criteria for diagnosis of disease. During the outbreak 380 clinically suspected cases were investigated. Of 55 cases diagnosed as confirmed/probable the mortality rate was 14.6%. Meningitis was reported in 60% of cases and meningococcaemia in 40%. Microscopy of petechial rash was positive in 87.5%, CSF Gram stain positive in 68.3%, and latex agglutination test of CSF positive in 64.9% of samples. Neisseria meningitidis (serogroup A) was isolated from 37.7% of cases, 57.7% from CSF. Blood culture was positive in 10.4% of cases. CrgA polymerase chain reaction for N. meningitidis confirmed the isolates. All isolates were susceptible to third-generation cephalosporins, azithromycin and rifampicin, with increasing resistance to ceftriaxone. Penicillin resistance was encountered in 15.4% of strains. Resistance to quinolones was very high at 100% for levofloxacin, 84.6% for ofloxacin and 65.4% for ciprofloxacin. All patients with penicillin-resistant organisms (4) or intermediate sensitivity (4) succumbed to the disease. These patients also had a higher minimum inhibitory concentration to ceftriaxone.

Remoxipride in the treatment of levodopa-induced psychosis.

Levodopa-induced psychotic symptoms frequently complicate the management of patients with Parkinson's disease (PD). We examined the efficacy and tolerability of a novel antipsychotic, remoxipride, in this population. This was a 7-week, open-label pilot evaluation of patients with moderate to severe PD and levodopa-induced psychotic symptoms of at least 2 months' duration. The patients were recruited at the Movement Disorders Clinic, The Toronto Hospital, a tertiary referral center. After 1 week of baseline observation, the patients received remoxipride, 25 mg, three times a day orally, with the dose increasing by 25 to 50 mg each week as tolerated. The outcome measures included the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impressions (CGI) scale, and the United Parkinson's Disease Rating Scale. Adverse symptoms were elicited by an open-ended questionnaire and a symptom checklist. Six men and three women aged 69.3 +/- 9 years received remoxipride 147 +/- 57 mg/day. Total BPRS score decreased modestly in eight of nine subjects, and there was a statistically significant improvement of mental status as indicated by the CGI scale score, which decreased from 3.8 +/- 0.4 at baseline to 2.4 +/- 1.3 at last rating (p < 0.05; Wilcoxon signed rank test). The motor performance deteriorated somewhat in two subjects, whereas the rest showed no appreciable change. The most common adverse effects included tremor, rigidity, akathisia, and hypersalivation. Remoxipride treatment reduced psychotic symptoms in eight of nine subjects while having no appreciable effect on the parkinsonian status of seven of nine subjects.

Acquired immunodeficiency syndrome-related visceral leishmaniasis presenting in a pleural effusion.

Visceral leishmaniasis is increasingly reported in immunocompromised patients, including patients with AIDS. We report a case of visceral leishmaniasis in an AIDS patient who presented with pulmonary symptoms and bilateral pleural effusions. Histologic evaluation of pleural fluid and bone marrow revealed histiocytes with intracellular Leishmania amastigotes. Visceral leishmaniasis should be considered in AIDS patients with a significant travel history who present with unexplained pulmonary symptoms.

Health status of women and children (pre-schoolers) in rural areas of Haryana.

PIP: 48% of India's 844 million population in 1991 were women and 62% were women and children. The health status of this population is a concern of the government in striving for Health for All by the year 2000. In this study, 60 women from Kurri and Bherian villages within 10-20 km of Hisar city of Haryana State, India and 82 preschoolers were randomly selected for health assessment in April-May 1990. Health status was assessed with anthropometric measures standardized by Jelliffe. The results for the women were grouped into good (80=100%) of standard values), average (60-79% of standard values), and poor (below 60% of standard values). The majority of women (56.66%) were aged 25-50 years and had an average health status, 43.44% had a good health status, and none was found in poor health status. Scores for height, head circumference and mid arm circumference were scored as 1 unit for weight, and totaled with parameters for weight for age, height for age, head circumference for age. Total scores were then grouped as good for 10-12 points, average for 7-9 points, and poor for 4-6 points; scores were determined as 1 for below 60% of the standard values, 2 for 60-79% of standard values, and 3 for 80-100% of standard values. The health status of children was found to show 53.66% of preschoolers with average health status, 35.36% with good health status, and 10.97% with poor status. 25.61% of the girls had an average health status and 28.05% of the boys had an average health status. Simple correlation analysis showed that the good health status of the mother was an important indicator of good health status of preschool children (r = .705, p .01). The health status of girls vs. boys was not found to be markedly different.^ieng

Role of radiation therapy in the treatment of benign ocular diseases.

Radiation therapy, although a prime treatment modality for malignant disease, has few definitive indications for some benign ocular diseases too. Orbital pseudotumour, Graves ophthalmopathy and pterygium are the conditions where the radiation oncologist has got an important role to play. This article reviews the current status of the role of radiation and its effectiveness in the management of these diseases.

Isolation and amino acid composition of the isotypes of a rat Clara cell specific protein.

A protein of molecular weight about 10,000 (Clara cell protein C) present in lung lavage fluid and specific to Clara cells has been shown to have three isotypes. The isotypes have been individually isolated and purified by a combination of molecular sieving, ion exchange chromatography, column chromatofocusing, and reverse phase chromatography. The protein was monitored by immunoblotting and its purity tested by silver staining of the gel following sodium dodecyl sulfate-polyacrylamide gel electrophoresis. About 33.7% of the 10-kDa protein present in starting rat lavage was recovered in final pure preparation. The 10-kDa Clara cell protein amounted to 0.38% of the total protein in rat lung lavage fluid. The three isotypes were present in a ratio of 1.0:2.8:8.8, the amounts increasing with decreasing pI. None of the isotypes bound to concanavalin A. The amino acid compositions of the three isotypes were similar and were remarkable in that the contents of leucine, glutamic acid, aspartic acid, serine, and proline were high, tyrosine was present in low amounts, and methionine and histidine were absent.

Bacterial proliferation in platelet concentrates.

Growth curves of bacteria in platelet concentrates were studied to determine whether increasing the shelf-life of platelets from 3 to 7 days might have contributed to the increased number of deaths caused by contaminated platelets that have been reported to the FDA since 1980. Platelets inoculated with 10(3) organisms or more showed logarithmic bacterial growth throughout the 7 days of storage or until the platelets became visibly abnormal. With an inoculum of 10(2) organisms or less, proliferation patterns were variable: 20 percent (%) showed uninhibited logarithmic growth and 50 percent (%) remained sterile throughout the 7 days. In another 30 percent (%), bacterial growth was temporarily suppressed for 5 to 6 days before bacteria actively proliferated. These data support the hypothesis that bacterial contamination of platelets not clinically significant at 3 days of storage might become so during the current 7 day shelf life.

Isolation of Chlamydia trachomatis from men with urethritis: relative value of one vs. two swabs and influence of concomitant gonococcal infection.

Two successive urethral swabs were used to obtain specimens for culture of Neisseria gonorrhoeae and Chlamydia trachomatis from 136 heterosexual men with urethritis. The first swab was used to culture N. gonorrhoeae and then C. trachomatis; the second was used to culture C. trachomatis only. C. trachomatis cultures from the second swab were positive more often (30 of 31 pairs) than were cultures from the first swab (22 of 31 pairs) (P less than .05). In addition, cultures from swab 2 had greater numbers of inclusions per coverslip more frequently (23 of 31 pairs) than did cultures from the first swab (six of 31 pairs) (P = .003). Numbers of chlamydial inclusions per coverslip were lower in specimens positive for both C. trachomatis and N. gonorrhoeae than in specimens positive for C. trachomatis only (P less than .02). In addition, the presence of N. gonorrhoeae in a specimen adversely affected the quality of the McCoy cell monolayer. In 17 of 21 instances of monolayer toxicity, cultures for N. gonorrhoeae were positive (P less than .01). These results demonstrate that when specimens from men with urethritis are cultured for N. gonorrhoeae and C. trachomatis, use of a second swab will improve rates of recovery of C. trachomatis. Material present in specimens that contain N. gonorrhoeae may adversely affect rates of isolation of C. trachomatis.

Analysis of adenocarcinoma in Barrett's esophagus utilizing a staging system.

Based on a retrospective review of nine patients with adenocarcinoma in a Barrett's esophagus and the reports of similar cases in the literature, a staging system for this malignancy was devised. A progression of changes could be identified that corresponded to the stages. These changes consisted of dysplasia progressing to carcinoma in situ and invasive malignancy with metastases. Stage III disease carried the same grim prognosis as a similar stage of squamous cell carcinoma of the esophagus. Earlier stages of adenocarcinoma of the esophagus appeared to have a better prognosis. White men with symptoms of reflux esophagitis, esophageal strictures, and/or hiatal hernias who have Barrett's esophagus extending proximal to the distal 10 cm of the esophagus appear to have a propensity to develop adenocarcinoma of the esophagus. Consideration should be given to antireflux surgery and close follow-up by periodic esophagoscopy and biopsy of the esophagus in these patients. If neoplasia is found, the thoracic esophagus should be totally removed with the stomach or left colon anastomosed to the cervical esophagus. Because of the poor prognosis of Stage III disease, postoperative chemotherapy should be considered.

Recognition of different pools of phosphatidylglycerol in intact cells and isolated membranes of Acholeplasma laidlawii by phospholipase A2.

Phospholipase A2 (EC 3.1.1.4) from pig pancreas hydrolyzes phosphatidylglycerol in intact cells and isolated membranes of Acholeplasma laidlawii. Complete degradation of phosphatidylglycerol in intact cells at 37 degrees C does not result in lysis as shown by the retention of intracellular K+ ions and the cytoplasmic glucose-6-phosphatase, as well as the inability to detect activity of membrane-bound intracellular NADH-oxidase. A. laidlawii was grown on linoleic acid. Phospholipase A2 treatment of these cells at 5 degrees C, at which temperature the lipids are still in the liquid-crystalline state, results in a rapid breakdown of 50% of the phosphatidylglycerol. The residual phosphatidylglycerol can be hydrolyzed only at elevated temperatures and at much smaller rates, depending strongly on the incubation temperature. When membranes isolated from these cells are incubated at 5 degrees C, 70% of the phosphatidylglycerol is hydrolyzed immediately. The hydrolysis of the residual 30% is again strongly temperature dependent. Cells were grown on palmitate, elaidate, or oleate to investigate possible effects of the lipid phase transition on the accessibility of phosphatidylglycerol for phospholipase A2. Under conditions in which all the lipid is in the solid state, no hydrolysis occurs. When solid and liquid-crystalline lipid phases coexist, a limited hydrolysis of phosphatidylglycerol can be observed. The results demonstrate the disposition of phosphatidylglycerol in three different pools in the membrane of A. laidlawii. Phospholipase A2 has been used to discriminate between these pools and to estimate the amount of phosphatidylglycerol which is present in the liquid-crystalline phase. The present data, however, do not allow a definite localization of the phosphatidylglycerol pools.