Occurrence, biochemical profile of vascular endothelial growth factor (VEGF) isoforms and their functions in endochondral ossification.

Vascular endothelial growth factor (VEGF), initially detected in bovine pituitary follicular cells, is widely localized in hypertrophic zones of chondrocytes in various tissues where focus is on bone growth. Similarly, VEGF found in chondrocytes of articular cartilage of osteo-arthritic/rheumato-arthritic joints reflected need for bone repair. Members of VEGF family of human origin are seven homo-dimeric, heparin-binding glyco-proteins, encoded by different genes located on different chromosomes. They encode seven isoforms: VEGF-A, -B, -C, -D, -E, -F, and PLGF, each catalyzing distinct functions. They are compared with VEGFs derived from bovine origin in biochemical composition and functions. Each isoform and subtype has specific receptors for binding, necessary for expression of specific functions in bone growth or repair. VEGF control is by diffusion of isoforms, hypoxic conditions, and bone (mandibular) positioning. Thus, transformation of cartilage into bone involves proliferation of mesenchymal cells, hypertrophy in chondrocytes, capillary invasion, and calcification by extra cellular matrix (ECM). Inherent limitations of in vitro/in vivo models and chronology of appearance of different isoforms have eluded precise mechanism of VEGF action and regulation. Nonetheless, central role of VEGF in bone growth is quite obvious.

An update on transforming growth factor-ß (TGF-ß): sources, types, functions and clinical applicability for cartilage/bone healing.

Transforming growth factor-ß (TGF-ß) has been reviewed for its sources, types of isoforms, biochemical effects on cartilage formation/repair, and its possible clinical applications. Purification of three isoforms (TGF-ß-1, ß-2 and ß-3) and their biochemical characterization revealed mainly their homo-dimer nature, with heterodimers in traces, each monomer comprised of 112 amino acids and MW. of 12 500 Da. While histo-chemical staining by a variety of dyes has revealed precise localization of TGF-ß in tissues, immune-blot technique has thrown light on their expression as a function of age (neonatal vs. adult), as also on its quantum in an active and latent state. X-ray crystallographic studies and nuclear magnetic resonance (NMR) analysis have unraveled mysteries of their three-dimensional structures, essential for understanding their functions. Their similarities have led to interchangeability in assays, while differences have led to their specialized clinical applicability. For this purpose, their latent (inactive) form is changed to an active form through enzymatic processes of phosphorylation/glycosylation/transamination/proteolytic degradation. Their functions encompass differentiation and de-differentiation of chondrocytes, synthesis of collagen and proteoglycans (PGs) and thereby maintain homeostasis of cartilage in several degenerative diseases and repair through cell cycle signaling and physiological control. While several factors affecting their performance are already identified, their interplay and chronology of sequences of functions is yet to be understood. For its success in clinical applications, challenges in judicious dealing with the factors and their interplay need to be understood.

Investigation of Hydrogel Isolated from Seeds of Ocimum basilicum as Binder.

Ayurvedic powders are widely used as therapeutic agents but most of them have unpleasant taste and large doses. One of the possible approach to overcome these drawbacks is to represent them in unit dosage form i.e. tablet dosage form. The purpose of this study is to elucidate and quantify the compressibility and compactibility of herbal granules prepared by using hydrogel isolated from whole seeds of Ocimum basilicum as a novel binder. The compressibility is the ability of the powder to deform under pressure and the compactibility is the ability of a powder to form coherent compacts. To test the functionality of novel excipients, Sonnergaard proved a simple linear model to confirm compactability, which is an uncomplicated tool for quantification. The tablets were compressed at increasing compression pressures and were evaluated for various mechanical properties. The linear relationship between specific crushing strength and compression pressure revealed the compactibility of the herbal granules and the linear relationship between porosity and logarithm of compression pressure revealed the compressible nature of the herbal granules according to the model developed by Sonnergaard. Thus the hydrogel isolated from whole seeds of Ocimum basillicum had potential as a granulating and binding agent.

Steroid pattern of bile and feces in response to a fruit-enriched diet in hypercholesterolemic hamsters.

The effect of a fruit (apple)-enriched diet on bile secretion and on fecal steroid excretion was studied in two strains of hamster: normal hamsters with normal cholesterolemia and spontaneous hypercholesterolemic hamsters with high-level hepatic cholesterol esters (FEC hamsters). Quantitative and qualitative alterations in the steroid composition in bile and feces were accompanied by changes in intestinal morphology. The fruit diet displayed a choleretic effect and increased the output of bile acids from liver in FEC hamsters. In addition, bile collected continuously from cannulated apple-fed animals was enriched with conjugates of cholic acid. Moreover, apple consumption lowered the lithogenic index of the bile. In response to the fruit diet, fecal excretion of bile acids and neutral sterols increased, essentially in the form of primary bile acids and sterol esters, respectively.

Prevalence of enteric parasites in homosexual patients attending an outpatient clinic.

A total of 372 pooled stool specimens from 274 homosexual men with diarrhea were submitted for parasitologic examination over a 2.5-year period. Each two-vial pooled specimen set contained portions of stool from 3 consecutive days in Formalin and polyvinyl alcohol. Of the 274 patients, 133 (48.5%) harbored one or more intestinal protozoa, with 161 (43.3%) of the 372 specimens submitted being positive for one or more organisms. The parasites identified included Entamoeba histolytica (71 patients), Giardia lamblia (22 patients), Endolimax nana (106 patients), Entamoeba coli (39 patients), Entamoeba hartmanni (25 patients), Dientamoeba fragilis (3 patients), Iodamoeba bütschlii (2 patients), and Chilomastix mesnili (2 patients). Cryptosporidium sp. (2 patients) and Isospora belli (1 patient) were also detected. Results of this study support the experience of other workers regarding high rates of infection with intestinal parasites in the homosexual population and also indicate that symptomatic individuals belonging to this acquired immunodeficiency syndrome risk group be screened for both common and uncommon intestinal pathogens.

Absorption of contrast medium during ERCP.

In order to assess systemic absorption, serum diatrizoate levels were measured in 25 patients requiring endoscopic retrograde cholangiopancreatography (ERCP). Urinary diatrizoate was measured in the urine of seven of these. In five additional patients, diatrizoate was instilled into the duodenum during endoscopy. Blood was drawn before and after completion of the procedure in all patients and at intervals from 2 to 24 hr in nine. Eighteen-hour urine collections were obtained from seven patients. Increases in serum diatrizoate concentration were 7.10 micrograms/ml +/- 3.01 (mean +/- SE) in the duodenal-instillation patients, 230.68 +/- 53.24 micrograms/ml in 9 patients in whom only the pancreatic duct was visualized, 7.83 +/- 1.05 micrograms/ml in three patients in whom only the bile duct was visualized, and 77.67 +/- 28.22 micrograms/ml in 13 patients in whom both ducts were visualized. The mean total urinary excretion of diatrizoate was 3.05 +/- 0.98 g of diatrizoate. Endoscopists performing ERCP should be aware of the likelihood of systemic absorption and the possibility of reactions to iodinated contrast materials in sensitive patients.

Recurrent choledocholithiasis following cholecystectomy, sphincterotomy and choledochoduodenostomy: successful treatment with chenodeoxycholic acid.

An elderly woman presented with recurrent choledocholithiasis. She had had three prior surgical procedures on the biliary tract, including a cholecystectomy with common duct exploration, a second common duct exploration with choledocholithotomy and sphincteroplasty, and subsequently a third common duct exploration with choledochoenterostomy. She refused further surgical therapy and chenodeoxycholic acid therapy was instituted. Within six months, there was partial dissolution of the gallstones. One year later, the stones were not longer demonstrable, and the patient was symptom-free. The potential role of chenodeoxycholic acid therapy, endoscopic papillotomy and postoperative extraction of common duct stones via the T-tube tract, using a Dormia basket, as alternates to surgical therapy of recurrent or retained gallstones are discussed.

Segmental tuberculosis of the colon mimicking carcinoma.

Tuberculosis of the distal colon occurring in the absence of ileocecal or pulmonary involvement is often mistaken for neoplasm or Crohn's disease. In spite of various studies, including colonoscopy and brushings with biopsy, the diagnosis might still be in doubt at the time of operation. The combined approach of surgery and chemotherapy appears to be the treatment of choice, especially in those patients who have bleeding and/or obstruction in whom the diagnosis cannot be made by other modalities.

Abnormalities of the bile duct associated with chronic pancreatitis.

The association of abnormalities of the common bile duct with chronic inflammatory disease of the pancreas is described in this report in which the important diagnostic role of endoscopic retrograde cholangiopancreatography (ERCP) is emphasized in this disease entity. ERCP was utilized as a single diagnostic modality in 27 patients (15 females) in whom both the biliary tree and pancreatic ducts were demonstrated. Abnormalities of the pancreatic duct were noted in all patients while the associated changes of the common bile duct were noted in 12 (44%--7 females). The role of ERCP in confirming the diagnosis and its importance in planning specific therapy is emphasized.

Low incidence of bacteremia following endoscopic retrograde cholangiopancreatography (ERCP).

Fifty patients (29 females) undergoing ERCP were studied prospectively for the occurrence of bacteremia associated with this endoscopic procedure. Each patient had blood samples drawn for aerobic and anaerobic cultures before endoscopy, after entering the duodenum, 5 and 15 minutes after cannulation of the papilla of Vater. Subcultures were made at 24 and 48 hours for a total of 1,200 cultures. No positive cultures were obtained in 48 patients. One patient developed a Staphylococcus epidermidis bacteremia during the procedure. The cleansing technic for the instruments consisted of alcohol and water only. Prophylactic antiobiotics were not administered. In contrast to other gastrointestinal procedures, our results suggest that bacteremia is an uncommon occurrence in ERCP despite the longer duration of the procedure and instrumentation of a sterile duct system.

Congenital hepatic duct obstruction with perforate diaphragms.

A patient had obstruction of the right and left hepatic ducts secondary to perforate diaphragms at the junction with the common hepatic duct. Transhepatic cholangiograms of both the right and left lobes were required to define the presence of diaphragms at the junctions of right, left, and common hepatic ducts. Excision of the diaphragms relieved the obstruction. A distinction should be made between congenital nonobstructive and congenital obstructive cystic dilation of intrahepatic biliary radicals.