10H-Phenothiazines: a new class of enzyme inhibitors for inflammatory diseases.

The phenothiazine nucleus is known for their inhibitory activity towards the regulatory enzymes that are contributing to diseases such as asthma, autoimmune diseases including allergic rheumatoid and encephalomyelitis. In this study a number of substituted phenothiazines were synthesized and screened for their biological activity against the regulatory enzymes involved in inflammatory diseases. Our results show that the newly synthesized compounds 4a-c and 5a-c exhibited promising target specific enzyme inhibition against phosphodiesterase, prostaglandin dehydrogenase and superoxide dismutase activity depending on steric factors of the molecules.

Functionalized alginate as immobilization matrix in enantioselective L (+) lactic acid production by Lactobacillus delbrucekii.

The imperative role of functionalized natural alginate in immobilization of Lactobacillus delbrucekii (NCIM 2365) cells in production of optically pure L (+) lactic acid was studied. L. delbrucekii cells were immobilized in alginate, succinylated alginate and carrageenan to evaluate the bead stability and selectivity towards production of optically pure L (+) lactic acid. The scanning electron microscopic studies of free and immobilized cells show little morphological changes. The present study highlights the use of functionalized alginate-immobilized L. delbrucekii cells in production of L (+) lactic acid in higher yields (0.93 Yp/s in grams) with an improved enantioselectivity (99%). In addition, they further revealed decreased by-product formation (acetic and propionic acid) when compared to free and other immobilized cell fermentation.

Optimization of fermentation conditions for production of glycopeptide antibiotic vancomycin by Amycolatopsis orientalis.

Glycopeptides produced by Streptomyces species are the drugs used against beta-lactam drug-resistant staphylococcal infections, and vancomycin is important among them. Increased prevalence of resistant strains increased the usage of vancomycin worldwide and also promoted attempts for indigenous production. The optimum process conditions pH, temperature, inoculum size, agitation, and aeration for vancomycin production by Amycolatopsis orientalis were evaluated, statistically analyzed, and the response surface curves were constructed. The optimum process conditions were a pH of 7.6, a temperature of 29 degrees C, an inoculum size of 4.5%, an agitation of 255 rpm, and an aeration of less than 1:10 medium-to-air ratio.

Efficient enantioselective reduction of ketones with Daucus carota root.

A novel and efficient reduction of various prochiral ketones such as acetopehones, alpha-azido aryl ketones, beta-ketoesters, and aliphatic acyclic and cyclic ketones to the corresponding optically acive secondary alcohols with moderate to excellent chemical yield was achieved by using Daucus carota, root plant cells under extremely mild and environmentally benign conditions in aqueous medium, has been described. Many of these optically active alcohols are the potential chiral building blocks for the synthesis of pharmaceutically important molecules and asymmetric chiral ligands. Hence, this biocatalytic approach is found to be the most suitable for the preparation of a wide range of chiral alcohols and gave inspiration for the development of a new biotechnological process.

Incarcerated obturator hernia

Incarcerated obturator hernia is rare, only approximately 550 cases appearing in the literature since the first case was reported in 1924. The three cases treated at the University Hospital of the West Indies are presented. They demonstrate many of the clinical features of the condition. Most cases occur in elderly women and they almost always present with symptoms amd signs of small bowel obstruction. Pressure on the obturator nerve by the hernial sac in the obturator nerve by the hernial canal results in a positive Howship-Romberg sign in about 50 percent of the patients. If the diagnosis is suspected pre-operatively, confirmation may be obtained by computerized tomography. This, however, seems unnecessary as prompt exploration is advisable due to the high incidence of gangrene of the bowel. At surgery, attempts at reduction frequently result in damage to the small bowel, and resection is often necessary due to injury or gangrene. Closure of the entrance to the canal with interrupted non-absorbable sutures is adequate, and prosthetic material is necessary only for very large defects. The high mortality rate reported is probably due to the age and poor general condition of affected patients (AU)

Ileo-colic volvulus

Three cases of volvulus of the right colon are presented, and the current literature is reviewed. Prompt diagnosis based on clinical suspicion and plain abdominal radiographs can be made. Urgent operative treatment is mandatory. If gangrene has already occurred or if the volvulus cannot be untwisted, primary resection or a Mikulicz procedure should be performed depending on the patient's condition after applying soft clamps to the bowel proximally and distally. In non-gangrene cases, simple detortion is inadequate. Right hemicolectomy may be performed in the fitter patients but caecopexy of the peritoneal flap type has been shown to be promising, and appears to be as effective and perhaps safer in less experienced hands. (AU)

Isolated torsion of the fallopian tube

Isolated torsion of the fallopian tube is an uncommon and ill-understood condition which presents as an acute abdominal emergency. It has not been previously reported from this region. The diagnostic difficulties, pathophysiology and management are discussed. It is suggested that better awareness of the condition may result in earlier diagnosis and treatment, with possible salvage of the affected tube (AU)

Oesophageal varices - abstract

The treatment of bleeding oesophageal varices remains a frustrating exercise for physicians and surgeons. At the University Hospital of the West Indies, during the period January 1971 to December 1982, 53 patients were admitted with bleeding oesophageal varices. The diagnosis was confirmed by barium meal, oesophagoscopy, surgery or at post-mortem. Thirty-nine of these were males. Their ages ranged from 11 to 81 years. Forty-two belonged to the 40 to 60-year age group. Initially, all patients were treated with blood transfusion, intravenous pitressin and the Sengstaken Blakemore tube. In 10 patients the bleeding stopped and they were discharged home. Of the remaining 43 patients, 29 died without surgery. Sixteen patients died within 3 days of admission, 7 patients were not fit for surgery and 6 refused operation. Fourteen patients underwent surgery. Eleven had an emergency surgical procedure to control bleeding and only 3 of these survived. Three patients had elective operations following conservative control of bleeding and all of them survived. The overall mortality form bleeding oesophageal varices of 70 percent reflects our difficulty in controlling bleeding adequately in the initial stages as a prelude to elective portal decompression in these patients. The reason for this are: (a) difficulty in monitoring the patients with Sengstaken-Blakemore tube on the general wards, and the frequent non-availability of the tube, (b) difficulty in obtaining adequate amounts of blood, and (c) lack of early surgical intervention in cases where bleeding is not controlled by conservative means. It is our belief that patients with acute variceal haemorrhage should be manged in an Intensive Care Unit. In this setting we are more likely to be able to control bleeding and to prepare the patient for elective surgery. We also need to develop a more aggresive approach to those patients whose bleeding is not promptly controlled and to advise surgical intervention before the general conditions of the patient deteriorates to a point where he is no longer fit for surgery (AU)

Abdominal aortic aneurysms: results of resection

One Hundred and One (101) patients with abdominal aortic aneurysms seen during the 18-year period January, 1956 to December, 1982, were reviewed. Resection was performed in 67, and 50 of these were non-ruptured. Compared to other reported studies, there was little difference in age group, patient population or mode of presentation. There were very few small and asymptomatic aneurysms, and large aneurysms were relatively common. These differences were interpreted to indicate a more advanced stage of aneurysmal disease in our patients. The mortality in the present series for resection of ruptured aneurysms remains above 50 percent, and the mortality for resection of non-ruptured cases is still higher than that reported elsewhere. The two most significant risk factors for elective resection in our patients seem to be advanced age and the presence of pre-existing coronary artery disease (AU)

Nosocomial surgical infections: incidence and cost in a developing country

Eight hundred twenty-nine patients were monitored for nosocomial surgical infections from January to December 1980 at the University Hospital of the West Indies. Two hundred twenty-five patients (27 percent) had 189 post-operative infections (POWI) and 295 other nosocomial infections with an average of 2.1 infections per infected patients. The incidence of POWI was 22.8 percent, varying from 7.3 percent in clean to 82.2 percent in infected wounds. The most common organisms isolated were gram-negative bacilli and Staphylococcus aureus. The most frequent nosocomial infection other than was urinary tract infection (27.8 percent). A statistically signifcant number of urinary tract infections and septicemias were associated with the use of medical devices such as indwelling urethral catheters and central venous pressure lines (p < 0.001). Septicemia was frequently associated with operations on the lower gastrointestinal and hepatobiliary tracts ( p < 0.001). The postoperative stay of an infected patient was prolonged by an average of 18 days. The total excess cost of hospitalization for the infected patients was U.S. $170,000 (AU).

Spontaneous rupture of the diaphragm during delivery

True spontaneous rupture of the diaphragm, as a consequence of pregnancy or delivery, is exceptionally rare; one only case has been recorded. We report a further case where diaphragmatic rupture was followed by herniation and subsequent infarction of the caecum, ascending colon and most of the transverse colon. The diagnostic difficulties, pathophysiology and management are discussed (AU)

Volvulus of the colon

Volvulus of the colon is a closed loop obstruction resulting from an axial rotation of the colon on its mesentry. It is one of the common causes for obstruction in Northern Iran, East Africa, Eastern Europe and India. It is probably related to the high roughage diet consumed in these communities. These diets are similar to the Jamaican diet. This retrospective study was undertaken to determine the frequency of this type of acute abdominal emergency seen at the University Hospital of the West Indies, (UHWI), Kingston, Jamaica. Colonic volvulus accounted for 8-9 percent of all intestinal obstruction seen at the UHWI between 1971-1976. All types of volvulus were seen with sigmoid volvulus being the most commonly encountered. A high incidence of compound volvulus was also noted. The high roughage diet is suggested as an etiological factor since it is similar to the diet in other countries where the incidence of volvulus is high. Colonic volvulus is an acute surgical emergency requiring prompt diagnosis and urgent treatment. (Summary)

Bacteriological study of diabetic foot ulcers

Bacteriological study of 61 patients with diabetic gangrene of non-gangrenous foot ulcers was undertaken to determine the pattern of infection and antimicrobial susceptibility with a view to suggest optimal antibiotic therapy for these patients. Grangrenous ulcers showed a higher frequency of mixed infection: the predominant organisms being enterococci, Proteus sp., Pseudomonas sp. and Klebsiella sp. Infected nongrangrenous ulcers showed Staph. pyogenes, and beta haemolytis Streptococcus as single organism in 12 patients. Anaerobes were more frequent isolated in gangrenous lesions than in non-gangrenous ulcers. Antimicrobial susceptibility showed that gram positive organisms were sensitive to co-trimoxazole, cephaloridine, ampicillin and penicillin. Gram negative aerobic bacilli were sensitive to gentomycin, chloramphenicol, cotrimoxazole and streptomycin. Anaerobes were sensitive to chloramphenicol, clindamycin and metronidazole. Antibiotics of choice for gangrenous lesions with spreading infection and septicaemia are a combination of gentamycin, ampicillin and metronidazole as an adjuvant to surgical treatment. (AU)

Bacteriological study of diabetic foot ulcers - abstract

This study was undertaken to evaluate the type of infection in ulcers of diabetic foot and to establish the optimal anti microbial therapy for these patients. Sixty-one patients from U.H.W.I. and Mona Rehabilitation Centre were studied for one year ( Oct. '78 - Sept. '79). Their ages ranged from 40 - 80 years. Thirty-four had diabetes for more than 12 years. Sixty wound swabs, 12 tissue specimens from gangrenous lesions and 48 wound swabs from non-gangrenous ulcers were cultured. Disc sensitivity tests were performed. Gangrenous lesions showed a higher incidence of mixed infection. The predominant organisms isolated in these lesions were enterococci (43), proteus sp. and enterococci in four patients. Two had pure anaerobic streptococcus. In non-gangrenous ulcers, the single causative organism in ten patients was Staph. pyogenes and in two was streptococci group A. Anaerobes were more frequently found in gangrene (13) than in non-gangrenous ulcers (3). Sensitivity tests showed that the gram positive organisms were sensitive to co-trimoxazole (99.1 percent), cephaloridine (95.4 percent), ampicillin (79.3 percent), and penicillin (78.3 percent). The gram negative organisms were sensitive to gentamycin and showed resistance to penicillin (93.8 percent), ampicillin (76.5 percent), cephaloridine (60.9 percent) and tetracycline (56.1 percent). All anaerobic organisms were sensitive to metronidazole, clindamycin and chloramphenicol. We recommend the anti microbial therapy of choice for patients with gangrenous lesions with spreading infection is combination of gentamycin, ampicillin and metronidazole. Non-gangrenous ulcers can be adequately treated by meticulous wound cleaning and antibiotic of choice depends upon the local or general complications (AU)

Carcinoma of bladder - abstract

Fifty-four case records of Carcinoma Bladder seen at the Kingston Regional Hospital during the period 1974-1978 were studied. Forty-nine were primary tumour of the bladder and five were secondaries. Twenty-nine were females. The age group ranged from 40 - 82 years; peak incidence was 60-70 years. Presenting symptoms were haematuria 90 percent, dysuria 60 percent, back pain 20 percent. All females had dysuria. Cystoscopy and biopsy were performed in all cases. Hystologically they were:- transitional cell (39), squamous cell carcinoma (5), anaplastic adeno-carcinoma (2), adeno-carcinoma and transitional cell carcinoma (2), transition from transitional cell carcinoma to squamous cell carcinoma (1), secondary transitional cell carcinoma from renal pelvis (1), squamous cell carcinoma from cervix (4). Thirty-nine cases had cobalt therapy only; nine patients had per urethral electro resection of the bladder tumour followed by cobalt therapy; two had partial cystectomy and three had total cystectomy. All had cobalt therapy. One had ideal conduit and cobalt therapy for the tumour, as the lesion was not resectable. Five-year follow-up of all patients was difficult due to the shifting population. Three year survival was 60 percent. Age group; sex ratio and histological type is similar to that seen in other countries, but the majority of our patients presented with Grade III Carcinoma (AU)

Radiological appearance in compound volvulus of the sigmoid colon

The appearances of plain supine and erect radiographs in ileo-sigmoid knotting and simultaneous volvulus of the sigmoid and transverse colon are described and their diagnostic significance is discussed (AU)

Foot ischaemia - a need for early rehabilitation

Ischaemia of the foot usually affects the elderly. The correlative study based on clinical data and pathological study has shown that maturity onset, diabetic foot ischaemia is usually due to severe arteriosclerosis. Because of the late presentation, most patients show end-stage obliterative vascular changes when first hospitalized which makes reconstructive surgery impossible. By early referral of all diabetic patients with infection, the number of below-knee or above-knee amputations can be reduced. Early prosthetic fitting is essential for the early rehabilitation of the patient. This paper was presented in part at the Commonwealth Caribbean Medical Research Council Meeting held at Bridgetown, Barbados in April, 1978. (AU)

Leiomyosarcoma of the duodenum

Only two cases of leimyosarcoma of the duodenum have been documented by the Jamaica Cancer Registry to date. One patient presented with obstructive jaundice which is an unusual presentation of this tumour. He died on the ninth post-operative day due to necrotising entero-colitis. The other patient presented with rectal bleeding, anaemia and an abdominal mass. The lesion was treated with pancreatico-duodenectomy and he is alive, but with recurrence up to the date of reporting. Neither of the two cases was diagnosed pre-operatively. Surgeons should be aware of this lesion while operating for upper-intestinal bleeding or on patients with obstructive jaundice (AU)