Endoscopic ultrasound-guided fine needle aspiration of peritoneal nodules in patients with ascites of unknown cause.

Ascites can pose a difficult diagnostic problem and in some patients, despite extensive work-up, diagnostic laparoscopy or laparotomy is required. We evaluated the usefulness of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of peritoneal nodules in 12  patients with undiagnosed ascites (9  men, 3 women; mean [SD] age 47.5 [11.8] years). On EUS, peritoneal deposits, noted as hyperechoic rounded lesions compared with surrounding anechoic ascitic fluid, were observed in 10/12  patients (83.3%). Cytological examination of EUS-FNA samples from these deposits revealed metastatic adenocarcinoma in four patients, poorly differentiated carcinoma in one patient and pseudomyxoma peritonei in one patient. It also revealed inflammatory cells without granulomas in four patients, and polymerase chain reaction (PCR) for Mycobacterium tuberculosis was positive in 2/4 patients (50%). Deposits were larger and clearly defined in malignant ascites in comparison with tubercular ascites. No complications of EUS-FNA were observed.

LLL-3 inhibits STAT3 activity, suppresses glioblastoma cell growth and prolongs survival in a mouse glioblastoma model.

Persistent activation of the signal transducer and activator of transcription 3 (STAT3) signalling has been linked to oncogenesis and the development of chemotherapy resistance in glioblastoma and other cancers. Inhibition of the STAT3 pathway thus represents an attractive therapeutic approach for cancer. In this study, we investigated the inhibitory effects of a small molecule compound known as LLL-3, which is a structural analogue of the earlier reported STAT3 inhibitor, STA-21, on the cell viability of human glioblastoma cells, U87, U373, and U251 expressing constitutively activated STAT3. We also investigated the inhibitory effects of LLL-3 on U87 glioblastoma cell growth in a mouse tumour model as well as the impact it had on the survival time of the treated mice. We observed that LLL-3 inhibited STAT3-dependent transcriptional and DNA binding activities. LLL-3 also inhibited viability of U87, U373, and U251 glioblastoma cells as well as induced apoptosis of these glioblastoma cell lines as evidenced by increased poly (ADP-ribose) polymerase (PARP) and caspase-3 cleavages. Furthermore, the U87 glioblastoma tumour-bearing mice treated with LLL-3 exhibited prolonged survival relative to vehicle-treated mice (28.5 vs 16 days) and had smaller intracranial tumours and no evidence of contralateral invasion. These results suggest that LLL-3 may be a potential therapeutic agent in the treatment of glioblastoma with constitutive STAT3 activation.

Effect of predominant methanogenic flora on outcome of lactose hydrogen breath test in controls and irritable bowel syndrome patients of north India.

The relationship between methanogenic flora and hydrogen (H(2)) production is considered to be a possible confounding factor in the interpretation of hydrogen breath tests (H(2)BT). Therefore, the present study was conducted prospectively and included 154 IBS patients (fulfilling Rome II criteria) and 286 age-and-sex-matched apparently healthy controls. Each subject underwent H(2)BT after overnight fasting using 25 g lactose. Methane and H(2) were measured using an SC Microlyser from Quintron, USA, at baseline and every 30 min for a total of 4 h. Subjects with fasting methane concentration <10 ppm were labeled as low methane producers (LMP) and >10 ppm as predominant methane producers (PMP). A rise >20 ppm over base line in hydrogen concentration was taken as +ve hydrogen breath test. IBS and control groups included 66.78% and 67.53% males, respectively. Mean age in the two groups were 48.52 +/- 30.54 years (range 15-68 years) and 45.67 +/- 30.54 years (range 15-78 years), respectively. Hydrogen breath test was +ve in 77/154 (50%) IBS patients and in 142/286 (49.65%) in controls (P > 0.05). It was also observed that the hydrogen breath test was -ve due to PMP in 5/77 (6.49%) of IBS patients and in 29/154 (20.14%) in controls. PMP affected lactose hydrogen breath tests in 6.49-20.14% subjects. This effect is more apparent in apparently healthy subjects as compared to patients with IBS.

Concomitant intestinal parasitism and non-cholera vibrio infection.

Concomitant parasitism is not uncommon especially in tropical countries with low socioeconomic status. Here we report an unusual combination of intestinal infection due to Strongyloides stercoralis, Blastomyces hominis and non-cholera Vibrio in a patient suffering from acute gastroenteritis and hypoalbuminemia. Early recognition and accurate treatment of gastrointestinal infections and infestations before the patient develops complications is important.

Study of small intestinal bacterial overgrowth in North Indian patients with irritable bowel syndrome: a case control study.

BACKGROUND: Approximately 20% of the general population has irritable bowel syndrome. Despite this high prevalence, the cause of irritable bowel syndrome is unknown. There is no data available concerning the prevalence of small intestinal bacterial overgrowth in North Indian patients with irritable bowel syndrome. AIM: This study evaluated the prevalence of small intestinal bacterial overgrowth in patients with irritable bowel syndrome compared with healthy controls. METHODS: This study included 225 consecutive patients of irritable bowel syndrome between the ages 20 and 65 years attending the gastroenterology clinics. Diagnosis of irritable bowel syndrome was made according to the Rome II criteria. Small intestinal bacterial overgrowth was estimated by using the non-invasive glucose hydrogen breath test. RESULTS: Of 225 patients of irritable bowel syndrome, 160 (71.1%) were male and 65 (28.9%) were female. Of 100 controls, 65 (65%) were male and 35 (35%) female. The prevalence of small intestinal bacterial overgrowth was 25 of 225 (11.1%) patients with irritable bowel syndrome and 1 of 100 (1%) in apparently healthy controls. This difference was statistically significant. The prevalence of small intestinal bacterial overgrowth in male and female patients was not significantly different. CONCLUSION: This study indicates that the prevalence of small intestinal bacterial overgrowth in irritable bowel syndrome patients from North India is approximately 11.1%, which is lower than the reported prevalence.

Orocecal transit time in patients with celiac disease from North India: a case control study.

AIM: The mechanisms responsible for bowel disturbances in celiac disease are still unknown. Small bowel motor abnormalities may be involved in this pathological condition; however, there is no study addressing small bowel transit in patients of celiac disease from Northern India. METHOD: The mouth-to-cecum transit time was studied in 80 celiac patients and 80 age and sex matched apparently healthy controls. RESULTS: Orocecal transit time in celiac patients was significantly delayed being 180+/-10.6 minutes (Mean+/-SE) as compared to 105+/-12.4 minutes in apparently healthy controls. CONCLUSION: This prolonged orocecal transit time could be due to impaired small bowel function (deranged motility) in patients with celiac disease.

Study of enzyme activities in the descending part of the duodenum in patients of duodenal ulcer.

The aim of this study was to measure the levels of lactase, sucrase, maltase, leucine amino peptidase and gamma-glutamyl transpeptidase in duodenum of Indian patients with duodenal ulcer. The effect of duodenum inflammation on these brush border enzymes has also been analysed in this study. Levels of lactase, sucrase, maltase, leucine amino peptidase and gamma-glutamyl transpeptidase were assessed in duodenal biopsies of 20 patients of duodenal ulcer and 20 non-ulcer dyspepsia. The duodenal biopsy specimens were also examined histopathologically for presence or absence of inflammation. There was no significant difference (p>0.05) in the activity of above mentioned enzyme levels in both the groups. Only levels of gamma-glutamyl transpeptidase were significantly decreased in patients of duodenal ulcer with duodenal inflammation. This study shows that only the levels of gamma-glutamyl transpeptidase were significantly decreased in patients of duodenal ulcer with inflammation but no change in duodenal enzymes due to duodenal ulcer as compared to non-ulcer dyspepsia.

Genomic structure of a Y-specific ribonucleic acid binding motif-containing gene: a putative candidate for a subset of male infertility.

The genetic basis of infertility remains unclear in a majority of infertile men. Deletion mapping studies suggest that genes on the long arm of the Y-chromosome (Yq) may be important in the spermatogenic process and may play a pathogenetic role in a subset of infertile men. Complementary DNA sequences of two Y-specific genes that contain ribonucleic acid binding motifs and, therefore, referred to as RBM genes (previously named YRRM) were published recently. To develop a PCR-single strand conformation polymorphism strategy for detection of point mutations in the RBM gene(s) in infertile men, we determined the genomic structure and flanking sequences at the intron-exon junctions. Two separate strategies were used in parallel to isolate the genomic fragment bearing the RBM gene. The first strategy employed screening of a P1 genomic library using PCR primers corresponding to the sequences in the 5'- and 3'-ends of the published RBM-1 complementary DNA sequence. The second strategy used subcloning of the YAC clone 925D10 (that contained the RBM gene described here) into cosmids. The P1 and cosmid clones were further restriction mapped and subcloned for DNA sequencing. Because the sequences contained in the P1 and cosmid clones were identical, the sequence information was pooled. A 15-kilobase genomic segment includes the entire RBM gene. The genomic structure of this RBM gene is characterized by 12 exons and 11 introns. There is considerable homology among exons VII, VIII, IX, and X; each encodes one of the SRGY boxes. Several introns also have a high degree of homology among them (introns VI, VII, VIII, and IX). Eleven of the 12 exons have complete sequence homology with the RBM-1 sequence. There is 1 base difference in exon IV at position 495 (a T in the previously published DNA sequence vs. an A in the sequence reported here). The exonic sequences of this gene are distinct from that of the RBM-2 gene. The flanking sequences at the exon-intron junctions were also determined and are reported. Reverse transcription-PCR analysis, using human testis ribonucleic acid suggests that this gene is either not expressed in the testis or, more likely, the single base difference from RBM1 represents a polymorphism in the YAC clone. A high degree of homology between intronic and exonic sequences within the same gene and between different members of the RBM gene family (data not reported in this paper) suggests origin from common ancestral sequences; this also indicates that development of a single strand conformation polymorphism approach for detection of point mutations is likely to prove difficult for some of the exons of this gene.