Decreased gastric acid secretion and bacterial colonization of the stomach in severely malnourished Bangladeshi children

To assess the effect of malnutrition on gastric acidity and gastric bacterial colonization, we studied 35 severely malnourished Bangladeshi children before (0 wk) and after (3 wk) they received nutritional rehabilitation for 3 wk. These results were compared with those obtained from a similarly examined group of 20 better-nourished Bangladeshi children. Gastric acid output, both basal and after betazole stimulation, was significantly lower in the malnourished group at 0 wk compared with the better-nourished children (p less than 0.01): basal 0.22 vs. 0.52 mEq HCl/h and stimulated 0.90 vs. 2.5 mEq HCl/h. Both the concentration of acid and the rate at which gastric juice was secreted were decreased in the malnourished group but serum gastrin levels were not significantly different. After 3 wk, the malnourished children had improved from 61% (+/- 9.0%; SD) to 81% (+/- 8.1%) of expected weight-for-height and were not significantly different than the better-nourished group (86% +/- 11%). Nevertheless, gastric acid concentration remained depressed in the 3-wk group, although the rate of gastric juice secretion equaled levels observed in the better-nourished group. None of the better-nourished children had detectable gram-negative bacterial colonization of their gastric juice. In contrast, 26 of 32 (81%) malnourished children at 0 wk were colonized--even after betazole stimulation, 11 of 33 (33%) gastric juice samples yielded viable organisms--suggesting that the decrease in gastric acid output greatly reduced the gastric acid barrier. Interestingly, only 9 of 20 (45%) better-nourished children had gastric juice with basal pH values below 4.0, suggesting that the gastric acid barrier may be an intermittent defense factor in Bangladeshi children.

Bone mineral density in women with endometriosis before and during ovarian suppression with gonadotropin-releasing hormone agonists or danazol

Lumbar bone mineral density (BMD) was evaluated by dual photon absorptiometry (DPA) in 38 women with laparoscopically diagnosed and staged endometriosis. DPA was performed before and at the completion of 26 weeks of treatment with either gonadotropin releasing hormone agonist (GnRHa) or danazol. Twenty-five women received GnRHa either nasally or subcutaneously and 13 women received danazol 200 mg four times daily by mouth. During treatment amenorrhea and suppressed estradiol levels were observed in all patients. Each patient took a supplement of oral calcium 1 gm daily. DPA (reproducibility +/- 1.5%) was read by a single observer unaware of the treatment assignment of the patient. The mean (+/- standard error) of the entire group prior to treatment was 98.8% +/- 0.03% of a control population of women from the same geographic area matched for race, age, and weight. At the completion of treatment, BMD was slightly decreased in the GnRHa group and marginally increased in the danazol group but neither change was significant. Women with endometriosis have lumbar BMD in the normal range and ovarian suppression with either GnRHa or danazol produces no significant change in BMD.

Problem prostheses: the radiologic evaluation of total joint replacement

The authors discuss and illustrate the various complications of total joint prostheses. Criteria for the evaluation of radiographs of total joint prostheses are presented.

Bone scanning in pregnant patients with breast carcinoma

Radionuclide scanning is usually contraindicated in pregnancy because of the danger of fetal radiation exposure. Radionuclide bone scanning with Tc-99m MDP is a sensitive indicator of early osseous metastases in breast cancer. Three cases of breast cancer during pregnancy are reported; modified bone scanning was utilized for staging and decision analysis. Modifications of bone scanning techniques to minimize fetal radiation exposure and fetal dosimetry calculations are described.

Physalindicanols, New Biogenetic Precursors of C28-Steroidal Lactones from Physalis minima var. indica

The structures of two isomeric C (28)-sterols isolated from PHYSALIS MINIMA Linn. var. INDICA were elucidated as ergosta-5,25-dien-3beta,24zeta,-diol and ergosta-5,24(28)-dien-3beta,25-diol on the basis of detailed spectral analysis. The isolated sterols are regarded as precursors in the elaboration of complex C (28)-steroidal lactones, native in this plant and related species.

Campomelia, cervical lymphocele, polycystic dysplasia, short gut, polysplenia

An aborted fetus, the offspring of consanguineous parents, had the unusual combination of campomelia, cervical lymphocele, polycystic kidneys, pancreas, and liver, short gut, and polysplenia. Births of earlier similarly affected fetuses suggest an autosomal recessive inheritance. Skeletal, lymphatic, and renal lesions were seen at 26 weeks' gestation by ultrasonography, but not at 16 weeks.

Colonic dysfunction during cholera infection

To study the function of the colon in cholera, 12 patients with acute cholera diarrhea were subjected to measurements of ileocecal flow rates, fecal flow rates, and ionic compositions of stool and ileocecal fluid. Subtraction of fecal flow rates from ileocecal flow rates was taken as a measure of net fluid absorption by the colon. Additionally, these patients underwent colonoscopic perfusion of the colon that measured net colonic absorption rates of water and ions. The mean ileocecal flow rate was 7.9 ml/min compared with a mean fecal flow rate of 7.6 ml/min, indicating a small mean net fluid absorption by the colon of +0.30 ml/min. By colonoscopic perfusion, 6 patients showed net colonic absorption of water and 6 patients net secretion of water with a slight mean net fluid secretion of -0.03 ml/min. The handling of ions by the colon showed mean net absorption of sodium (100 mu Eq/min) and chloride (127 mu Eq/min), and net secretions of potassium (-42 mu Eq/min) and bicarbonate (-112 mu Eq/min). During convalescence, 5 patients who were studied again all showed net colonic absorption of water, and the handling of potassium changed significantly from net secretion in acute disease to net absorption (p less than 0.05). These results showed that the colon contributes to the clinical expression of cholera by failing to absorb water normally, and by secreting potassium at high rates.

Abnormal bone and gallium scans in a case of multifocal systemic sporotrichosis

Sporotrichosis is a chronic infection of world wide distribution. It is caused by the diamorphic fungus Sporotrichum schenkii. The multifocal form of sporotrichosis usually involves skin, joints, long bones, lungs, and lymph nodes. Involvement of central nervous system although described is extremely rare. Bone and gallium imaging findings in a case of multifocal systemic sporotrichosis which nicely demonstrated the extensive spread of the disease are presented.

Anti-DNA antibodies in autoimmune disorders by ELISA using nylon as the solid phase

A rapid, simple and highly sensitive enzyme-linked immunosorbent assay (ELISA) utilizing nylon as the solid support is described for the detection of anti-DNA antibodies in autoimmune disorders. The optimal reaction conditions were established with an anti-DNA antibody-positive SLE serum. Fifty-three percent of systemic lupus erythematosus patients, 29 percent of patients with systemic lupus erythematosus with overlapping progressive systemic sclerosis and 10 percent of progressive systemic sclerosis patients were positive for anti-DNA antibodies. The sensitivity of the method was compared with passive hemagglutination and fluorometric assays, the latter using ethidium bromide as intercalating dye. The method described is specific, reproducible and convenient for use in clinical laboratories where large numbers of samples are to be screened for the detection of anti-DNA antibodies. The procedure requires small quantities of antigen or antibody and is, therefore, highly economical.

Surgical management of subclavian and axillary vein thrombosis in patients with a functioning arteriovenous fistula

Until recently, secondary thrombosis of the deep veins of the upper extremity was rarely encountered. The expanding use of the subclavian vein as a route to the central circulation has increased its occurrence, but symptoms are uncommon. Patients on hemodialysis with a functioning arteriovenous fistula become symptomatic with venous hypertension and swelling. Treatment becomes necessary, and fistula ligation is usually recommended; however, this renders the extremity unsuitable for a future life-sustaining access. Patency of grafts in the venous system has been accomplished with a temporary arteriovenous fistula. In six patients with chronic renal failure and a functioning arteriovenous fistula, a polytetrafluoroethylene graft was used to replace or bypass the obstructed vein. Symptoms resolved, and the fistula was preserved in three of the six patients for 1 to 3 years.

Bone scintigraphy in tuberculous sacroiliitis

Radionuclide bone imaging is becoming increasingly important in the evaluation of musculoskeletal pain of uncertain cause. A case in which Tc-99m MDP bone imaging was employed to investigate complaints of low back pain is presented. Scan abnormalities directed clinicians towards appropriate further workup and diagnosis of unilateral tuberculous sacroiliitis.

Stability of chloroplastic triazine resistance in rutabaga backcross generations

Triazine resistance originally observed in a weed biotype of birdsrape (Brassica campestris L.) has been transferred through cytoplasmic substitution into rutabaga (Brassica napus ssp. Rapifera [Metzg.] Minsk.) by conventional backcrossing. Photosynthetic function and resistance to triazines were examined in six backcross generations of rutabaga as well as in the original parents. Chloroplast thylakoid membranes were isolated and their sensitivity to atrazine, metribuzin, and diuron assayed by measuring the inhibition of photoreduction of 1,6-dichlorophenol indophenol as well as the alteration of in vitro chlorophyll fluorescence rise characteristics. Both assay methods indicated that triazine resistance persisted in all rutabaga backcross generations, and that it involved triazine binding sites in chloroplasts. There was little resistance to diuron. In vivo chlorophyll fluorescence was also monitored, in the absence of herbicides, as an indicator of the electron transfer properties of the chloroplast photosystem II complex. The results indicated that electron transport from Q(A) to Q(B) was slower (as indicated by a larger intermediate level fluorescence during the transient rise) in the triazine resistant parents as well as in all the rutabaga backcross generations.

Prolonged depression of serum zinc concentrations in children following post-measles diarrhoea

Serum zinc levels were measured in three groups of children aged 6 months to 6 years. In group I, there were 25 children with diarrhoea, who had a history of measles within the 2 weeks preceding the zinc level tests (post-measles diarrhoea); in group II there were 17 children who had diarrhoea only; and in group III there were 20 children who were apparently healthy and had neither diarrhoea nor measles (controls). Serum zinc concentrations of less than 5 mumol/l were observed in 5 out of 16 children in group I, but none of the children in group II had such low levels. The serum zinc level in group II rose significantly during the recovery stage compared to the acute stage (P less than 0.01). Children with post-measles diarrhoea showed a continued and prolonged depression of serum zinc levels.

Acute tentorial subdural hematoma as a false-positive in indium-111 leukocyte scintigraphy

A case of acute tentorial subdural hematoma detected by In-111 leukocyte scintigraphy and confirmed by CT brain scan is herein described. White blood cells are an integral part of the blood pool and labeled white cells freely leave the intravascular space in case of active bleeding. Acute hemorrhage and hematoma can thus be a cause of a false-positive study.

Demonstration of a false-positive lesion on indium-111 leukocyte scintigraphy in a case of active Crohn's disease

Increased fecal excretion of In-111 tagged leukocytes in patients with active inflammatory bowel disease may lead to a false-positive site of disease in patients with a diverting colostomy or ileostomy and fecal collection bags that overlie the abdominal wall or groin region.

Early egg production in genetically blind (rc/rc) chickens in comparison with sighted (Rc+/rc) controls

The impact of blindness on egg production was investigated by utilizing genetically blind chickens in a factorial experiment involving two genotypes (blind vs. sighted), two densities (1000 cm2 per bird vs. 2000 cm2 per bird), two flock sizes (1 male, 4 female female vs. 4 male male, 16 female female), and two replications (floor pens). Traits measured were number of eggs collected, egg weight, amount of feed taken from the feed troughs, body weight gain, fertility of eggs, feather pecking and comb damage scores, leukocyte count, plasma corticosterone level, and adrenal gland weight. During the 2-month experimental period, blind hens produced 12.7% more eggs (hen-day production) while requiring 44.1 g less feed per bird day compared to sighted hens. There was no significant difference in body weight gained between the two genotypes. Significant genotype X flock size and genotype X density interactions also indicated that the performance of the blind chickens was less affected by differences in density and flock size compared with sighted chickens. Other traits measured provided evidence that the blind chickens were less active, had better feather coverage, and were perhaps under less stress than sighted ones.

Effect of Pasteurization, Centrifugation and Additives on Quality of Concentrated Yogurt (Labneh)

Pasteurization of yogurt by heat at 60-80°C or by addition of 0.2 to 2% hydrogen peroxide were investigated. Heat-treatment caused a very pronounced reduction in the bacterial count of yogurt samples. Addition of hydrogen peroxide was not effective at the low levels studied. Higher concentrations of hydrogen peroxide that were effective in reducing the bacterial population persisted in the food for more than 4 weeks. Heat-pasteurization in the presence of hydrogen peroxide, was very efficient in destroying bacterial cells and hastened the disappearance of hydrogen peroxide residues from the food. "Labneh", which is usually prepared from yogurt by filtering out the whey through a cloth, had an inferior texture when prepared from pasteurized yogurt. Milder heat treatment in the presence of hydrogen peroxide and addition of potassium sorbate and thickeners, greatly improved the quality and the shelf-life of labneh as confirmed by sensory evaluation experiments. Further improvements were possible by preparing labneh using centrifugation at various speeds for a short time.

Oral rehydration therapy: efficacy of sodium citrate equals to sodium bicarbonate for correction of acidosis in diarrhoea

Forty patients with moderate degrees of dehydration and acidosis because of acute watery diarrhoea were successfully treated randomly with either WHO recommended oral rehydration solution containing 2.5 g sodium bicarbonate or an oral solution containing 2.94 g sodium citrate in place of sodium bicarbonate per litre of oral rehydration rehydration solution. Efficacies were compared by measuring oral fluid intake, stool and vomitus output, change in body weight, hydration status, and rate of correction of acidosis during a period of 48 hours. Seventy five per cent (21 cases) in the citrate group and 83% (19 cases) in the bicarbonate group were successfully rehydrated (p greater than 0.05). There were no significant differences in intake, output, gain in body weight, fall in haematocrit and plasma specific gravity, and correction of acidosis between the two groups of patients within 48 hours after initiation of therapy. The solution with sodium citrate base was as effective as WHO-oral rehydration solution for management of diarrhoea. This study shows the efficacy, safety, and acceptability of citrate containing oral rehydration solution for rehydration and correction of acidosis in diarrhoea.

The distribution of visceral leishmaniasis in Ethiopia

A total of 50 cases of visceral leishmaniasis (VL) were diagnosed among 1,184 patients examined in different parts of Ethiopia. The overall male: female sex ratio was 4:1. About 56% of the cases occurred in the 15- to 29-year age group. The incidence of VL in Aba Roba Village was 5.2 per 1,000 population. New foci of transmission identified include lowlands of Algena, Nakfa, Afabet, Teseney, and Genale River Basin, and west of Moyale.

Quantitative sacroiliac scintigraphy. The effect of method of selection of region of interest

Various authors have advocated quantitative methods of evaluating bone scintigrams to detect sacroiliitis, while others have not found them useful. Many explanations for this disagreement have been offered, including differences in the method of case selection, ethnicity, gender, and previous drug therapy. It would appear that one of the most important impediments to consistent results is the variability of selecting sacroiliac joint and reference regions of interest (ROIs). The effect of ROI selection would seem particularly important because of the normal variability of radioactivity within the reference regions that have been used (sacrum, spine, iliac wing) and the inhomogeneity of activity in the SI joints. We have investigated the effect of ROI selection, using five different methods representative of, though not necessarily identical to, those found in the literature. Each method produced unique mean indices that were different for patients with ankylosing spondylitis (AS) and controls. The method of Ayres (19) proved superior (largest mean difference, smallest variance), but none worked well as a diagnostic tool because of substantial overlap of the distributions of indices of patient and control groups. We conclude that ROI selection is important in determining results, and quantitative scintigraphic methods in general are not effective tools for diagnosing AS. Among the possible factors limiting success, difficulty in selecting a stable reference area seems of particular importance.

Fluorometric assay for anti-DNA antibodies: use of ethidium bromide as intercalating dye

Autoantibodies against double-stranded DNA in the sera of patients with various autoimmune diseases have been examined by fluorometric assay using ethidium bromide as intercalating dye. Forty-three per cent of SLE patients, 14% of SLE patients with overlapping PSS, 20% of PSS patients and none of the RA and SS patients were positive for anti-DNA antibodies. The method was found to be more sensitive than immunoprecipitation techniques and comparable with the hemagglutination assay. The technique is simple, sensitive, specific and can be employed for the detection of low concentration of anti-DNA antibodies.

Coronary artery disease: detection by phase analysis of rest/exercise radionuclide angiocardiograms

Thirty-six patients with chest pain but no myocardial infarction or conduction defects and 4 volunteers (3 normals and 1 with asymptomatic aortic insufficiency) underwent radionuclide angiocardiography. Phase analysis was performed and the standard deviation (SD) ("spread") and skewness ("asymmetry") of the left ventricular (LV) phase histogram determined at rest and during maximum exercise. The SD of the LV phase histogram was of no value; however, when -0.1 was taken as the upper limit of normal skewness at maximum exercise, skewness was equally as sensitive as conventional criteria for coronary artery disease (CAD) and also more specific. The authors conclude that LV histogram skewness during maximum exercise may be superior to conventional criteria for detection of CAD with rest/exercise radionuclide angiocardiograms.

Enzyme-linked immunosorbent assay for anti-DNA antibodies using fluorogenic and colorigenic substrates

An enzyme-linked immunosorbent assay is described for the assay of anti-DNA antibodies. The method employs plastic surface for immobilization of the antigen and alkaline phosphatase-linked rabbit anti-human IgG for the detection of immune complex using PNP-P and 4MU-P as substrates. The sensitivity of the assay increased by as much as 16-fold when fluorogenic substrate was used instead of conventional PNP-P and could therefore be employed for the detection of low avidity antibodies. Using PNP-P as substrate 57% of SLE patients were positive for DNA antibody, but if 4MU-P was introduced as substrate, 71% gave a positive response. Moreover, using a fluorogenic substrate, it was possible to minimise the amount of antigen (2 nM bp). The technique is simple, reproducible and of high sensitivity.

Spectrophotometric assay for the detection of antibodies to DNA

A spectrophotometric assay for the detection of anti-DNA antibodies in the sera of patients with various connective tissue diseases is described. The sensitivity of the method was compared with hemagglutination and enzyme-linked immunosorbent assay. The method is convenient, specific and suitable for use in clinical laboratories where facilities for radioimmunoassay do not exist.

Noninvasive identification of initial site of abnormal ventricular activation by least-square phase analysis of radionuclide cineangiograms

Least-square phase analysis (LSPA) of radionuclide cineangiograms demonstrates the sequence of onset of inward ventricular movement noninvasively. To validate the method and explore its ability to identify abnormal initial sites of ventricular activation, LSPA was applied to 14 patients with pacemakers (one with electrodes in two locations) (group 1) and three patients with recurrent ventricular tachycardia (VT) (group 2) who had undergone electrophysiologic endocardial mapping. The segment in which the site of initial ventricular activation was located was correctly identified in 13 of 15 paced studies and in two of three group 2 patients during VT. Pacing increased the duration of spread of onset of inward ventricular movement, and the duration of spread of onset correlated well with the duration of the QRS (r = 0.80). The sequence of onset of inward ventricular movement during VT was similar to the sequence of depolarization in all three group 2 patients. These preliminary results suggest that the sequence of onset of ventricular contraction as depicted by LSPA is a valid representation of the actual contraction sequence and that LSPA or radionuclide cineangiography correctly identifies abnormal sites of initial ventricular activation.