Solid-pseudopapillary tumour of the pancreas: a report of a rare case

The solid pseudopapillary tumour (SPT) of the pancreas is an uncommon cystic pancreatic neoplasm mostly seen in young females. We present a large SPT in a 16-year-old female who presented with acute onset upper- and mid-quadrant abdominal pain associated with nausea and vomiting for 4 days. The lesion was demonstrated by abdominal ultrasound and by computed tomography, which was successfully removed surgically.

Modulation of AMPA receptor GluR1 subunit phosphorylation in neurons by the intravenous anaesthetic propofol

BACKGROUND

The ionotropic glutamate receptor is a potential molecular site in the central nervous system that general anaesthetics may interact with to produce some of their biological actions. Protein phosphorylation has been well documented to occur in the intracellular C-terminal domain of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) subtype of glutamate receptors, which represents a pivotal mechanism for the post-translational modulation of AMPA receptor functions. In this study, we investigated a possible influence of an i.v. anaesthetic agent propofol on the phosphorylation of AMPA receptor GluR1 subunits in cultured neurons.

METHODS

The effect of propofol on phosphorylation of GluR1 subunits at serine 831 and 845 was assayed in cultured rat striatal and cortical neurons by western blot with phospho- and site-specific antibodies.

RESULTS

Propofol consistently elevated phosphorylation of GluR1 subunits at the C-terminal serine 845 site in both striatal and cortical neurons. The elevation in phosphorylation was concentration-dependent and started at a low concentration (3 microM). This increase in serine 845 phosphorylation was rapid and sustained during the entire course of propofol exposure. In contrast to serine 845, phosphorylation of GluR1 at serine 831 was not altered by propofol in striatal and cortical neurons. Total GluR1 abundance remained unchanged in response to propofol incubation.

CONCLUSIONS

These data indicate that propofol possesses the ability to upregulate AMPA receptor GluR1 subunit phosphorylation at a specific serine 845 site in neurons and provide evidence supporting the AMPA receptor as a molecular target for general anaesthetics.

A novel connexin50 mutation associated with congenital nuclear pulverulent cataracts

PURPOSE

To screen for mutations of connexin50 (Cx50)/GJA8 in a panel of patients with inherited cataract and to determine the cellular and functional consequences of the identified mutation.

METHODS

All patients in the study underwent a full clinical examination and leucocyte DNA was extracted from venous blood. The GJA8 gene was sequenced directly. Connexin function and cellular trafficking were examined by expression in Xenopus oocytes and HeLa cells.

RESULTS

Screening of the GJA8 gene identified a 139 G to A transition that resulted in the replacement of aspartic acid by asparagine (D47N) in the coding region of Cx50. This change co-segregated with cataract among affected members of a family with autosomal dominant nuclear pulverulent cataracts. While pairs of Xenopus oocytes injected with wild type Cx50 RNA formed functional gap junction channels, pairs of oocytes injected with Cx50D47N showed no detectable intercellular conductance. Co-expression of Cx50D47N did not inhibit gap junctional conductance of wild type Cx50. In transiently transfected HeLa cells, wild type Cx50 localised to appositional membranes and within the perinuclear region, but Cx50D47N showed no immunostaining at appositional membranes with immunoreactivity confined to the cytoplasm. Incubation of HeLa cells transfected with Cx50D47N at 27 degrees C resulted in formation of gap junctional plaques.

CONCLUSIONS

The pulverulent cataracts present in members of this family are associated with a novel GJA8 mutation, Cx50D47N, that acts as a loss-of-function mutation. The consequent decrease in lens intercellular communication and changes associated with intracellular retention of the mutant connexin may contribute to cataract formation.

Endocarditis due to Chryseobacterium meningosepticum

Chryseobacterium meningosepticum is a gram negative rod widely distributed in nature. It is known to cause meningitis in neonates and premature infants. Adult infections are not common and are usually nosocomially acquired. We report an unusual case of native valve endocarditis in a 58-year-old man due to this organism. A high degree of suspicion and correct identification and sensitivity testing is required to diagnose infections by this rare isolate.

Health outcome measurements in children with sleep disordered breathing

OBJECTIVE

To validate the Child Health Questionnaire, measure quality of life in children with obstructive sleep apnoea and assess the impact of surgery.

METHODS

The primary carer of a consecutive series of 42 patients with sleep disordered breathing referred to a paediatric otolaryngology clinic completed the Child Health Questionnaire (version PF 28). Questionnaires were analysed for data quality and completeness, item/scale correlation, internal consistency and discriminant validity, interscale correlation and reliability. Following overnight pulse oximetry 37 children were diagnosed with obstructive sleep apnoea and underwent adenotonsillectomy.

RESULTS

Child Health Questionnaire Physical Functioning 28 demonstrated excellent measuring characteristics in our population. Compared with normative data, children with obstructive sleep apnoea and their carers suffer a significant quality of life deficit, involving 10 of 13 subscales of the Child Health Questionnaire. This was most prominent in parental emotional impact, general health perception and family activities. There was no correlation between the severity of obstructive sleep apnoea and quality of life indices. Following surgery, there was a significant improvement in all Child Health Questionnaire subscales, which became equivalent to healthy children.

CONCLUSION

The Child Health Questionnaire Physical Functioning 28 is an accurate and reliable way of assessing the impact of obstructive sleep apnoea on the quality of life in children in Britain. This appears to be significant in most aspects of a child's life, but is fully reversed following surgery.

The oncogenic potential of human papillomaviruses: a review on the role of host genetics and environmental cofactors

Human papillomaviruses (HPVs), with over 100 genotypes, are a very complex group of human pathogenic viruses. In most cases, HPV infection results in benign epithelial proliferations (verrucae). However, oncogenic types of HPV may induce malignant transformation in the presence of cofactors. For example, over 99% of all cervical cancers and a majority of vulval, vaginal, anal and penile cancers are the result of oncogenic HPV types. Such HPV types have been increasingly linked to other epithelial cancers involving the skin, larynx and oesophagus. Although viral infection is necessary for neoplastic transformation, evidence suggests that host and environmental cofactors are also required. Research investigating HPV oncogenesis is complex and quite extensive. The inability to produce mature HPV virions in animal models has been a major limitation in fully elucidating the oncogenic potential and role of associated cofactors in promoting malignant transformation in HPV-infected cells. We have reviewed the literature and provide a brief account of the current understanding of HPV oncogenesis, emphasizing the role of genetic susceptibility, immune response, and environmental and infectious cofactors.

Validation of the Mayo Dysphagia Questionnaire

While multiple instruments characterize upper gastrointestinal symptoms, a validated instrument devoted to the measurement of a spectrum of esophageal dysphagia attributes is not available. Therefore, we constructed and validated the Mayo Dysphagia Questionnaire (MDQ). The 27 items of the MDQ underwent content validity, feasibility, concurrent validity, reproducibility, internal consistency, and construct validity testing. To assess content validity, five esophageal subspecialty gastroenterologists reviewed the items to ensure inclusion of pertinent domains. Feasibility testing was done with eight outpatients who refined problematic items. To assess concurrent validity, 70 patient responses on the MDQ were compared to responses gathered in a structured patient-physician interview. A separate group of 70 outpatients completed the MDQ twice to assess the reproducibility of each item. A total of 148 patients participated in the validation process (78 [53%] men; mean age 62). On average, the MDQ took 6 minutes to complete. A single item (odynophagia) tested poorly with a kappa value of <0.4. Otherwise, the majority of concurrent validity kappa values were in the good to excellent range with a mean of 0.63 (95% CI 0.22-0.89). The majority of reproducibility kappa values were also in the good to excellent range with a median kappa value of 0.76 (interquartile range: 0.67-0.81). Cronbach's alpha values were excellent in the range of 0.86-0.88. Spearman rank correlation coefficients to assess construct validity were also excellent in the range of 0.87-0.98. Thus, the MDQ is a concise instrument that demonstrates overall excellent concurrent validity, reproducibility, internal consistency, and construct validity for the features of esophageal dysphagia.

The role of the surgeon in the management of melanoma

While multimodality therapy has become the standard for most solid tumors, the mainstay of therapy for melanoma remains surgical. This includes not only early stage disease, but advanced melanoma as well. The surgical approach to melanoma has changed dramatically, with a trend towards less aggressive resection of the primary tumor, and towards a more aggressive approach to regional and metastatic disease. Melanoma surgery has been altered by our knowledge of the biology of the disease, and the results of well-designed, prospective randomized trials. Conversely, new surgical approaches have expanded our understanding of melanoma biology, and new randomized trials are needed to further define the optimal surgical approach. This article will review the evolution of melanoma surgery and the evidence behind today's recommendations.

The use of immunomodulators as an adjunct to antituberculous chemotherapy in non-responsive patients with osteo-articular tuberculosis

We studied 51 patients with osteo-articular tuberculosis who were divided into two groups. Group I comprised 31 newly-diagnosed patients who were given first-line antituberculous treatment consisting of isoniazid, rifampicin, ethambutol and pyrazinamide. Group II (non-responders) consisted of 20 patients with a history of clinical non-responsiveness to supervised uninterrupted antituberculous treatment for a minimum of three months or a recurrence of a previous lesion which on clinical observation had healed. No patient in either group was HIV-positive. Group II were treated with an immunomodulation regime of intradermal BCG, oral levamisole and intramuscular diphtheria and tetanus vaccines as an adjunct for eight weeks in addition to antituberculous treatment. We gave antituberculous treatment for a total of 12 to 18 months in both groups and they were followed up for a mean of 30.2 months (24 to 49). A series of 20 healthy blood donors served as a control group.

Twenty-nine (93.6%) of the 31 patients in group I and 14 of the 20 (70%) in group II had a clinicoradiological healing response to treatment by five months.

The CD4 cell count in both groups was depressed at the time of enrolment, with a greater degree of depression in the group-II patients (686 cells/mm3 (sd 261) and 545 cells/mm3 (sd 137), respectively; p < 0.05). After treatment for three months both groups showed significant elevation of the CD4 cell count, reaching a level comparable with the control group. However, the mean CD4 cell count of group II (945 cells/mm3 (sd 343)) still remained lower than that of group I (1071 cells/mm3 (sd 290)), but the difference was not significant. Our study has shown encouraging results after immunomodulation and antituberculous treatment in non-responsive patients. The pattern of change in the CD4 cell count in response to treatment may be a reliable clinical indicator.

A novel GJA8 mutation is associated with autosomal dominant lamellar pulverulent cataract: further evidence for gap junction dysfunction in human cataract

PURPOSE

To identify the gene responsible for autosomal dominant lamellar pulverulent cataract in a four-generation British family and characterise the functional and cellular consequences of the mutation.

METHODS

Linkage analysis was used to identify the disease locus. The GJA8 gene was sequenced directly. Functional behaviour and cellular trafficking of connexins were examined by expression in Xenopus oocytes and HeLa cells.

RESULTS

A 262C>A transition that resulted in the replacement of proline by glutamine (P88Q) in the coding region of connexin50 (Cx50) was identified. hCx50P88Q did not induce intercellular conductance and significantly inhibited gap junctional activity of co-expressed wild type hCx50 RNA in paired Xenopus oocytes. In transfected cells, immunoreactive hCx50P88Q was confined to the cytoplasm but showed a temperature sensitive localisation at gap junctional plaques.

CONCLUSIONS

The pulverulent cataract described in this family is associated with a novel GJA8 mutation and has a different clinical phenotype from previously described GJA8 mutants. The cataract likely results from lack of gap junction function. The lack of function was associated with improper targeting to the plasma membrane, most probably due to protein misfolding.

Recurrent spinal meningioma: a case report with review of the literature

Spinal meningioma generally responds favourably to surgical excision and has a low rate of recurrence. However, follow-up data on patients under 50 years of age are limited. We report a recurrence of intraspinal meningioma 18 years after the initial surgery in a 45-year-old woman. She presented with weakness in both lower limbs that had gradually progressed over the previous 8 months, and difficulty in walking for the last 2 months. She had no history of sensory loss or visceral involvement, but had undergone a major surgical intervention of the upper spine for a similar episode of weakness in both lower limbs 18 years earlier. She underwent a second surgery at the same site, and a greyish-white tumour was excised, which was histopathologically confirmed as recurrent psammomatous meningioma. The patient demonstrated complete neurological recovery in 8 months.

Early rehabilitation comparing hip resurfacing and total hip replacement

Hip resurfacing arthroplasty (RS) is said to be an operation that is suitable for the younger osteoarthritic population, allowing them to rehabilitate more rapidly. We wished to establish whether this was true and compared 35 consecutive RS (33 patients) with 41 consecutive total hip replacements (THR) (40 patients) and looked specifically at postoperative pain, speed of rehab-ilitation and length of hospital stay. A rehabilitation score was used. RS patients were significantly younger than THR patients (mean 53.0 years for RS, 64.7 years for THR; p<0.0001). However, no significant difference was found in the mean rehabilitation score at any stage after surgery or in the speed of rehabilitation between the two groups. Neither postoperative pain nor the length of hospit-alisation was significantly different between the two groups. We conclude that resurfacing arthroplasty has no evidence of an advantage over total hip replacement in the speed of postoperative rehabilitation. (Hip International 2005; 15: 189-94).

Iatrogenic calcinosis cutis--a rare differential diagnosis of soft-tissue infection in a neonate: a case report

This case report describes a rare differential diagnosis of soft-tissue infection in a neonate. Fever, pain, inflammation, and acute tenderness in the limb of a neonate signify acute infection or osteomyelitis unless proved otherwise. Iatrogenic calcinosis cutis presents with similar symptoms and signs; its diagnosis may be easily confused with an infective condition by an unwary orthopaedic surgeon. This report aimed to raise doctors' awareness on the presentation, aetiopathogenesis, and course of the relatively rare iatrogenic calcinosis cutis.

Decreasing strabismus surgery

AIM

To determine whether there has been a consistent change across countries and healthcare systems in the frequency of strabismus surgery in children over the past decade.

METHODS

Retrospective analysis of data on all strabismus surgery performed in NHS hospitals in England and Wales, on children aged 0-16 years between 1989 and 2000, and between 1994 and 2000 in Ontario (Canada) hospitals. These were compared with published data for Scotland, 1989-2000.

RESULTS

Between 1989 and 1999-2000 the number of strabismus procedures performed on children, 0-16 years, in England decreased by 41.2% from 15 083 to 8869. Combined medial rectus recession with lateral rectus resection decreased from 5538 to 3013 (45.6%) in the same period. Bimedial recessions increased from 489 to 762, oblique tenotomies from 43 to 121, and the use of adjustable sutures from 29 to 44, in 2000. In Ontario, operations for squint decreased from 2280 to 1685 (26.1%) among 0-16 year olds between 1994 and 2000.

CONCLUSION

The clinical impression of decrease in the frequency of paediatric strabismus surgery is confirmed. In the authors' opinion this cannot be fully explained by a decrease in births or by the method of healthcare funding. Two factors that might have contributed are better conservative strabismus management and increased subspecialisation that has improved the quality of surgery and the need for re-operation. This finding has a significant impact upon surgical services and also on the training of ophthalmologists.

Acute renal failure following para-phenylenediamine (PPD) poisoning: a case report and review

We report a case of systemic poisoning with para-phenylenediamine (PPD) presenting with characteristic features of severe angioneurotic edema, rhabdomyolysis and intravascular hemolysis with hemoglobinuria culminating in acute renal failure. Though rare in western countries, such poisoning is not uncommon in East Africa, Indian subcontinent and Middle East countries. We discuss here the clinical features and key management issues of systemic PPD poisoning.

Pulmonary artery dissection: an emerging cardiovascular complication in surviving patients with chronic pulmonary hypertension

Pulmonary arterial dissection is an extremely rare and usually lethal complication of chronic pulmonary hypertension. The condition usually manifests as cardiogenic shock or sudden death and is therefore typically diagnosed at postmortem examination rather than during life. However, recent isolated reports have described pulmonary artery dissection in surviving patients. The first case of pulmonary artery dissection in a surviving patient with cor pulmonale caused by chronic obstructive pulmonary disease is presented. The aetiology, pathophysiology, and clinical presentation of pulmonary artery dissection are reviewed and factors that may aid diagnosis during life are discussed.

Portal hypertension in sarcoid liver disease with hypomelanotic skin involvement

Portal hypertension due to sarcoid liver disease is a rare entity. We report the case of a 50-year-old female with sarcoid liver disease leading to portal hypertension. The literature on portal hypertension due to hepatic sarcoidosis has been reviewed and the role of steroid therapy discussed.

Modulation of altered hepatic foci induction by diallyl sulphide in Wistar rats

Diallyl sulphide (DAS) is a sulphur-containing volatile compound present in garlic (Allium sativum). It has been shown to inhibit a number of chemically induced forms of cancer in experimental animals. The present study demonstrates the inhibitory effect of DAS on the development of diethylnitrosamine (DEN) initiated and 2-acetyl-aminofluorene (2-AAF) promoted preneoplastic altered hepatic foci (AHF) in Wistar rats. AHF were scored and analysed by quantitative stereology using the Image Analysis system from frozen liver sections stained for biological markers, namely glutathione S-transferase, placental form (GST-P), gamma-glutamyl transpeptidase (GGT), adenosine triphosphatase (ATPase), glucose-6-phosphatase (G6 Pase) and alkaline phosphatase (AlkPase). DAS-supplemented rats were found to restore the near-normal levels of enzymes GST-P and GGT when exposed to DEN and 2-AAF. DAS administration following DEN and 2-AAF exposure led to the restoration of enzymic activity of ATPase, G6 Pase and AlkPase, as evident by number and area of the foci. These findings suggest the protective role of DAS in rat hepatocarcinogenesis, by suppressing DEN- and 2-AAF-induced AHF development.

Behaviour of the kyphotic angle in spinal tuberculosis

We followed 70 adult patients with spinal tuberculosis for a minimum of 2 years. Forty patients were treated by ambulant multi-drug chemotherapy (group A), and 30 with neurological complications (group B) were treated by antero-lateral decompression and chemotherapy. We studied the angle of spinal kyphosis as calculated on lateral spinal X-ray by the modified Konstam's method. The angle at final follow-up was compared with the pre-treatment angle. The relationship between the amount of initial vertebral loss, the predicted kyphotic angle and the observed kyphotic angle was analysed. Mean initial vertebral loss, mean pre-treatment angle and mean observed kyphotic angle in group A were 0.77 degrees, 24.3 degrees and 31.75 degrees respectively, with a mean increase in angle of 7.4 degrees. In group B, the readings were 0.67, 25.9 degrees and 26.8 degrees respectively, with a mean increase in angle of 0.9 degrees. Kyphotic deformity continued to progress until 2 years' follow-up. Progression was more pronounced in the non-operative group.

Dhaga syndrome: a previously undescribed entity

Three children between the ages of 18 months and four years presented with a discharging sinus or sinuses at the wrist due to a 'sacred' thread (the Moli Dhaga) which had been tied around it. This thread had been forgotten by the parents and had become embedded in the soft tissues of the wrist. Plain radiographs showed a circumferential constriction in the soft tissue shadow in all three. In two, there was a periosteal reaction in the distal radius or ulna with an indentation which we have called the constriction sign. Surgical removal of the buried thread was successful in all cases.

Surface anatomy of the inferior epigastric artery in relation to laparoscopic injury

The inferior epigastric artery (IEA) is at risk of injury in laparoscopic surgery. Current descriptions of the course of the IEA do not provide surface landmarks useful to the surgeon. This study aimed to define surface relations and propose guidelines for safer trocar placement. The posterior surfaces of the anterior abdominal walls of 30 preserved cadavers were dissected. The surface anatomy of 60 IEAs and their branches were defined. At the level of the anterior superior iliac spine (ASIS), the IEA is 38% +/- 18% (95% confidence interval [CI]) from the midline to the ASIS. At the mid-inguinal point the relation is 40% +/- 17% and at the umbilicus 40% +/- 22%. The pattern of branches is highly variable. Although giving guidelines for trocar insertion can be treacherous, we found the following to be of value: 1) the midline is avascular; 2) the main stem of the IEA will be avoided if trocars are inserted more than two-thirds of the distance along a horizontal line between the midline and the ASIS; and 3) IEA branches are least frequently found in the lowest part of the abdomen lateral to the artery.

Salmonella osteomyelitis in an otherwise healthy adult male-successful management with conservative treatment: a case report

A 21-year-old male presented with pain in the right thigh of insidious onset and 3 months' duration. He had a history of febrile illness lasting for 15 days, 2 months prior to the onset of pain. Examination revealed swelling over the lower lateral aspect of the right thigh with some induration and tenderness. Initial X-rays of the right femur and the computed tomography scan at 10 weeks after the onset of disease were normal. Magnetic resonance imaging scan showed signal alteration with minimal destruction of the anterior cortex in the mid-diaphyseal region of the right femur. A repeated X-ray taken at 15 weeks after the onset of illness showed erosive changes, along with periosteal reaction in the diaphyseal area. The Widal test was positive. Open biopsy of the lesion revealed inflammatory non-caseating tissue. Culture of the specimen grew Salmonella typhi. The patient was given antibiotic treatment. Both X-rays and the Widal titres were normal on subsequent follow-up at 3 months.

Inhibition of nitrification in soil by metal diethyldithiocarbamates

Nitrification acts as a key process in determining fertilizer use efficiency by crops as well as nitrogen losses from soils. Metal dithiocarbamates in addition to their pesticidal properties can also inhibit biological oxidation of ammonium(nitrification) in soil. Metal [M = V(III), Cr(III), Mn(II), Fe(III), Ni(II), Cu(II), Zn(II) and Co(II)] diethyldithiocarbamates (DEDTC) were synthesized by the reaction of sodium diethyldithiocarbamate with metal chloride in dichloromethane/water mixture. These metal diethyldithiocarbamates were screened for their ability to inhibit nitrification at different concentrations( 10 microg/g soil, 50 microg/g soil and 100 microg/g soil). With increasing concentration of the complex, capacity to retard nitrification increased but the extent of increase varied for different metals. At 100 microg/g soil, different complexes showed nitrification inhibition from 22.36% to 46.45% . Among the diethyldithiocarbamates tested, Zn(DEDTC)2 proved to be the most effective nitrification inhibitor at 100 microg/g soil. Manganese, iron and chromium diethyldithiocarbamates also proved to be effective nitrification inhibitors than the others at 100 microg/g soil. The order of percent nitrification inhibition in soil by metal diethyldithiocarbamates was: Zn(II) > Mn(II) > Fe(III) > Cr(III) > V(III) > Co(II) > Ni(II) > Cu(II).

Levels of metal ions after small- and large-diameter metal-on-metal hip arthroplasty

Metal-on-metal (MOM) bearings for hip arthroplasty are increasing in popularity. Concern remains, however, regarding the potential toxicological effects of the metal ions which these bearings release. The serum levels of cobalt and chromium in 22 patients who had undergone MOM resurfacing arthroplasty were compared with a matched group of 22 patients who had undergone 28 mm MOM total hip arthroplasty (THA). At a median of 16 months (7 to 56) after resurfacing arthroplasty, we found the median serum levels of cobalt and chromium to be 38 nmol/l (14 to 44) and 53 nmol/l (23 to 165) respectively. These were significantly greater than the levels after 28 mm MOM THA which were 22 nmol/l (15 to 87, p = 0.021) and 19 nmol/l (2 to 58, p < 0.001) respectively. Since the upper limit for normal patients without implants is typically 5 nmol/l, both groups had significantly raised levels of metal ions. MOM bearings of large diameter, however, result in a greater systemic exposure of cobalt and chromium ions than bearings of small diameter. This may be of relevance for potential long-term side-effects. It is not known to what extent this difference is due to corrosion of the surfaces of the component or of the wear particles produced.

Hip arthroscopy: complications in 1054 cases

Although arthroscopic surgery of the hip is becoming a more frequently done operation, there is relatively few data in the literature regarding the frequency of complications. In the current prospective study of 1054 consecutive hip arthroscopies, the authors report an overall complication rate of 1.4%. Complications included neurapraxia, portal wound bleeding, portal hematoma, trochanteric bursitis, and instrument breakage. The only major complication was one case of septic arthritis. It is concluded that, done properly, hip arthroscopy can be a considered a low-risk procedure.

Acute symptomatic seizures due to single CT lesions: how long to treat with antiepileptic drugs?

The duration of anti epileptic drug therapy for single small enhancing CT lesions (SSECTL) presents a major dilemma. We studied the efficacy of short duration (6 months) antiepileptic drug therapy as compared to long duration (2 years) drug therapy. Seventy three patients presenting with seizures and showing SSECTL on cranial CT scans (plain and contrast) were randomized into group A (6 months therapy) and group B (2 years therapy). There were 47 patients in group A and 26 patients in group B. Patients were followed up for one year after withdrawal of anti epileptic drugs. CT Head (plain and contrast) was repeated after 3 months, or earlier in cases of recurrence to rule out reinfection. 53.2% in group A and 53.8% in group B showed complete resolution and were seizure free on one year follow up. Punctate residual calcification was seen in 46.8% in group A and 46.2% in group B. Eight patients (17%) in group A and three (11.5%) in group B had a recurrence. The difference in recurrence of seizure between the two groups was not statistically significant (p<0.77) in the calcified lesion subset. Since none of the patients in total resolution subset showed recurrence, the difference between calcified and total resolution subset was highly significant. The study shows that a short duration (6 months) AED therapy in patients with total resolution of lesion on follow up scan, may be adequate in comparison to those who have calcific speck as a residue. However, a longer duration of therapy in case of calcific group probably does not alter their chances of recurrence.

Biophysical approaches to membrane protein structure determination

Recently, there have been several technical advances in the use of solution and solid-state NMR spectroscopy to determine the structures of membrane proteins. The structures of several isolated transmembrane (TM) helices and pairs of TM helices have been solved by solution NMR methods. Similarly, the complete folds of two TM beta-barrel proteins with molecular weights of 16 and 19 kDa have been determined by solution NMR in detergent micelles. Solution NMR has also provided a first glimpse at the dynamics of an integral membrane protein. Structures of individual TM helices have also been determined by solid-state NMR. A combination of NMR with site-directed spin-label electron paramagnetic resonance or Fourier transform IR spectroscopy allows one to assemble quite detailed protein structures in the membrane.

Fire during the use of Nd-Yag laser

Fire during the use of Nd-Yag laser is a very rare complication. A case report of laser fire during the use of Nd-Yag laser for congenital subglottic stenosis is reported. The probable causes for the fire, management and short review of literature are dealt with. This case report highlights the importance of following the safety protocol during laser surgery.