Radiographic study of carrying angle and morphometry of skeletal elements of human elbow

Lateral obliquity of the forearm from the arm when the forearm is supinated and extended is called carrying angle. In this study carrying angle was measured using radiographs of adult individuals and morphometry was done on dry bones taking part in formation of human elbow (on lower end of humerus-trochlear angle and inclination angle of olecranon fossa, on upper end of ulna-olecranon-coronoid angle and length and width of inferior medial trochlear notch). On radiographs, the difference between male and female carrying angle and difference between carrying angle of right and left limbs (in both sexes together as well as in same sex) was statistically not significant. All the morphometric parameters measured in this study did not show any significant sexual dimorphism or difference between right and left side except the inclination angle of olecranon fossa, which was significantly more on right side. Different findings of carrying angle as reported by various authors could be due to racial difference or due to different methods used to measure carrying angle. Morphometric parameters were similar to findings of radiographic method of measuring carrying angle. These factors should also be considered in construction of elbow prosthesis as well as use of carrying angle in identification of skeletal remains.

Pulmonary edema during repair of mycotic aneurysm of descending thoracic aorta, in postpartum period

Infective endocarditis is uncommon during pregnancy. The difficulty in diagnosing infective endocarditis during pregnancy, may increase the likelihood of development of complications like a mycotic aneurysm of the descending thoracic aorta. We describe a case of mycotic aneurysm in the postpartum period, as sequel to delayed diagnosis; who developed pulmonary edema during its repair.

157. LYMPHATICS IN THE HUMAN PLACENTAL BED AND SURROUNDING THE SPIRAL ARTERIOLES DISAPPEAR DURING ENDOMETRIAL DECIDUALISATION

The mammalian placenta plays central roles in maternal tolerance of the semi-allogeneic fetus and fluid balance between maternal and fetal compartments. The lymphatics play a role in both immune function and fluid balance. The aim of this study was to describe the distribution of lymphatic vessels in human placental bed and decidua, with particular focus on the lymphatics that surround the remodelling spiral arteries during decidualisation and trophoblast invasion. Placental bed, non-placental bed and decidual biopsies were obtained from women undergoing elective pregnancy termination (6–18 weeks gestational age) and from women undergoing elective caesarean section at term. Double immunohistochemical labeling was performed on serial sections to identify lymphatic vessels in conjunction with blood vessels, smooth muscle, epithelial and trophoblast cells, or proliferating cells. Using representative photomicrographs, descriptive findings of the organisation of the human placental bed lymphatics were made. Lymphatic vessels positive for podoplanin (D2-40) were abundant in hypersecretory endometrium (lacking stromal decidualisation) at all stages of gestation. By contrast, the decidua was nearly always devoid of lymphatics. In some samples, structures that appeared to be regressing lymphatics were observed at the boundary between hypersecretory and decidual tissues. Lymphatic vessels were notably absent from the vicinity of spiral arteries that were surrounded by decidualised stromal cells. Lymphatic vessels in hypersecretory endometrium appeared larger and more elongated as gestation progressed. Proliferating lymphatic vascular endothelial cells were identified in both large vessels, and in streaks of D2-40 positive cells that could have been newly forming lymphatic vessels. In conclusion endometrial stromal cell decidualisation results in a loss of lymphatics, with this phenomenon being particularly apparent around the spiral arterioles; the functional consequences of this loss have yet to be elucidated.

Day case surgery training for surgical trainees: a disappearing act?

INTRODUCTION

Over the past decade there has been considerable change to surgical training such as modernising medical careers which have raised concerns over exposure to operative experience. With the National Health Service (NHS) plan aiming for the majority of elective surgical cases to be performed as day cases we sought to assess the level of exposure modern day surgical trainees obtain in day case surgery.

METHODS

An anonymous electronic questionnaire survey was completed by 100 surgical trainees in surgical training across the United Kingdom (UK) from a variety of sub-specialities. 16 questions pertinent to day case surgery exposure were answered.

RESULTS

The majority of the trainees who completed the survey felt day case surgery is a vital part of their training as a surgeon. Only less than one-third of all the trainees had formal timetabled day case surgery lists. Of the 31 trainees who had scheduled day lists only 58% (n = 18) were consistently able to attend. The most common reasons for being unable to attend were rota issues and lack of encouragement from seniors. 90 trainees (90%) were not satisfied with their overall Day Case Surgery training.

CONCLUSIONS

The survey reveals that the modern surgical trainee is gaining a low and inconsistent level of exposure to day case surgery despite being aware of the importance of this modality of training. An urgent review is required to ensure trainees become actively involved in day case surgery and are not missing on this vital training opportunity.

RNAi-mediated knockdown of AURKB and EGFR shows enhanced therapeutic efficacy in prostate tumor regression

Aurora B kinase (AURKB) and epidermal growth factor receptor 1 (EGFR) belong to serine/threonine and tyrosine kinase family of proteins. Both these kinases are found to overexpress in a large number of epithelial cancers, including hormonal refractory prostate cancer. In this communication, we present evidence for down-regulated expression of AURKB and EGFR, either alone or in combination, in prostate cancer cells. The results show that AURKB and EGFR were efficiently down-regulated in a dose-dependent manner. AURKB and EGFR siRNA in combination have shown enhanced therapeutic effect by inhibiting PC3 cell proliferation and inducing apoptosis in vitro, whereas androgen-dependent cancer cells LNCaP remain unaffected correlating the endogenous expression levels. Knockdown of AURKB and EGFR individually resulted in inhibition of prostate tumor growth in athymic nude mice and their combined knockdown resulted in tumor regression in which 40% of the treated mice were found to be tumor free, implicating the potential therapeutic benefits of AURKB-EGFR combination therapy.

Treatment of angiolymphoid hyperplasia with eosinophilia with the carbon dioxide laser

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon, idiopathic condition that presents with isolated or grouped plaques or nodules in the periauricular region, forehead, or scalp. ALHE is marked by a proliferation of blood vessels with distinctive large endothelial cells accompanied by a characteristic inflammatory infiltrate that includes eosinophils. The lesion is benign but may be persistent and difficult to eradicate. Various therapeutic modalities that have been tried for its treatment include intralesional and oral corticosteroids, cryotherapy, oral retinoids, vinblastine, surgical excision, laser therapy, and INFalpha2a. We report two cases with this rare condition: one patient, treated with cryotherapy, did not improve, while the second patient was successfully treated with the CO(2) laser.

Hypoxia-associated p38 mitogen-activated protein kinase-mediated androgen receptor activation and increased HIF-1alpha levels contribute to emergence of an aggressive phenotype in prostate cancer

Androgen receptor (AR) signaling is involved in the development and progression of prostate cancer. Tumor microvasculature contributes to continual exposure of prostate cancer cells to hypoxia-reoxygenation, however, the role of hypoxia-reoxygenation in prostate cancer progression and modulation of AR signaling is not understood. In this study, we evaluated the effects of hypoxia-reoxygenation in LNCaP cells, a line of hormone responsive human prostate cancer cells. Our results demonstrate that hypoxia-reoxygenation resulted in increased survival, higher clonogenicity and enhanced invasiveness of these cells. Moreover, hypoxia-reoxygenation was associated with an increased AR activity independent of androgens as well as increased hypoxia inducible factor (HIF-1alpha) levels and activity. We also observed that the activation of p38 mitogen-activated protein (MAP) kinase pathway was an early response to hypoxia, and inhibition of p38 MAP kinase pathway by variety of approaches abolished hypoxia-reoxygenation induced increased AR activity as well as increased survival, clonogenicity and invasiveness. These results demonstrate a critical role for hypoxia-induced p38 MAP kinase pathway in androgen-independent AR activation in prostate cancer cells, and suggest that hypoxia-reoxygenation may select for aggressive androgen-independent prostate cancer phenotype.

Titrated low-dose vaginal and/or oral misoprostol to induce labour for prelabour membrane rupture: a randomised trial

OBJECTIVE

To evaluate the clinical effectiveness and safety of titrated low-dose misoprostol for induction of labour (IOL) in the presence of prelabour rupture of membranes (PROM).

DESIGN

Randomised controlled trial.

SETTING

Maternity units in the UK (9) and Egypt (1).

POPULATION

Women >34 weeks of gestation with PROM, singleton viable fetus and no previous caesarean section.

METHODS

Subjects randomised to IOL with a titrated low-dose misoprostol regimen (oral except if unfavourable cervix, where initial dose vaginal) or a standard induction method, namely vaginal dinoprostone followed by intravenous oxytocin if the cervix was unfavourable or intravenous oxytocin alone if the cervix was favourable.

MAIN OUTCOME MEASURES

Primary outcome measures were caesarean section and failure to achieve vaginal delivery within 24 hours. Analysis was by intention to treat.

RESULTS

The trial did not achieve the planned sample size of 1890 due to failure in obtaining external funding. Seven hundred and fifty-eight women were randomised (375 misoprostol and 383 standard). There were less caesarean section (14 versus 18%, relative risk [RR] 0.79; 95% CI 0.57-1.09) and less women who failed to achieve vaginal delivery within 24 hours in the misoprostol group (24 versus 31%, RR 0.79; 95% CI 0.63-1.00), but the differences were not statistically significant. Subgroup analysis showed that with unfavourable cervix, misoprostol may be more effective than vaginal dinoprostone. There was no difference in hyperstimulation syndrome. There were more maternal adverse effects with misoprostol, but no significant differences in maternal and neonatal complications.

CONCLUSIONS

Titrated low-dose misoprostol may be a reasonable alternative for IOL in the presence of PROM, particularly in women with an unfavourable cervix. Safety and rare serious adverse events could not be evaluated in a trial of this size.

Right lung agenesis

Congenital pulmonary agenesis or aplasia is extremely rare. Although more than fifty percent of patients die before first five years of age, some individuals may remain asymptomatic throughout their life. A three-month-old female child with right pulmonary agenesis presented to us with severe respiratory distress. She was misdiagnosed as a case of foreign body bronchus at the peripheral health centre. Bronchoscopy confirmed the diagnosis and relieved the symptoms. It is recommended that invasive diagnostic procedures and prophylactic surgery should not be done in asymptomatic cases.

Chondroid syringoma

Pleomorphic adenoma, or chondroid syringoma (CS), is a rare, benign, skin appendageal tumour. Because of the unremarkable clinical presentation of this rare tumour, the diagnosis is made on microscopic examination. The usual presentation is of an asymptomatic, slowly-growing mass, typically located in the head and neck region. We present a case of a CS located over the forehead of a 32-year-old man. In the evaluation of a middle-aged male patient with a small cutaneous nodule in the head and neck region, chondroid syringoma should also be considered in the differential diagnosis. For such a lesion, excisional biopsy, without destroying the aesthetic and functional structures, is the preferred diagnostic, as well as therapeutic approach.

Wound healing response is a major contributor to the severity of cutaneous leishmaniasis in the ear model of infection

In the conventional mouse model for cutaneous leishmaniasis involving infection with stationary phase Leishmania major promastigotes at the base of the tail, mice congenic for leishmaniasis resistance loci designated lmr1,2,3 cured their lesions more rapidly and laid down more ordered collagen fibres than the susceptible parental BALB/c mice, while the opposite was the case for the congenic mice carrying the susceptibility loci on the resistant C57BL/6 background. In that model, we showed that wound healing and not T cell responses played a major role in determining the resolution of skin infection. Here, we show a similar disease phenotype in the mouse model that mimics more closely the situation in humans, that is, strictly intradermal infection in the ear pinna with small numbers of metacyclic promastigotes. The data show that at the site of infection the innate and adaptive immune responses act in concert to clear parasites, and induce tissue repair and wound healing. Importantly, the data show that the host responses controlled by the lmr loci, which act locally to control infection in the skin, are distinct from the host responses operating systemically in the draining lymph node.

Ethnopharmacological approaches to wound healing--exploring medicinal plants of India

India has a rich tradition of plant-based knowledge on healthcare. A large number of plants/plant extracts/decoctions or pastes are equally used by tribals and folklore traditions in India for treatment of cuts, wounds, and burns. The present review thus attempts to analyze the ethnobotanical knowledge base for treatment of cuts and wounds which includes a usage of plants, methods employed by tribals and folklore practices prevailing in India. Pharmacological reports available on Indian medicinal plants employing various wound healing models and its underlying molecular mechanism, wherever available, has also been briefly reviewed. This pharmacological validation on Indian medicinal plants is very limited and a large number of plants used in tribal and folklore with enormous potential have not been validated for their wound healing activity. This review therefore attempts to bridge the lacunae in the existing literature and offers immense scope for researchers engaged in validation of the traditional claims and development of safe and effective and globally accepted herbal drugs for cuts and wounds.

Closed-loop anaesthesia delivery system (CLADS) using bispectral index: a performance assessment study

The development of electroencephalographic indices of anaesthetic depth has in turn generated interest in automated anaesthesia delivery systems using these as the input variable. In this paper, one patented closed loop anaesthesia delivery system (CLADS) (502/DEL/2003) is compared to manual control of propofol delivery titrated to the bispectral index (BIS). Forty ASA I-II patients undergoing elective surgery under general anaesthesia were enrolled in the study. The study participants were randomised using computer generated random numbers to two equal groups. One group received propofol titrated by the CLADS while in the other group (control), anaesthetic delivery was manually titrated to BIS. Closed loop anaesthetic delivery using our patented system led to lower induction doses of propofol (P < 0.05) and less overshoot of the target BIS (P < 0.05). The closed loop system maintained BIS to within +/-10 of target for a significantly longer time during the maintenance phase of anaesthesia (P < 0.01). Smaller amounts of anaesthetic agent were required (P < 0.01) and there was faster postoperative recovery (P < 0.05). Manual delivery of propofol required the infusion rate to be changed a median of 30 times (IQR 12-45), which required considerable time and attention by the anaesthetist. In conclusion, automated delivery of propofol adjusted to the bispectral index using our CLADS was both effective and efficient as compared to manual control.

Reversal of hepatotoxin-induced pre-fibrogenic events by Emblica officinalis--a histological study

Efficacy of a herbal product of E. officinalis (fruit) (EO) has been evaluated against carbon tetrachloride (CCl4) and thioacetamide (TAA) induced changes in rat liver. Chronic treatment of CCl4 and TAA revealed abnormal histopathology indicative of pre-fibrogenic events. EO reversed such alterations with significant regenerative changes suggestive of its preventive role in prefibrogenesis of liver.

A microculture technique for isolating live Leishmania parasites from peripheral blood of visceral leishmaniasis patients

Current procedures for diagnosing Leishmania parasites from patients involve invasive and dangerous tissue aspiration. We have developed a non-invasive and highly sensitive microculture method that can isolate parasites from the buffy coat of the patient's peripheral blood. The parasites were cultured in 96-well culture plates. Nineteen parasitologically proven visceral leishmaniasis (VL) patients were included in the study. Using this technique, we were able to isolate parasites from 16 (84%) samples. However, all 19 (100%) samples were positive on culture of splenic aspirates. We conclude that this technique is useful for the isolation and cryoconservation of parasites from patients' blood. This simple method could be tried as a first-instance alternative before other more sensitive procedures such as splenic aspirate; however, negative results should be confirmed by tests with higher sensitivity.

Mesh migration following obturator hernia repair presenting as a bezoar inducing small intestinal obstruction

This is the first report on synthetic mesh migration following obturator hernia repair. Obturator hernias have a low incidence--with fewer than 700 published case studies to date--usually occur in elderly women and are difficult to diagnose. Since 1976, there have been no more than 29 reported cases in which synthetic materials were used in obturator hernia repair. Thus, information relevant to the surgical repair of this type of hernia is based on small numbers only. The use of synthetic mesh for the repair of obturator hernias is a recent development, and to date no complications have been reported with this type of repair. We report here on the outcome of a patient with mesh migration after obturator hernia repair. This report provides a short overview of mesh migration as a complication following the use of synthetic grafts for surgical repair.

Cytotoxicity of Diospyrin and Its Derivatives in Relation to the Generation of Reactive Oxygen Species in Tumour Cells in vitroandin vivo

BACKGROUND

Alkyl ethers (D2 and D7) synthesized from diospyrin (D1), a naphthoquinonoid isolated from Diospyros montana Roxb., were evaluated for cytotoxicity and capacity to generate reactive oxygen species (ROS) in tumour cells.

METHODS

The tumour inhibitory activity of the quinonoids was assessed in vivo against Ehrlich ascites carcinoma (EAC), while cytotoxicity was determined in vitro on EAC and MCF-7 cancer cells by MTT assay. ROS generated by quinonoids in MCF-7 cells was measured fluorimetrically.

RESULTS

The tumour inhibitory activity, cytotoxicity and ROS generation capacity of quinonoids were found to be D7 > D2 > D1.

CONCLUSION

Alkyl ethers of D1 were more cytotoxic against tumour cells in vitro as well as in vivo.

Noradrenaline and albumin in paracentesis-induced circulatory dysfunction in cirrhosis: a randomized pilot study

OBJECTIVE

Therapeutic paracentesis in patients with cirrhosis is associated with a circulatory dysfunction. Intravenous albumin has been used to prevent the circulatory dysfunction; however, the use of albumin is controversial and costly. Splanchnic vasodilation is mainly responsible for circulatory dysfunction in these patients. There are no reports of use of noradrenaline, a vasoconstrictor, on the prevention of paracentesis-induced circulatory dysfunction in patients with cirrhosis. Therefore, we studied the preventive effect of noradrenaline on paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis and compared it with that of intravenous albumin in a randomized pilot study.

METHODS

Forty patients with cirrhosis and tense ascites underwent therapeutic paracentesis with albumin or noradrenaline in a randomized controlled trial at a tertiary centre. Effective arterial blood volume was assessed by measuring plasma renin activity at baseline and at 6 days after treatment.

RESULTS

Effective arterial blood volume as indicated by plasma renin activity before and 6 days after paracentesis did not differ in the two groups (20.62 +/- 10.27-22.02 +/- 10.15 ng mL(-1) h(-1); P = 0.11 in the albumin group and 19.66 +/- 8.91-20.78 +/- 9.41 ng mL(-1) h(-1); P = 0.37 in the noradrenaline group). Plasma aldosterone concentration before and 6 days after paracentesis were also similar in both groups (1196.5 +/- 434.2-1217.0 +/- 405.7 pg mL(-1); P = 0.7 in the albumin group and 1206.0 +/- 522.5-1273.5 +/- 444.8 pg mL(-1); P = 0.22 in the noradrenaline group). The cost of noradrenaline treatment was significantly lower when compared with that of albumin (P < 0.001).

CONCLUSIONS

Noradrenaline is as effective as albumin in preventing paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis, but at a fraction of the cost.

Serological diagnosis of Indian visceral leishmaniasis: direct agglutination test versus rK39 strip test

We evaluated the direct agglutination test (DAT), using freeze-dried (FD) and aqueous (AQ) antigen, and the rK39 immunochromatographic strip test in the diagnosis of Indian visceral leishmaniasis (VL). Sera from 508 subjects (150 parasitologically confirmed patients with VL, 100 and 153 healthy controls drawn from non-endemic and endemic regions, respectively, and 105 patients with other diseases presenting with fever and/or splenomegaly) were tested. The sensitivity of the tests were as follows: DAT (FD), 96% (95% CI 91-98); DAT (AQ), 97% (95% CI 93-99); rK39 strip test, 99% (95% CI 95-100). The specificity of DAT (FD), DAT (AQ) and rK39 strip tests were 85% (95% CI 81-88), 87% (95% CI 83-91) and 89% (95% CI 86-92), respectively. A significant correlation (high degree of agreement) was observed between all tests (kappa>0.80). We conclude that the sensitivity of FD antigen is comparable to that of AQ antigen. Similarly, the rK39 strip test is as sensitive as the DAT, but the strip test's greater convenience of use makes it a better tool for diagnosis of VL in peripheral areas of endemic regions.

Psoralen-ultraviolet A vs. narrow-band ultraviolet B phototherapy for the treatment of vitiligo

BACKGROUND

Although many treatment modalities have been tried for the treatment of vitiligo, none is uniformly effective. Psoralen phototherapy (psoralen ultraviolet A (PUVA)) is established as efficacious treatment for vitiligo. Recently, narrow-band UVB (NBUVB) has been reported to be an effective and safe therapeutic option in patients with vitiligo.

OBJECTIVE

To compare the efficacy of PUVA and NBUVB in the treatment of vitiligo.

DESIGN AND SETTING

Retrospective analysis of 69 patients with vitiligo who were treated either with PUVA or NBUVB at the pigmentary clinic of the Dermatology Department of the Postgraduate Institute of Medical Education and Research, Chandigarh, India.

OUTCOME MEASURES

The following variables were compared between the two groups of patients: repigmentation status, number of treatments for marked to complete repigmentation in existing lesions, appearance of new lesions or increase in size of existing lesions, adverse effect of therapy, stability of repigmentation and colour match.

RESULTS

In PUVA-treated group, 9 patients showed marked to complete repigmentation (23.6%) and 14 patients showed moderate improvement (36.8%), whereas in NBUVB-treated group, 13 patients showed marked to complete repigmentation (41.9%) and 10 patients showed moderate improvement (32.2%). A statistically significantly better stability and colour match of repigmentation with surrounding skin was seen in NBUVB-treated patients.

CONCLUSION

We showed that NBUVB is more effective than PUVA and repigmentation induced with NBUVB is statistically significantly more stable.

Isolates of Theileria annulata collected from different parts of India show phenotypic and genetic diversity

Phenotypic and genetic polymorphism was studied amongst four Theileria annulata isolates collected from three different parts of India. Amongst various markers studied for the comparison of growth characteristics of schizont cell lines established from these isolates, viability, non-viability counts and nitric oxide (NO) production showed significant variation. A negative correlation was observed between NO production and mRNA expression for TNF-alpha, a potent proinflammatory cytokine related to the pathogenesis of the disease. Phenotypic polymorphism was also revealed by T. annulata schizont-specific monoclonal antibodies (Mabs), viz. 1C7, 1E11, 2G2 and EU-106, which recognized variable number of cells in indirect fluorescent antibody and indirect immunoperoxidase tests, when tested against the four T. annulata isolates collected from India. Genetic polymorphism was recognized amongst the four isolates by restriction digestion analysis of Tams-1 gene PCR products. These observations revealed that the four isolates of T. annulata are different from each other and might be expressing different antigenic determinants on their cell surface.

Effect of topical calcipotriol, betamethasone dipropionate and their combination in the treatment of localized vitiligo

BACKGROUND

Treatment of vitiligo is a challenge. Steroids are known to be effective but are associated with serious adverse effects. Many uncontrolled studies have shown calcipotriol to be a promising therapeutic modality in vitiligo.

OBJECTIVE

To conduct a randomized trial to evaluate the effect of topical calcipotriol ointment (0.005%) and betamethasone dipropionate (0.05%) cream, given alone or in combination, in treatment of localized vitiligo.

METHODS

Forty-nine patients with vitiligo affecting 5% of their skin were recruited. Patients were randomized into three groups. Group I patients were treated with betamethasone dipropionate (0.05%) cream twice daily. Group II patients were treated with calcipotriol ointment (0.005%) twice daily, and group III with betamethasone dipropionate (0.05%) in the morning and calcipotriol (0.005%) in the evening.

RESULTS

Forty-five patients completed the study period of 3 months with 15 patients in each group. No patient achieved excellent (> 75%) pigmentation. Marked (50% to 75%) repigmentation was observed in 2 (13.3%), 1 (6.7%) and 4 (26.7%) patients in groups I, II and III, respectively. Moderate (25-50%) repigmentation was observed in 7 (46.7%), 5 (33.3%) and 7 (46.7%) patients in groups I, II and III, respectively. Patients with < 25% pigmentation were termed as minimal pigmentation or no response. The mean time for initial pigmentation to appear was 9.04 +/- 2.0 weeks in group I, 10.18 +/- 1.6 weeks in group II and 5.17 +/- 2.4 weeks in group III (P < 0.01). The acquired pigmentation in the lesions was more stable in group III as compared with patients in groups II and I (P < 0.01). Side-effects in the form of atrophy and lesional burning sensations were more common in group I when compared with groups II and III (P < 0.05).

CONCLUSION

Combined therapy appeared to give a significantly faster onset of repigmentation along with better stability of the achieved pigmentation and with lesser number of side-effects.

Upregulated TRPC1 channel in vascular injury in vivo and its role in human neointimal hyperplasia

Occlusive vascular disease is a widespread abnormality leading to lethal or debilitating outcomes such as myocardial infarction and stroke. It is part of atherosclerosis and is evoked by clinical procedures including angioplasty and grafting of saphenous vein in bypass surgery. A causative factor is the switch in smooth muscle cells to an invasive and proliferative mode, leading to neointimal hyperplasia. Here we reveal the importance to this process of TRPC1, a homolog of Drosophila transient receptor potential. Using 2 different in vivo models of vascular injury in rodents we show hyperplasic smooth muscle cells have upregulated TRPC1 associated with enhanced calcium entry and cell cycle activity. Neointimal smooth muscle cells after balloon angioplasty of pig coronary artery also express TRPC1. Furthermore, human vein samples obtained during coronary artery bypass graft surgery commonly exhibit an intimal structure containing smooth muscle cells that expressed more TRPC1 than the medial layer cells. Veins were organ cultured to allow growth of neointimal smooth muscle cells over a 2-week period. To explore the functional relevance of TRPC1, we used a specific E3-targeted antibody to TRPC1 and chemical blocker 2-aminoethoxydiphenyl borate. Both agents significantly reduced neointimal growth in human vein, as well as calcium entry and proliferation of smooth muscle cells in culture. The data suggest upregulated TRPC1 is a general feature of smooth muscle cells in occlusive vascular disease and that TRPC1 inhibitors have potential as protective agents against human vascular failure.

Mondor's disease of penis: a forgotten disease

BACKGROUND

Mondor's disease of penis is an uncommon genital condition involving the penile sulcus in a circumferential manner. Although this disorder is almost always self limited, it is associated with considerable psychological stress and sexual disharmony.

METHODS

All patients attending the sexually transmitted disease clinic during 1991-2003 were examined for evidence of Mondor's disease of penis. Detailed history and clinical findings were recorded in a specially designed proforma. Histopathological examination and staining with CD31 and CD34 monoclonal antibodies was also done in 11 patients.

RESULTS

18 out of 1296 patients attending the sexually transmitted diseases (STD) clinic during the study period were found to have penile Mondor's disease, giving an incidence of 1.39%. 17 patients had history of one or more episodes of STDs. Histopathological specimens showed prominent vessels with plump endothelial cells and thickened blood vessel walls. The occasional vessel showed complete occlusion of its lumen.

CONCLUSIONS

In our study we did not find any evidence of lymphatic involvement. Non-lymphatic vessels, mainly veins, were predominantly involved. In our opinion Mondor's phlebitis of penis or Mondor's disease of penis are better terms to describe the condition rather than non-venereal sclerosing lymphangitis.

Acanthosis nigricans: relation with type 2 diabetes mellitus, anthropometric variables, and body mass in Indians

OBJECTIVE

To determine the prevalence of acanthosis nigricans (AN) in type 2 diabetes mellitus (T2DM) and its correlation with various anthropometric measurements in Indians.

METHODS

One hundred and fifty consecutive subjects with T2DM attending the diabetes clinic at a tertiary referral centre in North India were considered as cases and 150 age and sex matched healthy attendants of non-diabetic subjects as controls. All the cases and controls were screened for the presence of AN and its severity. Anthropometric measurements of all of them were measured in standard method. Regression analysis was done to determine the association of AN with T2DM and various anthropometric measurements.

RESULTS

The prevalence of AN in subjects with diabetes and healthy controls was 62.6% and 40% respectively, and this difference was significant (p<0.05). Body mass index (BMI) between cases and controls was comparable by chance. There was a statistically significant correlation of increasing severity of AN with increasing BMI, waist circumference, hip circumference, waist-hip ratio, skinfold thickness, and body fat percentage in diabetic patients. However, in regression analysis after considering all the confounding factors there was a significant correlation of AN, only with diabetes mellitus and BMI.

CONCLUSIONS

Indians have high prevalence of AN and it is an independent cutaneous marker of both T2DM and BMI.

A study of the effect of annealing on Fe-doped LiNbO3by HRXRD, XRT and FT–IR

The annealing effect on the structural perfection of Fe-doped LiNbO3single crystals has been studied by high-resolution X-ray diffractometry (HRXRD), X-ray topography (XRT) and Fourier transform infrared (FT–IR) spectroscopy. The single crystals, prepared by mixing Li2CO3and Nb2O5powders in the molar ratio 48.6:51.4 with 0.05 mol% of iron at 1415 (1) K, were grown by the Czochralski (CZ) method along the [001] direction in air and poled during crystal growth by the application of a DC field. Two low-angle (tilt angle ∼1 arc minute) structural grain boundaries were observed in as-grown specimens. FT–IR spectra revealed that these crystals contain OH−and CO32−ionic defects. Grain boundaries and CO32−ionic defects were successfully removed, while the concentration of OH−ions was considerably reduced by post-growth thermal annealing at elevated temperatures.

Evaluation of PCR for diagnosis of Indian kala-azar and assessment of cure

This study was done to evaluate PCR with Ld1 primers for the diagnosis of Indian visceral leishmaniasis (VL) and to assess its role in prediction of the disease outcome. The PCR assay was performed with DNA isolated from the peripheral blood of parasitologically confirmed cases of VL before the initiation of treatment, just after the end of treatment, and at 3 and 6 months of follow-up. The pretreatment PCR result was positive for 100 of 101 patients (sensitivity, 99%; confidence interval [CI], 94 to 100%). None of the 150 negative controls tested were PCR positive (specificity, 100%; CI, 96.8 to 100%). Of 60 patients who were treated at our center, 51 (85%; CI, 73 to 93%) became negative immediately after treatment and continued to be negative at 3 and 6 months of follow-up. At the 3-month follow-up, two of the remaining nine patients were PCR positive, making 58 (96.7%; CI, 87 to 100%) patients PCR negative. At the 6-month follow-up, all patients became PCR negative. One patient who was PCR negative immediately after the end of treatment relapsed 11 months later. This limited prospective study with VL patients suggests that the PCR assay is a highly sensitive and specific (99% and 100%, respectively) tool for the diagnosis of VL. In the majority of patients, it can identify a successful disease outcome; however, its translation into the field setting remains a major challenge.