Simultaneous determination of the stereoisomers of guggulsterone in serum by high-performance liquid chromatography

Simultaneous separation of E- and Z-guggulsterone, which is the main ingredient of 'Guggulip', an ayurvedic drug, was accomplished by HPLC on a C18 column using methanol, acetonitrile, buffer and tetrahydrofuran as a mobile phase. The compounds were monitored at 248 nm on a photodiode array detector. The assay method was used for the simultaneous determination of stereoisomers (E and Z) of guggulsterone in spiked serum and dosed (50 mg/kg, p.o.) rats. The recoveries of E- and Z-isomers from serum samples were always greater than 90%. The calibration graph was linear over the range of 25-2500 ng/ml for Z- and E-isomers. Lowest quantitation limit of Z- and E-guggulsterones was 25 ng/ml.

Intraoperative use of mitomycin C in the treatment of recurrent pterygium

The prevalence rate of pterygium in Papua New Guinea (PNG) is as high as 15%. Recurrence rates up to 50% are encountered after primary excision. In a country such as PNG where resources in terms of funds and manpower are limited, a simple procedure had to be identified to reduce this alarmingly high rate of pterygium recurrence. This article compares the results of a randomized masked study involving the single intraoperative application of 0.02% mitomycin C solution in 65 eyes undergoing surgery for recurrent pterygium using the bare sclera technique with a similar group of 65 patients in which the drug was not used. The results indicate that a single intraoperative application of mitomycin C solution was enough to reduce the recurrence rate of pterygium to 3% in the treated group as compared to 48% in the untreated group at the end of a 12-month follow-up. In the study it was also seen that, in PNG, pterygia were more common in females and that recurrences tended to occur early and were obvious in the first few weeks following surgery.

Profile of ocular trauma in Papua New Guinea

BACKGROUND

Ocular trauma is a significant cause of blindness in Papua New Guinea (PNG). This study was done to determine the pattern and rates of ocular and adnexal injuries so as to determine the size and extent of the problem.

METHODS

A retrospective study of 4157 cases presenting with ocular trauma in three regions of PNG was carried out. The data were analysed with respect to the age, sex, province, type and cause of injury, time interval between injury and presentation to the hospital and the final visual outcome after treatment.

RESULTS

Ocular trauma rates in PNG were alarmingly high (39.1 per 100,000). The commonest cause of injury in the younger age group was due to lime. Alcohol-related violence and fights resulted in injuries in the adult age group. Most of the injuries were grievous and 60.7% of patients were left with a visual acuity of less than 6/60 in the injured eye. In addition, 78.7% of the patients were under 30 years of age.

CONCLUSIONS

Ocular injuries in PNG are an important cause of visual disability. Some specific injuries, such as those due to lime in children, can easily be prevented by health education.

Visual loss in immunocompetent patients with Cryptococcus neoformans var. gattii meningitis

In Papua New Guinea cryptococcal meningitis occurs predominantly in immunocompetent patients in whom Cryptococcus neoformans var, gattii is implicated in 95% of cases. Ocular complications are common. We have reviewed ophthalmic findings in 82 immunocompetent patients and have attempted to identify those features of the disease that predict an unfavourable visual outcome. Visual loss occurred in 52.6% of survivors and was associated with optic atrophy following optic disc swelling in 60.9%. Progression of disc swelling to optic atrophy was predicted by the presence of an abducens palsy (P = 0.049) and cerebrospinal fluid (CSF) cryptococcal antigen titres > 1:1024 (P = 0.036). Raised intracranial pressure (defined as opening CSF pressure > or = 300 mm on admission) was not associated with visual loss. Vision deteriorated in 17.3% of patients despite anticryptococcal therapy and in 3.7% it followed curative therapy. The high rate of visual loss in immunocompetent patients with C. neoformans var. gattii infection contrasts with others' experience of immunosuppressed patients with C. neoformans var. neoformans infection, in whom visual loss was rare. This difference may reflect immune mediated optic nerve dysfunction in C. neoformans var. gattii meningitis caused by either compression due to arachnoid adhesions or oedema and inflammatory cell-mediated damage.

Study of pulmonary functions in swimmers of Lucknow city

In this study, the pulmonary functions of young swimmers of K.D. Singh Babu Stadium, Lucknow were studied, 20 swimmers of the age group of 15-20 years were chosen along with 15 students as controls. The parameters taken into account were Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV1) and Peak Expiratory Flow Rate (PEFR). Two sets of readings were recorded. One before the start and the other at the end of the practice season. These readings were compared to each other and also with the values of the controls. The results indicate that swimming has considerable effect on enhancing lung functions of an individual as FVC, FEV1, PEFR were significantly raised in swimmers after swimming session. Such results suggest that swimming may be induced in the exercise programme for rehabilitation of respiratory patients who have compromised lung functions.

The effect of corticosteroids on visual loss in Cryptococcus neoformans var. gattii meningitis

In Papua New Guinea visual loss is a frequent sequal to Cryptococcus neoformans var. gattii meningitis in immunocompetent patients. We have previously postulated that visual loss may occur as a result of the immunological response to infection around the optic nerve. This retrospective study set out to explore the effect of corticosteroids on visual outcome. Sixteen patients received varying doses of corticosteroid (mainly 100-250 mg of hydrocortisone daily for the prevention of febrile reactions to amphotericin) and 10 received anticryptococcal therapy alone. Visual deterioration occurred less frequently in those treated with corticosteroids (2/16 [12.5%] vs. 7/10 [70%], P = 0.007), blindness was less frequent (1/16 [5.3%] vs. 5/10 [50%], P = 0.018), and in 3 patients vision improved. Corticosteroids may have a role in preventing or halting visual loss in C. neoformans var. gattii meningitis in immunocompetent patients.

Prognostic markers in amebic liver abscess: a prospective study

OBJECTIVES

Amebic liver abscess (ALA) is being increasingly recognized with the progressive spread of AIDS. The prognosis of ALA needs to be determined to decide whether aggressive intervention therapy should be used. A prospective study was conducted to determine the factors that predicted mortality in patients with ALA.

METHODS

The study population consisted of 135 consecutive patients with ALA who were treated with 80 mg/kg/day of metronidazole for 10 days if they survived. Needle aspiration or open surgical drainage was performed in patients who deteriorated despite drug therapy or had an abscess that clinically appeared to be at risk of impending rupture. Survivors and nonsurvivors were compared by univariate and multivariate analysis to identify predictors of outcome. These predictors were then prospectively evaluated in a subsequent cohort of patients with ALA.

RESULTS

Twenty-four patients died during the acute phase. Significant differences between survivors and nonsurvivors were observed. A stepwise logistic regression suggested that a bilirubin level >3.5 mg/dl, encephalopathy, volume of abscess cavity, hypoalbuminemia (serum albumin level <2.0 g/dl), and the number of abscesses were independent risk factors for mortality. The duration of symptoms and type of treatment did not influence mortality. The regression equation derived was then applied prospectively to 64 subsequent patients with ALA, and the validity of the prediction rule was confirmed. The qualities of simplicity, availability, low cost of derivation, and good discriminating power suggest that this index would be useful in assessing prognosis in patients with ALA.

Ocular manifestations of AIDS

The acquired immune deficiency syndrome (AIDS) is a lethal multisystem disease. Its ocular manifestations have received relatively little attention in the literature. Between 73% and 100% of AIDS patients develop ocular lesions. The commonest lesions seen are retinal--either infectious or noninfectious retinopathy. Involvement of the conjunctiva with Kaposi's sarcoma, infected tears and infected cornea as well as the vitreous are less common. Infections with cytomegalovirus and varicella zoster virus are common causes of visual loss and can be treated with antiviral agents such as ganciclovir and foscarnet. This greatly increases the quality of life in these patients by preventing visual loss.

Trabeculectomy and manual clot evacuation in traumatic hyphaema with corneal blood staining

BACKGROUND

The management of traumatic hyphaema with raised intraocular pressure and corneal blood staining is difficult. Residual blood clots after anterior chamber washout are responsible for sustained postoperative elevation of intraocular pressure, even after trabeculectomy and clot evacuation.

METHODS

Thirty-five patients with traumatic hyphaema, elevated intraocular pressure and varying degrees of corneal blood staining underwent a combined trabeculectomy with manual clot evacuation from the anterior chamber in a general hospital.

RESULTS

The postoperative control of intraocular pressure was found to be adequate in all patients at the end of two months. Examination of the posterior segment was made possible earlier. Although the procedure is more complex, no significant complications were encountered.

CONCLUSION

In patients presenting with traumatic hyphaema, secondary glaucoma and corneal blood staining, trabeculectomy with manual extraction of the clot through a large incision appears to be a safe and reliable procedure where medical therapy fails to control the intraocular pressure.

Sensitive high-performance liquid chromatographic assay method for the determination of guggulsterone in serum

Guggulsterone (I) is a new hypolipidemic agent, being developed at CDRI (Lucknow, India). A sensitive high-performance liquid chromatographic assay in serum has been developed and validated for the determination of guggulsterone in serum for pharmacokinetic studies. This assay method consists of extraction of the drug with hexane from spiked human serum samples. Separation was achieved using C18 reversed-phase column coupled with photodiode array detector, and an acetonitrile-water mixture as mobile phase. The method described herein is simple and has limit of quantitation of 10 ng/ml as compared to 200 ng/ml by the previous reported method. The standard curve was linear over the range of 10-1000 ng/ml in mobile phase as well as in normal human serum. Analytical recovery of I added to serum was > 90%. The reproducibility was determined by the inter- and intra-assay variations which were < 10%.

Pharmacokinetic evaluation of percutaneous hepatic venous isolation for administration of regional chemotherapy

Hepatic artery infusion (HAI) chemotherapy has been used to treat patients with unresectable liver tumours. We report a preclinical study of the pharmacokinetics of HAI combined with hepatic venous drug extraction (HVDE) for regional administration of doxorubicin. HVDE was aided by a double balloon catheter inserted via femoral vein cutdown into the inferior vena cava to collect all hepatic vein blood. Pigs received doxorubicin 0.5-9.0 mg kg-1 over 90 min via HAI or systemic infusion (SYSI). HVDE was performed for 240 min. SYSI pigs underwent hepatic venous isolation without drug filtration. Doxorubicin levels were assayed using high-pressure liquid chromatography (HPLC). HAI/HVDE reduced systemic exposure to doxorubicin with equivalent hepatic exposure at all doses. Pharmacokinetic enhancement ranged from 7.0 to 22.3 for peak concentration, 8.8-23.2 for the area under the curve and 2.9-4.2 for tissue concentration. HAI/HVDE also prevented the mortality which was observed with SYSI administration of high-dose (5.0 and 9.0 mg kg-1) doxorubicin. We conclude that HAI/HVDE reduces systemic exposure to doxorubicin as compared with SYSI of equivalent doses. Pharmacokinetic enhancement indices suggest that HAI/HVDE may allow equivalent hepatic drug exposure with reduced systemic exposure. This method may be applicable to other drugs and to other anatomic settings in which enhanced regional drug delivery is desirable.

Characterisation and starvation induced regulation of methionine uptake sites in mouse mammary gland

The sites of methionine uptake by 10 day lactating mouse mammary gland were determined in vitro. Four modes of methionine entry characterised were: (i) A sodium-dependent, N-(methylamino) isobutyric acid (MeAIB)--sensitive system with a Vmax of 18.8 nmol/g cells/min (this mode of entry was similar to the A site in other tissues); (ii) A sodium-dependent, MeAIB--insensitive uptake system with a Vmax of 12.4 nmol/g cells/min); this mode of entry was inhibited by substrates preferred by ASC system); (iii) A sodium-independent, 2-amino-bicyclo heptane 2-carboxylic acid (BCH)-sensitive system L with a Vmax of 30 nmol/g cells/min; and (iv) A sodium-independent entry which was not inhibited by high concentrations of MeAIB or BCH. The Km value of each of the former three carrier mediated transport systems was 0.46 mM. Starvation of animals brought about important increase in the Vmax of the A system by 97% and that of ASC system by 1003% which was accompanied by similar increases in the Km values of these systems. These results show an adaptive regulation of these two sodium-dependent sites as a result of starvation.

An evaluation of hepatic extraction and clearance of doxorubicin

A swine model was developed to study quantitatively the pharmacokinetics of hepatic extraction and clearance of doxorubicin (DOX). Systemic and hepatic artery infusions of DOX (0.5-9 mg kg-1) were administered to 34 pigs. Pharmacokinetic analysis was simplified by use of a double-balloon catheter in the inferior vena cava to collect hepatic venous effluent. During hepatic artery infusion only, DOX in hepatic venous blood was extracted using activated carbon filters to prevent drug recirculation. Hepatic extraction and clearance of DOX were independent of dose and route of administration. Extraction ratios varied from 0.75 to 0.91 during hepatic artery infusion and from 0.50 to 0.72 during systemic infusion. Clearance results were analogous. After cessation of drug infusions, hepatic extraction and clearance of DOX was negative, suggesting that the liver serves as a drug reservoir during DOX infusion and subsequently is a net source of unmetabolised drug. Liver extraction and clearance of DOX in pigs are substantial. During either systemic or hepatic artery infusion of DOX, the liver serves as a drug reservoir. Subsequent mobilisation of this hepatic pool of DOX may cause prolonged systemic exposure to drug.

Long term follow-up of amebic liver abscess: clinical and ultrasound patterns of resolution

A prospective study was undertaken to evaluate the clinical and sonographic patterns of resolution in amebic liver abscess (ALA). There were 146 patients of ALA attending the gastroenterology clinic of a tertiary care centre of whom 25 died. Of the remaining 121 patients, 107 were followed up for 20.9 +/- 11.4 months. 14 (11.3%) patients were lost to follow up before complete disappearance of the cavity. Complete disappearance of the cavity was seen in 84 (78.5%) and a reduction in volume to 50% at entry in 23 (21.5%). Abdominal pain, fever and hepatomegaly were the predominant forms of clinical presentation. On ultrasound, there were 121 cavities in 107 patients. The most frequent type of lesion was solitary, (96%) round cavity (80.4%) in the right lobe of liver (85%). Clinical and hematological parameters of resolution occurred rapidly (3.2 +/- 2.9 months). Sonographic resolution took much longer (9.6 +/- 6.8% months) in the 84 patients. The remaining 23 patients are on follow up. Three pattern of resolution were observed: Type I--where complete disappearance of the cavity occurred within 3 months (29.8%), Type II--where a gradual reduction and disappearance of the cavity occurred (64.3%) and Type III--where a rapid reduction till 25% of original cavity size remained and then a delayed resolution occurred (5.9%). There were no relapses in the patients on follow up. Factors that influenced healing time included the size of the abscess cavity at admission, hypoalbuminemia and anemia. The type of clinical presentation, nature of therapy, number or location of abscesses and time for clinical resolution did not influence the resolution time. None of the variables studied influenced the pattern of resolution. We conclude that rapid clinical resolution is common in patients with ALA. Sonographic resolution may be delayed and does not warrant additional or prolonged therapy.

Hepatic artery infusion of doxorubicin with hepatic venous drug extraction

Hepatic artery infusion (HAI) has been used to take advantage of the steep dose-response relationship characteristic of chemotherapeutic agents. Systemic toxicity, however, remains the dose limiting factor for HAI of low hepatic extraction drugs. This investigation compared the pharmacokinetics of doxorubicin administered using a system that combines HAI and hepatic venous drug extraction (HVDE) versus systemic administration without HVDE. HAI was accomplished by transfemoral cannulation of the hepatic artery. HVDE was aided by use of a double-balloon catheter inserted fluoroscopically via femoral vein cutdown into the inferior vena cava. Inflation of the balloons above and below the hepatic veins allowed collection of hepatic venous effluent. Hepatic venous blood was pumped through the double-balloon catheter into an extracorporeal circuit with activated carbon filters to extract drug prior to return to the systemic circulation. Domestic female swine (25-35 kg) received 3 mg/kg doxorubicin over 90 min via HAI. HVDE was performed for 240 min following initiation of HAI (Time 0-240 min). Control swine underwent hepatic venous isolation using the double-balloon catheter without drug filtration and received 3 mg/kg doxorubicin over 90 min via systemic vein (SYSI). Serum and myocardial doxorubicin and doxorubicinol levels were assayed using HPLC. Blood was serially sampled from hepatic vein blood, from the extracorporeal circuit after filtration, and from a systemic artery. Area under the curve (AUC) was integrated from time-concentration plots over Time 0-180 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterisation of the routes of methionine transport in mouse mammary glands

The sites of methionine uptake by mammary glands from late pregnant and lactating mice were studied in vitro. Using the specific A system inhibitor, N-(methylamino) isobutyric acid (MeAIB) and the specific L system inhibitor, 2-amino-bicyclo (2.2.1) heptane 2-carboxylic acid (BCH), we have defined four modes of methionine entry into these tissues. (i) A sodium-dependent A system with a Vmax of 13.4 and 18.8 n mol/g cells/min in pregnant and lactating mice, respectively. This mode of entry was completely inhibited by MeAIB and its Km value was similar (0.45 mM) in both groups. (ii) A sodium-dependent mode with a Vmax of 6.7 and 12.4 n mol/g cells/min and a Km of 0.24 and 0.46 mM in pregnant and lactating mice, respectively. This mode of entry was insensitive to inhibition by MeAIB, and was similar to the ASC (alanine, serine, cysteine) system in other tissues. (iii) A sodium-independent L system with a Vmax of 13.8 and 30.0 n mol/g cells/min and a Km of 0.27 and 0.46 mM in pregnant and lactating mice, respectively. This mode of entry was completely inhibited by BCH. (iv) A sodium-independent non-specific entry amounting to 25 per cent of the total entry at 0.1 mM external methionine which was not inhibited by high concentration of BCH. The results of our studies show an increase in the number of active carriers of the A, ASC and L systems of methionine uptake in mammary glands of mouse during lactation.

AroD deletion attenuates Shigella flexneri strain 2457T and makes it a safe and efficacious oral vaccine in monkeys

The aromatic-dependent live Shigella flexneri 2a vaccine strain SFL1070, with a deleted aroD gene, had a much reduced intracellular growth in HeLa cells compared with its parent strain S. flexneri 2457T. S. flexneri SFL1070 gave no adverse effects in eight Macaca fascicularis monkeys orally vaccinated with four doses of 1 x 10(11) live bacteria within a 5-week period, whereas S. flexneri 2457T caused dysentery in all eight non-vaccinated monkeys. Thus the aromatic dependency rendered S. flexneri SFL1070 significantly attenuated (p = 0.00008). Significant intestinal S. flexneri lipopolysaccharide (LPS)-specific sIgA responses were seen in seven of eight vaccinated monkeys (p < 0.01) after four doses with SFL1070. However, serum IgG or IgA responses to various S. flexneri LPS antigens and the invasion plasmid antigens (Ipa-s) were seen in only four of eight vaccinated monkeys. The serum IgG titre increases against S. flexneri Y and 2a LPS reached significant levels (p < or = 0.05). All but one of the vaccinated monkeys were protected against oral challenge with 1 x 10(10) or 1 x 10(11) live S. flexneri 2457T given 2 weeks after the last vaccination. The protection was highly significant (p = 0.0007) as all non-vaccinated monkeys challenged with equal doses of strain 2457T developed dysentery. Three of them succumbed. Challenge infection of vaccinated monkeys elicited serum IgA and IgG responses to the homologous S. flexneri 2a LPS in three monkeys each (0.005 < or = p < or = 0.025). Serum IgA and IgG responses to the Ipa-s were seen in five and four monkeys each (0.01 < p < or = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Induction of a humoral immune response to a Shiga toxin B subunit epitope expressed as a chimeric LamB protein in a Shigella flexneri live vaccine strain

Shigella flexneri vaccine strain (SFL124) given orally, evokes humoral immune response in human volunteers. Such a strain, expressing antigenic epitope of B subunit of Shiga toxin, would also provide immunity to the toxin produced by some species of Shigella. A synthetic oligonucleotide, specifying an epitope [13-26 amino acids (aa)] of the B subunit of Shiga toxin, was inserted into the lamB gene of Escherichia coli and expressed in the S. flexneri vaccine strain. The chimeric LamB protein functioned normally and the epitope was expressed at the surface of the bacteria. The animals immunized with the live bacteria, expressing the epitope or sonicated lysates, showed a humoral response that was specific to the peptide (13-26 aa) and to the whole B subunit molecule. The elicited antisera neutralized the toxin activity on HeLa cells up to 40%, while the purified IgG fractions from the sera gave 90% neutralization.

Enzymatic synthesis and isolation of thymidine diphosphate-6-deoxy-D-xylo-4-hexulose and thymidine diphosphate-L-rhamnose. Production using cloned gene products and separation by HPLC

A two-step enzymatic synthesis of dTDP-L-rhamnose is developed using enzymes from sonicated extracts of cultures of Escherichia coli K12 strains harboring plasmids containing different parts of the rfb gene cluster of Salmonella enterica LT2. The intermediate dTDP-6-deoxy-D-xylo-4-hexulose was isolated after a 1-h reaction, using only dTDP-D-glucose and dTDP-D-glucose 4,6-dehydratase, followed by protein precipitation and desalting by gel chromatography (yield 89%). In a two-step reaction using dTDP-D-glucose and dTDP-D-glucose 4,6-dehydratase in the first step, and with NADPH, dTDP-6-deoxy-D-xylo-4-hexulose 3,5-epimerase and NADPH:dTDP-6-deoxy-L-lyxo-4-hexulose-4-reductase in the second hour of incubation, the dTDP-D-glucose was fully converted to dTDP-L-rhamnose. The hexoses of both products were identified by mass spectroscopy. The molar yield of dTDP-L-rhamnose, after protein precipitation, anion-exchange chromatography and desalting by gel chromatography, was 62%, corresponding to more than 150 mg, starting from 250 mg of dTDP-D-glucose. When stored lyophilysed under nitrogen, these products were found to be stable for several months. Both dTDP-6-deoxy-D-xylo-4-hexulose and dTDP-L-rhamnose have light absorption maxima at 267 nm, with molar absorption coefficients close to that of dTMP. However, the absorption coefficient of dTDP-6-deoxy-D-xylo-4-hexulose at the absorption maximum of 320 nm (specific for sugars containing keto groups) was found to be approximately 20% higher than values presented earlier. Furthermore, an HPLC technique is presented for determining the net activity of dTDP-6-deoxy-D-xylo-4-hexulose 3,5-epimerase and NADPH:dTDP-6-deoxy-L-lyxo-4-hexulose-4-reductase, based on separation of dTDP-6-deoxy-D-xylo-4-hexulose and dTDP-L-rhamnose. The HPLC technique is also suitable for determination of all the nucleotide components involved in the synthesis.

Clinical profile of multiple amoebic liver abscesses

Of 70 consecutive patients with amoebic liver abscess admitted over a 3 year period, 15 (21.4%) had multiple abscesses. This condition, like solitary abscess, was a disease of the 2nd to 5th decade with a male preponderance. Multiple abscesses were more frequently associated with fever, jaundice, upper abdominal pain, pneumonitis and tender hepatomegaly. The left lobe of the liver was always enlarged in patients with multiple abscesses and 86% of patients required drainage of an abscess cavity. The presence of more severe clinical course, jaundice and left lobe hepatomegaly should raise the suspicion of multiple abscesses. After confirmation of the diagnosis by imaging technique, the abscess cavity should be aspirated for quick relief and cure.

Identification and sequence of rfbS and rfbE, which determine antigenic specificity of group A and group D salmonellae

Salmonella group A, group B, and group D strains have paratose, abequose, and tyvelose, respectively, as the immunodominant sugar in their O antigens, which are otherwise identical; only the final steps differ in the biosynthetic pathways of these sugars. The gene rfbJ from a group B strain, encoding abequose synthase, the final and only unique step in the biosynthesis of CDP-abequose, has been cloned and sequenced (P. Wyk and P. Reeves, J. Bacteriol. 171:5687-5693, 1989). In this study, we locate and sequence rfbS and rfbE from serovars typhi and paratyphi, representative of groups A and D. Gene rfbS is present in both groups and encodes paratose synthase, which carries out a step parallel to that of abequose synthase, but the product is CDP-paratose. The DNA and inferred amino acid sequences are compared with those of rfbJ. We conclude that the genes are homologous, but the divergence is extremely ancient. Gene rfbE encodes CDP-tyvelose epimerase, which converts CDP-paratose to CDP-tyvelose in group D strains; the gene is active in group D strains, and we find it to be present in a mutant form in group A strains. These two genes encode the steps unique to groups A and D and, like rfbJ of group B, are of low G+C content, suggesting transfer from outside of salmonellae. The evolutionary origin of these genes is discussed.

Serum alpha-feto protein in amoebic liver abscess

Serum alpha-feto protein (AFP) levels were determined using a sensitive and specific ELISA technique in healthy persons (40), patients with amoebic liver abscess (ALA, 70) and hepatocellular carcinoma (HCC, 20). The AFP levels in normal persons ranged between 0 to 20 ng/ml. Most of ALA patients had AFP levels in the normal range; only a small proportion (14.3%) showed elevated levels (range 20-75 ng/ml). Sera from HCC patients had significantly high AFP values in the range of 25 to 340 ng/ml as compared to normal controls and ALA patients. An analysis of serial samples from 10 ALA patients in convalescent phase showed no difference in AFP level during acute and convalescent phase of infection.

Electrophysiologic validation of two categories of dementias--cortical and subcortical

Recently, the dementias have been classified into 2 categories-Cortical (CD) and Subcortical (SD). Some studies have questioned this classification. We attempted to validate the classification on electrophysiologic grounds. Fourteen of 15 patients with SD had relatively normal EEGs as compared to only 3 of 15 patients with CD, matched for age, sex and severity of dementia (p greater than 0.01). SER test results were often abnormal in the SD group but always normal in CD patients. These preliminary data appear to validate the classification of dementias into SD and CD categories.

Bilateral idiopathic inflammatory pseudotumor of the orbits

Four cases of bilateral orbital idiopathic inflammatory pseudotumors are analysed as regards their clinical, CT and ultrasonographic features. Bilateral orbital involvement tends to occur in a younger age group while optic nerve involvement is invariable. Certain echographic features like variation of angle kappa, increase in the width of retrobulbar fat complex and decreased orbital pulsations on M-scan are highlighted.

Pharmacokinetics of valproic acid in young and elderly subjects

The disposition of valproic acid was studied following single dose intravenous administration in seven young male volunteers aged 20-35 years and six elderly male in-patients aged 75-87 years. Following administration of 400 mg sodium valproate, blood samples were collected for 48 h and valproic acid concentrations analysed by enzymatic immunoassay. The median elimination half-life was 7.2 h in the young subjects but 14.9 h in the elderly patients (P less than 0.01). However, clearance did not differ significantly between groups, the values for young and old being 0.69 and 0.58 1/h respectively. The prolonged half-life resulted from a greater volume of distribution in the elderly. The median values (1/kg) for young and old were 0.13 and 0.19 respectively (P less than 0.01). These pharmacokinetic changes are unlikely to be of clinical importance.

A three-year controlled follow-up study of persons identified in a mass screening program for diabetes

Each of 529 persons identified as positive in a diabetes mass screening industrial program was matched with a negative screenee of the same sex, race, age, and place of employment. A confirming glucose tolerance test classified the positive screenees into three groups: confirmed (204), not confirmed (141), and not tested (184). The confirmed group was slightly older than the other two groups. A three-year follow-up by means of a mail questionnaire showed that death occurred more frequently in confirmed positives (7 per cent); the self-perceived, current health state was poorer for the confirmed positives than for their controls, with no differences between the other positive and control groups; and significant weight loss occurred in confirmed and not tested positives. A positive screening test resulted in increased early contact with physicians, but only confirmed positives had evidence of continuing increased contact. Oral antidiabetic medications were currently prescribed for 28, 17, and 1 per cent, respectively, for the confirmed, the not tested, and the not confirmed positives. With no clear evidence of modification of the subjects' behavior toward continued medical care and, considering the potential harm of improper or early exhibition of oral drugs or the incorrect labeling of persons as diabetic, the possible benefits of early physician intervention and weight loss do not appear to offset the potential nonbenefit of mass screening. These conclusions have resulted in modification of the Cleveland program to one of discriminate screening rather than indiscriminate mass screening.