Steinernema shori n. sp., a new entomopathogenic nematode (Nematoda: Steinernematidae) from India

In this study, morphological and molecular features were used to identify a new Steinernema sp. from Chhattisgarh, India. Morphological and molecular features provide evidence for placing the new species into the "bicornutum" clade. The new species is characterized by the following morphological features: infective juveniles with a body length of 587 (494-671) μm; a distance from the anterior end to excretory pore of 46 (43-50) μm; a distance from anterior end to nerve ring of 72 μm (61-85 μm); and E% of 88 (77-97). The first-generation males are characterised by 27 genital papillae and very short spicules, with a length of 61 μm (53-67) μm. The SW% and GS% ratio of S. shori n. sp. are 139 (107-190) and 75 (62-90), respectively. The new species is further characterized by sequences of the internal transcribed spacer and partial 28S regions of the ribosomal DNA. Phylogenetic analyses show that S. shori n. sp. is most closely related to S. abbasi, S. kandii, and S. yirgalemense.

A comparative evaluation of anesthetic efficacy of articaine 4% and lidocaine 2% with anterior middle superior alveolar nerve block and infraorbital nerve block: An in vivo study

BACKGROUND

The ideal maxillary injection should produce a rapid onset of profound pulpal anesthesia for multiple teeth from a single needle penetration. The main objective is to compare the efficacy of articaine 4% and lidocaine 2% and to compare anterior middle superior alveolar nerve block (AMSANB) and infraorbital nerve block (IONB) for anesthesia of maxillary teeth.

MATERIALS AND METHODS

Forty patients undergoing root canal treatment of maxillary anteriors and premolars were included and randomly divided into four groups of ten each. Group I: patients receiving AMSANB with articaine, Group II: Patients receiving IONB with articaine, Group III: Patients receiving AMSANB with lidocaine, Group IV: Patients receiving IONB with lidocaine. The scores of onset of anesthesia and pain perception were statistically analyzed.

RESULTS

Onset of action was fastest for articaine with AMSANB and slowest for lidocaine with IONB by Tukey's test. A significant change was observed in the electrical pulp test readings at onset and at 30 min by paired t-test. All patients experienced mild pain during the procedure recorded by visual analog scale.

CONCLUSION

Articaine 4% proved to be more efficacious than lidocaine 2%, and AMSANB was more advantageous than IONB in securing anesthesia of maxillary anteriors and premolars.

Rare case of double looped ansa cervicalis associated with its deep position in the carotid triangle of the neck

Ansa cervicalis (AC) frequently shows its variations in the formation and distribution pattern. However, variation in its looping pattern associated with abnormal topographic disposition is relatively rare. Knowledge on the possible deviations in the looping pattern is clinically important, to avoid iatrogenic injuries in surgical procedures. We report here a concurrent rare case of double looped AC located deep to internal jugular vein. Anatomy of its superior root was normal, but the usual appearance of inferior root had gone astray due to formation of double loop. AC is being popularly used for nerve reconstructive surgery in treating paralyzed larynx, tongue hemiatrophy. Anatomical variation of it may potentially jeopardize the surgical procedures. Therefore, it is essential to the surgeons to be familiar with its unusual variations.

Glossopharyngeal neuralgia due to vascular compression by tortuous left posterior inferior cerebellar artery: a high strength (1.5 T) MRI study

Glossopharyngeal neuralgia is a rare condition with a frequency about 1% of that of trigeminal neuralgia. Vascular compression is a common and treatable cause of glossopharyngeal neuralgia. Microvascular decompression of the glossopharyngeal nerve is an effective treatment option for patients in whom the disease is caused by compression of the nerve by a blood vessel. Pre-operative detection of the pathology on imaging has become possible with high strength MRI imaging. We describe the case of a 54-year-old man with left glossopharyngeal neuralgia. Constructive interference in steady-state (CISS) and flow sensitive Gradient Echo MRI sequences clearly demonstrated the compression of the IX nerve by the left posterior inferior cerebellar artery (PICA). The patient was operated upon and a Teflon graft was put in between the nerve and the vessel. The intra-operative photographs and post-operative images are also presented here. After surgery, the patient improved symptomatically with no recurrence of the symptoms in the follow-up period of about eight months.

Effect of fractionated regional external beam radiotherapy on peripheral blood cell count

PURPOSE

The purpose of this study was to assess the need for obtaining weekly complete blood count (CBC) values and to identify the pattern of changes in CBC during regional conventional fractionated radiotherapy.

METHODS AND MATERIALS

A retrospective analysis of CBC data on 299 adult cancer patients who received definitive conventional radiotherapy to head and neck (n = 95), chest (n = 96), and pelvis (n = 108) was performed. Temporal patterns and magnitude of change in white blood cells, neutrophils, lymphocytes, and platelets during radiotherapy were examined.

RESULTS

There were statistically significant declines in all counts, albeit not clinically significant. Notable differences between disease sites were found. The greatest weekly interval change in counts occurred during the first week of radiotherapy for all groups of patients. The mean WBC nadir values during treatment were 5.8 for head & neck, 6.8 for chest, and 5.4 for pelvis. The nadirs for all counts occurred toward the middle-to-end of radiotherapy. Lymphocytes were found to be more sensitive to radiotherapy than other leukocyte subcomponents.

CONCLUSION

Our study suggests that weekly CBC monitoring is not necessary for all patients undergoing standard fractionated radiotherapy. Baseline blood counts may be used to determine an optimal schedule for monitoring CBCs in patients receiving conventional radiation alone. Reduced monitoring of CBC may result in significant financial savings.

Prevalence of rheumatic diseases in a rural population in western India: a WHO-ILAR COPCORD Study

BACKGROUND

COPCORD (Community oriented program from control of rheumatic diseases) is a global initiative of the WHO/International League of Associations from Rheumatology (ILAR). The prevalence data from the first Indian COPCORD survey (Stage 1), carried out in village Bhigwan (Dist. Pune), in 1996, is presented.

AIM

To study the rural prevalence of rheumatic-musculoskeletal symptoms/diseases (RMSD).

METHODS

A cross-sectional survey of the village (non-randomised selection) was completed in five weeks, using validated questionnaires, served by 21 trained volunteers. 746 patients (18.2%, 95% CI: 17-1-19-4) were identified (Phase 1) from 4092 adults (response 89%), and systematically evaluated (Phase 2 and 3) by a medical team, including a rheumatologist; limited investigations were carried out and diagnosis confirmed during a planned 12 week initial follow-up. Standard clinical criteria were used for the diagnosis; point prevalence estimates (prev)/confidence interval (CI) are shown in parenthesis.

RESULTS

There was a dominant distribution of 'pain at all sites' (articular/soft tissues) in the females; painful neck (9.5%), back (17.3%), and calf (8.5%) appeared significant when compared to the Bhigwan males and the Indonesian and the Chinese rural COPCORD results. 55% RMSD were due to soft tissue rheumatism (5.5%) and an ill-defined/unclassifiable symptom-related-diagnosis (7.1%). Osteoarthritis (5.8%) and inflammatory arthritis (IA) were seen in 29% and 10% patients respectively. 240 patients (5.9%) with chronic knee pains did not show any clinical evidence of OA. The prev of rheumatoid arthritis (0.5%, 95% CI: 0.3-0.7), as classified by the American College of Rheumatology, was the highest ever reported from an Asian rural COPCORD study. Though unclassifiable IA (0.9%, 95% CI: 0.6-1.1) was seen, well defined reactive arthritis, TB, leprosy and connective tissue disorders were not observed. Gout was diagnosed in five patients (0.12%).

CONCLUSIONS AND DISCUSSION

The Bhigwan COPCORD survey demonstrates a significant rural spectrum of RMSD. It provides a reasonable speculation about the Indian rheumatological burden. Further, an eight year prospective study is in progress to identify new cases and risk factors, and educate people (Stages 2 and 3).

Transferrin receptor expression by blast cells in acute lymphoblastic leukemia correlates with white cell count & immunophenotype

Transferrin receptor (TR) expression by blast cells in 127 cases of acute lymphoblastic leukemia (ALL) at presentation and 19 cases at relapse was examined using three anti-TR monoclonal antibodies to find its correlation with prognostic features such as the total leucocyte count (TLC), the morphology of blast cells and their cytochemical and immunophenotypic properties, as well as age and sex of the patients. Blasts in 62 per cent of thymic (T) ALL cases at presentation showed significant TR expression as compared to only 10.9 per cent in common ALL (CALL) (P < 0.001). This differential expression of TR was also observed among cases with > 50 x 10(9)/l TLC, while in cases with < 50 x 10(9)/ l TLC no such pattern was observed (30% TR positivity in T-ALL vs 20% TR positivity in non-T-ALL). Furthermore, the percentage of TR positive blasts was significantly higher (P < 0.005) in cases with > 50 x 10(9)/l TLC as compared to those with < 50 x 10(9)/l (48.3-54.4% vs 24.9-28.8%). In contrast to CALL cases at presentation, those at relapse showed a very high TR positivity (54-66%), similar to the T-ALL cases (53-84%). This suggests a high proliferative rate of blast cells in ALL at relapse, irrespective of its immunophenotype. There was no correlation of TR expression with blast cell morphology (FAB L1 vs L2), their cytochemical properties and sex of the patients. However, a significantly higher incidence of TR positivity was observed in patients above 10 yr of age compared to those below 10 yr (47% vs 15%; P < 0.001). The incidence of T-ALL was also significantly higher in the former group (56%) compared to the latter (33%) (P < 0.005). Our data suggest that by virtue of its association with features of poor prognosis, e.g., age above 10 yr, expression of thymic markers, high leucocyte count and disease relapse, TR expression by blast cells in ALL could serve as a biological marker of poor prognosis.

DNA ploidy analysis of hepatic preneoplastic and neoplastic lesions in woodchucks experimentally infected with woodchuck hepatitis virus

We analyzed the DNA ploidy and the nuclear size of hepatocytes within hepatocellular carcinoma, putative preneoplastic (clear cell and basophilic foci) and adjacent non-neoplastic liver in 30 woodchucks neonatally infected with the woodchuck hepatitis virus. In livers from control woodchucks, in clear cell foci and in most chronic portal hepatitis, the hepatocytes were diploid, with less than 10% tetraploid cells. Aneuploid peaks were found in 50% of the livers with chronic active hepatitis, in 63% of basophilic foci and in 90% of hepatocellular carcinoma. Within the same tumor, aneuploid peaks with different DNA indices were observed frequently, indicating heterogeneity of tumor. S-phase was always elevated, indicating an increased rate of proliferation. Aneuploid cells had nuclei that were larger than those of control liver cells. In some basophilic foci and in some livers with chronic active hepatitis, abnormal DNA was demonstrated before the development of hepatocellular carcinoma, suggesting that these may be populations of hepatocytes at risk of neoplastic transformation.

Image analysis versus flow cytometry for DNA ploidy quantitation of solid tumors: a comparison of six methods of sample preparation

With the availability of user-friendly interactive image analysis instruments for DNA analysis, there is a growing need for comparison with the established methodology of flow cytometry. We have compared the results of DNA ploidy quantitation in 12 solid tumors prepared by six different techniques of sample preparation: flow cytometry of fresh cell suspensions and of nuclei isolated from formalin-fixed, paraffin-embedded tissue; and image analysis of touch preparations, of disaggregated cells from paraffin-embedded tissue as well as of 3- and 7-microns-thick tissue sections. Complete agreement in DNA ploidy results obtained by the six methods was found in six out of 12 solid tumors. Image analysis of touch preparations detected most tetraploid and multiple aneuploid peaks. Sections of 7-microns-thick tissue gave better histogram quality than 3-microns-thick sections, however tetraploid peaks were not resolved in one case. Image analysis of disaggregated paraffin-embedded tumor showed comparable ploidy to fresh touch preparations in seven out of 12 cases, the discrepancies being due to loss of tetraploid or multiple aneuploid peaks. Flow cytometry gave good histograms, but tetraploid and multiple aneuploid peaks were occasionally not detected. Each method presents advantages and disadvantages. Flow cytometry and image analysis are complementary methods for DNA quantitation, and more than one method may be necessary to confirm the DNA content of solid tumors.

Tumor-associated glycoprotein distribution detected by monoclonal antibody B72.3 in salivary neoplasia

The expression of tumor-associated glycoprotein (TAG-72), an oncofetal mucin-like tumor-associated glycoprotein derived from membrane-enriched fractions of metastatic breast carcinoma, has been detected by monoclonal antibody (MoAb) B72.3 in adenocarcinomas of breast, colon, lung, endometrium, pancreas, and ovary. The authors reported the scope of TAG-72 expression detected by MoAb B72.3 in salivary neoplasia. They examined 96 salivary lesions (53 malignant and 37 benign primary tumors, 2 metastatic carcinomas, and 4 other benign lesions) and 17 normal tissues from parotid glands and found: diffuse TAG-72 expression in 29 of 55 (53%) malignant tumors and 6 of 36 (17%) benign tumors and in no normal tissue; focal TAG-72 expression in 10 of 55 (17%) malignant salivary tumors, 10 of 37 (25%) benign salivary tumors (all benign mixed tumors), and 1 of 17 (6%) histologically normal parotid gland ducts. Any expression of TAG-72, whether diffuse or focal, was found to have a 71% sensitivity for detecting salivary malignant tumors, but an unacceptably low specificity for malignant lesions (57%). Alternatively, if only diffuse TAG-72 expression was regarded as indicative of malignancy, the specificity of diffuse TAG-72 expression was 86%, but sensitivity of detection decreased to 53%. The authors studied a subset of benign and malignant mixed tumors (BMT and MMT) and found that 12 of 15 (80%) MMT diffusely and strongly expressed TAG-72, 2 of 15 MMT (13%) expressed TAG-72 focally, and 1 MMT (7%) was nonreactive. By contrast, most BMT did not express TAG-72; only sparse, focal TAG-72 expression was seen in 10 of 27 (37%) BMT. If diffuse TAG-72 expression is considered indicative of malignancy, its sensitivity and specificity for malignant mixed tumors is 80% and 100%, respectively. The authors suggest that diffuse TAG-72 expression may resolve conflicts in determining whether or not a mixed tumor is malignant.

Salivary duct carcinoma (cribriform salivary carcinoma of excretory ducts). A clinicopathologic and immunohistochemical study of 12 cases

Salivary duct carcinoma (cribriform salivary carcinoma of the excretory ducts [CSCED]) is an uncommon malignant tumor which occurs predominantly in men (83% in this series; mean age, 61 years) and most often in the parotid gland (92% in this series). The outcome is unfavorable for most patients; of 11 of 12 patients with follow-up, 45% had local recurrence, 54% had distant metastasis, and 45% were dead of disease within 10 years of diagnosis (mean, 3 years). Metastases to lymph nodes were common (72%). Immunohistochemical studies on paraffin-embedded tissue revealed that most tumors reacted with antibodies known to mark adenocarcinoma: B72.3 (11 of 11) and Lewis Y (ten of ten). High and low molecular weight cytokeratins were present in most tumors (nine of ten and seven of nine cases, respectively), supporting the concept that these adenocarcinomas were of ductal origin. Parotid ducts adjacent to CSCED expressed B72.3 in six of nine cases studied, but parotid ducts from normal tissue (adjacent to benign mixed tumors or enlarged periparotid lymph nodes) rarely expressed this marker (one of 17 cases). The detection of B72.3 diffusely in parotid ducts, especially those with atypia, may imply the presence of malignant tumor nearby, which could be useful in evaluating limited tissue from the parotid. However, further studies are necessary to confirm the significance of this finding.

Amyotrophic lateral sclerosis in Nova Scotia

A study of ALS incidence in Nova Scotia for a ten year period was carried out with the cooperation of neurologists, neurosurgeons, physiatrists and major medical hospitals. Over a ten year period 161 cases occurred, an incidence of 1.95 per 100,000 population in a province with a population of 825,000. There was an increase in incidence over the ten year period, with an incidence for the first five years of study of 1.50 per 100,000, and 2.40 per 100,000 for the latter five years. The peak incidence in 1981-1982 was 2.66 per 100,000. Although this is the highest incidence in community studies of ALS (excepting the unusual circumstances in Guam), it may reflect the realistic incidence of ALS rather than an unusual focus, as ascertainment was likely greater than in many other studies. The more significant finding is the suggestion of an increasing incidence, as noted in other studies in the U.S., England and Israel.

Expression of sialic acid on the alveolar surface of adult and fetal human lungs

Lung alveoli are coated by a thin layer of extracellular material rich in anionic charges. The nature of this acid layer and its relationship to the phospholipid surfactant are not known. We investigated the possible presence of sialic acid groups by light and electron microscopy in tissues from normal fetal and adult lungs, using neuraminidase treatment followed by staining with the galactose-binding lectin from peanut, labeled with peroxidase. Our results showed that adult lung does not bear peanut lectin-reactive sites but that a very thin and distinct reactive layer becomes evident after neuraminidase treatment, especially on type II pneumocytes. In fetal lung, the entire surface of the developing respiratory tree is outlined by a strongly peanut lectin-reactive layer even if neuraminidase digestion is not performed. We conclude that the acid coat of the alveolar lining is in part composed of sialic acid residues and that sialic acid is added to the fetal lung as the alveoli mature.

Globular Mallory-like bodies in renal cell carcinoma: report of a case and review of cytoplasmic eosinophilic globules

The case of a patient who had renal cell carcinoma with cytoplasmic eosinophilic globular hyaline bodies antigenically similar to Mallory bodies, highly suggestive of globular type III alcoholic hyalin, is presented. Mallory bodies are not found exclusively in the liver, having also been demonstrated in the lung. The renal tumor in this case represents an additional extrahepatic site.