Single-centre experience with peptide receptor radionuclide therapy for neuroendocrine tumours (NETs): results using a theranostic molecular imaging-guided approach

AIM

To summarise our centre's experience managing patients with neuroendocrine tumours (NETs) in the first 5 years after the introduction of peptide receptor radionuclide therapy (PRRT) with [177Lu]Lu-DOTA-octreotate (LUTATE). The report emphasises aspects of the patient management related to functional imaging and use of radionuclide therapy.

METHODS

We describe the criteria for treatment with LUTATE at our centre, the methodology for patient selection, and the results of an audit of clinical measures, imaging results and patient-reported outcomes. Subjects are treated initially with four cycles of ~ 8 GBq of LUTATE administered as an outpatient every 8 weeks.

RESULTS

In the first 5 years offering LUTATE, we treated 143 individuals with a variety of NETs of which approx. 70% were gastroentero-pancreatic in origin (small bowel: 42%, pancreas: 28%). Males and females were equally represented. Mean age at first treatment with LUTATE was 61 ± 13 years with range 28-87 years. The radiation dose to the organs considered most at risk, the kidneys, averaged 10.6 ± 4.0 Gy in total. Median overall survival (OS) from first receiving LUTATE was 72.5 months with a median progression-free survival (PFS) of 32.3 months. No evidence of renal toxicity was seen. The major long-term complication seen was myelodysplastic syndrome (MDS) with a 5% incidence.

CONCLUSIONS

LUTATE treatment for NETs is a safe and effective treatment. Our approach relies heavily on functional and morphological imaging informing the multidisciplinary team of NET specialists to guide appropriate therapy, which we suggest has contributed to the favourable outcomes seen.

Electrocatalytic oxidation of ethanol at Pd, Pt, Pd/Pt and Pt/Pd nano particles supported on poly 1,8-diaminonaphthalene film in alkaline medium

An ethanol oxidation reaction (EOR) in alkaline medium was carried out at palladium (Pd) or platinum (Pt) nanoparticles/poly 1,8-diaminonaphthalene (p1,8-DAN) composite catalyst electrodes. Pd and Pt were incorporated onto a p1,8-DAN/GC electrode by a cyclic voltammetry (CV) strategy. The obtained Pd/p1,8-DAN/GC, Pt/p1,8-DAN/GC, Pt/Pd/p1,8-DAN/GC and Pd/Pt/p1,8-DAN/GC modified electrodes were characterized by scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDX) and cyclic voltammetry (CV) techniques. Electrode surface areas (ESAs) of the obtained catalysts were calculated by carbon monoxide (CO) adsorption using differential electrochemical mass spectroscopy (DEMS). The electrocatalytic oxidation of ethanol (EtOH) at the catalyst electrodes was considered in 0.5 M NaOH solutions by CV and chronoamperometric techniques. The catalyst electrodes significantly enhanced the catalytic efficiency for EOR compared to a bare glassy carbon (GC) electrode. Bimetallic catalyst electrodes demonstrate improved catalytic activity, superior durability and higher tolerance to (CO) poison generated in the development of EOR compared with Pd/p1,8-DAN and Pt/p1,8-DAN catalysts, giving priority to Pt/Pd/p1,8-DAN/GC electrodes. Viability parameters, such as NaOH and EtOH concentrations, scan rate and upper potential limits, were examined and analyzed. This study suggests that the prepared catalysts have pronounced potential applications in direct EOR in fuel cells.

An ethanol oxidation reaction (EOR) in alkaline medium was carried out at palladium (Pd) or platinum (Pt) nanoparticles/poly 1,8-diaminonaphthalene (p1,8-DAN) composite catalyst electrodes.

Retrospective cohort analysis of neoadjuvant treatment and survival in resectable and borderline resectable pancreatic ductal adenocarcinoma in a high volume referral centre

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease. Neoadjuvant therapy (NA) with chemotherapy (NAC) and radiotherapy (RT) prior to surgery provides promise. In the absence of prospective data, well annotated clinical data from high-volume units may provide pilot data for randomised trials.

METHODS

Medical records from a tertiary hospital in Sydney, Australia, were analysed to identify all patients with resectable or borderline resectable PDAC. Data regarding treatment, toxicity and survival were collected.

RESULTS

Between January 1 2010 and April 1 2016, 220 sequential patients were treated: 87 with NA and 133 with upfront operation (UO). Forty-three NA patients (52%) and 5 UO patients (4%) were borderline resectable at diagnosis. Twenty-four borderline patients received NA RT, 22 sequential to NAC. The median overall survival (OS) in the NA group was 25.9 months (mo); 95% CI (21.1-43.0 mo) compared to 26.9 mo (19.7, 32.7) in the UO; HR 0.89; log-ranked p-value = 0.58. Sixty-nine NA patients (79%) were resected, mOS was 29.2 mo (22.27, not reached (NR)). Twenty-two NA (31%) versus 22 UO (17%) were node negative at operation (N0). In those managed with NAC/RT the mOS was 29.0 mo (17.3, NR). There were no post-operative deaths with NA within 90-days and three in the UO arm.

DISCUSSION

This is a hypothesis generating retrospective review of a selected real-world population in a high-throughput unit. Treatment with NA was well tolerated. The long observed survival in this group may be explained by lymph node sterilisation by NA, and the achievement of R0 resection in a greater proportion of patients.

Nyquist-shaped dispersion-precompensated subcarrier modulation with direct detection for spectrally-efficient WDM transmission

The use of single-sideband subcarrier modulation (SCM) with Nyquist (N) pulse shaping for cost-effective spectrally-efficient wavelength division multiplexed transmission with direct detection is described. Transmission of digitally pre-compensated 7 × 11 GHz-spaced QPSK SCM channels at 14 Gb/s per channel is experimentally demonstrated over distances of up to 800 km of uncompensated standard single-mode fiber (SSMF) (13440 ps/nm chromatic dispersion).

Designing a miniaturised heated stage for in situ optical measurements of solid oxide fuel cell electrode surfaces, and probing the oxidation of solid oxide fuel cell anodes using in situ Raman spectroscopy

A novel miniaturised heated stage for in operando optical measurements on solid oxide fuel cell electrode surfaces is described. The design combines the advantages of previously reported designs, namely, (i) fully controllable dual atmosphere operation enabling fuel cell pellets to be tested in operando with either electrode in any atmosphere being the focus of study, and (ii) combined electrochemical measurements with optical spectroscopy measurements with the potential for highly detailed study of electrochemical processes; with the following advances, (iii) integrated fitting for mounting on a mapping stage enabling 2-D spatial characterisation of the surface, (iv) a compact profile that is externally cooled, enabling operation on an existing microscope without the need for specialized lenses, (v) the ability to cool very rapidly, from 600 °C to 300 °C in less than 5 min without damaging the experimental apparatus, and (vi) the ability to accommodate a range of pellet sizes and thicknesses.

Demands for vascular access in a renal dialysis unit: Implications for a regional vascular unit

BACKGROUND

The development of regional dialysis units and the expanding indications for dialysis has led to increased demand for vascular access surgery. Consequently, the provision and maintenance of access, and the management of related complications has created a considerable burden on vascular surgical units in hospitals providing renal replacement therapy (RRT).

AIMS

The objectives of our study were to review our experience with a variety of vascular access modalities for haemodialysis and to quantify the associated surgical workload.

METHODS

We reviewed our experience in a consecutive group of dialysis patients who had access surgery for RRT in a regional hospital setting.

RESULTS

Between January 1995 and January 2000, 69 patients entered the long-term dialysis programme in the Mid-Western region (population = 320,000). Of the 158 procedures performed, 138 (87%) were for access creation, and 20 (13%) related to access revision procedures. Twenty patients (29%) developed a total of 30 access related complications. Vascular access procedures accounted for 10% of the vascular surgical workload (1598 procedures) in the five-year period.

CONCLUSION

Vascular access is an important part of the haemodialysis services and surgical expertise should be available at local level to cope with likely demand.

Prevalence of smoking among Karachi population

AIMS

To determine the prevalence of smoking in Karachi population and compare it with previous studies to see if any change has occurred in this addiction.

SETTING

Cross sectional survey in 5 districts of Karachi, using a questionnaire.

SUBJECTS AND METHODS

Apparently healthy subjects from 25 areas covering 5 districts of Karachi were interviewed regarding their smoking habits, ethnic origin, socioeconomic strata and the education level. Two modes of interview were adopted, one was a house to house and the other was interview at public places.

RESULTS

Previous studies showed a 21-32.3% prevalence of smoking which is almost similar to 32.7% seen in this study. In the present study highest frequency of smoking was seen in college going male students belonging to 21-25 years while in females majority were graduates belonging to 26-30 years age group. The age at which most cases acquired this habit was between 15-25 years and in majority it was introduced by friends. Although most knew that smoking was hazardous for health and many cases did make an attempt to quit but very few were able to get rid of this addiction.

CONCLUSION

Over the past few decades not much change has been seen in the frequency of smoking in our population. Stronger anti smoking campaigns using press and other media are required to improve public awareness.

Adrenomedullin expression in pathogen-challenged oral epithelial cells

Adrenomedullin, a multifunctional peptide, is expressed by many surface epithelial cells and, previously, we have demonstrated that adrenomedullin has antimicrobial activity. The oral cavity contains an epithelium that is permanently colonized by microflora, yet infections in a host are rare. We exposed oral keratinocytes to whole, live cells from four microorganisms commonly isolated from the oral cavity, Porphyromonas gingivalis, Streptococcus mutans, Candida albicans and Eikenella corrodens. There was upregulation of protein and gene expression in these cells in response to bacterial suspensions, but not with the yeast, Candida albicans. We propose there is a potential role for microbial products in enhancing mucosal defense mechanisms and that adrenomedullin participates in the prevention of local infection, thus contributing to host defense mechanisms.

The impact of tacrolimus ointment on health-related quality of life of adult and pediatric patients with atopic dermatitis

BACKGROUND

Atopic dermatitis can have detrimental effects on health-related quality of life (QOL).

OBJECTIVE

Our purpose was to examine the QOL impact of tacrolimus ointment in patients with atopic dermatitis.

METHODS

The Dermatology Life Quality Index (DLQI), Children's DLQI (CDLQI), and Toddler QOL Survey were used to assess QOL in adults (16 years or older), children (5-15 years), and toddlers (2-4 years) enrolled in 12-week, randomized, double-blind studies comparing two concentrations of tacrolimus ointment (0.03% and 0.1%) versus vehicle ointment for treatment of atopic dermatitis. QOL was assessed at baseline, week 3, and week 12/early discontinuation.

RESULTS

Of the 985 patients enrolled, 91.5% had evaluable QOL data. Among adults, both tacrolimus ointment groups experienced improved QOL relative to the vehicle control group for all QOL scales (P<.001). Among children and toddlers, both tacrolimus ointment groups demonstrated significant QOL improvements relative to the vehicle control group (P<.05) for all but the Personal Relationships scale in the 0.03% tacrolimus ointment group among children.

CONCLUSION

Tacrolimus ointment is associated with significant QOL benefits in adults, children, and toddlers with atopic dermatitis.

Expression of p53 in oral squamous cell carcinoma is associated with the presence of IgG and IgA p53 autoantibodies in sera and saliva of the patients

Around 50% of head and neck cancers are known to have aberrations of the p53 gene. Overexpression of the mutant p53 protein can induce a specific humoral response in cancer patients. Matched saliva, serum, and tissue samples from 26 patients with histologically confirmed oral squamous and verrucous carcinoma were investigated. p53 protein expression was evaluated by immunohistochemistry and antibodies specific for 53 protein were analysed in sera and whole mouth saliva by ELISA, immunoprecipitation, and competition assays; 16/25 (64%) samples demonstrated the stabilized p53 protein in tissues and 7/26 (27%) had a high level of p53 antibody in serum. In samples where matching saliva was available, p53 antibody was also present in saliva. In some tumours, only IgA-type p53 antibody was detected. p53 antibodies were found only in the serum and saliva of patients who showed p53 overexpression in their tumour tissues. These results demonstrate that detection of p53 antibodies can offer a specific and non-invasive method for the detection of a subset of tumours with p53 aberrations.

Pain related to different ways of minimal intervention in the treatment of small caries lesions

Pain during invasive treatment of dental caries is a common phenomenon, if no local analgesia has been used before cavity preparation. Atraumatic restorative technique (ART) is a suggested procedure which is at least less traumatic for the patient. Although the ART approach has been received well by both children and adults who belong to population groups hardly ever exposed to regular oral health care, it has not yet been proven that this particular procedure really causes less pain, compared to more conventional techniques with rotating instruments. In the present study, pain was reported in connection with tooth restoration in 19.3 percent of the cases, when the ART technique was used, which is significantly less than with a conventional restorative technique (35.7 percent). Finally the results show a clear relationship in the pain reports between the first and the following treatments in both ART and the conventional technique groups.

The frequency and significance of silent myocardial ischemia due to hyoscine butylbromide use in peripheral angiography

PURPOSE

Hyoscine-N-butylbromide (HB) is an anticholinergic drug used in digital subtraction angiography of the aortoiliac region because it decreases bowel gas movement artifact. HB also causes an increase in heart rate. We investigated whether this could cause silent myocardial ischemia (SMI) in susceptible patients during peripheral angiography.

METHODS

Thirty-six patients undergoing peripheral angiography were randomized into two groups, with 17 patients receiving 20 mg HB intraarterially during the angiogram and 19 patients receiving no drug. All patients were fitted with a Holter monitor that recorded the electrocardiogram before, during, and after the angiogram. Heart rate trends and ST segments were then analyzed.

RESULTS

Patients given HB had a statistically significant rise in heart rate compared with the control group. Although the difference was not statistically significant, two (12%) patients receiving HB had procedural ST depression compared with none in the control group. Pre- and postprocedural episodes of ST depression were common, occurring in 41% of patients receiving HB and 37% of patients receiving no drug, and were associated with an increase in heart rate.

CONCLUSION

The infrequent episodes of procedural SMI, potentially caused by the positive chronotropic effects of HB, are probably insignificant when compared with the high frequency of SMI episodes occurring outside the procedure.

Tacrolimus vs. cyclosporine immunosuppression: results in advanced-stage disease compared with historical controls treated exclusively with cyclosporine

A phase HI comparative trial of tacrolimus- vs. cyclosporine-based graft-vs.-host disease (GVHD) prophylaxis for human leukocyte antigen (HLA)-identical sibling bone marrow transplantation showed less GVHD but poorer survival in the tacrolimus arm. To test the comparability of the two treatment arms with respect to baseline survival prognosis, a matched control study using exclusively cyclosporine-treated patients from the International Bone Marrow Transplant Registry (IBMTR) database was performed. Controls were matched (2:1) based on age (within 5 years), disease, and pretransplant disease status. Two-year survival for tacrolimus-treated clinical trial patients was similar to that of their cyclosporine-treated matched controls (27 and 24%, respectively), and 2-year survival of the cyclosporine-treated clinical trial patients was similar to that of their cyclosporine-treated matched IBMTR controls (42 and 45%, respectively). Consistent with the clinical trial results, the cyclosporine-treated IBMTR controls matched to the tacrolimus group had significantly poorer 2-year survival than the cyclosporine-treated IBMTR controls matched to the cyclosporine group (24 and 45%, respectively; p < 0.01). No significant difference was seen in GVHD between the cyclosporine-treated clinical trial patients and their matched controls; however, the tacrolimus-treated clinical trial patients had significantly less GVHD than their cyclosporine-treated IBMTR controls (p < 0.01). These results support the hypothesis that the survival difference in the phase III trial resulted from an imbalance in the underlying risk factors for death in the two groups rather than from the randomized immunosuppressive regimen.

p53 aberrations in oral submucous fibrosis and oral squamous cell carcinoma detected by immunocytochemistry and PCR-SSCP

An archival series of oral biopsies from Karachi, Pakistan, consisting of 21 cases of oral submucous fibrosis (OSF) and 27 cases of squamous cell carcinoma (SCC), of which 6 had arisen from OSF, were used to examine the aberrations in the structure and expression of the p53 tumour suppressor gene. The PCR-SSCP method was used for mutation analysis of exons 2-9, and (over)expression of p53 protein was detected by immunocytochemistry using monoclonal antibody DO 7. Positive immunostaining was observed in 15/20 (75%) of OSF specimens, 3/6 (50%) of SCC arising from OSF and 14/21 (67%) of SCC not arising from OSF. Mobility shifts in SSCP indicative of a mutation in p53 or loss of heterozygosity (deletion of a band) were seen in 13/21 cases of OSF and 15/27 cases of SCC. There was concordance between immunocytochemistry and SSCP results in a majority (33/48) of samples. Though the number of analysed SCC cases arising from OSF was limited, the results suggest that p53 mutation/protein stabilisation may play a part in the pathogenesis of OSF and its progression to SCC.

Tacrolimus pharmacokinetics in BMT patients

The pharmacokinetics of tacrolimus following its administration as monotherapy or in combination with corticosteroids or methotrexate to 31 BMT patients are presented. All patients received i.v. tacrolimus initially and were subsequently switched to p.o. dosing. Patients received methotrexate by i.v. bolus on post-transplantation days 1, 3, 6 and 11. Patients were started on i.v. corticosteroids beginning on post-transplantation day 7. The noncompartmental pharmacokinetics of tacrolimus based on whole blood concentrations were determined following the i.v. and p.o. doses and were not different at steady-state compared to a single dose. The mean terminal elimination half-life of tacrolimus was 18.2 h following i.v. administration; the total body clearance was 71 ml/h/kg, the volume of distribution was 1.67 1/kg. Co-administration of methylprednisolone or methotrexate did not significantly alter tacrolimus pharmacokinetics. The p.o. bioavailability was 31-49%. Trough blood concentrations (Cmin) at 0 h (pre-dose) and 12 h (post-dose) correlated well to AUC(0-12)indicating that, as in solid organ transplantation, Cmin was a good index of drug exposure. Correlation at 0 h (r = 0.92) and at 12 h (r = 0.93) indicate that either time point can be used for therapeutic drug monitoring in patient management.

Evaluation of multiple micronutrient supplementation in the management of oral submucous fibrosis in Karachi, Pakistan

Oral submucous fibrosis (OSF) is an oral precancerous condition characterized by symptoms such as intolerance to spicy food, altered salivation, progressive difficulty in opening the mouth, and signs like vesiculation, ulceration, blanching, rigidity, and stiffening of the oral mucosa and depapillation and altered mobility of the tongue. It is seen mostly among people of Indian subcontinent origin. The major structural change is extensive fibroelastic scarring of the lamina propria and deeper connective tissues. A combination of micronutrients (vitamins A, B complex, C, D, and E) and minerals (iron, calcium, copper, zinc, magnesium, and others) was evaluated for its efficacy in controlling the symptoms and signs of OSF in 117 compliant subjects in Karachi, Pakistan, in a single-arm preliminary study. The subjects received supplementation for one to three years. Significant improvement in symptoms, notably intolerance to spicy food, burning sensation, and mouth opening, was observed at exit. The interincisor distance deteriorated in 11 subjects (10%) at exit; it was stable in 56 subjects (49%) and improved in 48 (41%). The mean interincisor distance was 19.1 +/- 10.8 (SD) mm at exit compared with 16.2 +/- 7.5 mm at baseline. A significant proportion of concomitant lesions like leukoplakia also regressed at exit. The major outcome from this study was a beneficial clinical response in subjects with OSF to multiple micronutrient intervention, which justifies its further evaluation in well-designed randomized controlled trials in other settings in South Asia.

Tacrolimus and minidose methotrexate for prevention of acute graft-versus-host disease after matched unrelated donor marrow transplantation

Thirty adults with leukemia or lymphoma undergoing marrow transplantation from HLA-compatible unrelated donors received tacrolimus (FK506), a new immunosuppressive macrolide lactone, and minidose methotrexate to prevent acute graft-versus-host disease (GVHD). The group had a median age of 36 years (range 21 to 49 years). Twenty-four patients had advanced disease, and 11 were resistant to conventional therapy. Tacrolimus was administered at 0.03 mg/kg/d intravenously (i.v.) by continuous infusion from day -2, converted to oral at four times the i.v. dose following engraftment, and continued through day 180 posttransplant. Methotrexate 5 mg/m2 was given i.v. on days 1, 3, 6, and 11. All patients engrafted. Grades 2-4 GVHD occurred in 34% (95% CI, 17% to 52%), and grades 3-4 GVHD in 17% (95% CI, 3% to 31%). Mild renal toxicity was common before day 100; 63% of patients had a doubling of creatinine, and 52% had a peak creatinine greater than 2 mg/dL, but only one patient was dialyzed. The median last i.v. dose of tacrolimus was 53% of the scheduled dose, and the median oral dose on day 100 was 41% of that scheduled. Overall survival at 1 year was 47% (95% CI, 27% to 66%). We conclude that tacrolimus can be combined safely with minidose methotrexate, and the combination has substantial activity in preventing acute GVHD after unrelated donor marrow transplantation.

Role of areca nut in the causation of oral submucous fibrosis: a case-control study in Pakistan

A case-control study on chewing and smoking habits and oral submucous fibrosis (OSF) was undertaken in Karachi in 1989/90. Cases were patients detected with fibrous bands and leathery mucosa and hospital-based controls were matched by age and sex. Information on habits was collected by personal interview of 157 cases and 157 controls. Despite overall female preponderance, a substantial number of young men were enlisted. The male/female risks were found to be similar. Immigrants from India to Pakistan (Mohajir) had a similar risk status to local Punjabis. No differences between risks were found when comparing the three age categories, 21, 21-40, 41-60 yr. Among the cases, an increased risk was observed for areca nut chewing. This habit when practised alone appeared to have the highest risk (RR 154), followed by pan with or without tobacco (RR 64, 32 respectively). Logistic regression and discriminant analysis showed that daily consumption rates appeared to be more important with respect to risk than lifetime duration of habit. Tobacco habits were more prevalent amongst those 15 cases who presented with concurrent carcinoma and OSF: We conclude that areca nut chewing has a causal relationship with OSF: additional tobacco insult may be necessary for subsequent carcinoma development.

Prevalence of mutans streptococci and dental caries in Pakistani children

The caries status of two hundred and eighteen 12 year old school children from four schools of Karachi and Lahore was determined through a WHO pathfinder survey. In addition, the levels of mutans streptococci in the sample were estimated in order to define the proportion of children with high and low mutans levels. A mean DMFT of 1.82 (1.67-0.03-0.12), for decayed and filled teeth respectively; 42% were caries free. Four mutans streptococci; 22% had mutans class 0, 22% class 1, 31% class 2 and 25% class 3. The mean DMFT was respectively, 1.0 + 1.23, 0.98 + 1.52, 2.03 + 2.36 and 3.04 + 3.08. The difference was statistically significant. Twenty four children had 5 or more DMF all except two of them, belonging to mutans classes 2 or 3.

Evidence that the N-terminus of human growth hormone is involved in expression of its growth promoting, diabetogenic, and insulin-like activities

Recent work with various point and deletion mutants of human GH (hGH) has suggested that the proximal N-terminal end of the hormone molecule is important for its growth promoting action. This study was conducted to examine the growth promoting, diabetogenic, and insulin-like activities of two N-terminal mutants of hGH, the deletion mutant Des-7 hGH (met8, ala11), and a chimeric mutant of bovine GH (bGH) and hGH containing the N-terminal 13 amino acids of bGH (met, ala 1-13/14-191, asp11). The CD spectra of these mutants are similar to that of wild-type hGH and they retain lactogenic activity on Nb2 lymphoma cells, whereas their ability to bind to somatogenic receptors on IM-9 lymphocytes and bovine liver membranes is markedly reduced. In this study, growth promoting activity of the mutants was assessed using the 9-day weight gain test in hypophysectomized rats. Des-7 hGH had a potency of 0.03 IU/mg protein in this assay, whereas the potency of the bGH/hGH chimera was 0.71 IU/mg. Diabetogenic activity was tested in the ob/ob mouse, using the elevation of fasting blood glucose and the worsening of glucose tolerance after a 3-day course of treatment as end-points. Both Des-7 hGH and the bGH/hGH chimera had reduced diabetogenic activity compared to that of biosynthetic wild-type hGH, consistent with their reduced growth activity. Insulin-like activity was assessed by testing the in vitro ability of the mutants to stimulate [14C] glucose oxidation by epididymal adipose tissue of hypophysectomized rats. Des-7 hGH had about 1% the activity of wild-type hGH, whereas the chimera was about 20% as active. When Des-7 hGH was added to the incubation medium along with wild-type hGH in ratios of 5, 12.5, or 25:1 (Des-7 hGH:hGH), the insulin-like action of hGH was significantly inhibited, indicating that the mutant is a modest antagonist of the insulin-like action of hGH. When the ability of Des-7 hGH to compete with [125I] hGH for binding to isolated rat adipocytes was tested, the mutant was about 10% as effective as wild-type hGH. Thus, Des-7 hGH appears to be more effective in binding to adipocyte GH receptors than in triggering an insulin-like response, perhaps accounting for its modest antagonistic activity. The results of this study suggest that the proximal N-terminal end of the hGH molecule is involved in the expression of the growth promoting, diabetogenic and insulin-like activities of GH.

Oesophageal changes in oral submucous fibrosis using fibreoptic endoscopy--a pilot study

Thirty patients with oral submucous fibrosis (OSMF) underwent fibreoptic upper G.I. endoscopy and oesophageal biopsy from 20 cms to see if any correlation is found between visual and histological changes in OSMF and oesophageal mucosa. On endoscopy, the colour of oesophageal mucosa was normal in 28 and whitish pale in 2 cases. On endoscopy mucosa felt stiff and fibrotic in 19, leathery in 4, firm/gritty in 2 and normal in 5 cases. The biopsies were difficult to take in most cases yielding small tissue samples on repeated attempts. On histology most of the samples consisted of only a few layers of hyperplastic epithelium with lamina propria and submucosa being absent in all samples. Good correlation was found between the grade of OSMF and oesophageal changes seen on endoscopy.

Dental disorders in Pakistan--a national pathfinder study

A pilot study on dental diseases and treatment needs along with oral hygiene aids used and on provision of dental care was conducted in 1988 using WHO oral health assessment forms. A total of 1146 persons of 12-15 years and 35-65 years were included in the study. The sample was equally distributed in four provinces of Pakistan taking 13 urban and rural areas. Dental caries was found in 55% of children between 12-15 years of age and in 78% of adults. The DMFT index was 1.2 in the younger age group (12 years) and rose to 18.3 for 45-54 years. The percentage of periodontally healthy persons at age 12 was 32% decreasing to 10.4% at age 50. Calculous was the most frequently observed condition in all age groups.

Injection into the extra-arachnoid subdural space. Experience in the treatment of intractable cervical pain and in the conduct of extradural (epidural) analgesia

The anatomy and radiological appearances of the subdural space in the cervical region are described. Recognition of this space facilitates neurolytic injections for severe cancer pain in the distribution of the cervical nerve roots. The subdural space may have significance also in explaining the extensive sensory block which follows a delayed or 'massive' lumbar extradural injection.