Suppurative corneal ulceration in Bangladesh

Suppurative keratitis is an important preventable cause of blindness, particularly in the developing world. This study analyses 142 cases of suppurative keratitis referred to Chittagong Eye Infirmary, Bangladesh. Some 53.5% of cases were bacterial and 35.9% were fungal. The five most common pathogens were: Pseudomonas sp. 24%, Streptococcus pneumoniae 17%, Aspergillus sp. 13%, Fusarium sp. 7% and Curvularia sp. 6%. Gram stain and culture results were consistent in 62.6% of cases. Previous antibiotic treatment was a significant factor for failure of culture isolation and less so for Gram stain failure. On Gram stain, 55.9% of pseudomonal cases were missed, but only 2% of fungal cases were missed. Over all, Gram stain had a sensitivity of 62% and positive predictive value of 84% for bacterial cases, and 98% and 94% for fungal cases, respectively. Fungal ulcers were typically filamentous, but an antecedent history of trauma was not common. The most frequent injury was due to rice grains, but the inoculum appeared to be introduced during eye washing with contaminated water. Pseudomonal ulcers occurred most frequently in the monsoon season, and Fusarium cases were seen only in the hot, dry season.     

Psychiatric mental health nursing: challenge and change

. We invited Dr Peplau to provide a personal reflection on the recent history of psychiatric nursing and her thoughts on immediate challenges facing the profession. The paper is an individual scholar's commentary on the way that psychiatry has waxed and waned over the years, in relation to nursing. This historical review discovers and reports a challenge to current practice. Dr Peplau describes a professional shift that is pulling nurses toward the subordinate role observed earlier this century. The paper draws attention to how contemporary practice can be positively influenced, e.g., by giving a structure to the allocation and conduct of nurse–patient time.     

Cytotoxic molecule expression and epithelial cell apoptosis in oral and cutaneous lichen planus

We evaluated the expression of T cell-restricted intracellular antigen (Tia-1), granzyme B, and perforin by lymphocytes and the degree of epithelial apoptosis in oral and cutaneous lichen planus (LP) in 51 untreated cases, including 27 oral LP (OLP) and 24 cutaneous LP (CLP) cases. The number of total dermal-positive lymphocytes in OLP and CLP was similar, indicating similar activity of the inflammatory process. Intraepithelial Tia-1-positive, perforin-positive, and granzyme B-positive lymphoid cells were more numerous in OLP than in CLP (P < .05). The epithelial cell apoptotic index (AI) was increased significantly in OLP (P < .05), particularly in erosive-atrophic variants. A linear correlation between AI and the mean +/- SEM number of intraepithelial and dermal perforin+ cells (6.85 +/- 2.44 and 27.48 +/- 10.19, respectively), per 10 high-power fields for OLP and for CLP (1.17 +/- 0.88 and 10.42 +/- 5.74, respectively), was found (intraepithelial, r = 0.50; dermal, r = 0.51; P < .01). These data suggest a pivotal role for perforin in triggering epithelial cell apoptosis. The differences of infiltrating cytotoxic cells and related AI observed in OLP and CLP are in keeping with the clinical behaviors that distinguish these LP variants.     

Insulin reduces HBsAg production by PLC/PRF/5 human hepatoma cell line

Summary Although its action at the molecular level is not completely understood, insulin, as well as its antagonist glucagon, certaily plays an important role in the modulation of protein synthesis.In order to observe whether insulin is involved in virus gene expression, we studied its effect on PLC/PRF/5 human hepatoma cell line, which posses HBV DNA sequences integrated at several sites.While human insulin had no effect on cell growth and increased the production of two plasma proteins, a selective inhibitory effect on HBsAg production could be detected.This observation might be useful for further studies both on virus gene expression and insulin action at the molecular level.With 3 Figures     

Clinical significance of the histomorphometric evaluation of diabetic microangiopathy in the oral mucosa

Several structural parameters of the capillary vessels were measured in the oral mucosa of patients with diabetes mellitus of type 1 (D.1) and of type 2 (D.2), and of control cases (C), by means of an image analyser in histological sections of routinely processed biopsies. The studied parameters included: a) capillary wall thickness; b) capillary diameter; c) the ratio of capillary wall thickness and diameter; d) capillary wall area; e) capillary area; f) the ratio of capillary wall area and capillary area; g) density of capillary vessels in the lamina propria; h) density of endothelial cells; i) endothelial nuclear area. Clinical and laboratory parameters were also evaluated (duration of the disease, systolic and diastolic blood pressure levels, glycemia, glycosylated haemoglobin, glycosylated albumin, fructosamines, apolipoproteins A1 and B), in order to assess whether a relationship exists with the morphometric parameters studied. Statistically significant differences, at the level of p less than 0.05, were found in the following morphometric parameters between controls and each group of diabetic patients: mean and standard deviation of capillary wall thickness, mean capillary wall area, mean ratio of the capillary wall area and capillary area. A reduction in the capillary density, i.e. the number of capillary vessels per mm2 of lamina propria, was also observed in diabetic patients with respect to the control group, although it was not statistically significant (C vs. D.1: p less than 0.21; C vs. D.2: p less than 0.10).(ABSTRACT TRUNCATED AT 250 WORDS)     

Survey on Torino courses

Since March 1991 a monthly course on laparoscopic cholecystectomy has been organized at the Department of Surgery of the University of Turin. To evaluate the impact of this course and to obtain feedback from surgeons in order to improve the teaching of laparoscopic surgery, detailed questionnaires were sent to the participants of the first 20 courses.The outcome of this survey shows that short-residency hands on courses do not represent a completely satisfactory training, either for practicing surgeons or for residents, mainly because of the constraints of time and the lack of proctoring and supervision. Besides, the present study shows a significant difference in the diffusion of laparoscopic surgery in different areas of Italy.However, clinical results reported by this group of surgeons are satisfactory and comparable to the best multicentric series: 2,127 laparoscopic cholecystectomies were performed by 48 surgeons with a conversion rate of 6% and a complication rate of 2.4%.     

Correlation between the degree of contrast enhancement and the volume of peritumoral edema in meningiomas and malignant gliomas

Peritumoral edema and contrast enhancement of brain tumors are both thought to be due to breakdown of the blood-brain barrier (BBB); however, the exact mechanism by which these two phenomena occur and whether there is a quantitative or etiological relationship is not known. Our purpose was to determine whether the relationship between the breakdown of the BBB, defined radiologically as the degree of contrast enhancement, and the volume of surrounding edema is different for high-grade gliomas and meningiomas. We analyzed 13 meningiomas and 23 gliomas. A direct linear relationship between the degree of contrast enhancement (dC) and volume of peritumoral edema (V) with a high correlation coefficient (R = 0.66, P = 0.0006) was established for gliomas. A mathematical relationship between dC and V could not be established for meningioma. The findings for gliomas offer indirect radiological evidence that the defect in the BBB which causes edema is quantitatively and etiologically related to the defect in the BBB responsible for contrast enhancement. For meningiomas, the lack of a relationship between dC and V implies either that the mechanisms responsible for formation of edema and contrast enhancement are fundamentally different or that a physical barrier in certain meningiomas limits propagation of edema into the adjacent white matter. Received: 4 March 1999 Accepted: 18 March 1999     

99Tcm-MIBI scintimammography in 300 consecutive patients: factors that may affect accuracy

We evaluated the diagnostic yield of 99Tcm-MIBI scintimammography in a relatively large series of consecutive patients referred for breast surgery on the basis of physical examination or mammogram. 99Tcm-MIBI uptake was correlated to tumour size, receptor status, neovascularity, proliferating activity, P-170 glycoprotein expression and the patient's gonadal state. Three hundred consecutive patients referred to our institution, with either a positive mammogram or a palpable mass, were entered into the study. All patients underwent 99Tcm-MIBI scintimammography. Pathological status was obtained after surgery in all patients. Breast cancer was diagnosed in 218 (73%) patients. The MIBI scan was positive in 89% (194/218) cancer patients and in 17% (14/82) of patients with benign masses (false-positives); the scan was negative in 24 (11%) cancer patients (false-negatives). The sensitivity of MIBI scintigraphy was higher for tumours > 1 cm (95 vs 48% in lesions < or = 1 cm) and in pre-menopausal women (95 vs 85%). Conversely, the specificity was better for lesions < 1 cm (100%) and in post-menopausal women (89%). The positive predictive value of MIBI scan was good both in small (< 1 cm) and large tumours (100% and 93%, respectively) and slightly modified by gonadal state (89% and 96% in pre- and post-menopausal state). The negative predictive value was unsatisfactory, especially in small tumours and in older patients. The diagnostic performance increased stratifying data for tumour size, indicating that lesion size is a major determinant in the diagnostic accuracy of MIBI scintimammography. We conclude that 99Tcm-MIBI scintimammography is useful in the diagnostic evaluation of young patients, because it can select patients for further invasive diagnostic procedures. In older patients, a positive 99Tcm-MIBI scan is highly suggestive of malignancy and might be an indication for surgery. In the case of a negative scan, biopsy is advisable given the poor negative predictive value. Small tumour size and a well-differentiated histotype characterize false-negative cases.