Endoscopic removal of a dental prosthesis in the hepatic flexure of the colon

The diagnosis of impacted foreign body in the colon is usually delayed until the complications such as perforation or abscess formation occur. Here we describe a patient who presented with diffuse abdominal pain due to the impaction of a dental prosthesis in the hepatic flexure of the colon. The dental prosthesis, which was inadvertently swallowed, was successfully removed under colonoscopy. Unexplained abdominal pain should alert the clinician to the possibility of foreign body ingestion and further therapeutic colonoscopy may replace or lessen the need for surgical procedures to extract foreign bodies from the colon.     

Common anxieties of patients undergoing oesophago-gastro-duodenoscopy, colonoscopy and endoscopic retrograde cholangio-pancreatography

AIMS & METHODS: To investigate the anxieties of patients undergoing oesophago-gastro-duodenoscopy (OGD), colonoscopy and endoscopic retrograde cholangio-pancreatography (ERCP) in relation to their demographic features, their knowledge and understanding of the procedure, its indication, and their doctors' explanation. A standard questionnaire was filled in consecutively for 280 OGD patients, 64 colonoscopy patients and 50 ERCP patients. RESULTS & CONCLUSIONS: Majority of the anxious patients were afraid of pain. There was no difference between the "fearless" and "fearful" groups in terms of source of referral and inpatient/outpatient status. However for all 3 procedures, anxious patients were significantly younger by a mean of 10 years. Females, better educated and OGD patients undergoing the procedure for the first time were more anxious but this difference was not seen with the more complex colonoscopy and ERCP. The more sophisticated ERCP seemed to instill greater anxiety amongst Malay patients. Doctors were significantly more likely to explain the indication for OGD and colonoscopy than how it would be done. This discrepancy was not seen with ERCP where the endoscopists tend to adopt a more personal approach. Most patients prefer to be sedated.     

Recurrent gastric varices bleeding after living-related liver transplantation successfully eradicated by splenic artery embolization

Living related liver transplantation (LRLT) may not be the only treatment for recurrent bleeding due to severe gastric varices secondary to left-side portal hypertension and splenic vein thrombosis. Splenectomy is the preferred long-term standard treatment for non-orthotopic liver transplantation patients, but additional treatments such as post-transplantation partial splenic arterial embolization to preserve the immunological function of the spleen and thus prevent the occurrence of post LRLT severe infection are suggested for these patients.     

Olfactory marker protein is present in olfactory receptor cells of human fetuses

Light microscopic observations indicated that cellular differentiation of the primary olfactory pathway in human fetuses was relatively advanced by the end of the first trimester. However, immunohistochemical staining showed that olfactory marker protein was present in the receptor cells only at about 28 weeks post-conception. At about 32 weeks, modest amounts of the protein could be found in the peripheral olfactory nerve layer and a few glomeruli, with increased staining observed in subsequent weeks. The results show conclusively that human fetal olfactory neurons synthesize olfactory marker protein during the later half of gestation.     

Risk factors for development of dehydration in young children with acute watery diarrhoea: a case-control study

In a case-control study to understand the risk factors for development of life-threatening dehydration, a total of 379 children comprising 243 cases (moderate or severe dehydration) and 136 controls (non or mild dehydration) up to 2 years of age suffering from acute watery diarrhoea were studied. By univariate analysis, the presence of vibrios in stool, withdrawal of breast feeding during diarrhoea, not giving fluids, including oral rehydration solution (ORS), during diarrhoea, frequent purging (> 8/ day), vomiting (> 2/day) and undernutrition were identified as risk factors. However, by multivariate analysis after controlling for confounders, withdrawal of breast feeding during diarrhoea (odds ratio (OR) = 6.8, p < 0.00001) and not giving ORS during diarrhoea (OR = 2.1, p < 0.006) were identified as significant risk factors. The confounding variables which also contributed significantly to increasing the risk were age (≤ 12 months; OR = 2.7, p = 0.001), frequent purging (> 8/day; OR = 4.1, p < 0.00001), vomiting (> 2/day; OR = 2.4, p = 0.001) and severe undernutrition (%median <60 weight-for-age of Indian Academy of Paediatrics classification; OR = 3.1, p = 0.001). We feel that these findings will be useful for Global and National Diarrhoeal Diseases Control Programmes for formulating intervention strategies for preventing death due to diarrhoeal dehydration.     

The Methylazoxymethanol Acetate (MAM-E17) Rat Model: Molecular and Functional Effects in the Hippocampus

Administration of the DNA-alkylating agent methylazoxymethanol acetate (MAM) on embryonic day 17 (E17) produces behavioral and anatomical brain abnormalities, which model some aspects of schizophrenia. This has lead to the premise that MAM rats are a neurodevelopmental model for schizophrenia. However, the underlying molecular pathways affected in this model have not been elucidated. In this study, we investigated the molecular phenotype of adult MAM rats by focusing on the frontal cortex and hippocampal areas, as these are known to be affected in schizophrenia. Proteomic and metabonomic analyses showed that the MAM treatment on E17 resulted primarily in deficits in hippocampal glutamatergic neurotransmission, as seen in some schizophrenia patients. Most importantly, these results were consistent with our finding of functional deficits in glutamatergic neurotransmission, as identified using electrophysiological recordings. Thus, this study provides the first molecular evidence, combined with functional validation, that the MAM-E17 rat model reproduces hippocampal deficits relevant to the pathology of schizophrenia.     

Calcium Intake, Vitamin D and Bone Health Status of Post-menopausal Chinese Women in Kuala Lumpur

Bone health status was investigated in 178 free-living Chinese post-menopausal women in Kuala Lumpur. Body mass index (BMI), body composition (using whole body DXA), calcium intake and serum 25-OH vitamin D status were measured along with biochemical markers of bone turnover, that is, pro-collagen Type 1 N-terminal peptide (P1NP), osteocalcin (OC) and C-telopeptide β cross link of Type 1 collagen (CTX- β). Bone mineral density (BMD) was measured using DXA (Hologic, USA) at the lumbar spine, femoral neck and total hip. Results showed that osteopenia was present in 50% of the subjects at the spine and 57.9% at the femoral neck. Osteoporosis was diagnosed in 10% of the subjects at both the femoral neck and spine. A total of 29.3% of the subjects had high levels of CTX- β. Mean serum level of 25-OH vitamin D was 60.4+15.6 nmol/L and 50.6% of the subjects had hypovitaminosis D (defined as < 50 nmol/l). Mean total calcium intake of the subjects was 497 + 233 mg, of which only 14% met the RNI for calcium with the additional intake of calcium supplements. Body fat was also significantly correlated (r=0.181, p< 0.05) with BMD at the spine but not BMD at the femoral neck. Lean body mass was positively correlated with BMD at the spine (r=0.289, p< 0.001) and femoral neck (r=0.295, p< 0.001). CTX-β was negatively correlated with BMD at the spine (r= -0.235, p< 0.001), whereas P1NP (r=-0.215, p< 0.001) and osteocalcin (r=-0.265, p< 0.001) were both negatively correlated with BMD at the femoral neck. Generally, the study found that women with osteopenia had higher levels of bone turnover markers, less lean body mass and lower calcium intake than women with normal BMD. In conclusion, this study demonstrated that the majority of free living Chinese post-menopausal women in Kuala Lumpur have low calcium intake, low 25-OH vitamin D status and low bone mass and elevated biochemical markers of bone turnover.