Comparison of intra‐arterial digital subtraction angiography using carbon dioxide by ‘home made’ delivery system and conventional iodinated contrast media in the evaluation of peripheral arterial occlusive disease of the lower limbs

To prospectively compare the feasibility, safety and diagnostic role of carbon dioxide (CO₂) digital subtraction angiography (DSA) using a ‘home made’ delivery system with iodinated contrast medium (ICM) DSA in the evaluation of peripheral arterial occlusive diseases (PAOD) of lower limbs. Twenty‐one patients (27 limbs; all men; mean age, 47.6 years) who presented with PAOD of lower limbs underwent DSA using both intra‐arterial CO₂ and ICM. Conventional ICM DSA was performed first and used as gold standard. Carbon dioxide was then injected by hand using a locally improvised home made plastic bag delivery system. Patient tolerance was assessed subjectively. Arteries from aortic bifurcation to the ankle were independently evaluated by two radiologists and graded for stenosis using a five‐point scale. For each patient, the quality of CO₂ DSA images were compared with the corresponding images of ICM DSA and an overall grade of ‘good’, ‘acceptable’ or ‘poor’ was assigned. Cohen’s kappa coefficient was used to determine inter‐observer agreement. Carbon dioxide opacified 86.2% (188/195) of major arteries and depicted stenosis adequately in 84.5% (191/226) of arterial segments. A good or acceptable image quality of CO₂ DSA was obtained in over 95% of patients. Infrapopliteal arteries were inadequately visualized. Mild pain was seen in six (28.6%) patients with both contrast agents; one patient developed severe pain during CO₂ DSA. Inter‐observer agreement was good (k > 0.75) at 70% of the segments. Administration of CO₂ into lower limb arteries is well tolerated. Carbon dioxide DSA using the locally improvised home made delivery system is a feasible and safe alternative to ICM DSA in the evaluation of PAOD. It provides adequate imaging of arteries of lower extremities except infrapopliteal segments.     

Gene polymorphisms,tobacco exposure and oral cancer susceptibility: a study from Gujarat,West India

Polymorphic variability in the enzymes involved in biotransformation of tobacco‐related pro‐carcinogens plays an important role in modulating oral cancer susceptibility. CYP1A1*2A, CYP1A1*2C, GSTM1 and GSTT1 polymorphisms were determined in 122 oral carcinoma cases and 127 controls from Gujarat, West India using PCR‐based methods. The results revealed that the polymorphic variants of CYP1A1 gene did not show association towards oral cancer risk. The GSTM1 and GSTT1 null genotypes were found to be over‐represented in patients than controls, suggesting a moderate increase in risk of oral cancer. The oral cancer risk was significantly increased in the patients having either alone or concurrent deletion of GSTM1 and GSTT1. The results also suggested significant association between tobacco habits, especially chewing, variant genotypes of CYP1A1, GSTM1 and GSTT1 and oral cancer risk. Our data have provided evidence that GST polymorphism modified the susceptibility to oral cancer and individuals with variant genotypes of the three genes with tobacco habits are at significant risk of developing oral cancer.     

Small intestine ischemia simulating primary colonic disease

Clinical and radiographic findings were reviewed for four patients in whom colonic diverticulitis was suspected clinically but in whom small intestine ischemia was proved surgically. In each patient the initial diagnostic studies--plain abdominal radiography and barium enema examination--revealed generalized small intestine distention and non-specific colonic abnormalities, respectively. The latter findings consisted of an extrinsic impression on the superior or inferior aspect of the sigmoid colon with associated thumbprinting or spiculation. In each patient serosal inflammation of the sigmoid colon produced by an adherent segment of the ischemic small intestine was confirmed at laparotomy. In two patients, delay in surgical intervention resulted in small intestine necrosis. In a patient who has clinical signs and symptoms of colonic ischemia, diverticulitis, or small intestine obstruction but nonspecific findings on barium studies, the diagnosis of small intestine ischemia should be considered and further diagnostic imaging, such as angiography or small intestine follow-through examination, should be performed.     

Crohn disease of the small intestine: diffuse mucosal granularity

A diffuse granular mucosal pattern, produced by a reticular network of radiolucent foci 0.5 to 1 mm in diameter, was identified in 39 out of 46 consecutive patients with Crohn disease of the small intestine. Resected specimens demonstrated that this pattern represented wide, blunted villi with lymphocytic infiltration. Such a pattern was the only evidence of small bowel involvement in 17 cases. In 3 patients with the commonly recognized lesions, separate regions of diffuse granularity were seen. No such pattern was detected in normal patients. Demonstration of diffuse granularity may contribute to the diagnosis and management of Crohn disease.     

Evaluation of the efficacy of a combination of diltiazem and periprostatic nerve block in pain control during transrectal ultrasonography-guided biopsy of the prostate

Introduction

The choice of analgesia during prostate biopsy remains controversial. The pain has dual origin: from the insertion of the probe as well as the biopsy itself. Periprostatic nerve block (PPNB) is currently the gold standard modality for decreasing pain of prostate biopsy but it does not alleviate the pain of probe insertion. A randomised controlled trial was performed to test the efficacy and safety of the combination of topical application of diltiazem gel and PPNB for pain control during transrectal ultrasonography guided prostate biopsy.

Methods

A total of 73 patients who were to undergo their first prostate biopsy were randomised to receive either 2ml of 2% topical diltiazem gel or a placebo 15 minutes before the biopsy. All the patients then had a PPNB using 1% lignocaine. A ten-point visual analogue scale was used to record the pain immediately after the insertion of the probe and during the biopsy. Any adverse effects were also recorded.

Results

There was no significant difference in the mean age and prostate volumes between the groups. There was a significantly lower mean pain score due to probe insertion in those patients who received topical diltiazem than in the placebo group (p<0.0001). There was no significant difference between the pain scores during the biopsy itself between the two groups.

Conclusions

Topical diltiazem significantly reduces the pain of probe insertion during prostate biopsy and can be used effectively as an adjuvant to PPNB.     

Assessment of a radioisotopic assay for vitamin B12 using an intrinsic factor preparation with R proteins blocked by vitamin B12 analogues

A competitive protein binding radioassay kit for serum vitamin B₁₂ has been assessed. Precision, linearity, sensitivity, and specificity have been found to be satisfactory. Falsely-normal assay results in patients with vitamin B₁₂ deficiency have not been observed.     

Insulin‐like growth factor‐II is produced by,signals to and is an important survival factor for the mature podocyte in man and mouse

Podocytes are crucial for preventing the passage of albumin into the urine and, when lost, are associated with the development of albuminuria, renal failure and cardiovascular disease. Podocytes have limited capacity to regenerate, therefore pro‐survival mechanisms are critically important. Insulin‐like growth factor‐II (IGF‐II) is a potent survival and growth factor; however, its major function is thought to be in prenatal development, when circulating levels are high. IGF‐II has only previously been reported to continue to be expressed in discrete regions of the brain into adulthood in rodents, with systemic levels being undetectable. Using conditionally immortalized human and ex vivo adult mouse cells of the glomerulus, we demonstrated the podocyte to be the major glomerular source and target of IGF‐II; it signals to this cell via the IGF‐I receptor via the PI3 kinase and MAPK pathways. Functionally, a reduction in IGF signalling causes podocyte cell death in vitro and glomerular disease in vivo in an aged IGF‐II transgenic mouse that produces approximately 60% of IGF‐II due to a lack of the P2 promoter of this gene. Collectively, this work reveals the fundamental importance of IGF‐II in the mature podocyte for glomerular health across mammalian species. Copyright © 2013 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.