Video assisted thoracoscopic (VATS) Thymectomy-a better alternative

Background With the introduction of video imaging technique in late 1980s the field of thoracoscopy was expanded into video assisted thoracic surgery (VATS) in 1990. VATS has several unique advantages like reducing repiratory complications, hospital stay and post operative pain due to avoidance of thoracotomy/sternotomy. It is indicated in almost all thoracic surgical procedures-both diagnostic and therapeutic. VATS thymectomy is being practised more and more replacing conventional thymectomy with thoracotomy/sternotomy. Methods From 2000 to 2003 we have performed 22 cases of VATS thymectomy in Myesthenia Gravis. Surgery was performed in supine decubitus under General anaesthesia with Double Lumen E T Tube for epsilateral Lung Collapse. Three ports were made on the right chest at 2nd space parasternal, 4th space anterior axillary line and at 5th space just below the nipple. At the end of the procedure a chest drain was introduced through the lowest port. Results Out of 22 patients 12 were females and 10 males. Median age was 36 years (Range 16 years to 64 years). Median operating time was 2 hours and drainage was 200 ml. Median ventillation time was 6 hours. Median hospital stay was five days. There was no mortality and no major complications. Conclusion VATS thymectomy is a suitable alternative to conventional thymectomy with thoracotomy/sternotomy. Results are comparable. VATS is now developing into an exciting adjunct in thoracic surgery. The morbidity associated with this procedure is extremely low. VATS has become an essential component of all thoracic surgical units and more and more thoracic surgical dieases will be managed with this minimally invasive technique in future.     

Nano-purification of raw semen minimises oxidative stress with improvement in post-thaw quality of buffalo spermatozoa

The study consisted of application of anti-ubiquitin antibodies (Abs)-coated iron oxide-nanoparticles (IONPs) for minimisation of oxidative stress to contemporary live spermatozoa from the raw semen. Round-shaped IONPs (12.09 ± 0.91 nm) after two-stage functionalisation (silanisation and pegylation) were conjugated with Abs. Four aliquots from each of the 24 ejaculates (4 buffalo bulls) formed Control (Group I) and treatment (II, III and IV) groups; each containing 150 ± 25 million dead/damaged spermatozoa. IONPs-Abs complex were added at ratio of 1:1 (0.5 µg/ml), 1:2 (1.0 µg/ml) and 1:4 (2.0 µg/ml), respectively, in Groups II, III and IV. The semen quality parameters showed improvement at lag-stage (post-nano-purification before processing for cryopreservation). The mean post-thaw motility (%) in Group IV was found to be greater (p < .05) than Group I. Moreover, the overall DNA integrity (%) at post-thaw stage was improved in the nano-purified semen samples. The value of malondialdehyde was greater (p < .001) in Group I than Groups II, III and IV. The mean total antioxidant capacity and superoxide dismutase (U/mg protein) activity values in Group IV was greater (p < .05) than Group I. The study results show that IONPs conjugated with anti-ubiquitin Abs at 2.0 µg/ml can be an effective dose for depletion of dead/damaged spermatozoa from buffalo ejaculates to minimise oxidative stress.     

Inhaled insulins

As a result of knowledge gained from the management of asthma with inhalers and nebulisers, pulmonary delivery devices for insulin have been developed. Particle size of the aerosol particularly influences drug delivery. Although several pharmaceutical companies are developing different systems, Pfizer have launched the first inhaled insulin (Exubera). Clinical trials have taken place in patients with both type 1 and type 2 diabetes, but have shown similar glucose control as subcutaneous insulin delivery. However, patient satisfaction does seem to be increased in patients taking inhaled insulins. Further studies are needed to investigate compliance, side-effect profiles, quality of life, long-term glycaemia control and cost effectiveness.     

人体子宫内膜血管内皮生长因子的研究

目的 :对人体子宫内膜增殖期 (n =3)、分泌期 (n =6 )和增生过长 (n =6 )标本 ,进行VEGF的免疫定位和半定量测定 ,了解雌激素对子宫内膜VEGF的影响。方法 :研究组用免疫组织化学方法 ,对照组用无关的免疫球蛋白代替第一及第二抗体 ,用辅助视频图像分析系统进行计算。结果 :增殖期VEGF在腺体 (P <0 .0 0 1)和间质 (P <0 .0 1)的浓度 ,明显高于分泌期和子宫内膜增生过长 ,总的看来 ,腺体的VEGF高于间质。结论 :雌激素提高子宫内膜的VEGF的含量 ,并与增殖晚期新的血管形成和血管通透性增加有关。此外 ,子宫内膜增生过长的腺体VEGF并不升高 ,提示人体子宫内膜的腺体生长和血管生成调节是不同的。     

Percutaneous Closure of Perimembranous Ventricular Septal Defect with Amplatzer Device

Background

The Amplatzer perimembranous ventricular septal occluder is an innovative device for percutaneous closure of perimembranous ventricular septal defects (PMVSD). In appropriately selected cases this procedure is safe and effective.

Methods

Fourteen patients with the mean age 10.53 years (range 18 months to 55 years) and mean body weight 20.64 kg (range 6 to 52 kg) underwent PMVSD closure.

Result

The PMVSD mean diameter was 5.28 mm (range from 4 to 9 mm). Implantation was successful in 92% of the cases and all patients had complete occlusion of the shunt within three months.

Conclusion

Device orientation was excellent in all cases. Device-related aortic insufficiency, tricuspid insufficiency or left ventricular dysfunction was not observed. One patient had embolisation of the device and another had complete heart block which required a permanent pacemaker implantation. The excellent short term results need to be confirmed over long-term follow-up.Key Words: Perimembranous ventricular septal defect, Arrhythmias, Percutaneous closure     

Vitiligo patients from India (Mumbai) show differences in clinical,demographic and autoantibody profiles compared to patients in western countries

Background Vitiligo is a common, idiopathic skin disorder characterized by depigmented skin due to the loss of cutaneous melanocytes. Several studies have reported the clinical and demographic characteristics of Indian vitiligo patients, however, none has characterized their antibody profiles. Objective To establish the clinical, demographic and serological details of a population of vitiligo patients from Mumbai, India, and to evaluate the data for any associations between clinical presentations and the occurrence of antibody responses. Methods Vitiligo patients (n = 79) were recruited to the study and their clinical and demographic details recorded. Serum antibodies, including those against melanocyte‐specific antigens, thyroid antigens and keratinocytes, were evaluated. Results The prevalence of vitiligo was independent of sex, and non‐segmental vitiligo was the most common form of the disease occurring in 65% of the patients. Patients with segmental vitiligo (mean age = 14.4 ± 4.6 years) presented at a younger age than those with non‐segmental disease (mean age = 32.5 ± 17.8 years). Personal and family histories of other autoimmune diseases occurred in 3% and 8% of patients, respectively. Antibodies were detected against tyrosinase, tyrosine hydroxylase, thyroid peroxidase, thyroglobulin and keratinocytes at frequencies of 11%, 22%, 18%, 24% and 27%, respectively. Overall, antibodies were more common in patients with non‐segmental vitiligo (50–67%) than in those with segmental disease (0–17%), and were detected more frequently in patients with shorter disease durations (<10 years). Conclusion Our study provides novel information relative to the clinical details, demographic features and serological parameters of a population of vitiligo patients from Mumbai, India. Important distinctions from similar surveys conducted in European patients were evident such as an infrequency of family history, a low prevalence of clinical autoimmune disease, and an absence of particular antibody specificities. These differences may have a bearing on the pathogenesis and course of the disease in Indian patients.     

“Pseudo” Nomenclature in Dermatology: What's in a Name?

In the bewildering array of scientific nomenclature in the medical field, it is important to use correct terminology, know their aberrations and the reason behind a specific terminology. This paper is an attempt towards compiling all the pseudo-nomenclatures coined in dermatology, in order to make it easier to retain and recollect these pseudo names, signs, morphology, diseases, and conditions. It is also imperative to know the true entities that these pseudo names masquerade as, so as to understand the explanation for assigning the term ‘pseudo’ to these conditions. A total of 52 pseudo-terms have been compiled here in reference to dermatology. Most of these pseudo-nomenclatures were coined due to some clinical or histopathological resemblance to the true conditions, while some were premature conclusions drawn from a flawed understanding of the basic nature of the condition. Clear understanding of each of these terms and the explanation behind them being pseudo will enable a dermatologist to avoid misdiagnosis and needless confusion.     

Analysis of two types of cone bipolar cells in the retina of a New World monkey, the marmoset, Callithrix jacchus.

Two types of cone bipolar cells, the blue cone bipolar cell and the diffuse bipolar cell (DB3), were labelled immunohistochemically and investigated in the retina of a New World monkey, the marmoset. Blue cone bipolar cells were labelled with an antiserum against cholecystokinin. Short-wavelength-sensitive (SWS) cones were labelled with an antiserum against the SWS cone opsin. The DB3 cells were labelled with antibodies to calbindin. Blue cone bipolar cells in marmoset do not form a regular mosaic but instead follow the random distribution of the SWS cones. Nevertheless, the SWS cone to blue cone bipolar cell connectivity in marmoset is very similar to that previously described for macaque. In contrast to the blue cone bipolar cells, the DB3 cells form a regular mosaic. The synaptic connectivity of DB3 cells in the inner plexiform layer was analyzed. They make output synapses onto ganglion cells and amacrine cells, and gap junctions with each other. Our results provide further evidence for the existence of parallel bipolar cell pathways in the primate retina and support the view that the retinae of Old World and New World primates have common neuronal connectivity. The random distribution of SWS cones and blue cone bipolar cells is an exception to the general rule of a regular mosaic distribution of cell populations in the retina.     

Midget and parasol ganglion cells of the primate retina express the alpha1 subunit of the glycine receptor

Glycine is a major inhibitory neurotransmitter in the mammalian retina and has been shown to influence the responses of ganglion cells. Midget and parasol ganglion cells serve distinct physiological roles in the primate retina and show differences in their response characteristics to light stimuli. In the present study, we addressed the question of whether the expression of glycine receptors differs in midget and parasol ganglion cells. Ganglion cells in the retinae of marmoset and macaque monkeys were injected with Neurobiotin in a live in vitro retinal whole-mount preparation. Retinal pieces were then processed with an antibody against the alpha1 subunit of the glycine receptor. Strong punctate immunoreactivity indicative of synaptic localization is present in the ON and OFF sublamina of the inner plexiform layer. Many of the immunoreactive puncta coincide with the dendrites of both midget and parasol ganglion cells. Immunoreactive puncta are present on distal and proximal dendrites of ON and OFF cells. These results suggest that ON and OFF midget and parasol cells do not differ with respect to the distribution of the alpha1 subunit of the glycine receptor.