A rare case of coexistent carcinoma of the colon with tuberculosis

This is a case report of a 35-year-old female who presented with acute intestinal obstruction initially diagnosed as ileocaecal tuberculosis. She was submitted to exploratory laparotomy with a right hemicolectomy for a non-passable ileocaecal mass. Histopathology showed colon cancer with tuberculosis both in the colon as well as the mesenteric lymph node. In addition to its pathological rarity, this case is of particular interest, because it highlights the diagnostic dilemma and therapeutic challenge associated with such a condition.     

Pregnancy in Jamaican women with homozygous sickle cell disease. Fetal and maternal outcome

The outcome of 664 pregnancies in 297 Jamaican women with homozygous sickle cell (SS) disease over the period 1959-1984 was reviewed. Overall, the spontaneous abortion rate was 118 per 1000 pregnancies, the stillbirth rate 128 per 1000 births, and perinatal mortality 171 per 1000 births. There was a striking secular increase in both spontaneous abortions and stillbirths which was accounted for, in part, by a trend for abortions to increase with maternal age up to the age of 30 years, a greater proportion of patients in the high-risk 25-29 year age group occurring in the 1980-1984 period. Another factor contributing to the poor obstetric performance in the 1980-1984 period was probably an increased survival and pregnancy rate in high-risk patients. Seven women had pregnancy-related deaths giving a pregnancy mortality rate of 1.1%.     

Amethocaine-induced inhibition of mitochondrial monoamine oxidase activity

Amethocaine (tetracaine) (1-10 microM) produces a concentration-dependent in-vitro inhibition of mitochondrial membrane-bound MAO activity towards tyramine (18-84% in brain and 19-84% in liver) and 5-hydroxytryptamine (5-HT) (23-94% in brain and 20-100% in liver). At relatively higher concentrations (25-300 microM) of amethocaine, benzylamine oxidation is inhibited in brain (24-91%) and liver (29-100%). The extent of MAO inhibition is appreciably reduced when preincubation time of the enzyme with a low concentration (7.5 microM) of amethocaine is increased from zero to 45 min. This inhibition is reversible. The Km of MAO for tyramine is increased in brain (106-473%) and liver (121-352%) in the presence of amethocaine (2-7.5 microM) accompanied by a decrease in Vmax (21-51% in brain and 18-57% in liver). Similarly the Km of MAO for 5-HT is increased to the extent of 79-336% in brain and 51-225% in liver and the corresponding Vmax is decreased by 35-55% and 39-74%, respectively, in the presence of 2-5 microM amethocaine. At relatively higher concentrations (25-100 microM), amethocaine increases the Km of MAO for benzylamine in brain (25-101%) and liver (26-85%) and decreases the Vmax by 28-64% and 32-63% in the respective tissues. Thus these results suggest that amethocaine preferentially inhibits MAO-A and the nature of inhibition is reversible and of mixed type.     

Repeated exposure to high environmental temperature changes brain regional GABA metabolism

The effects of repeated exposure (2 h/day) to high environmental temperatures (40 degrees C) for 7, 15 and 30 consecutive days on gamma-aminobutyric acid (GABA) metabolism in different regions of adult rat brain were investigated. The GABAergic activity in hypothalamus was increased with the increase in duration (7-30 days) of HET exposure. In corpus striatum, on the other hand, 7 days repeated HET-induced increase in GABAergic activity was attenuated on prolongation of HET exposure from 15-30 consecutive days. Repeated HET exposure for 7 consecutive days also enhanced cerebrocortical GABAergic activity that became normalized following 15 or 30 days repeated HET exposure. These results suggest that long-term (repeated HET exposure enhanced hypothalamic GABAergic activity to adapt to the environment with the regulation of body temperature.     

Juvenile polyposis in a tropical country

The clinical profile, malignant potential, and management of 17 children with juvenile polyposis (more than five juvenile polyps) were evaluated clinically and endoscopically. Colonoscopy and polypectomy were done three weekly until colonic clearance was achieved, and thereafter two yearly. All polyps were subjected to histological examination. Mean age was 7.7 years, with a male preponderance (3:1). Presentation was with rectal bleeding (94%), pallor (65%), stunted growth (53%), and oedema (47%), and the mean (SD) duration of symptoms was 33 (27) months. None had a positive family history or any congenital anomaly. Two children had six polyps up to the transverse colon; the rest had numerous polyps all over the colon. All children had juvenile polyps on histology and 10 (59%) had adenomatous changes (dysplasia). Total colectomy was done in six for intractable symptoms. Colon clearance was achieved in eight after an average 3.4 polypectomy sessions, and three were still on the polypectomy programme. In conclusion, juvenile polyposis is commonly associated with low grade dysplasia. Serial colonoscopic polypectomy is effective but colectomy is required for intractable symptoms and when clearance of the colon is not possible.     

Country watch: India

In North Bengal, India, more than 340 tea plantations (estates) are registered with the State Tea Board; estate workers contribute to the spread of human immunodeficiency virus (HIV) infection and sexually transmitted disease (STD) through their use of multiple sex partners and alcohol, and via the drug and prostitute trafficking in the region. The West Bengal Voluntary Health Association (WBVHA) convinced estate managers to offer HIV/STD education to their workforce, which numbers more than 250,000. Three employers' associations were mobilized. Initial activities included the organization of education seminars and meetings at estates for plantation managers, physicians, social workers, and workers. Labor leaders motivated workers to participate. WBVHA and government health institute staff used lectures, printed materials, flipcharts, videos, and audiocassettes to provide basic information on HIV and acquired immunodeficiency syndrome (AIDS), STDs, and condom use. At the request of the estate managers, WBVHA has prepared an action plan. It includes development of an HIV/STD policy, regular collection of KABP data, periodic meetings with managers and workers to provide updated information, and peer educator training. Some of the estates have begun distributing condoms and offering STD treatment through their health clinics. Workers requesting HIV testing are referred to medical institutes where WBVHA conducts weekly counseling. Ladies' clubs have been established; some of the peer educators will be recruited from these groups.