Encephalopathy associated with acute measles

Thirty children presenting with acute encephalopathic illness within a month of measles were studied. A male preponderance was found and 83.3% of cases were below 5 years of age. The interval between onset of measles rash and that of encephalopathy ranged from 0 to 20 days. Fever (96.6%), convulsions (70%), and coma (90%) were found in a high percentage of cases, while focal neurological deficits and abnormal movements were found in a small number of patients (3.3% and 16.6% respectively). Signs of cerebellar or medullar involvement were not seen. Only 1 (3.3%) case had pleocytosis in the cerebrospinal fluid. Eleven (36.6%) patients died in hospital. The pathogenesis of acute encephalopathy following measles is discussed. An erratum to this article is available at .     

Perforated tubercular enteritis of childhood: A ten year study

One hundred sixty seven children were operated at the Kalawati Saran Children Hospital for acute peritonitis during last 10 years (1978–88). Bowel perforation was seen in 123 cases. Nineteen cases had underlying Tubercular enteritis. Preoperative diagnosis was usually difficult. The terminal ileum was affected in 12 and the jejunum in 5 cases. Multiple perforations were seen in 3 cases. Postoperative mortality was high (12/19) and usually attributable to their poor preoperative status.     

Camurati-Engelmann disease with recurrent bone marrow hypoplasia

A one year old girl with Camurati-Engelmann disease suffered from recurrent episodes of anemia and mucocutaneous bleeding, following upper respiratory or diarrheal infections. On two of such occasions, the bone marrow trephine biopsy showed hypoplastic marrow. Each time she showed complete hematological recovery, after corticosteroid therapy.     

Progressive dystonia with marked diurnal variation

A8 year old girl with progressive dystonia with marked diurnal variation who showed marked response to L-DOPA therapy, is being discussed to highlight the need for prompt recognition of this treatable disease.     

Endoscopic versus open saphenous vein harvest: a comparison of postoperative wound complications

BACKGROUND: Wound complications associated with long incisions used to harvest the greater saphenous vein are well documented. Recent reports suggest that techniques of endoscopic vein harvest may result in decreased wound complications. A prospective, nonrandomized study was developed to compare outcomes of open versus endoscopic vein harvest procedures. METHODS: There were 106 patients in the open vein harvest group, and 154 patients in the endoscopic vein harvest group. Patient characteristics and demographics were similar in both groups. Wound complications identified were dehiscence, drainage for greater than 2 weeks postoperatively, cellulitis, hematoma, and seroma/lymphocele. RESULTS: Wound complications were significantly less in the endoscopic vein harvest group (9 of 133, 6.8%) versus the open vein harvest group (26 of 92, 28.3%), p less than 0.001. By multivariable analysis with logistic regression, the open vein harvest technique was the only risk factor for postoperative leg wound complication (relative risk 4.0). CONCLUSIONS: Endoscopic vein harvest offered improved patient outcomes in terms of wound healing compared with the open vein harvest technique.     

Distribution of furamidine analogues in tumor cells: targeting of the nucleus or mitochondria depending on the amidine substitution

Diphenylfuran diamidines represent an important class of DNA minor groove binders of high therapeutic interest as antiparasitic or antitumor agents depending on the compounds structures. To exert their cytotoxic action, the compounds must first get into the cell and reach the nuclear compartment where the main target, DNA, is located. The forces that drive the drugs into cell nuclei, as well as the influence of the molecular structures on the cell distribution, are not known. To address these issues, we took advantage of the fluorescence of the molecules to analyze their intracellular distribution profiles in tumor cells of different origins (B16 melanoma, MCF7 mammary adenocarcinoma, A549 lung carcinoma, HT29 colon carcinoma, LNCaP, and PC3 prostatic carcinoma) by epifluorescence and confocal microscopy. A homogeneous series of synthetic bis-substituted alkyl or phenyl amidine and reverse amidine derivatives of furamidine was used to dissect the molecular mechanisms that control the distribution of the drugs into the cytoplasm or the nucleus of the cells. The amidine (DB75) and the various N-alkyl derivatives were found to accumulate selectively in the cell nuclei. This is also the case for a guanidine derivative but not for the phenyl-substituted compound DB569, which essentially localizes in cytoplasmic granules. Similar cytoplasmic patterns were observed with a reverse amidine analogue and a pyridine-substituted compound indicating that the presence of aromatic rings on the terminal side chain is the limiting factor that restricts the uptake of the compounds in the nuclear compartment. The use of different organelle-selective fluorescent probes, such as JC-1 and chloromethyl-X-rosamine, both specific to mitochondria and neutral red considered as a lysosome-selective probe, suggests that DB569 preferentially accumulates in mitochondria. Competition experiments with the antitumor drug daunomycin reveal that the diphenylfurans are attracted into the nuclei by the DNA. The DNA minor groove-drug interactions provide the driving force that permits massive accumulation of the fluorescent molecules in the nuclei. The DNA binding properties of the diphenylfuran derivatives were investigated by DNase I footprinting and surface plasmon resonance biosensor experiments to measure sequence selectivity and binding affinities, respectively. Furamidine and its phenyl-substituted analogue that accumulate in the cell nuclei and mitochondria, respectively, share a common selectivity for AT sites and bind equally tightly to these sites. Therefore, it is possible to modulate the intracellular distribution of the furamidine derivatives without affecting their DNA binding and sequence recognition properties. The introduction of aromatic substituents on diphenylfuran diamidines represents a novel strategy to control the intracellular compartmentalization of these DNA binding agents and directs them to mitochondria. This drug design strategy may prove useful to trigger drug-induced apoptosis.