Colonic gallstones:a case report

BACKGROUND:Colonic gallstone is an uncommon entity with high morbidity and mortality due to various reasons. It remains a diagnostic challenge because of delayed and non-specific presentations,especially in the elderly population,often with multiple co-morbidities. METHOD:We present a case of 81-year-old woman who had a large bowel obstruction due to colonic gallstone. RESULTS:Immediately after a cholecysto-colonic fistula was found by laporotomy,she underwent a single stage enterolithotomy,cholecystectomy and fistula closure. CONCLUSIONS:A single stage enterolithotomy,cholecys- tectomy and fistula closure is ideal for this condition. Various other surgical options in the literature are discussed.     

Sleep architecture, cocaine and visual learning

BACKGROUND: Disturbances in sleep associated with chronic cocaine use may underlie abstinence-related cognitive dysfunction. We hypothesized that sleep-related cognitive function would be impaired in chronic cocaine users, and that this impairment would be associated with abstinence-related changes in sleep architecture. METHODS: Twelve chronic cocaine users completed a 23-day in-patient study that included randomized, placebo-controlled, cocaine self-administration sessions. We report polysomnographic measurement of rapid eye-movement (REM) sleep and slow-wave activity, and performance on a visual texture discrimination task. FINDINGS: Progressive abstinence from cocaine was associated with characteristic changes in REM sleep. REM sleep was shortest on nights following cocaine use and rebounded in the first week of abstinence before diminishing with progressive abstinence, following a pattern opposite that of slow-wave activity. Overnight visual learning was observed over the first night following 3 consecutive days of laboratory cocaine use; however, learning was not observed at 3 days or 17 days of abstinence. Across all points of abstinence, early-night slow-wave activity was associated strongly with non-deterioration of visual performance overnight. Furthermore, overnight enhancement of visual performance was predicted by the co-occurrence of sufficient early-night slow-wave activity and late night REM sleep, similar to results from studies in healthy subjects. CONCLUSIONS: These results suggest that abstinence-associated sleep-dependent learning deficits are related to characteristic changes in sleep architecture, and promote the idea that treatments directed at sleep ('somno-tropic' treatments) could be helpful in offsetting physiological consequences of cocaine abstinence.     

Pediatric-type nodal follicular lymphoma: an indolent clonal proliferation in children and adults with high proliferation index and no BCL2 rearrangement

Pediatric follicular lymphoma (PFL) is a variant of follicular lymphoma (FL) presenting as localized lymphadenopathy in children. Unlike conventional adult FL, PFL typically does not recur or progress. Clear diagnostic criteria for PFL are lacking, and it is uncertain whether this indolent lymphoma is defined by age or may occur in adults. We analyzed 27 FL in patients < 40 years of age and found that all 21 cases that lacked a BCL2 gene abnormality (BCL2-N; P < .0001) and had > 30% Ki67 fraction (high proliferation index, HPI; P = .0007) were stage I and did not progress or recur; in comparison, all 6 cases with BCL2 rearrangement and/or PI < 30% were stage III/IV, and 5 of 6 recurred or progressed. In a separate cohort of 58 adult FL (≥ 18 years of age), all 13 BCL2-N/HPI cases were stage I, and none progressed or relapsed, whereas 11 of 15 stage I cases with BCL2 gene abnormality and/or LPI relapsed or progressed (P = .0001). The adult and pediatric BCL2-N/HPI FL cases had similar morphologic features. Our results confirm the highly indolent behavior of PFL and suggest that these are characterized by HPI and absence of BCL2 gene abnormality. PFL-like cases also occur in adults and are associated with indolent behavior in this patient population.     

Induction of the Swallowing Reflex by Electrical Stimulation of the Posterior Oropharyngeal Region in Awake Humans

We designed an electrical stimulation system to safely and reliably evoke the swallowing reflex in awake humans, and then examined the neural control of reflex swallowing initiated by oropharyngeal stimulation. A custom-made electrode connected to a flexible stainless-steel coil spring tube was introduced into the pharyngeal region through the nasal cavity and placed against the posterior wall of the oropharynx. Surface electrodes placed over the suprahyoid muscles recorded the electromyogram during swallowing. Swallowing reflexes were induced several times by 30?s of repetitive electrical pulse stimulation (intensity: 0.2?C1.2?mA, frequency: 10?C70?Hz, pulse duration: 1.0?ms). The onset latency of the swallowing reflex was measured over the 10?C70?Hz frequency range. In addition, the two time intervals between the first three swallows were measured. The onset latency of the swallowing reflex became shorter as the stimulus frequency increased up to ??30?Hz. Once the frequency exceeded 30?Hz, there was no further reduction in the latency. This finding was consistent with those of previous studies in anesthetized animals. The time intervals between successive swallowing reflexes did not change with increased stimulus frequencies. Furthermore, prolonged stimulation often failed to elicit multiple swallowing reflexes. The frequency dependence of onset latency suggests that temporal summation of pharyngeal afferents is required to activate the medullary swallowing center. This reliable stimulation method may help in rehabilitation of dysphagic patients without causing aspiration.     

Bacterial spectrum and their sensitivity pattern in patients of chronic suppurative otitis media

The study was conducted from March 2008 to February 2010 in Microbiology Department, Citi Lab, Rawalpindi, to determine the causative microorganisms and their antibiotic sensitivity pattern in patients with chronic suppurative otitis media. One hundred and eighty-three samples received at Citi Lab were included in the study. Pus samples were cultured aerobically. Antibiotic sensitivity testing was done with standard antibiotic discs using modified Kirby-Bauer disk diffusion method. Out of 183 patients, microbiological culture was yielded from 154 specimens (84%). There were 148 bacterial isolates (96%) and 06 fungi (4%). Pseudomonas aeruginosa (n=59, 38%) was the most common isolate followed by Staphylococcus aureus (n=34, 22%). Susceptibility pattern of Pseudomonas aeruginosa showed that 100% isolates were sensitive to Piperacillin/Tazobactam, whereas 98% isolates were sensitive to Imipenem and 76% to Ciprofloxacin. Continuous surveillance of susceptibility pattern is suggestive for effective therapy of chronic suppurative otitis media.     

DAI scores and its relation to self-perceived dental aesthetic and orthodontic concern in Bangladesh and Japan

PurposeTo investigate the relationship between the severity of occlusal irregularities and orthodontic treatment concern among the population of a developing country using DAI score and to compare with the relationship found in a developed country.Materials and methodsThe sample comprised 400 randomly selected university students of Bangladesh, a developing country, 210 males and 190 females, aged 20–27 years. A pretested questionnaire was used to assess the subjects’ satisfaction with own dental appearance and orthodontic treatment concern; the actual severity of malocclusion was determined using the Dental Aesthetic Index (DAI). Statistical analysis was carried out using t-test for gender differences; Spearman rank-order correlation coefficients, Scheffe's post hoc test, one way ANOVA and logistic regression analysis were done for correlation between malocclusion severity and response to questionnaire. The data from a similar study that was carried out on the university students of Japan, a developed country, was compared.ResultIn Bangladeshi sample, males were more affected by malocclusion. Moderate correlation was found between malocclusion, self-satisfaction and treatment concern where satisfaction was decreased and treatment desire was increased with the severity of malocclusion. In Japanese sample, the prevalence of malocclusion was found more in females. Self-satisfaction and malocclusion showed weak correlation and no significant correlation was found between treatment concern and malocclusion.ConclusionAlthough DAI can be used universally to evaluate malocclusion and self-perception, it should be used carefully to determine the subjects’ actual desire for orthodontic treatment where the socio-economic condition can be a provocative factor.     

Completely self-contained cell culture system: from storage to use

In vitro cell culture systems provide researchers the appropriate tools for effectively studying cell growth and differentiation, understanding cellular response to specific environmental stimuli, and elucidating the function of heterologous biological molecules produced from expression systems. All in vitro cell culture systems require a specific culture media formulated to the nutritional and metabolic requirements of the particular cell type to be cultured. However, the complexity of these systems varies depending on the model organism origin of the cells being cultured (e.g., bacteria, plants, yeast or animal). Unlike bacteria and yeast, mammalian cell cultures require sophisticated auxiliary technologies (e.g., controlled gas mixtures and pressure flow systems, specialized facilities and equipment) and careful handling by trained personnel. These complex requirements pose a limitation to transferring cells to and from remote field locations for investigations. Furthermore, this limitation is a technical hurdle in the development of technologies involving use of live cells (e.g., cytosensors). We identified a novel and unrealized feature in the conventional cell culture system that may be exploited to adapt simple existing technologies to form a portable apparatus for storing and growing cells. The approach we describe is a completely self-contained cell culture system that not only will bring down the cost of culturing cells but also will expand cell culture applications in medicine, research, environmental health, and safety.