Massive osteolysis of hemimandible: a case report

Massive osteolysis or Gorham’s stout disease or phantom bone is a rare disorder which normally appears in adulthood with no specific predilection for any sex. Work to find out exact etiology of disorder has been done. But actual cause has not yet been found. Any of the bone could be involved in this disease. A clinical, radiographic and histological evaluation of massive osteolysis of mandible is presented and discussed.     

Supernatants from ultraviolet-irradiated keratinocytes decrease the resistance and delayed-type hypersensitivity response to Mycobacterium bovis bacillus Calmette-Guerin in mice and impair the phagocytic ability of macrophages.

We recently demonstrated that exposure of mice to a single high dose or multiple smaller doses of ultraviolet (UV) radiation decreased the induction of the delayed-type hypersensitivity (DTH) response to bacillus Calmette-Guerin (BCG) from Mycobacterium bovis injected into unexposed sites. In view of the limited ability of UV radiation to penetrate beyond the epidermis and upper layers of the dermis, it is not entirely clear how exposing the dorsal skin of mice to UV radiation causes systemic impairment of the immune response to BCG. In this study we report that mice injected with supernatants from keratinocyte cultures exposed to UV radiation in vitro impaired host resistance to BCG. Both induction and elicitation of the DTH reaction were suppressed after the intravenous injection of supernatants from UV-irradiated keratinocytes. Furthermore, these supernatants interfered with the elimination of viable bacteria from the lymphoid organs. To determine whether macrophages were the target of the UV-induced, keratinocyte-derived, suppressive cytokine, macrophages were isolated from mice injected with the suppressive cytokine or treated in vitro with the supernatants and tested for their ability to ingest and kill BCG in vitro. Injection of the suppressive factor significantly reduced the phagocytosis of BCG by the macrophages but did not alter the rate of intracellular killing. Similarly, phagocytosis was reduced when normal macrophages were treated in vitro with the suppressive factor. These findings suggest that the suppressive cytokine interferes with the elimination of bacteria in vivo by inhibiting the initial step in bacterial clearance, the uptake of the bacteria by host macrophages.(ABSTRACT TRUNCATED AT 250 WORDS)     

Renal transplantation in gigantism: A case report

BACKGROUNDGigantism, characterized by excessive growth and height is due to increased secretion of growth hormone, most commonly from a pituitary adenoma. In addition to the surgical and anesthetic complexity, the extreme stature of these patients presents a unique challenge for kidney transplantation in deciding whether to proceed with a single or dual kidney transplantation. The lack of relevant literature further adds to the dilemma. CASE SUMMARYA 45-year-old patient with untreated gigantism and end stage renal failure on renal replacement therapy was waitlisted for a deceased donor dual kidney transplantation due to the extreme physical stature (Height-247 cm and weight-200 kg). He was offered 2 kidneys from a 1-0-1 HLA mismatched 24-year-old DCD donor (Height-179 cm and weight-75 kg), and was planned for a bilateral retroperitoneal implantation into the recipient external iliac vessels. The immunosuppression consisted of alemtuzumab induction (50 mg) and steroid-free maintenance with tacrolimus. The donor’s right kidney was uneventfully implanted extra-peritoneally into the right external iliac vessels. On contralateral exposure, the left common and external iliac arteries were ectatic and frail. A complex vascular reconstruction was not preferred in order to preserve the arterial supply to the left lower limb, to minimise the cold ischemia time and prevent additional warm ischemic insult to the second kidney. Hence, it was decided not to proceed with dual transplantation. Amidst concerns of nephron mass insufficiency, the graft function was remarkable with a serum creatinine of 120 µmol/L within a month from transplantation and 94 µmol/L at 1-year post transplantation, and without proteinuria. CONCLUSIONTo our knowledge, this is the first case report on kidney transplantation in gigantism. Although it is believed that dual kidney transplantation is ideal, a single kidney transplantation from an appropriately selected donor can provide sufficient functioning nephron mass in patients with gigantism.     

Food consumption and serum nutritional status of people living in the Kathmandu valley in Nepal

Objective The food consumption and serum nutritional status of people living in the Kathmandu valley, Nepal, were examined to obtain actual data for comparison with our previous findings. Methods A dietary survey of 45 males and 60 females was carried out in March 1997 by the 24-hr dietary recall method and nutrient intake was calculated from food tables of India and Japan. Fasting venous blood samples were obtained and serum biochemical parameters were measured using clinical kits. Results The mean body mass index values was at about the same level in both sexes, although the mean percentage body fat of females was higher than that of males, and vice versa for packed red cell volume. The main foods consumed by both sexes, were rice, potatoes, meats, milk & dairy products and vegetables, with a difference in the amounts consumed. Females did not drink alcoholic beverages. The mean daily intakes of energy, protein, lipids, iron and vitamin B group for the males were higher than those for the females, while those of vitamins A and C for the males were lower than those for the females. The mean values of serum biochemical parameters for both sexes were generally at the normal levels, but those of ALT and TG were at the higher end of the normal range. Differences of correlation between food groups and between serum parameters were observed depending on the sex, however, no clear relationship between food and nutrient intake and serum biochemical parameters were observed. Conclusions The present food intake study revealed that the amounts of food consumption for both sexes, especially for the females, were mostly insufficient although the serum parameters were at the normal levels. The energy intake of both sexes was lower than that of estimated requirements and those in Terai region. The relatively high serum TG level of the subjects may be due to the consumption of large amounts of cereals containing much carbohydrate. Our findings suggested a marked influence on food consumption by food price and income in spite of the easier food availability in the city, and also lack of knowledge about nutrients and health, thus there is need for improvement of the nutritional status of this group of people.     

Outcomes of Percutaneous Portal Vein Intervention in a Single UK Paediatric Liver Transplantation Programme

CardioVascular and Interventional Radiology - Percutaneous transluminal angioplasty (PTA), with or without stent placement, has become the treatment of choice for portal vein complications (PVC)...     

Relationship between serum copper and protein thiols in hyperlipidemic patients

Objective:To measure serum copper and protein thiols along with lipid profile in hyperlipidemic patients and to establish the relationship between serum copper,protein thiols and lipid profile parameters.Methods: The study group consisted of 26 newly diagnosed hyperlipidemic patients not associated with any other systemic diseases and 26 age and sex matched healthy controls.Fasting lipid profile was done by enzymatic method using automated analyzer.Serum copper and protein thiols were measured spectrophotometrically.Results: Serum copper and protein-SH levels were significantly decreased in cases(P<0.01,P<0.01) compared to controls.Serum copper correlated positively with protein thiols(r=0.800,P<0.01) and negatively with LDL cholesterol(r=-0.351 P<0.05).Conclusion: Serum copper and protein thiols were decreased in hyperlipidemia and they correlated positively indicating protective role of copper in preventing homocysteinylation of protein and hence in preventing atherosclerosis.     

The in vivo immunomodulatory effect of recombinant tumour necrosis factor-alpha in guinea pigs vaccinated with Mycobacterium bovis bacille Calmette-Guérin

A void in understanding primary biliary cirrhosis (PBC) is the absence of appropriate animal models. Our laboratory has studied a murine model of autoimmune cholangitis induced following immunization with 2-octynoic acid (2OA), an antigen identified following extensive quantitative structural activity relationship (QSAR) analysis, using human autoantibodies and three-dimensional analysis of the mitochondrial autoantigen, the E2 subunit of the pyruvate dehydrogenase complex (PDC-E2). Mice immunized with 2OA coupled to bovine serum albumin (BSA) develop anti-mitochondrial antibodies (AMAs) of the identical specificity as humans with PBC, and in addition develop inflammatory portal cell infiltrates in liver. However, the natural history of disease is less severe than in humans and does not include fibrosis. Data from human and autoimmune murine models suggest that environmental and/or infectious agents can exacerbate autoimmune reactions, and a model of PBC has been described in which polyinosinic-polycytidylic acid (poly I:C), a viral RNA mimetic and Toll-like receptor 3 (TLR-3) agonist induces low-titre AMAs and in mild portal infiltrates. We took advantage of our established model to determine whether immunization with 2OA-BSA coupled with poly I:C alters the disease process. Indeed, the addition of poly I:C produces a profound exacerbation of autoimmune cholangitis, including a significant increase in CD8(+) infiltrating T cells, as well as a marked increase of proinflammatory cytokines. In addition, mice have evidence of fibrosis. These findings lend support to the concept that besides breakdown of self-tolerance, there is a requirement of a second 'hit' during the breakdown process that leads to disease which more faithfully mimics human PBC.     

Effect of local ultraviolet irradiation on infections of mice with Candida albicans, Mycobacterium bovis BCG, and Schistosoma mansoni.

In this study, we investigated whether mice given ultraviolet (UV)-B (280-320 nm) radiation in doses sufficient to alter cutaneous immune cells and impair the induction of contact hypersensitivity would also have impaired resistance to infectious agents administered at the site of UV irradiation. C3H mice were exposed to 400 J/m2 UVR from FS40 sunlamps on four consecutive days. Immediately after the last UV treatment, groups of mice were injected subcutaneously with Candida albicans, injected intradermally (ID) with Mycobacterium bovis bacillus Calmette-Guerin (BCG), or infected percutaneously with Schistosoma mansoni in UV-irradiated skin. The induction of the delayed hypersensitivity response to C. albicans and BCG, as assessed by footpad swelling, was unaffected by UV irradiation. However, the number of viable mycobacteria recovered from the lymphoid organs of BCG-infected mice was increased significantly in the UV-irradiated animals for a period of more than 2 months. Low-dose UV irradiation of the skin at the site of infection did not influence the number of S. mansoni parasites recoverable from the internal organs of mice that had been infected with cercariae percutaneously 6 weeks earlier. We conclude that the ability of UV radiation to impair the development of cell-mediated immunity to antigens introduced in a UV-irradiated site is not universal and depends on the particular antigen administered. We hypothesize that the involvement of epidermal Langerhans cells as the primary antigen-presenting cells in the induction of cell-mediated immunity may be the critical factor in determining whether a particular immune response will be affected by local UV irradiation.