Angiomyoma of the palate--a case report

Leiomyomas are rare tumors of the palate amongst which angiomyomas are the commonest sub-type. Recurrence is rare and prognosis is excellent. Only a few case reports are available in literature. We report a case of angiomyoma of the palate presenting as an encapsulated swelling in the roof of the mouth.     

Allograft rejection and glomerular basement membrane antibodies in Alport's syndrome

BACKGROUND: Anti-glomerular basement membrane (GBM) antibodies occasionally occur in Alport patients after renal allograft transplantation. METHODS: We report a patient with Alport's syndrome who lost four transplants each within the first year post transplantation. We searched for the presence of anti-GBM antibodies using recombinant NC1 domains of type IV collagen. Immunoblotting, enzyme linked immunosorbent assay (ELISA), and immunofluorescence were used to detect the presence of antibodies against the glomerular basement membrane. RESULTS: High antibody titers to the alpha3 chain (the Goodpasture antigen) and alpha5 chain of type IV collagen were detected. Review of pathologic specimens showed features of vascular rejection in all specimens. CONCLUSION: The association of high titer anti-GBM antibodies and vascular rejection may be important. When vascular rejection occurs in Alport patients, the presence of anti-GBM antibodies should be sought. Recombinant anti-GBM assays should be used if standard anti-GBM testing is equivocal.     

Role of F.E.S.S. in chronic sinusitis

Functional endoscopic sinus surgery (FESS) is a new and exciting treatment for chronic sinus disease. A prospective study of 50 patients undergoing FESS was undertaken at the department of Otolaryngology, Dayanand Medical College & Hospital, Ludhiana. Parameters studied included patient symptoms, medical history, medical therapy, radiologic findings, complications and postoperative symptoms. 62% of our patients had sinonasal polypi (ethmoidal polypi 56%, antrochoanal polypi 6%) while 38% had chronic sinusitis. Osteomeatal complex involvement (88%) was the most common preoperative CT scan findings. All the cases were subsequently suhjected to functional endoscopic sinus surgery, studied for post-operative complications and 82% of the patients achieved improvement in preoperative symptoms. It was concluded that FESS is a highly successful treatment for chronic sinus disease.     

An improved method of preparing the amyloid beta-protein for fibrillogenesis and neurotoxicity experiments.

Synthetic amyloid beta-protein (A beta) is used widely to study fibril formation and the physiologic effects of low molecular weight and fibrillar forms of the peptide on cells in culture or in experimental animals. Not infrequently, conflicting results have arisen in these studies, in part due to variation in the starting conformation and assembly state of A beta. To avoid these problems, we sought a simple, reliable means of preparing A beta for experimental use. We found that solvation of synthetic peptide with sodium hydroxide (A beta x NaOH), followed by lyophilization, produced stocks with superior solubility and fibrillogenesis characteristics. Solubilization of the pretreated material with neutral buffers resulted in a pH transition from approximately 10.5 to neutral, avoiding the isoelectric point of A beta (pI approximately 5.5), at which A beta precipitation and aggregation propensity are maximal. Relative to trifluoroacetate (A beta x TFA) or hydrochloric acid (A beta x HCl) salts of A beta, yields of "low molecular weight A beta" (monomers and/or dimers) were improved significantly by NaOH pretreatment. Time-dependent changes in circular dichroism spectra and Congo red dye-binding showed that A beta x NaOH formed fibrils more readily than did the other A beta preparations and that these fibrils were equally neurotoxic. NaOH pretreatment thus offers advantages for the preparation of A beta for biophysical and physiologic studies.     

Urine proteomic profiling of pediatric nephrotic syndrome

The prognosis of pediatric nephrotic syndrome (NS) correlates with the responsiveness to glucocorticoid therapy. Steroid-resistant NS (SRNS) patients progress to end-stage renal disease, while steroid-sensitive NS (SSNS) and steroid-dependent (SDNS) patients do not. We have performed proteomic profiling of urine samples from a cross section of pediatric and adolescent subjects with SSNS, SRNS, and orthostatic proteinuria (OP) to identify urinary biomarkers of steroid resistance. We performed surface-enhanced laser desorption/ionization time of flight mass spectrometry (SELDI-TOF MS) on urine from 19 subjects with SSNS/SDNS in remission, 14 with SSNS/SDNS in relapse, 5 with SRNS in relapse, and 6 with OP. Genetic algorithm search of principal component space revealed a group of five peaks distinguishing SRNS subjects, with mass/charge (m/z) values of 3,917.07, 4,155.53, 6,329.68, 7,036.96, and 11,117.4. Our analyses identified the peak at m/z 11,117.4 with an accuracy of 95% for classifying SRNS. Multidimensional protein fractionation and mass spectrometric analysis of SRNS urine samples combined with immunodepletion identified the 11,117.4 protein as β₂-microglobulin (B2M). Using an unbiased protein profiling approach, we have validated previously reported findings of B2M as a biomarker associated with SRNS. Prospective studies are warranted to establish additional biomarkers that would be predictive of SRNS.MK and AZT contributed equally to this work.     

Primary bladder dermoid: a case report and review of the literature

Bladder dermoid is a rare presentation. Diagnosis of this case was made cystoscopically and confirmed histopathologically. Complete excision was possible endoscopically. This is the 3rd case report from the Indian and Asian subcontinent.     

Identification of acetylcholine receptor subunits differentially expressed in singly and multiply innervated fibers of extraocular muscles

PURPOSE: To identify the acetylcholine receptor (AChR) isoforms among the neuromuscular junctions (NMJs) of singly and multiply innervated fibers (SIFs and MIFs) of rat extraocular muscles (EOMs). METHODS: EOMs were dissected from adult rats and serially sectioned. Sections were simultaneously stained for acetylcholinesterase and with an antibody to the slow myosin heavy chain to identify NMJ topography and fiber types in the same section. Synapses and subsynaptic regions of SIFs and MIFs were isolated by laser capture microdissection and the AChR subunits identified by RT-PCR. RESULTS: The en plaque endings of SIFs expressed only the adult epsilon subunit, not the fetal gamma subunit, of the AChR, whereas the en grappe endings of the MIFs expressed only the gamma subunit, and not the epsilon subunit. Although the expression of the epsilon subunit was confined to the NMJ region of the SIFs, the gamma subunit was expressed both synaptically and extrasynaptically within the MIFs. The gamma subunit in MIFs correlated with the expression of the myogenic regulatory factor myogenin. Moreover, an unusual neuronal AChR subunit, alpha9, was found in the EOMs, but not in the limb muscles. CONCLUSIONS: The adult epsilon and fetal gamma subunits of the AChRs are segregated into distinct synapses on distinct fiber types. The maintenance of the fetal subunit in a population of fibers is probably linked to the expression of myogenin and is a unique attribute of the EOM allotype.     

Gastric and postpyloric total enteral nutrition

Opinion statement The provision and maintenance of good nutrition in patients with acute and chronic illness is a fundamental part of standard medical and surgical care. Recently, there is great interest in using enteral nutritional support to reverse the morbidity and mortality associated with malnutrition. Enteral nutrition is preferred over parenteral nutrition because it is more physiologic, maintains intestinal structure and function, limits bacterial translocation, has less morbidity, has fewer complications, and is less expensive. However, the decision to feed into the stomach or into the small bowel (postpyloric) continues to be a matter of some debate and continued clinical investigation. Although the gastric route of enteral feeding is easier and less expensive, some physicians worry that gastric feeding may predispose to aspiration and pneumonia, especially in critically ill patients who frequently have delayed gastric transit. In these critically ill patients, small bowel function usually remains relatively intact and placement of a postpyloric feeding tube may permit more effective delivery of nutrients. However, it should be noted that placement of postpyloric feeding tubes can be challenging, and this may lead to a delay in initiation of nutritional support.