Simultaneous bilateral fungal keratitis caused by different fungi

Fungal keratitis is an important cause of corneal disease in the tropical world. We report a rare presentation of simultaneous bilateral corneal ulceration caused by different fungi.     

White matter T(1) relaxation time histograms and cerebral atrophy in multiple sclerosis

T(1) relaxation time (T(1)) provides a quantitative magnetic resonance imaging (MRI) parameter for evaluating tissue damage in the brain. We aimed to measure T(1) in the white matter of patients with multiple sclerosis (MS) and study relationships with cerebral atrophy, T(2) lesion load and clinical parameters. Twenty-six patients with relapsing-remitting MS and sixteen healthy controls were scanned with dual-echo T(2)-weighted, 3-dimensional (3-D) magnetization-prepared rapid acquisition gradient echo and whole brain, multi-slice inversion recovery (IR) sequences. White matter masks were defined on axial T(1) map slices using semi-automated seed growing and normalized 'total white matter' T(1) histograms generated. Atrophy data was obtained using the Cavalieri method of modern design stereology. T(2) lesion volume was also determined using seed growing.T(1) histogram-derived measures (median, peak height, peak position and standard deviation) in MS patients were significantly different (p < 0.0001) from controls. Median T(1) correlated significantly with supratentorial (r = 0.42, p = 0.036), lateral ventricle (r = 0.55, p = 0.004), and T(2) lesion volumes (r = 0.84, p < 0.0001), but not with clinical parameters.Total white matter T(1) provides a robust, quantitative measure of global disease burden in MS, and also correlates significantly with cerebral atrophy. Serial studies are required to determine its potential role as a surrogate marker of disease progression.     

The bottom line: Outcomes after conservation treatment in anal cancer

At the Department of Radiation Oncology, Westmead Hospital, between 1980 and 2000, 60 patients with squamous cell carcinoma of anal canal or margin (including 15 with Stage IIIA or IIIB) were treated radically; 55 received chemoradiation (89% were prescribed mitomycin C and 5‐fluorouracil). Five‐year overall survival was 64% (95% confidence interval (CI): 48–79%), with a median survival of 9.75 years (median follow up 5.6 years, range 5 months to 22.5 years). Ten patients have died of disease. At 2 years the local control rate was 86%, and colostomy‐free survival was 83%. Relapse after 2 years was uncommon. Tumour size was the main factor driving outcomes, especially survival. Patients with larger tumours (T > 4 cm) had a hazard ratio for survival of 5.7 (95% CI: 1.8–17). Fourteen (24%) patients experienced treatment interruptions as a result of acute toxicity, including one death from neutropoenic sepsis. Seven (12%) patients, in total, experienced one or more late toxicities, grade 3 or above, including four women (all postmenopausal) who developed a radiation‐induced bone injury. Most patients with anal cancer can expect to retain a functional sphincter after chemoradiation/radiation. Further studies are in progress to determine the optimal chemoradiation protocol.     

Spectrum and the susceptibilities of microbial isolates in cases of congenital nasolacrimal duct obstruction.

PURPOSE: To determine the microbial profile of congenital nasolacrimal duct obstruction (CNLDO) and the appropriate antimicrobial agents based on the sensitivity pattern of the isolated microorganisms. METHODS: Two hundred thirty-eight eyes of 187 young children in the age group of 0-5 years with CNLDO were included in the study. A group of 40 children (80 eyes) who had attended the hospital for other ocular disorders was considered a control. Material obtained from the lacrimal sac was cultured, and infectious agents were isolated. Susceptibility testing was done by Kirby-Bauer disk diffusion method for 7 different antibiotics. Fisher's exact test was used to look for statistical associations between the age group, the type of discharge, and the type of microorganisms isolated. RESULTS: Of the 238 samples with a clinical diagnosis of CNLDO, 197 (83%) yielded a positive culture. There was no growth in 41 samples (17%). Altogether, there were 217 isolates. One hundred twenty-four (57%) isolates were Gram-positive bacteria, the most frequent isolate being Streptococcus pneumoniae. Gram-negative bacteria accounted for 93 (43%) of the isolates, the most frequent isolate being Haemophilus influenza. There was one fungal isolate (0.5%) of Candida tropicalis. Gram-positive bacteria were sensitive to chloramphenicol, vancomycin, and ofloxacin and Gram-negative bacteria to ofloxacin and ciprofloxacin. CONCLUSIONS: Chronic dacryocystitis caused by CNLDO is associated with an almost-equal proportion of Gram-positive and Gram-negative bacteria. Ofloxacin topical drops can be used in the treatment of cases with CNLDO.     

Alveolar capillary dysplasia. Report of a case of prolonged life without extracorporeal membrane oxygenation (ECMO) and review of the literature

We describe an unusual infant with the diagnosis of alveolar capillary dysplasia who had a relatively prolonged life without extracorporeal membrane oxygenation (ECMO). We have used this case as a springboard for a thorough review of the literature. This was a full-term female infant who presented with a picture of persistent pulmonary hypertension of the newborn. She was treated as such, with various ventilatory modes, alkalinizing agents, surfactant therapy, tolazoline, prostacyclin and nitric oxide. Because of the prolonged clinical course the possibility of alveolar capillary dysplasia was raised. The parents refused ECMO. Despite all efforts she progressively deteriorated and died at 22 days of age. Macro- and microscopic examination of the lung at autopsy were diagnostic of alveolar capillary dysplasia. A detailed review of 39 cases published in the literature with comments regarding incidence, etiology, pathophysiology, clinical picture, diagnosis and treatment is presented.     

Differential growth control of normal, preneoplastic and neoplastic Syrian hamster embryo cells in serum-free media

The objective of this work was to develop a serum-free mediumthat supported the growth of secondary Syrian hamster embryo(SHE) cells suitable for use in the morphological transformationassay (MTA). The current assay employs high levels of fetalbovine serum, each lot of which must be selected for its efficacyin the assay. To circumvent the problems associated with theuse of serum, two serum-free media (CGM–4 and CGM–9)were developed. The approach used was to replace serum withmore defined hormones and growth factors. DME/F12 with low NaHCO₃(pH 6.7) was chosen as a basal nutrient medium since this pHhas been reported to give enhanced transformation. Both serum-freemedia supported the clonal high density growth of normal secondarySHE cells. These media were also found to support the growthof several established SHE cell lines exhibiting successivestages of neoplastic progression. However, significant differentialresponses of the individual cell lines to CGM-4 and CGM-9 wereobserved, whereas, in serum-supplemented medium all three linesresponded similarly. These results raise the hope that CGM-4and CGM-9 will be useful for studies of altered autocrine functionduring transformation and progression as well as for use inthe transformation assay itself.     

Carcinogenicity studies on the two tobacco-specific N-nitrosamines, N'-nitrosonornicotine and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone

The tobacc-specific N-nitrosamines (TSNA) have been implicatedin oral cancer. However, except for one study using rats, nostudy has shown the ability of TSNA in inducing oral tumoursin experimental animals. We have studied the carcinogenic potentialsof N'-nitrcssonornicotine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone(NNK) in mice and hamsters, wherein the nitrosamines were administeredon the tongues of the mice and the cheek pouches of the hamstersto simulate the exposure conditions of humans. It was observedthat in Swiss and BALB/c male mice, both NNN and NNK inducedtumours of lung, forestomach and liver. However, no oral tumourswere induced in mice. The effect of vitamin A depletion wastested in Swiss male mice. It was found that a low vitamin Astatus did not alter the percentage incidence of tumours inducedby both nitrosamines to a significant extent. In the studiesusing Syrian golden hamsters, long-term treatment of NNK tohamster cheek pouch induced tumours in the lung, liver, stomachand cheek pouch. Subsequently, the effed of hydrogen peroxide(H₂O₂) on NNK-induced carcinogenicity in hamsters was studied.It was observed that simultaneous administration of NNK andH₂O₂ to the animals increased the incidence of cheek pouch tumours.Another pertinent observation was that even whena small initiatordase of NNK was given followed by the application of H₂O₂, avery significant increase in the tumour incidence was observed.This observation suggeststhat H₂O₂ could act as a promoter toNNK-induced carcinogenesis. In conclusion it may be stated thatboth NNN and NNK do not show any strain or species specificity.They failed to produce tumours at the site of application inmice but in hamsters few cheek pouch turnours were seen or wereinduced when NNK was applied alone. The cheek pouch tumour incidenceincreased when H₂O₂ was given concurrently or when applied fora long period after a low initiator dose of NNK was administeredin the cheek pouch.     

Efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting

Objectives : To determine the efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting. Methods : In this double-blind field trial, 156 children aged 4 36 months with persistent diarrhoea not associated with Giardia lamblia infestation seeking treatment in a community outpatient clinic, were randomized to receive a combination of nalidixic acid and metronidazole, metronidazole alone, or placebo for 7 days. Results : In comparison with placebo, metronidazole treatment did not result in a significant reduction in the mean post-enrolment diarrhoeal duration and stool frequency, increase in the proportion of patients recovered by days 3, 5 and 7 of treatment, and increase in weight gain at days 7 and 14. Comparing the combination of nalidixic acid and metronidazole with metronidazole alone, 17.5% more children treated with the combination recovered by day 3 of treatment ( p = 0.08) and the mean stool frequency ascertained on day 7 for the previous 24 h was 26.8% less in them ( p = 0.05). The weight gains at days 7 and 14 were similar in the two groups. Conclusions : These findings indicate that metronidazole offers no therapeutic benefit in persistent diarrhoea not associated with Giardia lamblia and nalidixic acid has only a modest clinical benefit, which is not substantial enough to warrant its routine use.