MYOCARDIAL REVASCULARIZATION

Atherosclerotic coronary artery disease causes more morbidity, mortality and loss of economic capacity than any other group of diseases. The modalities of revascularization of the myocardium have undergone rapid advances with emphasis shifting alternately from medical methods to surgical. Lately interventional cardiology armed with laser technology stands at par with coronary artery bypass grafts.KEY WORDS: Coronary artery disease, Coronary artery bypass grafts, Angioplasty     

BORDERLINE TUBERCULOID LEPROSY: CLINICOPATHOLOGICAL EVALUATION OF MULTIDRUG THERAPY

Efficacy of multi-drug therapy as per WHO recommendation in 125 fresh cases of borderline tuberculoid (BT) leprosy was evaluated. There were 116 (92.8%) male and 9 (7.2%) female patients. Age of the patients ranged from 18-50 years but the majority (80.8%) were young adults in the age group 21-35 years. The commonest site of lesion was the upper extremity in 65 (52%) cases. Skin smear for acid fast Mycobacterium leprae was positive in 11 (8.8%) patients. All patients were given multidrug therapy consisting of rifampicin 600 mg once a month and dapsone 100 mg daily for 6 months. At the end of 6 months, 42 (33.6%) patients had shown marked improvement, 14 (11.2%) had increase in activity, 51 (45.6%) had shown regression and 12 (9.6%) cases became clinically inactive. Histologically complete clearance of the infiltration was not observed in any patient. Compact granulomas persisted in 30 (24%) cases. In 1 (0.8%) patient M. leprae were found in the skin smear at the end of 6 months. This study indicates that treatment with MDT for 6 months is inadequate to treat all types of BT leprosy cases.KEY WORDS: Drug therapy combination, Leprosy borderline, Leprostatic agents, Mycobacterium leprae.     

Pain management in advanced cancer.

This article presents a primary care approach to pain management in patients with advanced cancer. Assessment of "total" pain is reviewed along with interdisciplinary care. Pharmacologic and nonpharmacologic therapies are outlined, with emphasis on the correct use of narcotics and adjuvant analgesics.     

Comparative toxicity of selenite and selenate to the amphipodHyalella azteca

Selenium contamination of aquatic ecosystems is rapidly becoming a concern throughout the United States, leading to a lowering of the freshwater selenium criteria by the U.S. Environmental Protection Agency from 35 g/L to 5 g/L measured as total selenium. However, considerable information indicates important differences in bioaccumulation and toxicity between the various selenium forms. We conducted a series of experiments to determine the comparative toxicity of selenite and selenate to the amphipodHyallela azteca. In 48 h, 96 h, and 240 h (10 d) LC50 tests, selenite was 2 to 4 times more toxic than selenate, the difference decreasing as exposure time increased. This difference in toxicity was even more pronounced in the 24 d reproductive bioassay, where selenite caused a significant decrease in number of young per female at 200 g/L while selenate had no effect up through 700 g/L (the highest concentration tested).     

Hyaline membrane disease and intraventricular haemorrhage in small for gestational age infants

19 small for gestational age (SGA) infants with gestational ages less than or equal to 32 weeks were matched with 19 appropriate for gestational age (AGA) preterm neonates with similar risk factors for intraventricular haemorrhage and hyaline membrane disease. Gestational age, 1- and 5-minute Apgar scores, type of delivery, survival rate, use of corticosteroids before delivery, sex, twinning, presence of premature rupture of membranes, and birth date were comparable in the two groups. Gestational age of both groups was 30 (+/- 1.8) weeks, and birthweights were 919 (+/- 202) g (SGA group) and 1268 (+/- 212) g (AGA group). The incidences of hyaline membrane disease and intraventricular haemorrhage were different: 74 and 42% respectively for AGA neonates, 5 and 11% respectively for SGA infants. We suggest that a stressful environment in utero may enhance maturation and prevent hyaline membrane disease and intraventricular haemorrhage.     

Effects of chemotactic peptide f-met-leu-phe (FMLP) on C3b receptor (CR1) expression and phagocytosis of microspheres by human neutrophils

FMLP caused maximal upregulation of CR1 on neutrophils at a concentration of 10^–8 M but caused maximal enhancement of CR1-dependent phagocytosis of C3b · IgG-coated microspheres only at a concentration of 10^–6 M. There were positive correlations between FMLP-mediated upregulation of CR1 and FMLP-mediated enhancement of phagocytosis (correlation coefficient=0.73, slope=2.2) and between FMLP-mediated upregulation of CR1 and FMLP-mediated increase in total cell-associated microspheres (correlation coefficient=0.88, slope=1.3). The phagocytic capacity of both untreated and 10^–6 M FMLP-treated neutrophils was completely inhibited by fluid phase C3b and partially inhibited by aggregated IgG. The data suggest that CR1 upregulation is required but is not sufficient for maximal phagocytosis by the leukocytes. The data also suggest that FMLP at the higher concentrations may impart a phagocytic function to CR1, activate other phagocytic receptors, elicit phagocytosis—inducing mediators or may elicit a separate mechanism of phagocytosis. During the study, it was observed that there was considerable individual variation among different neutrophil preparations with respect to CR1 expression and binding and phagocytic capacity.     

Mutations that disrupt the carboxyl-terminus of gamma-sarcoglycan cause muscular dystrophy

Recently, mutations in the genes encoding several of the dystrophin- associated proteins have been identified that produce phenotypes ranging from severe Duchenne-like autosomal recessive muscular dystrophy to the milder limb-girdle muscular dystrophies (LGMDs). LGMD type 2C is generally associated with a more severe clinical course and is prevalent in northern Africa. A previous study identified a single base pair deletion in the gene encoding the dystrophin-associated protein gamma-sarcoglycan in a number of Tunisian muscular dystrophy patients. To investigate whether gamma-sarcoglycan gene mutations cause autosomal recessive muscular dystrophy in other populations, we studied 50 muscular dystrophy patients from the United States and Italy. The muscle biopsies from these 50 patients showed no abnormality of dystrophin but did show diminished immunostaining for the dystrophin- associated protein alpha-sarcoglycan. Four patients with a severe muscular dystrophy phenotype were identified with homozygous, frameshifting mutations in gamma-sarcoglycan. Two of the four have microdeletions that disrupt the distal carboxyl-terminus of gamma- sarcoglycan yet result in a complete absence of gamma-and beta- sarcoglycan suggesting the importance of this region for stability of the sarcoglycan complex. This region of gamma-sarcoglycan, like beta- sarcoglycan, has a number of cysteine residues similar to those in epidermal growth factor cysteine-rich regions.      

Influence of pH changes on the actions of verapamil on vascular excitation-contraction coupling

We have previously shown that pH changes alter the cardiovascular responses to verapamil in rat, in vivo and in isolated rat heart. The current study investigated the influence of pH changes on the actions of verapamil on potassium- or noradrenaline-stimulated contraction in rat tail arteries. The proximal 2-2.5 cm of ventral tail artery was bathed in and perfused initially (20-25 min) with physiological salt solution (pH 7.4) which was later made calcium-free at pH 7.4 (control), pH 7.2 (acidosis) or pH 7.67 (alkalosis). After equilibration each artery was exposed to verapamil following which the contractile responses to increasing concentrations of calcium were recorded. The patterns of responses in noradrenaline- or potassium-stimulated arteries were different. In normal conditions, the vasodilator effect of verapamil was predominant in potassium-stimulated arteries but less in the noradrenaline-stimulated preparations. With pH changes the effect of verapamil was enhanced more in noradrenaline- than in potassium-stimulated arteries. It is postulated that pathology-induced changes in the character of calcium channels could alter the effect of calcium channel blockers.     

ABDOMINAL INCISIONAL HERNIAS - A REVIEW OF 50 OPERATED PATIENTS

Fifty patients (5 men and 45 women) in the age group of 25 to 65 years with abdominal incisional hernia were studied. The most common antecedent cause (in 86 per cent patients) was found to be a gynaecological operative procedure done earlier through a lower midline incision. All patients underwent anatomical repair and were followed-up after repair for an average of 18 months (range 6–32 months). The results were reviewed and it was seen that there was evidence of recurrence in 3 patients only.KEY WORDS: Abdominal incisional hernia, Hernia ventral, Surgical wound dehiscence