Valvular heart disease in Antiphospholipid antibody syndrome: Isolated Tricuspid stenosis

Antiphospholipid antibody syndrome (APLS) is a rare disorder characterized by a hypercoagulable state. Manifestations include arterial or venous thrombosis, recurrent fetal wastage, coronary artery disease, valvular heart disease, dilated cardiomyopathy, pulmonary artery hypertension, and intracardiac thrombus. Most commonly mitral valve is affected followed by aortic and then tricuspid valve. In this report, a rare case of spontaneous aortic thrombosis with tricuspid stenosis uncomplicated by other valve lesions is presented with clinical and echocardiographic studies and computed tomographic images.     

Binding mode of conformations and structure-based pharmacophore development for farnesyltransferase inhibitors

Farnesyltransferase (FTase) is one of the prenyltransferase family enzymes that catalyse the transfer of 15-membered isoprenoid (farnesyl) moiety to the cysteine of CAAX motif-containing proteins including Rho and Ras family of G proteins. Inhibitors of FTase act as drugs for cancer, malaria, progeria and other diseases. In the present investigation, we have developed two structure-based pharmacophore models from protein–ligand complex (3E33 and 3E37) obtained from the protein data bank. Molecular dynamics (MD) simulations were performed on the complexes, and different conformers of the same complex were generated. These conformers were undergone protein–ligand interaction fingerprint (PLIF) analysis, and the fingerprint bits have been used for structure-based pharmacophore model development. The PLIF results showed that Lys164, Tyr166, TrpB106 and TyrB361 are the major interacting residues in both the complexes. The RMSD and RMSF analyses on the MD-simulated systems showed that the absence of FPP in the complex 3E37 has significant effect in the conformational changes of the ligands. During this conformational change, some interactions between the protein and the ligands are lost, but regained after some simulations (after 2 ns). The structure-based pharmacophore models showed that the hydrophobic and acceptor contours are predominantly present in the models. The pharmacophore models were validated using reference compounds, which significantly identified as HITs with smaller RMSD values. The developed structure-based pharmacophore models are significant, and the methodology used in this study is novel from the existing methods (the original X-ray crystallographic coordination of the ligands is used for the model building). In our study, along with the original coordination of the ligand, different conformers of the same complex (protein–ligand) are used. It concluded that the developed methodology is significant for the virtual screening of novel molecules on different targets.     

Multi-detector CT angiography for lower gastrointestinal bleeding: Can it select patients for endovascular intervention?

This is a retrospective review of the results at our institution of using multi-detector CT angiography (CTA) to localise lower gastrointestinal (GI) bleeding. We hypothesised that in our patient population: (i) CTA was unlikely to demonstrate bleeding in patients who were haemodynamically stable; (ii) in haemodynamically unstable patients in whom CTA was undertaken, the results could be used to select patients who would benefit from catheter angiography; and (iii) in haemodynamically unstable patients in whom CTA was undertaken, a subgroup of patients could be identified who would benefit from primary surgical treatment, avoiding invasive angiography completely. A retrospective review was conducted of the clinical records of all patients undergoing CTA for lower GI haemorrhage at our institution between 1 January 2005 and 30 June 2007. Out of the 20 patients examined, 10 had positive CTAs demonstrating the bleeding site. Nine were haemodynamically unstable at the time of the study. Four patients with positive CT angiograms were able to be treated directly with surgery and avoided invasive angiography. Ten patients had negative CTAs. Four of these were haemodynamically unstable, six haemodynamically stable. Only one required intervention to secure haemostasis, the rest stopped spontaneously. No haemodynamically stable patient who had a negative CTA required intervention. CTA is a useful non-invasive technique for localising the site of lower GI bleeding. In our patient population, in the absence of haemodynamic instability, the diagnostic yield of CTA was low and bleeding was likely to stop spontaneously. In haemodynamically unstable patients, a positive CTA allowed patients to be triaged to surgery or angiography, whereas there was a strong association between a negative CTA and spontaneous cessation of bleeding.     

Quadrivalvular rheumatic heart disease

Three cases of chronic rheumatic heart disease with involvement of all four valves are presented. The involvement of tricuspid and pulmonary valves was suspected clinically and was confirmed by two-dimensional echo, Doppler, hemodynamic and angiographic findings. These findings were also verified surgically and histopathologically in 2 cases. One of the cases died after cardiac catheterization; the other 2 cases were treated surgically with success.     

Laparoscopic transhiatal surgery of the esophagus.

OBJECTIVE: Esophagectomy is an operation with high morbidity and mortality. Its adoption as a minimally invasive operation worldwide has been slow, but the potential benefits of reducing the trauma of surgery need to be considered. Our 30-month experience with transhiatal esophagectomy in a district general hospital is presented herein. METHODS: Patients were considered for surgery after radiological staging had excluded inoperable disease. Laparoscopic staging was initially performed. Patients with tumors of the esophagus and high-grade dysplasia in a Barrett's esophagus were included. RESULTS: Twenty-nine patients were referred for consideration for resectional surgery. Nine underwent outpatient laparoscopy only. Twenty patients (age range, 34 to 78, 15 males:5 females) underwent resectional surgery. Seventeen transhiatal resections were completed, 2 were converted to open procedures, and 1 transhiatal resection of a benign tumor was performed. Median time of surgery was 415 minutes (range, 320 to 480) and blood loss was 300 mL (range, 200 to 350). The median length of post-operative ventilation and critical care stay were 1 (range, 1 to 4) and 4 (range, 2 to 8) days. Median duration of hospitalization was 17 days (range, 10 to 28). Thirty-day mortality was 0; 1 patient who was converted to an open procedure died after a cerebrovascular event on day 34. CONCLUSION: A zero mortality rate for laparoscopic resection and a low-morbidity rate compare well with morbidity and mortality in reported series using this method and open surgery. Laparoscopic transhiatal esophagectomy is an advanced, complex procedure that can be performed safely in a district general hospital setting.     

Intraluminal Radiation for Esophageal Cancer: A Howard University Technique

The objective of radiotherapeutic management in esophageal cancer is to accomplish maximum tumor sterilization with minimal normal tissue damage. This sincere effort is most often countered by the differential in tumor dose response vs normal tissue tolerance. Intraluminal isotope radiation, with its inherent advantage of rapid dose falloff, spares the lungs, the spinal cord, and other vital structures, yet yields adequately high doses to esophageal tumor. Though in existence since the turn of the century, the method of intracavitary radium bougie application dropped out of favor due to technical difficulties imposed by the size of the radium source and radiation exposure to the personnel involved. The authors describe a simple “iridium 192 afterloading intraluminal technique” that eliminates technical problems and reduces radiation exposure considerably.     

Application of Microalgal Physiological Response as Biomarker for Evaluating the Toxicity of the Textile Dye Alizarin Red S

Textile dyes are becoming a growing threat to the environment. This report presents the findings of the study on the toxicity of the textile dye Alizarin Red S on two freshwater microalgae. The acute toxicity assay revealed that 96-h EC₅₀ values of Chlorella vulgaris and Spirulina platensis were 29.81 mg/L and 18.94 mg/L respectively. The pigments chlorophyll-a, b and carotenoids in C. vulgaris on 96-h exposure to the dye were 2.91, 3.29 and 3.01 times lower in analogy to control whereas Spirulina platensis showed 2.89and 2.56 fold decrease in chlorophyll-a and carotenoid content than control. After the test period of 96-h with dye, the protein content of C. vulgaris and S. platensis were 2.33 and 1.77 times lower compared to the control. The growth inhibition rate, pigment as well as the protein content declined in compliance with the rise in dye concentration, which anticipate paradigm about the toxic effects of the textile dye.

     

Human leukocyte response to an endurance race

Summary The response of circulating leukocytes (WBC's) with regard to changes in number, proportion of neutrophils versus lymphocytes and changes in lymphocyte function as well as proportions of T and B cells was studied in eleven men who ran a 20-mile race. A marked leukocytosis was noted 10–15 min after the race with the predominant increase being polymorphonuclear leukocytes (P<0.001). A significant rise in mean serum cortisol levels was also noted (P<0.001) which correlated with both the increase in total WBC's (P< 0.001) and granulocytes (P<0.001), but not lymphocytes. The increase in serum cortisol was inversely correlated with miles of prior training (P<0.001). An increase in lymphocytes from 1767±112/mm³ to 2431±202/mm³ was less than that previously described in short-term exercise. As with short-term exercise the most significant increase in lymphocytes was in B lymphocytes bearing surface immunoglobulin (P<0.0025). However, in contrast to short-term exercise lymphocytes maintained good in vitro response to the mitogen phytohemagglutinin.This study demonstrates that endurance racing produces a more marked granulocytosis and less lymphocytosis than short bouts of exercise. It is suggested that the degree of leukocytosis is stress dependent in that it was positively correlated with serum cortisol and inversely correlated with prior training.Supported in part by a joint fellowship from the National and Wisconsin Kidney Foundations     

Characterization of bound phenthoate residues in citrus

The metabolism and fate of phenyl ring-labeled¹⁴C-phenthoate {O,O- dimethylS-[-(carboethoxy)benzyl] phosphorodithioate} was examined in the Valencia orange fruit with emphasis on the characterization of bound phenthoate residues in the fruit peel. The products recovered from the citrus fruit wash were unchanged phenthoate, phenthoate oxon, demethyl phenthoate, phenthoate acid, ethyl mandelate, and mandelic acid. The same products, with the exception of phenthoate oxon, were found in the acetone extract of the fruit peel. Enzymatic hydrolysis of the bound residue in the peel with-glucosidase, followed by acidic and basic hydrolysis gave ethyl mandelate as the major product, followed by mandelic acid, demethyl phenthoate and phenthoate acid. Phenthoate was metabolized and conjugated in citrus fruits into detoxication products.