Double balloon enteroscopy: Bangladesh experience.

Double balloon enteroscopy (DBE) is a newly developed endoscopic modality for diagnosis and treatment of small bowel disorders. The aim of this study was to evaluate the diagnostic and therapeutic impact of DBE in patient with suspected small bowel disease. This was a prospective study. Sixty one double balloon enteroscopy procedures (30 antegrade 31 retrograde) were done in thirty six patients (20M/16F, mean age 40 ± 12.5 range 16-65 years ) at gastroenterology department, Sir Salimullah Medical College, Dhaka between October 2011 and September 2012. Indications for DBE included chronic abdominal pain 14 (38.9%), obscure GI bleeding 11 (30.56%), Small bowel obstruction 05 (13.89%), and chronic diarrhea 06 (16.67%). The morphologic findings were ulcerations 13 (36.11%), growth 03 (8.33%), vascular ectasia 03 (8.33%) and polyp 01 (2.78%). Therapeutic interventions were performed in one patient only. No serious complications were observed. Diagnostic yields in case of chronic abdominal pain, chronic diarrhea, obscure GI bleeding and small bowel obstruction were 50%, 66%, 63% and 40% respectively. The findings were adenocarcinoma 04 (11%), lymphoma 03 (8.4%), tuberculosis 03 (8.4%), non specific findings 05 (13.9%), IPSID 01(2.8%), Crohn's disease 01 (2.8%), vascular ectasia 03 (8.33%) and normal 16 (44.44%). DBE is well tolerated, feasible and useful technique for the diagnosis as well as treatment of small intestinal disorders.

Milrinone echocardiographic viability test: a pilot study.

We assessed the utility of milrinone to predict recovery of function after surgical myocardial revascularization in patients with severe baseline left ventricular systolic dysfunction caused by coronary artery disease (CAD). Prediction of viable myocardial segments that will regain function after revascularization may help in the selection of patients who will benefit from coronary artery bypass graft surgery (CABG) as well as aid in the choice of target sites for coronary revascularization. We investigated 20 consecutive patients with CAD and left ventricular ejection fraction < or = 40% who had evidence of myocardial viability by either thallium scan or dobutamine viability test and were candidates for elective CABG. Left ventricular regional wall motion and global ejection fraction were assessed by transesophageal echocardiography in the operating room. Measurements were done before and 10 minutes after milrinone infusion, and immediately after CABG. Left ventricular wall motion score was derived by means of a 12-segment model. Functional improvement for each segment was defined as a wall motion change > 1. Baseline ejection fraction was 27% +/- 5% (mean +/- SD). Ejection fraction increased to 35% +/- 5% after milrinone infusion (P < .0001) and to 36% +/- 6% after CABG (P < .0001). Post-CABG ejection fraction was significantly correlated with postmilrinone ejection fraction (r = 0.65, P < .0001). Milrinone infusion resulted in augmentation of contraction in 98 of the 209 abnormal segments (wall motion score > or = 2); 91 (92.9%) of these improved after CABG. One hundred nine of the 111 segments that showed no improvement with milrinone did not improve after revascularization (98.2%). Seventy-three segments were akinetic or dyskinetic at baseline; 46 (63.0%) of these improved with milrinone. Improvement in regional wall motion after revascularization was detected in 84.8% of the segments that improved with milrinone versus only 3.7% of the segments that did not improve with milrinone. In patients with ischemic cardiomyopathy, improvement in left ventricular function (segmental wall motion and global ejection fraction) during milrinone infusion is highly predictive of improvement after CABG.

Gallstone disease in a rural Bangladeshi community.

BACKGROUND: The prevalence of gallstone disease (GSD) in Bangladesh is not known. We evaluated the prevalence of GSD and its relation with certain factors in a rural community in Bangladesh. METHODS: A total of 1332 persons aged 15 years and above from two villages were invited to participate in the study; 1,058 (80%) subjects responded after three invitations. Each subject answered a questionnaire, including demographic features, and underwent an upper abdominal ultrasound examination. RESULTS: GSD (current cholelithiasis and history of cholecystectomy) was detected in 5.4% of subjects. The prevalence was higher in women (7.7%) than in men (3.3%; p=0.002) The prevalence rates increased from 0.9% to 10% (p=0.0124) from those aged <30 years to those >50 years. A larger proportion of obese subjects (25/52; 48.1%) had GSD than non-obese subjects (32/1006; 3.2%). Prevalence in low, middle and high socio-economic classes was 1.5%, 5.7% and 13.4%, respectively (p=0.000). A majority (71.9%) of subjects with GSD were asymptomatic. CONCLUSION: Approximately 5% of the Bangladeshi rural community evaluated have GSD. Higher age, female gender, presence of obesity and higher socio-economic class were associated with higher prevalence of GSD.

The delay phenomenon: the story unfolds.

Our previous studies have shown that when a flap is delayed, there is dilation of existing vessels within the flap not ingrowth of new vessels. The maximal anatomic effect on the arterial tree occurs at the level of the reduced-caliber "choke" anastomotic vessels that link adjacent vascular territories. To further investigate the sequence of anatomic changes that occurs during the delay phenomenon, a large series of 200 rabbits and 17 dogs underwent a flap delay procedure in either skin or muscle and the tissues were examined at postoperative periods between 1 hour and 1 year by using well-established fluorescein, angiographic, light microscopic, immunohistochemical, and electron microscopic techniques. These data in the rabbit skin consistently demonstrated an initial period of vasoconstriction that resolved within 3 hours postoperatively and was followed by an active and progressive dilation of choke vessels that was most dramatic between 48 and 72 hours. In vivo intravenous fluorescein dye testing revealed an interesting parallel in that there was a temporary barrier to the flow of fluorescein that occurred at the level of the choke vessels immediately after the flap was raised and that this temporary barrier-continued to impede the flow toward the flap tip in rabbits where flaps had been delayed for periods up to 72 hours. Thereafter, there was no obstruction to the flow of fluorescein along the flap. During this early delay period of 3 days, light microscopy revealed a decrease in vessel wall thickness associated with an increase in lumen diameter. Over the next 4 days, the luminal diameter continued to dilate to a lesser extent and the vessel wall thickened. Immunohistochemical analysis showed increased cell division, maximal between 24 and 72 hours, in all layers of the choke vessel wall. During this same postoperative interval, transmission electron microscopy revealed phenotypic changes in smooth muscle cells from contractile to synthetic cells. Hypertrophy of the smooth muscle cells was also observed. The vascular endothelium, which initially showed evidence of denudation, was restored to a healthy intact appearance within the first week after delay. When followed for longer periods, long-term studies of the delayed flap of up to 1 year demonstrated dramatically a permanent dilation of the choke vessel lumen and a thickening of the choke vessel wall. In canine studies, one rectus abdominis muscle was delayed by ligating the deep inferior epigastric artery. The time sequence of choke vessel dilation, studied by sequential angiograms in vivo, was comparable to that of the rabbit skin model. To ascertain the permanence and irreversibility of this dilation, the normal circulation of the delayed rectus abdominis muscle was restored by reanastomosing the deep inferior epigastric artery. Even after a recovery period of up to 3 months, the choke vessels remained dilated and tortuous instead of reverting to their original narrow diameters. From this work, it is suggested that the choke vessel dilation seen in the delay period is a permanent and irreversible event. It is an active process associated with both an increase (hyperplasia) and an enlargement (hypertrophy) of the cells in all layers of the choke artery wall and a resultant increase in caliber of these vessels. The time sequence for delay appears to be similar in different species and in different tissues, suggesting the possibility of a universal process for delay.

Refractory immune thrombocytopenia after heart transplantation: a case report.

Chronic immune thrombocytopenia responds to steroids and splenectomy in approximately 80% of the patients. Intravenous immunoglobulin, plasmapheresis, combination chemotherapy, and androgens may help in refractory cases. This report describes the course and management of refractory immune thrombocytopenia after heart transplantation.

Purification and characterization of collagens from rat fibrosarcoma induced by 3-methylcholanthrene.

The distribution of various collagen types was studied in rat fibrosarcoma. Collagens extracted from fibrosarcoma tissue were characterized by the criteria of solubility in NaCl, SDS-PAGE, ion exchange chromatography, CNBr peptide mapping and amino acid analysis. Fibrosarcoma was found to produce excess amount of type V, type I trimer and type III collagens; comparatively, type I collagen and total collagen content were noticed to decrease in fibrosarcoma. We observe that the increase in type V collagen content in fibrosarcoma might be due to the enhanced transcription of type V collagen gene. Increased type I trimer collagen in fibrosarcoma might be attributed to the differential expression of alpha 1(I) and alpha 2(I) gene and might also be due to the expression of a different gene for type I trimer collagen.

Neoplastic association of enhanced type V collagen production in rat fibrosarcoma.

Collagens present in the connective tissues of the extracellular matrix of fibrosarcoma were isolated and characterized. The fibrosarcoma was induced in rats by the administration of 3-methylcholanthrene. The results obtained were compared with normal muscle. An excess amount of type V collagen was found to be produced by the fibrosarcoma tissue compared to the normal muscle. Type V collagen from fibrosarcoma was characterized on the basis of solubility behavior in sodium chloride solutions, electrophoretic mobility on SDS-polyacrylamide gels, elution pattern of phosphocellulose chromatography and amino acid composition.

Alterations in human gingival glycosaminoglycan pattern in inflammation and in phenytoin induced overgrowth.

Glycosaminoglycans were extracted from normal, inflamed and phenytoin induced overgrowth of human gingival tissue by proteolysis and alcohol precipitation. Extracts were run in a Dowex-1 column and the fractions were treated with mucopolysaccharidases. Cellulose acetate electrophoresis was carried out with or without enzyme digestion for identification of individual glycosaminoglycans. Glycosaminoglycans were found to be decreased in inflammation but were observed to increase in the overgrowth. Hyaluronic acid was found to be increased in both the pathological conditions. Dermatan sulphate, chondroitin sulphate and heparan sulphate were observed to be decreased in inflammation. In overgrowth, dermatan sulphate and chondroitin sulphate were found to increase while the presence of heparan sulphate was not significant. The changes in the pattern of individual glycosaminoglycan in the two varied conditions are discussed.

Purification and characterization of collagenolytic property of renal cathepsin L from arthritic rat.

1. This paper describes the purification and characterization of collagenolytic property of renal cathepsin L isolated from kidney of rats rendered adjuvant arthritis. The enzyme was isolated by acid extraction, ammonium sulfate fractionation, Sephadex gel filtration, CM-Sephadex chromatography and Sephacryl S-300 chromatography. 2. The enzyme preparation was found to be homogeneous by gel filtration and SDS-polyacrylamide gel electrophoresis. The molecular weight of the enzyme was estimated to be 29,000. 3. Incubation of rat tail tendon collagen with purified cathepsin L resulted a conversion of cross-linked beta-chain dimers into uncross-linked alpha-chain monomers. The pH optimum for collagen degradation by purified cathepsin L was found to be 3.5. This optimal pH is shifted to 4.5 when haemoglobin was used as a substrate for the enzyme. 4. Various activators and inhibitors were tested for their influence on the activity of cathepsin L. The purified enzyme showed a maximal activity in the presence of EDTA. Cysteine was also found to increase the activity of cathepsin L. This enzyme was strongly inhibited by iodoacetate, p-chloromercurobenzoate, mercuric chloride but not inhibited by pepstatin or PMSF. E-64 and leupeptin were also found to be strong inhibitors for cathepsin L. The degradation of rat tail tendon collagen by cathepsin L was completely inhibited by E-64. 5. The results presented in this investigation suggest that cathepsin L play a crucial role in the pathogenesis of adjuvant arthritis.

Toxicity of dimethoate on urinary hydroxyproline in rats.

The effect of the administration of three different concentrations (2.25, 1.13 and 0.56 mg/100 g body weight) of dimethoate on the urinary excretion of total, non dialysable and free hydroxyproline were studied in female albino rats. Compared to controls, the urine contents were significantly lower in higher concentration (2.25 mg/100 g body weight) of dimethoate treated rats. The results clearly indicate that the urine contents were not much affected in lower concentration (0.56 mg/100 g body weight) of dimethoate treated rats compared to the other concentrations (1.13 and 0.56 mg/100 g body weight) of dimethoate treated rats.

Toxic effects of different concentrations of dimethoate on lysosomal enzymes of female albino rats.

The effect of three different concentrations of dimethoate on the activity of certain lysosomal enzymes, viz. beta-glucuronidase, beta-N-acetylglucosaminidase, cathepsin B and cathepsin D in serum, skin, liver, kidney and spleen and the stability of liver and kidney lysosomes was studied in female albino rats. The activity of beta-glucuronidase, beta-N-acetylglucosaminidase, cathepsin D was found to increase in serum and tissues in higher concentration (2.25 mg/100 g body weight) of dimethoate treated rats. A significant increase in the rate of release of beta-glucuronidase was found in the liver and kidney of higher concentration of dimethoate treated rats compared to controls. The results demonstrate that the activity of lysosomal enzymes increased in higher concentration of dimethoate treated rats than the lower concentration (0.56 mg/100 g body weight) of dimethoate treated rats.

Metabolic studies on connective tissue collagens in bone and tendon of adjuvant arthritic rat.

The metabolic alterations in the matrix of connective tissue collagen were investigated in bone and tendon of rats with adjuvant-induced arthritis. Adjuvant arthritis was induced in rats with the immunization of Freund's adjuvant containing heat-killed Mycobacterium tuberculosis. The changes in the metabolism of collagen were studied using radioactive isotopic measurements with (3H)-proline. Tissue specimens were fractionated individually into soluble and insoluble collagens. The synthesis of collagen was examined by measuring the total collagen content and the radioactivity of (3H)-hydroxyproline in soluble collagen fraction within 24 hours after the administration of tritiated proline. The conversion of soluble to insoluble collagen was analyzed by measuring the radioactivity of (3H)-hydroxyproline in both soluble and insoluble collagens. The catabolism of soluble and insoluble collagens was studied by estimating the radioactivity of urinary (3H)-hydroxyproline 24 hours after the injection of tritiated proline. It was observed that the total collagen content and the total radioactivity of (3H)-hydroxyproline in bone and tendon were decreased significantly in adjuvant arthritic rats. The specific and total radioactivities of (3H)-hydroxyproline in soluble collagen were found to be reduced, indicating the decreased de novo synthesis of collagen during the diseased state. The conversion of soluble to insoluble collagen was impaired in tissues as evidenced by the increased content of soluble collagen in arthritic disease. In addition, an enhanced excretion of hydroxyproline was found in urine of arthritic rats, indicating the increased degradation of collagen in arthritic disease. These observations could, therefore, explain in part the changes in synthesis and degradation of collagen in bone and tendon during the development of experimentally induced adjuvant arthritis in rats.

Studies on the intracellular degradation of newly synthesized collagen in 3-methylcholanthrene induced fibrosarcoma cells.

The intracellular degradation of newly synthesized collagen was studied in both normal fibroblast and 3-methylcholanthrene induced fibrosarcoma cells. The degradation of newly synthesized collagen was examined using pulse-chase experiments and radioactive labelling techniques with [3H]-proline. The percentage of intracellular proteolysis of newly synthesized collagen was determined by measuring the formation of [3H]-hydroxyproline containing fragments in alcohol-soluble and insoluble fractions of normal cells and fibrosarcoma cells in the culture. The rate of degradation of newly formed collagen was then followed by estimating the radioactivity of [3H]-hydroxyproline at different intervals, during the chase period. The results clearly demonstrated that the percent of intracellular degradation of newly synthesized collagen was approximately three fold higher in fibrosarcoma cells than in normal fibroblast cells. The increased intracellular degradation of newly formed collagen was followed by an increase in the activity of cathepsin B and L in fibrosarcoma cells. The pulse-chase experiments indicated that the rate of degradation of newly synthesized collagen in fibrosarcoma cells is relatively greater than in normal fibroblast cells. In addition, as the labelling time increased, the formation of [3H]-hydroxyproline containing peptides in the ethanol-soluble fraction were found to be increased in both normal cells and fibrosarcoma cells, but the extent of formation was higher in fibrosarcoma cells compared to normal fibroblast cells. The results of this investigation collectively suggest that the intracellular degradation of newly synthesized collagen is enhanced in fibrosarcoma cells.

Effects of dimethoate on collagen metabolism in rats.

The effects of three different doses of dimethoate on the collagen metabolism in the tissues of female albino rats were studied by measuring the specific and total activities of 3H-hydroxyproline in the dermal, gingival and uteral collagen fractions and in the urine. Compared to controls, the total activity of 3H-hydroxyproline in the soluble collagen and in the urine at 12 h after the administration of 3H-proline was significantly lower by 44.45 and 58.12 per cent in the higher dose (2.25 mg/100 g body weight) of dimethoate treated groups respectively. The urinary excretion of hydroxyproline and the total activity of urinary 3H-hydroxyproline measured after 28 days of injection of labelled proline were decreased by 45.56 and 32.68 per cent in higher doses of dimethoate treated animals respectively but the excretions of urinary 3H-hydroxyproline were decreased by 6.36 and 2.88 per cent in lower doses of dimethoate (0.56 mg/100 g body weight) treated animals. The results of the present investigation clearly indicate that the synthesis of collagen is decreased in the higher doses of dimethoate treated animals compared to lower doses of dimethoate treated animals. In addition, the rates of catabolism of both soluble and insoluble collagens were decreased in higher doses of dimethoate treated rats. In concludes that the lower doses of dimethoate (0.56 mg) treated rats were less affected than the higher doses of dimethoate (2.25 mg) treated rats.

Metabolism of glycosaminoglycans in tissues of adjuvant arthritic rat.

The metabolic changes in the connective tissue glycosaminoglycans were studied in tissues of adjuvant induced arthritic rats. Arthritic process was induced in rats with the inoculation of Freund's adjuvant containing heat killed Mycobacterium tuberculosis in paraffin oil. The connective tissue glycosaminoglycans were fractionated into sulfated and non-sulfated glycosaminoglycans by chemical and enzymatic methods. The biosynthesis of sulfated glycosaminoglycans was examined using radioactive labeled (35S)-sulfate incorporation measurements into the sulfated glycosaminoglycans in tissues such as liver, kidney, spleen and skin of arthritic rats. The catabolism of glycosaminoglycans was studied by measuring the activity of various connective tissue degrading lysosomal glycohydrolases in tissues of experimental animals. In addition, the changes in the contents of total glycosaminoglycans, mono-sulfated, highly-sulfated and non-sulfated glycosaminoglycans were quantitatively assessed in diseased tissues. Alterations in the metabolism of connective tissue glycosaminoglycans were demonstrated in tissues of arthritic rats. The uptake of (35S)-sulfate into the tissue was found to be increased in liver, kidney and spleen, while that of skin decreased during the process of arthritis. The total glycosaminoglycan content was significantly elevated in diseased tissues compared to normal. Similarly, mono-sulfated, highly-sulfated and non-sulfated glycosaminoglycans were found to be increased in arthritic tissues. In addition, the activity of various connective tissue degrading lysosomal glycohydrolases such as beta-glucuronidase, beta-N-acetylglucosaminidase, cathepsin B, cathepsin L and collagenolytic cathepsin was increased in tissues of arthritic rat. The results presented in this communication indicate that the characteristic alterations were induced in the metabolism of glycosaminoglycans by the dynamic process of adjuvant arthritis.

Increased glucocorticoid receptors in diphenylhydantoin induced human gingival overgrowth.

A pilot study on the glucocorticoid receptors in normal and pathological condition of human gingiva was carried out for a better perception of glucocorticoid action in gingiva. Gingival cytosol prepared from normal and diphenylhydantoin induced overgrowth was incubated with [3H]dexamethasone with or without cold competitor. Results obtained show a single class of receptor in both the conditions with no difference in binding specificity. Contrary to this, B-max was found to be significantly increased in the overgrown tissue sample compared to normal. The increase in glucocorticoid receptors in the gingival pathology is discussed.

Toxic effect of dimethoate on the crosslinking of gingival and uteral collagen in female albino rats fed with normal and high protein diets.

The effect of dimethoate on gingival and uteral collagen crosslinking was studied in normal and high protein diets fed female albino rats. The gingival and uteral samples were collected from all the groups of rats and percent reversibility of neutral salt soluble collagen gel and the solubility of insoluble collagen in KCNS or urea were determined. The analysis of gingival and uteral samples showed alpha 1 and alpha 2 sub units of neutral salt soluble collagen appreciably increased beta chains and aldehyde content significantly decreased in dimethoate treated animals compared to controls. The results indicate that due to the effect of dimethoate, the crosslinking and maturation of collagen are impaired.

Connective tissue metabolism in bone and cartilage of adjuvant arthritic rat.

The metabolism of connective tissue matrix components such as glycosaminoglycans and glycoproteins was investigated in normal as well as pathological tissues of bone and cartilage associated with adjuvant arthritis using rat as animal model of the disease. The inflammatory process of adjuvant arthritis was induced in rats with the inoculation of Freund's adjuvant containing heat killed Mycobacterium tuberculosis suspended in paraffin oil. The changes in the metabolism of matrix components in bone and cartilage were examined using radioactive isotopic labeling measurements during the acute as well as chronic phases of arthritic disease. The glycosaminoglycans were fractionated into sulfated and non-sulfated glycosaminoglycans by chemical and enzymic modifications. The biosynthesis of sulfated glycosaminoglycans was evaluated using radioactive labeled (35S)-sulfate. Alterations were demonstrated in the metabolism of connective tissue in the bone and cartilage tissues of arthritic rat. The results obtained showed an increased incorporation of radioactive sulfate in specimens of bone and cartilage during the process of adjuvant arthritis. The contents of sulfated as well as non-sulfated glycosaminoglycans were found to be increased in both the tissues of arthritic rat. Similarly, the amount of total glycosaminoglycans was also found to be increased significantly in the diseased tissues. In addition, various components of tissue glycoproteins such as fucose, sialic acid and total hexose were found to be elevated in insoluble fractions of bone and cartilage during the diseased state. The effects of experimentally induced adjuvant arthritis on the connective tissue were discussed in the light of changes taking place in the metabolism of glycosaminoglycans and glycoproteins in bone and cartilage of arthritic rat.