A Rare Occurrence of Multiple Intracranial Osteomas in the Cranial Cavity of a Cadaver With a Short Review on Subdural Osteoma.

Osteomas are most common among all primary bone tumors of skull bones. They are usually asymptomatic due to their small size and slow growth. They are found incidentally on imaging studies for other neurologic symptoms. Osteoma may be single or multiple when present. They should be differentiated from meningiomas, chordomas, schwannomas, and parosteal osteosarcoma by using different diagnostic methods, including histopathologic study. During routine dissection for MBBS students in an 87 years old female cadaver, we found multiple (seven in number) irregular, lobulated bony masses/structures. Their positions were different with respect to the layers of meninges. Some were present between the dura mater and arachnoid mater compressing the adjacent brain tissues forming impressions on them, and some were outside the dura mater. So, into the previously existing classification, we want to add a new variety under the type b category, i.e., mixed type (intraparenchymal, dural, skull vault) as pointed under the subtype V, which is found in our case.

Regional variation of human pancreatic islets dimension and its impact on beta cells in Indian population.

Background & objectives: Islet of Langerhans, the endocrine pancreas plays a significant role in glucose metabolism. Obesity and insulin resistance are the major factors responsible for beta cell dysfunction. Asian Indian population has increased susceptibility to diabetes in spite of having lower BMI. The morphology of islets plays a significant role in beta cell function. The present study was designed for better understanding the morphology, composition and distribution of islets in different parts of the pancreas and its impact on beta cell proportion. Methods: We observed islet morphology and beta cell area proportion by Large-scale computer-assisted analysis in 20 adult human pancreases in non-diabetic Indian population. Immunohistochemical staining with anti-synaptophysin and anti-insulin antibody was used to detect islet and beta cells respectively. Whole slide images were analyzed using ImageJ software. Results: Endocrine proportion were heterogeneously increasing from head to tail with maximum islet and beta cell distribution in the tail region. Larger islets were predominately confined to the tail region. The islets in Indian population were relatively smaller in size, but they have more beta cells (20%) when compared to American population. Interpretation & conclusions: The beta cells of larger islets are functionally more active than the smaller islets via paracrine effect. Thus, reduction in the number of larger islets may be one of the probable reasons for increased susceptibility of Indians to diabetes even at lower BMI. Knowledge about the regional distribution of islets will help the surgeons to preserve the islet rich regions during surgery.

A case of potentially lethal vascular variation in association with palmaris profundus muscle.

Arterial variations in upper limbs are often reported commonly. Superficial arterial variations accounting for 4.2% of all arterial variations are hazardous during any invasive procedures of the upper limb, from routine intravenous injections to surgeries. Arterial variations are usually associated with inverted or absent palmaris longus. Palmaris profundus, a rare anomalous variation of palmaris longus has been reported in carpal tunnel syndrome as its tendon was associated with median nerve in the carpal tunnel. The authors reported a unique variation in the upper limb arterial pattern-the presence of bilateral superficial brachioulnar artery associated with unilateral palmaris profundus muscle and an abnormal radicle of musculocutaneous nerve to the median nerve in the left side.

Persistent median artery of the forearm and palm: a cadaver study into its origin, course, fate and clinical significance.

The median artery is the axis artery of forearm till the 811 week of gestation and thereafter nor- mally regresses, only its proximal part remaining patent as the companion artery of the medi- an nerve in adults. A large, well developed persistent median artery extended to the palm and contributed to its vascular supply in 6 out of 100 upper limbs dissected. Dissection was used to demonstrate the persistent median arteries from their origin to termination. The persistent median artery originated from the ulnar artery in the cubital fossa. It pierced the median nerve, descended anterior t4 the nerve'in a common sheath and passed deep to the flexor retinaculum. An accessory head of flexor pollicis longus, which is a usual finding associated with the persis- tent median artery, was seen in one forearm. The superficial palmar arch was not seen in any specimen with persistent median artery. In all the specimens with persistent median artery, the lateral half of the palm and lateral 2½ digits were supplied by it, whereas the medial half of palm and the medial 2½ digits were supplied by the ulnar artery. The persistent median artery may contribute to median nerve compression neuropathy. The variations in the vascular supply of hand have clinical implications.

Elevated autoantibodies against oxidized palmitoyl arachidonoyl phosphocholine in patients with hypertension and myocardial infarction.

Oxidized 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphocholine (oxPAPC) is antigenic and an important epitope of oxLDL. This study validates the assay for autoantibodies against oxPAPC (anti-oxPAPC-Ab) and investigates the possible association between anti-oxPAPC-Ab and cardiovascular disease. A synthetic PAPC was oxidatively modified as an antigen for the anti-oxPAPC-Ab assay. The concentrations of the antibody in serum were measured by EIA. The analytical parameters of the anti-oxPAPC-Ab assay were validated. Levels of anti-oxPAPC-Ab were prevalent in patients with hypertension, myocardial infarction (MI) and healthy subjects. Anti-oxPAPC-Ab specifically reacts with oxPAPC, but not with 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphocholine (PAPC). The characteristics of the assay included precision (inter-assay coefficients of variation were 7.9% for IgG and 13.2% for IgM), cross-reactivity, clinical sensitivity for hypertension (43% and 47%) and MI (37% and 41%), clinical specificity (95.2%) and normal values (less than 13 Unit/mL for IgG and less than 7 Unit/mL for IgM). Elevated levels of anti-oxPAPC-Ab were found in smoking populations, in patients with hypertension and MI. Anti-oxPAPC-Ab are significantly elevated in patients with hypertension and MI. A synthetic PAPC, after oxidation, was used to detect anti-oxPAPC-Ab, which may greatly enhance the reliability of the assay. The determination of anti-oxPAPC-Ab could serve as an autoimmune marker in the associating diagnosis of cardiovascular disease.

Detection of genomic polymorphisms associated with venous thrombosis using the invader biplex assay.

A multi-site study to assess the accuracy and performance of the biplex Invader assay for genotyping five polymorphisms implicated in venous thrombosis was carried out in seven laboratories. Genotyping results obtained using the Invader biplex assay were compared to those obtained from a reference method, either allele-specific polymerase chain reaction (AS-PCR), restriction fragment length polymorphism (PCR-RFLP) or PCR-mass spectrometry. Results were compared for five loci associated with venous thrombosis: Factor V Leiden, Factor II (prothrombin) G20210A, methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C, and plasminogen activator inhibitor (PAI-1) 4G/5G. Of a total of 1448 genotypes tested in this study, there were 22 samples that gave different results between the Invader biplex assay and the PCR-based methods. On further testing, 21 were determined to be correctly genotyped by the Invader Assay and only a single discrepancy was resolved in favor of the PCR-based assays. The compiled results demonstrate that the Invader biplex assay provides results more than 99.9% concordant with standard PCR-based techniques and is a rapid and highly accurate alternative to target amplification-based methods.

Anti-idiotypes to oxidized LDL antibodies in intravenous immunoglobulin preparations--possible immunomodulation of atherosclerosis.

OBJECTIVE: The aim of this study was to examine whether intravenous immunoglobulin (IVIg) preparations contain anti-oxLDL and anti-anti-oxLDL antibodies. BACKGROUND: Oxidized low-density lipoprotein (oxLDL) is one of the major players in atherogenesis. IVIg can reduce atherosclerosis in experimental animal models. METHODS: Six commercial IVIg preparations were tested for the presence of anti-oxLDL antibodies by EIA. Inhibition studies were performed with the different IVIg preparations and IgGs purified from a pool of sera from patients with high anti-oxLDL antibody levels. Absorption assays were carried out to evaluate the presence of anti-idiotypes against anti-oxLDL antibodies in IVIg preparations. RESULTS: IVIg preparations tested had various degrees of reactivity towards oxLDL. Absorption experiments suggested that the reactivity was specific because it could be effectively absorbed by oxLDL and not by an irrelevant antigen PPD. The reactivity was smaller than that observed with the IgG from the pool with high anti-oxLDL antibody levels. Inhibition studies with IVIg demonstrated 20-45% inhibition of anti-oxLDL binding to oxLDL, compared to 76% inhibition by the pool with high anti-oxLDL levels. To investigate the presence of anti-idiotypes against anti-oxLDL antibodies within IVIg, F(ab')2 fragments of IVIg IgG were used to absorb IgG F(ab')2 fragments from the pool of sera with high anti-oxLDL levels. The decreased binding to oxLDL of the absorbed supernatants shows that IgG F(ab')2 fragments of the IVIg preparations had high inhibitory capacities ranging from 65 to 90%. CONCLUSIONS: IVIg preparations contain both anti-oxLDL and anti-anti-oxLDL activity. This finding may explain the immunomodulating effect of IVIg in atherosclerosis.

Autoantibodies in early seropositive rheumatoid arthritis, before and during disease modifying antirheumatic drug treatment.

OBJECTIVE: Autoantibodies observed in patients with rheumatoid arthritis (RA) during clinical trials of immunomodulating agents may cause concern about possible induction of autoimmunity by the therapeutic intervention. We determined the frequency and variability of selected autoantibodies in patients with early rheumatoid factor (RF) positive RA during a prospective observational study. METHOD: The study cohort consisted of 276 patients with active RA and with RF > or = 40 IU, who were enrolled between January 1, 1993, and April 1, 2000, before starting disease modifying antirheumatic drug (DMARD) therapy (average duration of symptoms, 7 mo). During an average of 3.5 years followup, a panel of autoantibodies was determined at entry, 6 months, 12 months, and yearly thereafter, in addition to routine clinical, radiographic, and laboratory assessments. After enrollment, patients were treated with DMARD at the discretion of their rheumatologists. RESULTS: At entry before any DMARD therapy, antinuclear antibody (ANA; by HEp-2) values were negative in 31%, borderline (8 IU/ml) in 26%, and > 8 (mean 65.5 IU/ml) in 41%. Tender and swollen joint counts, Disease Activity Score, and RF values were significantly higher in those with ANA > 8. During followup 726 paired serial specimens were available; 12.5% changed from negative to positive ANA and 12.3% from positive to negative. Additional autoantibodies were present in specimens of 20% of the subjects; 8% had 2 and 1.4% had 3 other autoantibodies. Anti-dsDNA was detected in 13 (5.5%) patients; 4 changed from negative to positive and one from positive to negative. SSA IgG and SSB IgG autoantibodies were both present in one of these patients. Ribosomal P protein autoantibodies were noted in 2 other patients, but Sm (Smith) and uRNP/snRNP IgG autoantibodies were not present in any patient. No patient had a diagnosis of systemic lupus erythematosus. Antithyroid peroxidase (20 patients), parietal cell (15), smooth muscle (14), reticulin (9), mitochondrial (5), striational (2), SSB (2) and SCL-70 (1) autoantibodies were detected in some specimens. Seven patients were diagnosed with hypothyroidism, one with chronic thyroiditis, one with hepatitis C, and 9 with malignancies. CONCLUSION: In patients with early RF positive RA the frequent occurrence of autoantibodies before and during treatment with standard DMARD may make it difficult to attribute their presence to new therapies.