Inverted papilloma: a clinico-pathological dilemma with special reference to recurrence and malignant transformation.

To study the clinicopathological profile, recurrence and malignant potential of the inverted papilloma of nose and paranasal sinuses in relation to the definitive diagnosis and the management undertaken. A total number of 52 cases of histologically proven inverted papilloma managed in our department of otolaryngology over a 10-year period (May 1998-April 2008) were followed up (until October 2009) and the results were analyzed retrospectively to find out any incidence of recurrence of these tumours. A total of 52 inverted papilloma cases were managed with different surgical interventions. Male:female ratio was found to be 10:1. The mean follow up period was 74 months (range 16 months-11 years). Recurrence was observed in 20 (38%) cases. 23% had recurrence without any specific histological pattern, 12% had recurrence with focal dysplasia and 4% had recurrence with malignant transformation into squamous cell carcinoma (SCC). Post-operative radiotherapy was given to 8% (four cases) with malignant transformation. The management of inverted papilloma depends on its size and extension. Recurrence can be minimized by an appropriate surgical planning. Careful endoscopic assessment is essential to detect early recurrence. Recurrent inverted papilloma should be treated more aggressively. Malignant transformation in inverted papilloma should be managed like any aggressive sino-nasal malignancy.

An unusual complication of CSOM - Lateral sinus thrombosis with lung abscess: A clinicoradiological study.

AIMS: To present a case report of a child presenting with lateral sinus thrombosis with bilateral multiple lung abscesses as a rare consequence of CSOM with an emphasis on the radiological findings. MATERIAL AND METHODS: An 11-year-old male child with a history of pyrexia of unknown origin, right-sided torticollis, cough with expectoration and right ear discharge was referred to us from department of paediatric medicine. Chest examination revealed dull areas on percussion and areas with bronchial breath sounds on auscultation bilaterally. Otological examination revealed right attic retraction pocket filled with cholesteatoma, post-auricular tenderness and Greisinger's sign along with foul smelling muco-purulent discharge. RESULTS: Routine blood investigations revealed normocytic normochromic anaemia, polymorpho-nuclear leucocytosis and raised ESR. Audiological investigations showed a right-sided mixed hearing loss. Digital radiography of chest showed multiple thin walled cavities involving all of the lung zones bilaterally. USG (Ultrasonography) of neck showed thrombosis of right internal jugular vein. CT scanning of head, neck and thorax showed soft tissue collection within the right mastoid with erosion of posterior wall & presence of gas bubble in the right sigmoid sinus and thrombosis of right internal jugular vein and multiple abscess cavities occupying both lung parenchyma. The patient was initially managed with conservative antibiotic therapy for lung abscess followed by radical mastoidectomy and thromboembolectomy from the lateral sinus. CONCLUSION: Otogenic lung abscess though rare in this present postantibiotic era, it can occur in underprivileged and poor population like our country.

Adrenergic involvement in the locus ceruleus and adjoining regions in the facilitation of predatory attack behavior as induced by hypothalamic stimulation in cats.

The present study was carried out in five cats which did not attack the rats spontaneously. Predatory attack on an anaesthetized rat was elicited by electrical stimulation of extreme lateral regions of hypothalamus. These sites were stimulated at a current strength from 300-700 microa to evoke a predatory attack on an anaesthetized rat. The attack was accompanied by minimal affective display such as alertness, pupillary dilatation, and culminated in beck biting at higher current strength. A scoring system allowed the construction of stimulus response curves, which remained fairly constant when repeated over a period of 3-4 weeks. Microinfusions of norepineprine and clonidine in 4.0 and 5.0 microg dose respectively in locus ceruleus and adjoining tegmental fields facilitated the predatory attack and there was a significant reduction in the threshold current strength for the elicitation of affective and somatomotor components. Microinfusions of yohimbine, an alpha-2 blocker, in 5 microg dose completely blocked the predatory attach response as indicated by an increase in the threshold current strength for the affective components. The somatomotor components were completely inhibited and could not be elicited even when the current strength was increased to 1000 microA. The predatory attack behavior remained completely inhibited for almost two hours following microinfusion of yohimbine. During this period, the animal was extremely drowsy and reacted very slowly even to a painful stimulus such as pinching of tail. Microinfusions of propranalol (beta-blocker), practalol (beta-1 blocker), prazosin (alpha-1 antagonist), propylene glycol as well as saline in similar volumes (0.5 microl) as control failed to produce any blocking effect, thus indicating the involvement of alpha-2 adrenoceptive mechanisms in the modulation of predatory attack in this region of midbrain. The facilitatory effects of norepinephrine and clonidine were significant at P<0.01 and P<0.05 respectively with Wilcoxon's signed rank test. The inhibitory effects of yohimbine were significant at P<0.05. The present study indicates the involvement of alpha-2 adrenoceptive mechanisms in the facilitation of hypothalamically elicited predatory attack.

Protective immune response of the capsid precursor polypeptide (P1) of foot and mouth disease virus type 'O' produced in Pichia pastoris.

Foot and mouth disease virus (FMDV) is the aetiological agent of a highly contagious vesicular disease of cloven-hooved animals. The gene coding for the capsid polyprotein (P1) of FMDV from serotype 'O' vaccine strain (O75Madras) was cloned and expressed in yeast Pichia pastoris. The expressed P1 protein was characterised by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and Western Blot analysis. Immunisation of Guinea pigs with recombinant P1 induced FMDV type O specific immune response. The humoral response to vaccine was measured by indirect ELISA and a serum neutralisation test (SNT). The Guinea pig sera showed high titres both in ELISA and SNT. Upon challenge with virulent Guinea pig adapted homologous type 'O' virus, the animals showed a protective index of 2.52. This study shows that the yeast expressed FMDV P1 could be a safe vaccine in non-endemic countries and a cost-effective vaccine in endemic countries. This is the first report on the production of FMDV structural proteins in yeast and their application as a vaccine.

Enkephalinergic involvement in substantia nigra in the modulation of hypothalamically-induced predatory attack behavior.

The present study was carried out in five cats which did not attack the rats spontaneously. Predatory attack on an anaesthetized rat was elicited by electrical stimulation of lateral hypothalamus at a mean current strength of 650 microA. The attack was accompanied by minimal affective display and culminated in neck biting. Microinfusions of DAME (delta-alanine methionine enkephaline) in 500 ng dose in substantia nigra facilitated the predatory attack and there was a significant reduction in the threshold current strength for affective display as well as somatomotor components. Microinfusions of naloxone, an opioid antagonist in 1.0 microg dose when DAME effect was at its peak reversed the facilitatory effects and the threshold returned to the control levels within 10 minutes of naloxone infusion at the same locus. Microinfusions of naloxone alone in similar dosage completely blocked the predatory attack response as indicated by an increase in the threshold current strength for somatomotor as well as affective display components. The somatomotor were completely inhibited and could not be elicited even when the current strength was increased to 1000 microA. Control injections of saline in similar volumes (0.5 microl) failed to produce any response Microinfusions of naloxone in lower dose (250 ng) failed to produce any blocking effect. These findings indicate that hypothalamically elicited predatory attack is facilitated by enkephalinergic mechanisms operating at the midbrain level.

Rhinosporidial infection in west bengal-a calcutta based hospital study.

Rhinosporidiosis is one of the common tropical diseases in ENT practice. In the present study, it constitutes about 1% hospital admission for E: surgery per annum. Nasal and extranasal involvement particularly occular involvement was critically examined in this study. Complete excision of rhinosporidial mass under endoscopie guidance for nasal rhinosporidiosis is found to give superior result in term of recurrence.

Development and characterization of monoclonal antibodies to foot and mouth disease virus type 'C'.

Five fusion experiments were conducted with spleen cells from Balb/c mice immunized with purified 146S antigen of foot and mouth disease virus type 'C' (vaccine strain). Monoclones (31) thus developed were isotyped as IgM (3), IgG1 (6), IgG2a (5), IgG2b (3) and IgG3 (14). Eleven clones isotyped as IgM, IgG2a and IgG2b showed neutralizing activity in virus neutralization and plaque reduction tests. Six of the neutralizing clones precipitated 146S virus in Ouchterlony reaction. On the basis of location of MAb reactive epitopes in relation to intact virus (146S), 12S particles and VP1 in ELISA test, the clones were classified as Class II (6), Class III (11) and Class IV (14). These clones may be useful for purposes of antigen detection from field isolates and for estimation of antibody titres in vaccinated animals.

Enkephalinergic mechanisms in midbrain (dPAG) in modulation of hypothalamically-induced predatory attack behaviour.

Present study was carried out in nine cats which did not attack the rats spontaneously. Predatory attack on an anaesthetized rat was elicited by electrical stimulation of lateral hypothalamus at a mean current strength of 690 microA. The attack was accompanied by minimal affective display and culminated in neck biting. Microinjections of delta-alanine methionine enkephaline (DAME) in 250 ng dose in dorsal periaqueductal gray completely suppressed the predatory attack. There was a significant increase in the threshold current strength for affective display components while the somatic components were completely inhibited even when the current strength was increased to 1000 microA. Microinjections of naloxone, an opioid antagonist in 1 microgram dose reversed the DAME blocking effect and the thresholds returned to control levels within 10 min of microinjections. Microinjections of naloxone alone in similar dose facilitated the response as indicated by a decrease in threshold current strengths for both affective display and somatomotor components. Control injections of saline in similar volumes (0.5 microliter) failed to produce any change. These findings indicate that hypothalamically induced predatory attack is inhibited by enkephalinergic mechanisms operating at the dPAG level in the midbrain.

Role of midbrain ventro-lateral tegmental area (VTA) enkephalinergic mechanisms in the facilitation of hypothalamically-induced predatory attack behaviour.

Bipolar concentric electrodes were implanted in five cats in extreme lateral regions of hypothalamus. These sites were electrically stimulated using biphasic square wave pulses at a current strength ranging from 300-800 microA to evoke predatory attack on an anaesthetized but live rat. At lower current strength (300 microA) only alertness with pupillary dilatation was produced. Gradual increase in the current strength led to the recruitment of somatic and affective components and a predatory attack was exhibited at a mean current strength of 700 microA. A scoring system allowed the construction of stimulus response curves, which remained fairly constant when repeated over a period of 3-4 weeks. Bilateral microinjections of delta-alanine methoinine enkephaline (DAME) (500 ng in 0.5 microliter saline) in ventrolateral tegmental area (VTA) elevated the mean threshold current strength for affective components while somatomotor components were totally inhibited. The blocking effect of DAME persisted for 1 hour. Microinjections of naloxone (1 microgram) in similar volumes facilitated the response as indicated by a reduction in threshold current strength for somatomotor and affective components. Microinjections of naloxone (1 microgram) in similar volumes facilitated the response as indicated by a reduction in threshold current strength for somatomotor and affective components. Microinjections of naloxone (1 microgram) also reversed the blocking effect of DAME and the thresholds returned to the control level within 10 min while microinjection of normal saline as control had no effect. The excitatory effects of naloxone and inhibitory effects of DAME were statistically significant at P < 0.01 and P < 0.05 respectively with Wilcoxon's signed rank test. The present study indicates that enkephalinergic as well as opioidergic mechanisms operating at the midbrain (VTA) level are involved in the inhibition of predatory attack as elicited from lateral hypothalamus.

Development of an effective vaccine against foot-and-mouth disease with partially purified and concentrated virus antigen.

Foot-and-mouth disease (FMD) virus is poorly immunogenic. There is need to improve the quality of the vaccine by incorporating enhanced quantity of purified virus antigen to prevent sporadic breakdown of immunity in regularly vaccinated organized herds. A technique has been standardized for virus purification and concentration by polyethylene glycol (PEG) treatment for large scale production of concentrated FMD vaccine. The vaccine prepared with tenfold concentrated antigen was given field trial in an organised farm with a reduced dose as compared to the conventional vaccine. High level serum neutralizing antibody in cattle was observed throughout the entire period of study. The concentrated vaccine controlled the spread of the disease when used in face of outbreak in villages adjacent to the organized farm.

Partial replacement of serum with peptone and lactalbumin hydrolysate for the production of foot-and-mouth disease vaccine in BHK-21 cells.

Two batches of experimental media were prepared with Difco-Peptone and Centron-Peptone in combination with lactalbumin hydrolysate (LAH) in Eagle's salts containing 3 amino acids, vitamins and 1% bovine serum. Both medium batches supported the growth of Razi BHK-21 cells in serial passages and the replication of foot-and-mouth disease (FMD) virus type "A". The infectivity and complement fixing antigen (CFU) titres of the virus were comparable with those in Eagle's medium. The protection indices "C" of the experimental batches of vaccine were highly satisfactory. The experimental media saved up to 90% of serum in comparison with Eagle's medium.

Studies on the development of a medium with peptone and casein hydrolysate for the production of foot-and-mouth disease vaccine in BHK-21 cells.

Studies were undertaken to develop a cheaper medium with indigenous sources of peptone and casein hydrolysate for continuous culture of BHK-21 (suspension) cells and production of foot-and-mouth disease (FMD) vaccine. Eleven batches of experimental media were prepared using different indigenous sources of casein hydrolysate and peptone. These batches of media were tested for the growth of Razi BHK-21 cells in suspension and compared with the growth in control Eagle's medium. Out of eleven batches only four batches of the media produced cell growth equivalent to that with the Eagle's medium. Cells passaged in these batches of the experimental media supported virus growth and titres were comparable with those in Eagle's medium. Experimental batches of vaccine against FMD virus type A5 were prepared on a pilot scale as well as on a fermenter scale. The protection indices of these vaccine in guinea-pigs were satisfactory and induced 100% protection in cattle. One source each of peptone and casein hydrolysate was found suitable for the experimental medium. The medium developed is able to replace 10 out of 13 amino acids and also tryptose phosphate broth in Eagle's medium and is expected to reduce the cost of medium by 33% compared with Eagle's medium.

Milk whey as a serum supplement for the growth of FMD virus in BHK-21 cells.

Two batches of experimental media containing 10% milk whey (sweet or sour) and 1% bovine serum supported the growth of BHK-21 cells in serial passages. The cell yield was greater than 2 x 10(6)/ml at 48 h. The cells were susceptible to inoculation with foot and mouth disease (FMD) virus type 'A' and the virus titres obtained were comparable with those in Eagle's MEM-G with 10% serum. The use of milk whey could reduce the consumption of serum required for the growth of FMD virus in BHK-21 cells by up to 90%.