Comparative Analysis of Milk Triglycerides Profile between Jaffarabadi Buffalo and Holstein Friesian Cow.

Milk lipids are known for a variety of biological functions, however; little is known about compositional variation across breeds, especially for Jaffarabadi buffalo, an indigenous Indian breed. Systematic profiling of extracted milk lipids was performed by mass spectrometry across summer and winter in Holstein Friesian cow and Jaffarabadi buffalo. Extensive MS/MS spectral analysis for the identification (ID) of probable lipid species using software followed by manual verification and grading of each assigned lipid species enabled ID based on (a) parent ion, (b) head group, and (c) partial/full acyl characteristic ions for comparative profiling of triacylglycerols between the breeds. Additionally, new triacylglycerol species with short-chain fatty acids were reported by manual interpretation of MS/MS spectra and comparison with curated repositories. Collectively, 1093 triacylglycerol species belonging to 141 unique sum compositions between the replicates of both the animal groups were identified. Relative quantitation at sum composition level followed by statistical analyses revealed changes in relative abundances of triacylglycerol species due to breed, season, and interaction effect of the two. Significant changes in triacylglycerols were observed between breeds (81%) and seasons (59%). When the interaction effect is statistically significant, a higher number of triacylglycerols species in Jaffarabadi has lesser seasonal variation than Holstein Friesian.

Quality parameters, fatty acid profiling and estimation of umbelliferone in grahanimihira tailam: An ayurvedic oil preparation.

BACKGROUND: Grahanimihira tailam is an unexplored ayurvedic oil preparation which consists of 34 ingredients. The efficacy of this traditional ayurvedic medicine is undisputable. Proper clinical standardization of this formulation will go a long way in securing greater recognition for it. The main objective of this study was to develop standardization parameters for the formulation in a multidisciplinary way. MATERIALS AND METHODS: A simple and efficient method for the quantification of umbelliferone by high performance thin layer chromatography was developed and validated. Presence of the major fatty acids and their percentage were assessed by using gas chromatography-mass spectrometry (GC-MS). Various physio-chemical parameters, microbiological load, aflatoxins and mineral oil were also evaluated. Spread plate method was used for checking microbial contamination. RESULTS: The results were validated as per standard protocols. Quantitative estimation revealed the percentage of umbelliferone to be in the range of 0.88-0.98 (w/w). GC-MS analysis of sample led to the identification of 14 fatty acids, in which linoleic acid was obtained as the major fatty acid. Microbes, aflatoxins and mineral oils were found to be absent in the tailam. CONCLUSION: The results which give the quantitative estimates of various physico-chemical parameters can be adopted to establish new standards for analysis of batch-to-batch variation and this data will facilitate shelf life studies in the future.

The blood flow to the femoral head/neck junction during resurfacing arthroplasty: a comparison of two approaches using Laser Doppler flowmetry.

We used Laser Doppler flowmetry to measure the effect on the blood flow to the femoral head/neck junction of two surgical approaches during resurfacing arthroplasty. We studied 24 hips undergoing resurfacing arthroplasty for osteoarthritis. Of these, 12 had a posterior approach and 12 a trochanteric flip approach. A Laser probe was placed under radiological control in the superolateral part of the femoral head/neck junction. The Doppler flux was measured at stages of the operation and compared with the initial flux. In both groups the main fall in blood flow occurred during the initial exposure and capsulotomy of the hip joint. There was a greater reduction in blood flow with the posterior (40%) than with the trochanteric flip approach (11%).

Is bronchoscopic lung biopsy helpful in the management of patients with diffuse lung disease?

Few studies have evaluated how the results of bronchoscopic lung biopsy (BLB) affect clinical management. The objective of the present study was to evaluate the clinical usefulness of BLB in the overall management of patients with diffuse pulmonary diseases. The study was a retrospective analysis of patients who underwent fluoroscopy-guided BLB over a 2-yr period. Patients whose biopsy was of a lung mass or single dominant lung nodule were excluded. The usefulness of BLB was assessed to determine whether the results affected the clinical management of these patients. During the study period, 603 patients underwent 651 BLB procedures. The results of BLB were clinically helpful in 494 (75.9%) out of 651 procedures. No diagnostic abnormality was identified in 107 (16.4%) out of the 651 biopsy procedures. This finding was clinically helpful in 59 (55.1%) out of 107 procedures, as the results excluded specific processes suspected before BLB. In 52 procedures (8% of all BLB), no lung parenchyma was obtained. In conclusion, bronchoscopic lung biopsy is a clinically useful test in approximately 75% of procedures. In the 25% of bronchoscopic lung biopsies that were clinically unhelpful, the reason for failure in approximately one-third of patients was the failure of the procedure to obtain an adequate quantity of lung parenchyma for a meaningful histological analysis.

Aerosol granulocyte-macrophage colony-stimulating factor for pulmonary alveolar proteinosis.

Recently, granulocyte-macrophage colony-stimulating factor (GM-CSF) auto-antibodies have been found in many patients with pulmonary alveolar proteinosis (PAP). The present study reports a retrospective case series of patients who used aerosolised GM-CSF in the treatment of idiopathic PAP. Between 1999 and 2003, 12 patients elected to receive aerosolised GM-CSF (250 microg b.i.d. every other week) in lieu of whole-lung lavage or observation. Patient characteristics, pulmonary function tests, arterial blood gas analysis, laboratory values and chest radiographs were extracted from the patient's medical records. Of the six patients tested, all had GM-CSF neutralising antibodies. Additionally, abnormalities in GM-CSF gene expression (one patient), receptor expression (two patients) and ability to upregulate adhesion molecules (one patient) were found. All patients except one had a positive response (mean improvements in arterial oxygen tension, alveolar-arterial oxygen gradient, carbon monoxide diffusing capacity of the lung and forced vital capacity were 17.1 mmHg, 18.4 mmHg, 16.6% pred and 13.5% pred, respectively). Two patients made a complete recovery and were disease free 1 and 2 yrs after discontinuing treatment. Four patients showed complete response to both the initial course or when treated again for recurrence after discontinuation of treatment. One patient required dose escalation (500 microg b.i.d.) with complete response. GM-CSF was well tolerated without late toxicity after median (range) follow-up of 30.5 (3-68) months. In conclusion, aerosolised granulocyte-macrophage colony-stimulating factor is safe and effective in treating pulmonary alveolar proteinosis providing an alternative to whole-lung lavage or subcutaneous granulocyte-macrophage colony-stimulating factor.

Birth hypoxia and spinal reflex in newborn babies.

Birth hypoxia is detrimental to neuronal function. In this study, its effect on spinal monosynaptic reflex was investigated on two different age groups of human newborn babies using few non-invasive electrophysiological parameters. A total of 57 newborns (25 hypoxic + 32 non-hypoxic) were the study subject. Out of which, 31 newborns (11 hypoxic + 20 non-hypoxic) were examined within 48 hours of birth, and the rest 26 (14 hypoxic + 12 non-hypoxic) were examined between 48h and 120h (five days) of birth. H-reflex latency (HRL), distal motor latency (DL), and H-reflex conduction velocity (HRCV), were estimated for understanding the transmission of impulse in the monosynaptic reflex pathway. Moreover, Hmax, Mmax, and H/M ratio were observed for studying the spinal motor neuronal excitability. The injurious effect of hypoxia was detected on HRL, HRCV, Hmax and H/M ratio in babies who were examined within 48h of birth. The HRL was significantly increased and other parameters were significantly reduced. In the older group of babies, however, Hmax was the only parameter affected by hypoxia. The relatively older babies of hypoxic or non-hypoxic group had higher Hmax and H/M ratio compared to younger ones of their own group.

Peri-engraftment respiratory distress syndrome during autologous hematopoietic stem cell transplantation.

From 1987 to 1998, 19 of 416 patients (4.6%) who underwent autologous hematopoietic stem cell transplantation experienced peri-engraftment (within 5 days of neutrophil recovery) respiratory distress syndrome (PERDS) not attributable to infection, fluid overload, or cardiac dysfunction. The median time from stem cell infusion to onset of PERDS was 11 days (range 4-25). Risk of PERDS or its outcome was not predicted by any pre- or peri-transplant clinical or laboratory feature. The respective median white blood cell and platelet counts at first symptoms were 1.3 x 10(9)/l and 25 x 10(9)/l. No patients had an infectious etiology by bronchoalveolar lavage. Six of the 19 patients had alveolar hemorrhage, which was significantly correlated with high neutrophil count. PERDS was directly implicated in four deaths (21%). Eleven patients received high-dose corticosteroid therapy, including five of the six who required mechanical ventilation. Ten of these patients experienced clinical improvement, which occurred within 24 h in five. The rapid response to corticosteroid treatment and the fact that such therapy was delayed until after intubation in all the mechanically ventilated cases point to a therapeutic benefit.

Computerised measurement of tibiofemoral alignment.

Tibiofemoral alignment has a direct correlation with the survival of total knee arthroplasty. Traditionally, it has been measured using a goniometer on radiographs. We describe new software which measures this alignment on scanned radiographs by automatically detecting bones in the image. Two surgeons used conventional methods and two clerical officers used the computerised routine to assess 58 radiographs of the knee on two occasions. There were no significant differences between any of the paired comparisons. The largest mean difference detected was 1.19 degrees. Across all comparisons, the mean correlation was 0.755. A standardised routine for measuring tibiofemoral alignment was the greatest factor in reducing error in our study. These results show that non-medical staff can reliably use the software to measure tibiofemoral alignment. It has the potential to measure all the parameters recommended by the Knee Society.

Role of bronchoscopy in modern medical intensive care unit.

This article gives a broad overview of the increasingly important applications of bronchoscopy, flexible (FOB) and rigid (RB), in a modern medical intensive care unit. Special emphasis is made to bronchoscopy use in mechanically ventilated patients. Therapies such as endobronchial stenting and Nd:YAG laser are being used to improve respiratory failure and facilitate weaning from mechanical ventilation. Practical applications of recent advancements in technology (endobronchial stenting, laser therapy, and so forth), the increasing use of rigid bronchoscopy, and the new generation of flexible bronchoscopes like battery bronchoscopes, and ultra-thin bronchoscopes, are also discussed. The risks, potential benefits, complications, and suggested technique of performing bronchoscopy in mechanically ventilated patients are reviewed.

Tracheobronchial amyloidosis.

OBJECTIVE: To evaluate the presentation and clinical course of patients with tracheobronchial amyloidosis. PATIENTS AND METHODS: We retrospectively reviewed the records of all patients with biopsy-proven tracheobronchial amyloidosis who were evaluated at the Mayo Clinic in Rochester, Minn, between 1973 and 1999. All relevant information, such as clinical, historical, demographic, laboratory, and histological data, was examined. RESULTS: Tracheobronchial amyloidosis was diagnosed in 17 patients (9 women and 8 men), with a mean age of 56.6 years. The most common symptoms at presentation were dyspnea, cough, hemoptysis, and hoarseness. None of the 14 patients who underwent investigation for systemic amyloidosis had any evidence of disease outside the tracheobronchial system except for a man in whom multiple myeloma had been diagnosed 3 years before the development of respiratory disease. Treatment of tracheobronchial amyloidosis consisted of laser or forceps resection, external radiation, systemic therapy, or observation. Two patients died of complications directly related to their disease. CONCLUSIONS: Patients presenting with tracheobronchial amyloidosis have symptoms similar to those caused by various airway disorders. Tracheobronchial amyloidosis is not typically associated with systemic amyloidosis or pulmonary parenchymal involvement. It often recurs and despite repeated attempts with bronchoscopic techniques, airway compromise remains a major problem.

Varicella-zoster virus detection by polymerase chain reaction using bronchoalveolar lavage specimens.

We report the use of polymerase chain reaction (PCR) techniques from a bronchoalveolar lavage (BAL) specimen for the successful early diagnosis in a case of atypical but severe varicella-zoster virus (VZV) pneumonitis. Atypical presentations of disseminated VZV frequently prolong the time required for accurate diagnosis, resulting in increased morbidity, or mortality. Although further investigation is necessary to determine the sensitivity and positive predictive value of this test, PCR analysis of bronchoscopic specimens may expedite the diagnosis of disseminated VZV.

The role of anticholinergics in bronchoscopy. A randomized clinical trial.

BACKGROUND: Anticholinergic medications have been utilized frequently prior to bronchoscopy and are thought to facilitate the drying of secretions to limit the amount of required topical anesthetic on the airway mucosa, prevent cardiac arrhythmias during the procedure, and increase patient comfort. OBJECTIVE: To determine if atropine or glycopyrrolate, two anticholinergic agents utilized most frequently in this setting, have any significant role for this purpose. DESIGN: Double-blind, placebo-controlled study, in which patients were randomly selected to receive atropine (0.01 mg/kg body weight, IM injection), glycopyrrolate (0.005 mg/kg, IM injection), or saline solution placebo (approximately 2 mL, IM injection) 15 to 45 min prior to being sedated with midazolam until judged to be lightly sedated. SETTING: A large academic teaching hospital in the midwestern United States. PARTICIPANTS: Two hundred seventeen outpatients referred for bronchoscopy who satisfied inclusion and exclusion criteria. MEASUREMENTS AND RESULTS: Using a modified visual analog scale (0 to 100 mm), the bronchoscopist and the nurse anesthetist estimated the antisialagogic effect, effectiveness in cough suppression, and overall patient comfort during the procedure. The patients completed a similar questionnaire after recovering from the procedure. Patients were also monitored for complications (cardiac arrhythmias, oxygen desaturation, hypertension, wheezing, or coughing severe enough to curtail the procedure). There was no significant difference found among atropine, glycopyrrolate, and placebo for the primary end point of secretion control. In addition, there was no difference found between either medication and placebo for effectiveness of cough suppression, amount of topical anesthetic used, complication rates, or overall patient comfort. CONCLUSION: The use of anticholinergic agents prior to bronchoscopy did not affect performance of bronchoscopy or complication rates, and there was no appreciable benefit from the resultant reduction in airway secretions in a population of patients receiving concurrent sedation with benzodiazepines.

Alpha1-antitrypsin deficiency and inflammatory bowel diseases.

OBJECTIVE: To evaluate a possible etiologic role of alpha1-antitrypsin deficiency (alpha1AD), most frequently caused by a Z allele mutation, in ulcerative colitis (UC) and Crohn disease (CD). PATIENTS AND METHODS: This retrospective study included 10 patients diagnosed with and/or treated for inflammatory bowel disease (IBD) between 1976 and 1997 and identified from the Mayo Clinic Medical Index System. All 10 patients had either alpha1AD and CD or alpha1AD and UC. The alpha1-antitrypsin (alpha1AT) types and levels were determined with isoelectric focusing testing. The allele types, representing genotypes, were designated PiZZ (or ZZ) for homozygotes and PiMZ (or MZ) for heterozygotes. RESULTS: Seven patients had UC: 4 were genotype ZZ and 3 MZ. Four of these 7 patients had emphysema, 2 had asthma, and 1 had chronic bronchitis. Five were cigarette smokers, but only 1 had smoked coincident with activity of her UC. Two of the UC patients never smoked, and 1 of these 2 had asthma. Three of the 10 patients had CD, 2 genotype ZZ and 1 MZ. Two of the 3 patients were long-term cigarette smokers, and both had emphysema. Nine of the 10 patients with UC and alpha1AD required surgery. CONCLUSIONS: The need for surgery in patients with UC and alpha1-AD may point to a unique phenotypic subgroup of patients with alpha1AD and severe UC. Further studies are required to substantiate the etiologic role of alpha1AD in IBD. Our observations, if confirmed by future studies, suggest that in patients with both IBD and chronic obstructive pulmonary disease, alpha1AD testing should be considered.

Advances in bronchoscopic procedures.

Bronchoscopy is currently the most commonly employed invasive procedure in the practice of pulmonary medicine. Both the rigid and flexible bronchoscopes are used to diagnose and treat various pulmonary disorders. The main diagnostic indications include pulmonary involvement by neoplasms, infections, diffuse lung diseases, and airway problems. Bronchoscopic needle aspiration remains an underutilized technique in the staging of lung cancer. Newer techniques such as bronchoscopic ultrasound appear promising and may lead to improved diagnostic yield from bronchoscopic procedures. The bronchoscope is used in application of laser therapy, brachytherapy, electrocautery, cryotherapy, placement of airway stents, and balloon dilatation to relieve airway obstruction caused by malignant and benign airway lesions.

Therapeutic bronchoscopy in broncholithiasis.

Bronchoscopy is considered the most important diagnostic test for broncholithiasis. However, its role in the treatment of broncholithiasis in a large group of patients has not been studied. To evaluate the therapeutic role of bronchoscopy, we retrospectively reviewed the clinical data of patients with broncholithiasis who also underwent bronchoscopy at Mayo Clinic. Bronchoscopy revealed 127 broncholiths (free or partly eroded calcified material in the airway lumen) in 95 patients (49 men and 46 women) evaluated between 1954 and 1994. Bronchoscopic removal of 71 (56%) broncholiths was attempted in 48 patients (50.5%) during 61 bronchoscopy sessions. Forty-eight of the broncholiths selected for removal were partly eroding into the tracheobronchial lumen and 23 were free. Forty-eight percent (23 of 48) of the partly eroding broncholiths were successfully removed bronchoscopically, with a greater percentage removed with the rigid bronchoscope (67%) than with the flexible bronchoscope (30%). All free broncholiths were completely extracted regardless of the type of bronchoscope used. Complications occurred in only two patients (4% of the bronchoscopic broncholithectomy group), both with partially eroded broncholiths, and consisted of hemorrhage in one patient requiring thoracotomy and acute dyspnea in another patient, caused by a loose broncholith lodged in the trachea. We conclude that flexible and/or rigid bronchoscopic extraction of partly eroded or free broncholiths in the tracheobronchial tree can be considered safe and effective.

Pulmonary arteriovenous fistulas: Mayo Clinic experience, 1982-1997.

OBJECTIVE: To describe the results of analysis of clinical, physiologic, diagnostic, and therapeutic aspects and complications in patients with pulmonary arteriovenous fistulas (PAVFs). PATIENTS AND METHODS: Retrospective review of medical records of all patients with the diagnosis of PAVF evaluated at Mayo Clinic Rochester from 1982 through 1997. Demographic characteristics, presence or absence of hereditary hemorrhagic telangiectasia, clinical features, and results of imaging studies and blood gas analyses, treatments, and complications related to PAVFs were reviewed. RESULTS: Among the 93 patients, 44 were male and 49 female. The mean age at the time of evaluation was 40 years (range, 5-83 years). Fifteen patients (16%) were asymptomatic. History of hereditary hemorrhagic telangiectasia was present in 52 patients (56%). Notable clinical findings included epistaxis in 46 (49%), hemoptysis in 14 (15%), cyanosis in 27 (29%), clubbing in 18 (19%), dyspnea in 53 (57%), and pulmonary bruits/murmurs in 32 (34%). Chest x-ray films with or without tomograms showed abnormal findings in 87 (94%), of which 68 (73%) suggested PAVF. Polycythemia was detected in 12 (13%). Pretherapy arterial PO2 measured on room air averaged 56 mm Hg (range, 32-95 mm Hg), and the posttherapy PO2 averaged 77 mm Hg (range, 46-110 mm Hg). Echocardiography with indocyanine green dye was diagnostic of extracardiac right-to-left shunt in 26 (90%) of 29 patients tested. Diagnostic studies revealed single lesions in 32 patients (34%) and multiple lesions in 61 (66%). The most prominent complications of the disease were neurologic events in 34 patients (37%). These complications included transient ischemic attacks, hemiplegia, brain abscesses, and seizures. Surgical resection alone was carried out in 18 patients (19%), embolization therapy alone in 41 (44%), and both therapies in 7 (8%). The 48 patients treated with embolization required 78 embolization sessions with more than 200 lesions occluded. Complications of treatment included postembolization hemothorax in 1 patient and right-sided hemiparesis in another patient. Follow-up disclosed that 1 patient died from PAVF-related complications. CONCLUSIONS: Among our patients with PAVFs, hereditary hemorrhagic telangiectasia was observed in more than half and neurologic complications in more than one third. Because of the considerable risk of neurologic and other complications, definitive treatment should be considered in patients with PAVFs. Embolization is currently the preferred treatment in most patients. Frequent follow-up of treated patients is necessary because PAVFs tend to increase both in number and in size over time.

Effect of activity levels on polyethylene wear in Charnley low-friction arthroplasty.

Polyethylene wear debri has been implicated as a major cause of aseptic loosening following total hip replacement. The purpose of this study is to classify patient activity levels following total hip replacement and determine if it has an effect on radiographic wear of the socket. 97 patients (115 hips) with osteoarthritis who underwent Charnley low-friction arthroplasty with a minimum of 10 year follow-up were selected. Nine patients had died. Eighty-eight questionnaires were sent of which 59 replied. However, only 40 patients (45 hips) with a complete set of x-rays were finally studied. Activity levels were classified according to post-operative occupation and activities into 'active' and 'less active' groups. Radiographic wear was measured by studying the post-operative and the 10-year review radiograph. There was a significant difference in acetabular wear between the active and the less active group (p = 0.024). No correlation was found between weight and acetabular wear (p = 0.475) or between age and acetabular wear (p = 0.278). It was concluded, therefore, that surgeons who advise their patients to avoid heavy or high intensity activities for prolonged periods, after Charnley low-friction arthroplasty, are justified in this approach.

Radiation-induced pneumonitis in the "nonirradiated" lung.

OBJECTIVE: To describe six cases of radiation-induced organizing pneumonitis occurring outside the direct radiation field and to review clinical, radiologic, and histologic aspects of this entity. MATERIAL AND METHODS: We present detailed case reports of six women, with a mean age of 62.8 years (range, 50 to 75), who had received radiation therapy (mean dose, 6,560 cGy) for breast cancer. RESULTS: From 6 to 17 months (mean, 8.8) after the completion of radiotherapy, recurrent and migrating lung infiltrates were detected outside the radiation field in the six study patients. Three patients had pronounced respiratory symptoms, whereas the rest were minimally symptomatic or asymptomatic. Thoracic computed tomography showed dense alveolar infiltrates. Bronchoalveolar lavage in two patients revealed lymphocytosis (25% and 19%), and lung biopsy in five patients demonstrated a histologic pattern consistent with bronchiolitis obliterans organizing pneumonia. Even though the symptomatic patients showed prompt resolution of their symptoms and roentgenographic abnormalities after systemic corticosteroid therapy, the lung infiltrates recurred after corticosteroid therapy was discontinued. CONCLUSION: These six cases, including their prompt response to corticosteroid therapy, provide additional evidence that irradiation damages lung tissue outside of the direct treatment field and suggest that an immunologically mediated lymphocytic alveolitis may be responsible for the recurrent migratory organizing pneumonitis.