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Background: Sexual dysfunctions (SDs) are common and lead to psychological distress and impair quality of life (QOL). However, little attention has been paid to explore SD in severe mental illnesses (SMIs). Hence, this study aimed to evaluate the occurrence of SD and its impact on the QOL in persons suffering from schizophrenia, bipolar disorder, and depression and compare it with healthy controls. Materials and Methods: In this cross-sectional study, 79 clinically stable patients and 50 healthy controls underwent evaluation for SD on the Arizona Sexual Experience Scale, and their QOL was measured using the WHO QOL-BREF scale. Chi-square test was used for the categorical variables, whereas comparison of continuous variables was done by t-test with post hoc corrections. Results: Compared to healthy controls, patients with depression had significantly higher rates of SD in the domain of obtaining penile erection (P = 0.019), ability to reach orgasm (P = 0.03), and satisfaction from orgasm (P = 0.01). Patients with schizophrenia had higher rates of problems in achieving arousal (P < 0.01), penile erection (P = 0.03), and satisfaction from orgasm (P = 0.03), whereas those with bipolar disorder only differed significantly on the domain of ability to reach orgasm (P = 0.03). However, patients fared better than the controls on various domains of QOL (except social domain). Conclusion: A significant number of patients with SMI suffer from SD. Hence, it should be made a routine practice to evaluate and address the problem of SDs in patients with SMI.

In the USA, the third leading cause of a large bowel obstruction in adults is volvulus with torsion occurring commonly in the sigmoid and the cecum. Transverse colonic volvulus is exceedingly rare and specific involvement of the splenic flexure is even more uncommon. In the present report, we discuss a Veteran octogenarian who presented with a long-standing history of constipation, but then developed an acute abdomen from a large bowel obstruction. At laparotomy, he had a double closed loop obstruction with volvulus of the splenic flexure. The colon at the splenic flexure was ischemic with patchy areas of necrosis, but no perforation. He underwent a subtotal colectomy with an ileostomy. This case illustrates the need for prompt intervention of this unusual entity. Current trends in the incidence, management, morbidity and mortality are discussed.

BackgroundIn the United States, the third leading cause of a large bowel obstruction (LBO) is colonic volvulus with torsion occurring most commonly in the sigmoid and the cecum. Transverse colonic volvulus (TCV) is exceedingly rare and specific involvement of the splenic flexure (SFV) is even less common. The present analysis was undertaken to interrogate current trends in presentation, management, and outcomes of TCV.MethodsIn the present report, the world literature was reviewed for the past 90 years (1932 to 2021). We conducted a systematic review to identify all cases of TCV following the PRISMA guidelines.ResultsWe identified 317 cases of TCV. This included SFV (n = 75), TCV in pediatric patients (n = 63), TCV in pregnant patients (n = 8), and TCV associated with other pathology such as Chilaiditi’s syndrome (n = 11). Compared to sigmoid and cecal volvulus, TCV was rare (.94%). It affected slightly more women (54%) than men, commonly in their third decade of life (37.7 ± 23.8). The clinical presentation and diagnostic imaging were consistent with LBO. Compared to sigmoid volvulus, there was a limited role for conservative management and colonoscopic decompression was less effective. The most common operation was segmental resection (25%). Mortality was (20%) commonly because of cardiopulmonary complications and affected more women (63%). The average age of this cohort was 55.7±24.6 years old.DiscussionOur review showed that TCV is an uncommon surgical entity. The diagnosis is likely to be made at laparotomy. Prompt recognition is paramount in preventing ischemia necrosis and perforation. Compared to sigmoid and cecal volvulus, the mortality for TCV remains high.

Background: Suicide being a global health issue, the attitudes and beliefs of the healthcare professionals towards these attempters have significant effect on the outcome of the treatment. Objectives: Aim of the study was to assess the attitude of nursing students towards patients with suicide attempt. Materials and Methods: The study had a cross sectional design of 284 nursing students who were randomly recruited from the two institutions. Suicide opinion Questionnaire was administered. Results: Most were young single females, from rural locality, who were pursuing either BSc Nursing or GNM courses. Very few had previous exposure to suicide prevention training programmes. More than half of the students showed favourable attitude towards patients with suicidal attempt. Majority of students showed favourable attitudes for more than half of the attitudinal statements giving importance to the mental illness, disturbed family life, and depression and risk factors for suicide attempt. Unfavourable and uncertain attitude was noticed for a few of the statements. Conclusions: The nursing students showed favourable attitude towards patients with suicide attempts. More educational and training programs are therefore needed in these students for improving the uncertain and unfavourable responses to a few of these attitudes for better management of these patients.

Oral anticoagulant (OAT)-associated intracranial hemorrhage (ICH) is a life-threatening emergency for which prothrombin complex concentrates (PCC) are considered first-line reversal agents. The only approved PCC in the USA for warfarin-associated ICH is non-activated PCC. Little data are available regarding the safety and effectiveness of factor VIII inhibitor bypassing activity (FEIBA) which is an activated prothrombin complex concentrate (aPCC). The aim of this analysis was to assess the safety and effectiveness of FEIBA compared to fresh frozen plasma (FFP) for reversal of OAT-associated ICH. Data were retrospectively collected to compare coagulation markers and in-hospital clinical outcomes in patients who received aPCC with or without FFP versus FFP alone for the reversal of OAT-associated ICH. Eighty-four patients met inclusion criteria; 50 patients received FFP alone, and 34 patients received FEIBA (mean dose 20 U/kg) with or without FFP for OAT-associated ICH. The proportion of diagnosed thrombotic events during hospitalization was similar in both groups (8% in the FFP group vs. 12% in the FEIBA group; P = 0.56). Median time to INR

Propofol injection is known to cause distressing pain, and various methods have been used to decrease this pain. We investigated the efficacy of the lidocaine + metoclopramide and lidocaine + ketamine combinations on modulating propofol injection pain.Ninety ASA I/II patients aged 20-60 years were randomly assigned to three groups to receive lidocaine 20 mg (group L), lidocaine 20 mg + metoclopramide 10 mg (group LM), or lidocaine 20 mg + ketamine 5 mg (group LK), respectively, with venous occlusion for 1 min using a forearm tourniquet. Propofol 0.5 mg/kg was subsequently administered into a dorsal hand vein, and pain was assessed during its injection using a verbal rating score. The results were analyzed statistically with analysis of variance, the chi-square test, and the Wilcoxon rank sum test, where appropriate. The significance level was set at p 0.05.The incidence of pain was rated to be significantly less in patients in groups LM (40 %) and LK (6.7 %) than in those in group L (83.3 %) (p = 0.001 and p 0.001, respectively). The pain score [median (range)] was also significantly less in patients in groups LM [0 (0-3)] and LK [0 (0-2)] than in those in group L [2 (0-3)] (p = 0.001 for both groups).The lidocaine-ketamine combination is most effective for decreasing the pain on propofol injection.

Prevalence of different abnormal hemoglobins (Hb) in Indian tribal and nontribal population groups is well established. Sickle cell hemoglobin (HbS) is mostly concentrated in Central and South Indian states, whereas HbD and Hb E is mostly found in North-North-West and North-North-East states respectively. HbJ, an alpha globin gene variant, is earlier reported in North India whereas; its presence in the tribal Chhattisgarh state is not well understood. HbE, a beta-globin gene variant was earlier reported in North Eastern states of India. Prevalence of both these abnormal hemoglobins in the Central India specifically in Durg, Chattisgarh is incompletely understood. In this study attempts were made to analyze the presence of abnormal hemoglobins during screening for sickle cell anemia. Briefly, blood samples (N=44) were analyzed for sickle cell anemia screening and confirmatory tests by solubility tests and cellulose acetate membrane electrophoresis at alkaline pH. Two samples showed an abnormal pattern of separation on cellulose acetate membrane other than HbS. Out of total 44 tested samples, five were sickle cell carriers (HbAS), one was heterozygous HbAJ and the another one was homozygous for HbE while remaining other were normal genotypes i.e. HbAA. In brief, a case of homozygous Hemoglobin E from Kurmi caste of other backward community (OBC) and a different heterozygote pattern, i.e. Hb AJ from Brahmin community is reported from Durg, Chattisgarh, Central India. This study provides possible indication of variation of different abnormal hemoglobins, other than HbS, present in the tribal state of Chhattisgarh.

Various long-term complications have been reported with inferior vena cava filters. In this report, the authors describe unusual complications associated with a G2 filter in a patient with aortic lumen and vertebral body penetration.

Plasmacytomas occurring in the gastrointestinal tract are extremely rare. We report one such case of pancreatic and jejunal plasmacytoma in a single patient with known multiple myeloma with emphasis on computed tomographic (CT) findings.

Background Noninvasive intracranial pressure (ICP) measurement would represent a major advance for patients with neurological problems. The Vittamed ICP meter is an ultrasound-based device reported to have high agreement with lumbar puncture cerebrospinal fluid (CSF) pressure measurement. However, previous studies included mostly patients with normal levels of ICP. The purpose of our study was to perform an independent clinical validation study of a transcranial Doppler-based noninvasive ICP meter in patients anticipated to have a wide range of ICP. Methods In a prospective cross-sectional design, we simultaneously measured ICP with the Vittamed device and the invasive lumbar CSF pressure. The operator of each procedure was blinded to the result of the other method. Data were analyzed using Bland-Altman plots, Pearson correlation coefficients, and receiver operator characteristic curves. Results Twenty-four independent paired measurements of Vittamed and lumbar CSF pressure were obtained; with mean absolute difference between paired measures of 4.5 mmHg (standard deviation 3.1). The 95% limits of agreement were −10.5 to +11.0. The systematic bias (mean of paired differences) was negligible at 0.25 mmHg. The sensitivity, specificity, and area under the curve for ICP >20 mmHg were 0.73, 0.77, and 0.71, respectively. Conclusions The Vittamed ICP meter had fair agreement with lumbar CSF pressure measurement. The wide limits of agreement would preclude using this version of the device as a stand-alone method for ICP determination, but may be useful if combined with other ICP screening methods. Ongoing improvements to the Vittamed hardware and software may lead to improvements in accuracy and clinical utility of this device.

Sir, Percutaneous nephrolithotomy (PCNL) is used commonly for the treatment of large renal and upper ureteric calculi. We report a 30-year-old female who developed a massive hydrothorax diagnosed postoperatively following PCNL for left renal calculus. Standard anaesthesia with controlled ventilation was administered. PCNL was performed in the prone position with a left supracostal (between 11th and 12th rib) approach. Multiple attempts were required to reach the superior calyx. Intraoperatively the patient remained haemodynamically stable. The procedure lasted 120 min; blood loss was ≈ 400 mL. Following extubation the patient was comfortable and haemodynamically stable with oxygen saturation (SpO2) 98% on 40% oxygen. After 30 min, the patient complained of breathing difficulty. She was tachypnoeic, with SpO284% (O2 5 L/min). Air entry was absent in left hemithorax, with dullness on percussion. Chest radiograph revealed left hydrothorax [Figure 1a]. An intercostal chest drain with underwater seal was inserted in the left 5th intercostal space. Haemorrhagic fluid (850 mL) was drained. Patient experienced difficulty in breathing following rapid pleural decompression. Continuous positive airway pressure was given by face mask with 100% oxygen for 20 min. Thereafter, she was asymptomatic, SpO2 was 100% and arterial blood gas analysis was normal. Repeat chest radiograph 24 h later showed lung expansion [Figure 1b]. The drain was removed on the 3rd postoperative day. The patient was discharged on the 6th postoperative day. Figure 1 Postoperative chest radiograph showing (a) opacity of left hemithorax and (b) re-expansion of the lung at 24 h Anaesthetic challenges during PCNL include the potential for fluid absorption, dilutional anaemia, hypothermia, blood loss, injury to adjacent organs and pleural space violation.[1,2] The renal calyceal system can be accessed via a subcostal or supracostal route. The supracostal access (above the 12th or 11th rib) is commonly used as it provides direct access to the upper, middle and lower calyx and the upper ureter.[2] However, this approach can potentially damage the lung and pleura resulting in hydrothorax, pneumothorax or hydropneumothorax.[1] Pleural injury can be avoided by supracostal puncture over the most lateral portion of the 12th rib as this portion of the diaphragm is not covered by a pleural reflection.[3] The intercostal puncture is made in the lower half of the intercostal space to avoid injury to intercostal vessels.[4] The supracostal approach requires coordination with the anaesthesiologist to control ventilation. The needle is passed through the retro-peritoneum and diaphragm during complete exhalation to prevent injury to the lung. The passage of the needle through the renal parenchyma to the collecting system is done during deep inspiration (the kidney gets displaced downwards). An Amplatz sheath is used to maintain low-pressure irrigation that can reduce the risk of pleural effusion and extravasation.[4] Reasons for development of hydrothorax are three-fold: (a) Inadvertent entry into the pleura; (b) inadequate tamponade of the nephrostomy tract combined with inadequate drainage of the kidney after the puncture; and (c) failure to seal the tract with a working sheath during stone removal.[5] Hydrothorax and pneumothorax can be difficult to identify during PCNL. Intraoperatively, a decrease in SpO2 and a significant increase of airway pressure is suggestive of hydrothorax. The diagnosis can be confirmed with a chest radiograph; with the patient in the prone position, fluid can be seen tracking along the lateral borders of the chest cavity and compressing the ipsilateral lung.[3] In the immediate postoperative period, pleural injury presents clinically with poor SpO2, dyspnoea and tachypnoea.[4] A postoperative chest X-ray is mandatory. The treatment of hydrothorax depends on patient symptoms and its extent.[4] Patients with no or mild symptoms and minimal effusion are managed conservatively; those with significant symptoms and large pleural effusion need intercostal drainage. Re-expansion pulmonary oedema, an uncommon complication following drainage of a pneumothorax or pleural effusion, presents clinically as cough, chest discomfort and hypoxemia. Risk factors include young age, long duration of lung collapse and rapid re-expansion. Treatment is largely supportive (oxygen supplementation, noninvasive and invasive ventilation). A high index of suspicion should be maintained when PCNL is performed with a prolonged operating time, multiple tracts and supracostal access. The access puncture should be performed in complete lung deflation and ventilator stand-still in coordination with the anaesthesiologist to minimise the risk of pleural injury. A chest X-ray should be performed promptly in symptomatic postoperative patients to exclude intrathoracic injury. Hydrothorax, haemothorax and/or pneumothorax sustained during PCNL may necessitate chest tube placement.

Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has emerged as a strong diagnostic tool for the diagnosis and staging of neoplasms. Uptake in the thymus at (18)F-FDG PET complicates the assessment of mediastinal involvement by tumor in children and young adults. Increased thymic (18)F-FDG uptake may represent normal physiologic uptake but may also indicate the presence of thymic hyperplasia, lymphomatous infiltration, primary thymic neoplasm, or metastatic disease. Familiarity with the patterns of (18)F-FDG uptake that characterize these pathologic conditions is crucial to the interpretation of PET findings in the thymus. In addition, awareness of the subsets of patients in whom physiologic uptake may be seen and of the normal morphologic features and (18)F-FDG PET appearance of the thymus, along with a general sense of the upper limits of metabolic activity for physiologic thymic uptake, will aid in differentiating between physiologic thymic uptake and mediastinal disease. In equivocal cases, correlation with morphologic data from computed tomography or magnetic resonance imaging will likely continue to play a key role in diagnosis and will aid in differentiating benign thymic uptake from malignancy.

We present a rare case of incidentally found mobile thoracolithiasis in a 76-year-old cirrhotic patient on serial computed tomography scans performed before and after transarterial chemoembolization for hepatocellular carcinoma. Mobility and calcification are the important clue to diagnosing this benign condition and avoiding unnecessary surgery.

A limitation in the administration of parenteral products is the pain caused upon injection. Injection site pain has been predominately associated with intravenous, intramuscular, and subcutaneous administration. It becomes important for the formulation scientist to have a basic understanding of the physiology underlying the pain process, as well as the pharmaceutical factors associated with injection site pain. Initially, this review will provide the reader with a primer on the mediation of pain in the periphery and a compilation of those drugs that have been associated with pain on injection. In addition, this review will present important considerations and general formulation approaches or methods that have been used to overcome pain on injection. Finally, a brief overview of the various experimental systems used to investigate injection site pain is discussed.

Littoral cell angioma (LCA) is a rare primary splenic tumor that is difficult to differentiate preoperatively from other benign and malignant splenic lesions. Most of the cases present as multiple nodules in the spleen. We report a case of large solitary LCA of the spleen, an uncommon presentation. LCA should be considered in the differential diagnosis of multiple and solitary splenic lesions.

Intermediate filaments (IFs), a group of highly heterogenous proteins grouped on the basis of their size, are expressed almost ubiquitously and specifically. Earlier, IFs were considered to play a major role in maintaining cell shape along with other cytoskeletal elements, however, the multitude of IFs are unlikely to have a single function. Evolution pattern of IFs reveals presence of simple IFs in a wide range of cells in lower vertebrates whereas structurally complex IFs have specific distribution in higher vertebrates, implicating they may have evolved later in need to perform specialized functions. There could be functions common to various IFs, but some IFs may have very specific functions. Functional capabilities could also be a result of the various dynamic modifications displayed by IFs under influence of different intrinsic and extrinsic factors. Functions assigned to the IFs in the literature range from providing a passive skeletal support to the cells to involvement in macromolecular biosynthesis, signal transduction and control of gene expression. In this review, we have attempted to outline the possible functional roles that IFs may play in resting. and actively dividing and differentiating cells.

We report a rare case of mammary fibroadenoma in a 75 year old male patient with emphasis on imaging findings and review of the previously reported cases.

To determine if chronic cerebral venous insufficiency exists in patients with multiple sclerosis (MS) using ultrasonography and 4-dimensional color Doppler ultrasonography examination and unverified criteria proposed by Zamboni et al.Patients with MS and clinically isolated syndrome were matched by age and sex with subjects with migraine or no neurological disease. All subjects underwent gray-scale, color, and spectral Doppler ultrasonography examination of the internal jugular veins (IJVs), vertebral veins, and deep cerebral veins for stenosis, absence of signal, and reflux.Academic MS center.All patients with MS fulfilled revised McDonald criteria for the diagnosis of MS. Patients with clinically isolated syndrome exhibited a typical transient focal neurological deficit and had magnetic resonance imaging lesions typical of MS. Control subjects were recruited from the VA migraine clinic or staff.Five parameters of venous outflow used by Zamboni et al were examined: (1) IJV or vertebral vein reflux, (2) deep cerebral vein reflux, (3) IJV stenosis, (4) absence of flow in IJVs or vertebral veins, and (5) change in cross-sectional area of the IJV with postural change.There was no significant difference in the number and type of venous outflow abnormalities in patients with MS compared with controls.This study does not support the theory that chronic cerebral venous insufficiency exists in MS.

Extramedullary hematopoiesis is manifested by several clinical hematological disorders. Its localization to presacral space as mass is extremely rare. We report one such case in a patient with hereditary spherocytosis. In the appropriate clinical setting when the imaging appearances are typical, biopsy may not be necessary for diagnosis.

Drug targeting is a phenomenon which maneuvers the distribution of drug in the body in such a manner that the major fraction of the drug interacts exclusively with the target tissue at a cellular or subcellular level. Numerous strategies have been developed to accomplish this goal; some of them have been tried clinically for improving cancer chemotherapy. This review updates the current status of research in the area of targeted drug delivery, with particular emphasis on its application in the clinical management of carcinomas.

Regression analysis has been applied to compare the tumor response following the administration of free and microsphere-loaded adriamycin to the rats. A nonmetastasizing sarcoma was induced in male A.S. inbred rats. When the sarcoma was in its fourth passage and 12 days old, four groups of animals received intratumoral injections of 2 or 8 mg/kg of adriamycin as a solution or via albumin microspheres. The animals in each group were monitored over a period of three weeks for changes in body weight and tumor size and their survival, and the results were statistically compared with the data obtained from an untreated group of animals (control). The use of regression analysis in conjunction with partial F-test revealed that the microsphere-delivered drug exhibited a meager but significantly greater response than the free drug. The implications of intratumoral administration of microsphere-loaded drug in the treatment of sarcomas is discussed.

Birt-Hogg-Dube syndrome is a rare disorder characterized by cutaneous hair follicle tumors, pulmonary cysts, and renal tumors. We report a case of a 63-year-old male patient with this syndrome. The radiological findings seen with this syndrome are described. Radiologists should be aware of and able to recognize this syndrome.

A 67-year-old man with a history of distal pancreatectomy underwent an F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) scan for suspected recurrent pancreatic cancer in the head/neck of the pancreas seen on a computed tomography scan done 1 week earlier. The FDG-PET scan showed intense uptake in this mass consistent with recurrent malignancy. Incidentally, rim-like increased uptake of FDG was noted in the gallbladder wall. Because clinically there were no symptoms suggestive of acute cholecystitis, he underwent cholescintigraphy and ultrasound (US) examination, which indicated complete common bile duct obstruction. However, there was no evidence of acute cholecystitis. The laboratory workup done subsequently showed significantly abnormal liver function tests compatible with biliary obstruction. The rim uptake of FDG in the gallbladder wall on PET in the absence of cholecystitis could not be understood, and we presume that this uptake may be related to stretching and contraction of the smooth muscle of the distended gallbladder wall from complete common bile duct obstruction. This is a possible cause proposed for digestive tract FDG uptake.

A 60-year-old female patient with a 5-year history of rheumatoid arthritis (RA) presented with pulmonary nodules on chest radiograph and computed tomography (CT) scan. The positron emission tomography (PET) demonstrated mild fluorodeoxyglucose (FDG) uptake in these nodules, which is characteristic of benign lesions. Histopathological correlation confirmed this. Although rheumatoid pulmonary nodules are benign, confirmation to exclude coincidental malignancy is very important. FDG-PET is a noninvasive imaging technique, which acts as a metabolic biopsy and can help in avoiding morbidity and cost of invasive tissue sampling.

Estrogens induce rapid (non-genomic) and delayed (genomic) effects on the target cells. The early effects include induction of signal transduction pathway within seconds, whereas the delayed responses require hours and involve transcription and translation. The rapid effects of estradiol (E) on the vaginal epithelial cells (VEC) involved calcium uptake within seconds via the induction of phosphoinositol lipid metabolism as reported in our earlier studies. In this study, we demonstrate the presence of classical estrogen receptors (ER) on the plasma membrane of VEC of the rats. Immunoreactive bands of 67, 56 and 35 kDa are detectable in the membrane fractions (mf ) using antibodies recognizing different epitopes of ER. We have also been able to purify a protein having a mass of 67 kDa from the detergent-soluble fraction of the plasma membrane of VEC, which shows properties identical to the classical receptor purified from the cytosolic fraction of the cells. The membrane receptors get dissociated upon binding to the ligand. Besides a role in signal transduction events induced by estradiol, the membrane estrogen receptors may have an important role to play in translocation of the steroid to the cytosolic compartment. © 2002 Elsevier Science Inc. All rights reserved.

A 74-year-old woman with a history of rectal carcinoma underwent whole body combined positron emission tomography/computed tomography (PET/CT) scanning for staging. Diffuse intense FDG uptake was seen in the distended infrarenal inferior vena cava (IVC) extending to the bilateral common iliac and left external as well as internal iliac veins. Heterogeneous hyperdense material was seen on the corresponding CT scan, suggesting tumor thrombus. Tumor thrombus shows increased FDG uptake resulting from the increased glycolytic rate in malignant cells.

A 62-year-old asymptomatic woman with carcinoma of the tongue underwent PET imaging for staging. She also had a history of a descending thoracic aortic aneurysm with dissection, which was repaired surgically by placing a proximal graft after rupture a year earlier. This was complicated by a leak from the distal end of the graft forming a contained hematoma within the aneurysmal lumen, in which sealing was attempted with adhesive material. A recent CT scan demonstrated a large aortic aneurysm with a patent, true lumen and a graft with thrombus as well as a contained leak. The PET scan demonstrated diffuse FDG uptake in the patent lumen and a perigraft leak and no uptake in the thrombus.

Objective: A case report of a successful desensitization protocol in a patient with immunoglobulin induced severe anaphylactic reaction. Background Intravenous Immunoglobulin (IVIG) is an accepted mainstay of treatment in patients with progressive chronic inflammatory demyelinating polyneuropathy (CIDP). Anaphylactic reactions to IVIG therapy are relatively rare, and usually related to low immunoglobulin A (IgA) levels. Though a successful desensitization protocol for anaphylactic reactions is well known, to our knowledge successful application in a patient receiving IVIG without immunoglobulin deficiency has not previously been reported. Design/Methods: Case report from a tertiary medical center. Results: We present a 69 year old male treated with IVIG for progressive CIDP who experienced an anaphylactic reaction during the IVIG test dose. Serum IgA level prior to test dose was normal. After failing alternate treatments and continued symptomatic progression, we rechallenged the patient with IVIG after desensitization under supervision in the neurological intensive care unit. The patient was premedicated with prednisone; and his required IVIG dose was calculated according to body weight. Desensitized protocol consisted of an initial IVIG dose of 1/10,000 of the required total dose with subsequent doubling of the dose every 30 minutes over a 24 hour period. The desensitization was well tolerated up to the completion of the IVIG dose without significant complication. Subsequently, the patient was able to tolerate multiple sessions of IVIG with symptomatic improvement of his CIDP. Conclusions: To our knowledge this is the first reported case of IVIG desensitization for an anaphylactic reaction in a patient with continued progression of CIDP refractory to alternate treatment modalities. Disclosure: Dr. Malaiyandi has nothing to disclose. Dr. Gupta has nothing to disclose. Dr. Pandya has nothing to disclose. Dr. Barboi has nothing to disclose.

Objective: To present a case of Superficial Siderosis of the CNS in a patient with bilateral internal jugular vein narrowing from an external compression of elongated styloid processes. Background Superficial Siderosis of CNS is an uncommon disorder that results from hemosiderin deposition in leptomeninges, subpial layers of brain, and spinal cord from chronic subarachnoid hemorrhage (SAH). The source of SAH is not identified in half of the cases. We present a case of superficial siderosis in a patient with bilateral jugular vein narrowing causing venous congestion from an external compression of styloid processes. Design/Methods: Case report from a tertiary medical center. Results: A 59 year old female presented with slowly progressive gait ataxia, sensorineural hearing loss, and episodic headaches for 6 months. MRI of brain and spinal cord revealed a pituitary adenoma and T2 hypointensity involving the cerebellum, brainstem, and spinal cord consistent with superficial siderosis. CSF studies demonstrated elevated protein without xanthochromia. A dynamic cerebral venogram with extension and flexion views revealed severe bilateral internal jugular vein narrowing at the level of C1-C2, more severe with neck flexion, with considerable congestion of the paravertebral veins and spinal epidural venous plexus. Manometry study revealed an increased pressure gradient across the narrowing between the sigmoid sinuses and internal jugular veins, which was worse with neck flexion compared to neutral position. Computerized tomography angiography of the neck demonstrated elongated styloid processes with external compression of the internal jugular veins at the level of the narrowing. The patient was referred to surgery for styloidectomy. Conclusions: We present a case of superficial siderosis with possible etiology related to bilateral internal jugular vein narrowing leading to significant venous congestion from an external compression of elongated syloid processes. Disclosure: Dr. Gupta has nothing to disclose. Dr. Pandya has nothing to disclose. Dr. Lazzaro has nothing to disclose. Dr. Fitzsimmons has nothing to disclose.

The efficacy of magnetic albumin microspheres in the targeted delivery of an anti-cancer agent, doxorubicin hydrochloride, has been investigated in rats. Using the tail as a target organ, the animals were intra-arterially administered with either 0.12 mg/kg of free drug, or 0.04 mg/kg of microsphere entrapped drug in the presence of a 8000 Gauss magnet applied for 30 min at the target-site. In each group, the animals were sacrificed over a 48 h period and their various tissues analysed for drug concentration using HPLC. It was found that compared to the free drug, a one-third dose of microsphere entrapped drug resulted in almost eight times higher drug exposure (AUC0-infinity) at the target site. In addition, the drug delivery to all the non-target tissues, including liver and heart, was substantially reduced. The study confirms the efficacy of magnetic albumin microspheres in the targeted delivery of chemotherapeutic agents.

The influence of magnetic albumin microspheres on the disposition of adriamycin was evaluated. Adriamycin concentrations were monitored in multiple rat tissues for 48 hr after its intra-arterial administration (2 mg/kg) as a solution and associated with magnetic albumin microspheres. The magnetic dosage form was targeted to a predefined tail segment with a magnetic field strength of 8000 G applied for 30 min after dosing. A physiological pharmacokinetic model was used to describe the disposition of adriamycin following its administration from either dosage form. The model developed for the data resulting from administration of adriamycin as a solution served as a foundation for the model developed for adriamycin resulting from the administration of adriamycin associated with the magnetic dosage form. The model for adriamycin following administration of the magnetic microspheres required additional relationships to describe the transport of adriamycin associated with the microspheres. For both models, the predicted adriamycin concentrations were in adequate agreement with the observed values. The present investigation demonstrates the use of a physiological pharmacokinetic modeling method to represent drug kinetics following its administration via a targeted drug delivery system.

In this double-blind, placebo-controlled study, treatment of 60 acute hepatitis patients with ribavirin resulted in a more rapid reduction of abnormal laboratory values when compared with the placebo group. Moreover, improved clinical status as reflected by increased appetite with resultant weight gain was noted to be significantly greater in the ribavirin-treated patients. Ribavirin was well tolerated. With this dosage regimen, there were no side effects or changes in laboratory values that could be associated with drug-related toxicity. Since hepatitis A is one of the most common viral infections afflicting the Indian population, the use of a safe and effective therapeutic agent, such as ribavirin, will be necessary to treat these cases.

The disposition of adriamycin following its intra-arterial administration in rats as a solution (control) or via magnetic albumin microspheres (treatment group) has been investigated. The rat tail was demarcated into three segments: T1, the pre-target site; T2, the target site; and T3, the post-target site. In both groups, 2.0 mg/kg of adriamycin HCl was injected into the ventral caudal artery in T1 through a T-piece cannula. A magnetic field of 8000 G was directed towards T2. The concentration of adriamycin was measured in the heart, kidney, liver, lung, serum, small intestine, spleen, T1, T2, and T3 as a function of time using an ion-pairing HPLC assay. Areas under the mean adriamycin concentration–time curves were used to determine two indices of drug delivery: the relative tissue exposure and targeting efficiency. It was demonstrated that the magnetically responsive albumin microspheres altered the tissue distribution of adriamycin in rats. Administration of drug via magnetic microspheres was shown to increase the relative drug exposure to both T2 and liver.

The ultrastructural disposition of intra-arterially administered adriamycin-associated magnetic albumin microspheres has been investigated. The rat tail was used as the target organ and demarcated into the following three parts: T1, the injection site; T2, the target site; and T3, the posttarget site. Adriamycin HCl (2.0 mg/kg) was administered via the carrier through a cannula fixed at T1. The target site, T2, was exposed to a magnetic field of 8000 G for 30 min postdosing. Animals were sacrificed at scheduled time intervals over a 72-h period, and the tissue samples from T2 were observed by light and transmission electron microscopy. Electron microscopy revealed that microspheres traverse the vascular endothelium of the target tissue as early as 2 h after dosing. Gradual loss of tissue organization and cellular components, as a function of drug exposure time, demonstrated that the pharmacodynamic characteristics of the drug are not altered by its entrapment and delivery via the magnetic microspheres. The study confirms second-order drug targeting in the target tissue of healthy animals.