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Recent successes in treating type 1 diabetic patients with islet transplantation portends a future need for an increase in available islets. Ductal structures of the adult pancreas contain multipotent stem cells that, under the proper in vitro conditions, can both self-renew and differentiate into functional islets of Langerhans. In vitro-generated islets exhibit temporal changes in mRNA transcripts for islet-associated markers as well as regulated insulin responses following glucose challenge. When implanted into diabetic mice, in vitro-generated islets induce neovascularization and reverse insulin-dependent diabetes. The possibility of growing functional endocrine pancreas from stem cells provides new opportunities to produce large numbers of islets, even autologous islets, for use as implants.

Type 1 (insulin-dependent) diabetes is one of the most costly chronic diseases of children and adolescents in North America and Europe. It occurs in genetically predisposed individuals when the immune system attacks and destroys specifically the insulin-producing beta cells of the pancreatic islets of Langerhans. Although routine insulin injections can provide diabetic patients their daily insulin requirements, non-compliance commonly results in blood glucose excursions that eventually lead to microvascular and macrovascular complications and early death. The only real 'cure' for type 1 diabetes is replacement of the beta-cell mass which, today, is either an ectopancreatic transplant or an islet of Langerhans implant. Two new developments may offer additional options: surrogate, non-endocrine cells genetically modified to secrete insulin in response to high blood glucose levels; and stem cells that possess the capacity to differentiate to endocrine pancreas. In this short review, we discuss the efforts currently being made to regulate pancreatic stem cell growth in order to produce large numbers of functional islets that can be used as implants. Hopefully, autologous stem cell-derived islet cell implants without lifelong immunosuppressive therapy may one day be realized.

Type 1, insulin-dependent, diabetes is one of the more costly chronic diseases of children, adolescents and adults in Europe and North America. While routine insulin injections currently provide diabetic patients with their daily insulin requirements, blood glucose excursions are common, leading eventually to microvascular and macrovascular complications and early death. A 'cure' for Type 1 diabetes relies on replacement of the beta-cell mass which, today, is accomplished by pancreas transplants or islets of Langerhans implants. Recent advances in the isolation of stem cells that possess the capacity to differentiate to functional endocrine pancreas provide new opportunities to produce large numbers of islets, even autologous islets, that can be used as implants. We discuss briefly this new technology and its meaning for diabetes.

The pathogenicity of microbes may be determined by substances sequestered from blood and bound to their constituent lipid. The brain may not perceive substances sequestered by microbes, to interfere with control to maintain normal levels. Pathological conditions can be induced as organisms exposed to antimicrobial substances/conditions and/or deprived of nutrients essential to cell wall synthesis, disintegrate to free lipid-bound compounds and produce L-forms that can deplete nutrients as they revert to bacteria. Microbes may act as active carriers for the continuing interaction of sequestered substances. Changes in the molecular structure of substances effected during sequesteration could cause them to be seen as substances 'synthesized' by an organism. In media that contain substances to inhibit 'contaminants', L-forms can be seen as mycoplasma. Elementary bodies of L-forms with a specific substance or tissue affinity may be seen as 'receptors'. Bartonella are global agents for disease--pleomorphic organisms (description suits Proteus)--and they can be seen as 'contaminants'.

Twenty five cases of post operative cranial vault defects were repaired using tailor made silastic implants in the last three years. Twenty four patients are tolerating the implant without any problems. All of them had symptomatic, relief and achieved an excellent cosmetic skull contour. Ten patients had subgaleal serous collection postoperatively, probably due to reaction to the implanted material, which usually subsided within three weeks. Only in one patient, the implant had to be removed due to infection. In conclusion, silastic is a good implant material for cranioplasty.

Bartonella, genus Proteus, can cause immunodepressive disease. The organisms, in parasitized red blood cells, may invade the brain and every other system and space in the human body. Bartonella henselae is proposed to have a role in the pathogenesis of acquired immunodeficiency syndrome (AIDS) encephalopathy. Bartonella bacilliformis produces two known toxins that can induce spasm and angiomatosis, respectively, and manifest as diseases associated with symptomatic AIDS. The skin lesions of bartonellosis may be mistaken clinically and histologically for Kaposi's sarcoma. Bacteria of the genus Proteus produce L-forms: their elementary bodies may be mistaken for what are called the 'human immunodeficiency viruses' (HIV). Antibiotics, especially penicillin, induce bacteria to produce L-forms. Air pollution and high sugar, salt and fat diets are factors that may increase the lipid content of microbes that produce toxins and L-forms that may persist or revert to bacterial form.

Objective and Importance: Primary hydatid cysts of the spinal canal are very rare. The patient in the present case presented with lower cauda equina compression caused by a primary solitary hydatid cyst of the sacral spinal canal, which is a remote possibility. To the best of our knowledge, such a case has not been reported previously., Clinical Presentation: A 15-year-old male patient presented with lower motor neurone type of bladder and bowel involvement, with saddle-shaped anesthesia involving S2-S5 dermatomes. Plain x-rays and magnetic resonance imaging (MRI) scans revealed a widened sacral canal with pressure changes. MRI scans confirmed the cystic nature of the lesion, which had no specific characteristics and demonstrated intensities that were similar to those of cerebrospinal fluid., Technique: Surgical exploration of the sacral canal with enucleation of the cyst in toto was performed. A midline posterior approach was used by decompressing thinned posterior elements. Adjuvant therapy with mebendazole or albendazole was not administered, although recently, some authors claim good results with integrated surgical and medical treatment., Conclusion: The patient experienced dramatic improvement and became continent. At a follow-up examination after 1 year, he had only minimal urinary stress incontinence. If spinal hydatid cyst is surgically removed unruptured and other common primary sites are excluded, medical treatment can be deferred, provided the patient undergoes strict follow-up. MRI, although not specific for hydatid disease, should be the investigation of choice in suspected cases of spinal hydatid cyst.

Bartonella bacilliformis invades the endothelial lining of the cardiovascular system. Damage to the red blood cells and white blood cells, the effects of the toxins, invasion of the brain and electrical charges induced by the organism so interfering with normal electrical stimulation of the heart may explain many of the features of cardiovascular disease (1-5).

A double blind randomised study comparing the effects of oral mexiletine and placebo given to elderly patients (65 years and older) immediately following hospital admission with suspected myocardial infarction (MI) is described. The study comprised one hundred and fifty-four patients of which 74 had confirmed myocardial infarction according to the diagnostic criteria of the study. Eighty patients without definite evidence of myocardial infarction were subsequently excluded from the study. Thirty-three patients (44.5%) with confirmed MI treated with mexiletine, compared with 41 (51%) in the placebo group showed no significant difference in mortality at 48 hours and 14 days. The mexiletine treated group showed a significant reduction (p less than 0.05) in certain forms of ventricular dysrhythmias. Six of these patients (18%) taking mexiletine had the drug withdrawn because of possible adverse drug reactions compared with two (4.8%) of the placebo group. None of the patients withdrawn because of possible adverse drug reactions had any long term side effect. Mild confusion observed in one patient was reversed after withdrawal of therapy. Results of this study indicate the safety of mexiletine as an anti-arrhythmic drug and its efficacy in suppression of certain ventricular dysrhythmias in the elderly with acute myocardial infarction. The overall mortality rate in both groups (mexiletine and placebo) remained unchanged.

Since CT was introduced, 355 cases of putaminal hemorrhage were experienced and surgical indication was evaluated in relation to long-term outcome (ADL). Among these cases, 198 (55.8%) were from operated group and 237 cases (66.8%) were admitted within 6 hours of onset. Comparison of ADL among operated, operated within 6 hours and non operated group was done. In general, results showed no advantage of surgery, and surgery at super-acute stage (within 6 hours). However it showed some surgical advantage in Moderate type, cases of operated within 6 hours and some Severe type.

A retrospective analysis of our series of 355 cases of putaminal hemorrhage revealed some interesting aspects of its pathogenesis. All the cases were studied in detail with special attention to clinical presentation, diagnostic findings and the long-term clinical outcome. Role of surgery in management of putaminal hemorrhage is still controversial. Inability to form proper useful classification has been one of the reasons responsible for this controversy. A new classification is formulated which divides putaminal hemorrhage into four types. Mild type has hematoma localized to external capsule while moderate type shows hematoma extension to corona radiata from external capsule. In severe type, hematoma extends to internal capsule also while in very severe type it further extends to midbrain. These four types could be very well correlated to long-term clinical outcome. Accessory hematoma is discussed in detail. It is found to be more common in severe and very severe types. Its presence in mild or moderate types results in worse clinical outcome. Hypertension (BP greater than 200 mm of Hg) may play an important role in further extension of hematoma.