Biliary hamartomas associated with biliary stones presenting as multiple microabscesses: case report

A 63-year-old men suffered from fever, jaundice, and right upper quadrant pain for 1 week. Biliary stones with biliary tract infection were diagnosed. He was treated with parenteral antibiotics. However, abdominal ultrasonography showed multiple hyperechoic lesions in both lobes, and infiltrating hepatocellular carcinoma was suspected initially. Numerous hypervascular nodular-enhancing lesions were revealed by computed tomography. Magnetic resonance imaging further disclosed numerous tiny cystic lesions with peripheral enhancement. Exploratory laparotomy was performed for biliary calculi and probable underlying malignancy. Cholecystectomy, choledocholithotomy, and liver wedge biopsy were done. The pathology revealed bile duct hamartomas with microabscess formation. The past literature about biliary hamartomas is reviewed.     

Mortality after successful transcatheter arterial embolization in patients with unstable pelvic fractures: rate of blood transfusion as a predictive factor

BACKGROUND: To determine the factors predictive of mortality in patients with unstable pelvic fractures after successful transcatheter arterial embolization. METHODS: A retrospective study of pelvic fractures between May of 1995 and April of 1998 was performed. Of 507 patients, 17 who were unstable underwent embolization. The success rate of embolization and the mortality rate after successful embolization were reviewed. Predictive factors (contrast medium extravasation, initial blood pressure, Injury Severity Score, timing of external fixation, time to angiography, volume of blood transfusion, rate of blood transfusion) of the final outcome were statistically analyzed. RESULTS: Embolization was 100% effective in stopping pelvic hemorrhage. The mortality of patients treated successfully with embolization was 17.6%. Among the predictive factors analyzed, only the rate of blood transfusion before embolization, 11.3 +/- 11.0 units/h (death) versus 3.2 +/- 1.9 units/h (survival) showed statistical significance with an odds ratio of 1.62 (95% confidence interval, 1.07-2.46). CONCLUSION: The success rate of embolization was 100% in stopping arterial hemorrhage of unstable pelvic fractures. The survival rate after successful embolization was 82.4%. Patients who had rapid blood transfusion before embolization had a poor final outcome. The risk of dying increased by 62% for every 1 unit/h increase of transfusion rate.     

Applications of 24-hour noninvasive ambulatory blood pressure monitoring.

Casual blood pressure (CBP) measurements using a standard sphygmomanometer have traditionally constituted the principal modality for the assessment and management of hypertension. However, CBP measurement has shortcomings. Ambulatory blood pressure monitoring (ABPM) provides abundant information on blood pressure (BP), including heart rate, all BP readings for test periods, BP average, BP variability, BP load, load index, distribution pattern of BP, reduction percentage of BP, trough/peak ratio, and summary statistics for overall 24-hour, daytime and nighttime periods. Over the last three decades, ABPM has evolved from a research device to an established and valuable clinical tool for assessment and management of hypertension. This technology has been proven to be useful in terms of the distribution pattern of BP, characterization of BP profiles in normotensive and hypertensive patients, evaluation of patients with mild or labile hypertension, physiologic and psychologic factors for fluctuation of BP, load index study, study of white coat hypertension, etiology of hypertension, prognosis of hypertension, and assessment of antihypertensive management. Nevertheless, the technology remains underused due to lack of insurance reimbursement in most countries. Accordingly, insurance reimbursement is crucial to promote increased utility of ABPM. Clinicians should be familiar with the role of this technology in the care of patients with abnormal BP. This review is an attempt to increase clinicians' understanding of ABPM and the appropriate use of this technology.     

Phase I/IIa study of cetuximab with gemcitabine plus carboplatin in patients with chemotherapy-naive advanced non-small-cell lung cancer.

PURPOSE: This multicenter, open-label, phase I/IIa study was undertaken to establish the safety/toxicity profile of cetuximab in combination with gemcitabine and carboplatin in patients with chemotherapy-na?ve, epidermal growth factor receptor-positive, stage IV non-small-cell lung cancer. Secondary objectives were to gather preliminary evidence of efficacy including tumor response rate, time to progression, and overall survival. PATIENTS AND METHODS: Thirty-five patients received a total of 264 3-week cycles of treatment with cetuximab, carboplatin, and gemcitabine. An initial dose of cetuximab 400 mg/m2 intravenously was administered the first week, followed by weekly doses of 250 mg/m2. Carboplatin (area under the curve = 5, day 1) and gemcitabine 1,000 mg/m2 on days 1 and 8 were administered every 3 weeks. Patients were evaluated for tumor response after every two cycles of therapy. RESULTS: The most frequently reported adverse events related to cetuximab included an acne-like rash (88.6%), dry skin (34.3%), asthenia and skin disorders (31.4%), mucositis/stomatitis (25.7%), fever/chills (20%), and nausea/vomiting (17.1%). The majority of these toxicities were mild to moderate. One patient withdrew from the study because of a grade 3 allergic reaction. Myelosuppression was the most frequently observed toxicity related to chemotherapy. Responses among 35 assessable patients included 10 partial responses (28.6%). Twenty-one patients had stable disease. The median time to progression was 165 days, and the median overall survival was 310 days. CONCLUSION: The combination of cetuximab, carboplatin, and gemcitabine was well tolerated with an acceptable toxicity profile. Most grade 3 adverse events were attributable to chemotherapy. The response rate and median survival are encouraging and warrant additional investigation.     

Adult‐onset inflammatory linear verrucous epidermal nevus: Immunohistochemical studies and review of the literature

Adult‐onset inflammatory linear verrucous epidermal nevus (ILVEN) is an uncommon cutaneous disease compared to childhood‐onset ILVEN. The typical histopathologic features are alternating parakeratosis and orthokeratosis with an absent granular layer underneath parakeratosis, in contrast to a thickened granular layer below the foci of orthokeratosis in psoriasiform epidermal hyperplasia. Herein, we present a 49‐year‐old woman with typical clinical and histopathologic characteristics of adult‐onset ILVEN, including linear arrangement of thick scaly papules and plaques localized on the medial side of her right leg, ankle, and foot. Immunohistochemical studies included involucrin, Ki‐67, and keratin‐10. Compared to the staining pattern in psoriasis, the expression of involucrin in this case was of lower intensity and localized to upper epidermal layers with relatively less extensive staining beneath regions of parakeratosis as compared to orthokeratosis; Ki‐67 showed lower basal layer proliferative activity; and keratin‐10 showed a greater intensity of staining within suprabasal epidermis.     

Insulin Use and Smoking Jointly Increase the Risk of Bladder Cancer Mortality in Patients With Type 2 Diabetes

BackgroundWhether insulin use predicts bladder cancer mortality has not been investigated. Furthermore, it is not known whether insulin use and smoking jointly influence the risk.Materials and MethodsA total of 86,939 patients (40,014 men, 46,925 women) with type 2 diabetes mellitus (T2DM) and aged ≥ 25 years in a nationally representative cohort were followed prospectively from 1995 to 2006 for bladder cancer mortality. Cox regression was used considering the following independent variables: age, sex, diabetes duration, body mass index, smoking, insulin use, and area of residence. The models were created for patients aged ≥ 25 and ≥ 65 years, separately; and sensitivity analyses were conducted after excluding (1) patients with duration between onset of diabetes and bladder cancer mortality < 5 years, and (2) patients with diabetes duration at recruitment < 3 years. The joint effect of insulin use and smoking was evaluated.ResultsPatients who died of bladder cancer were characterized by older age, male predominance, longer diabetes duration, smoking, and insulin use. In multivariable Cox models, age, male sex, and insulin use were consistently predictive for bladder cancer mortality in all analyses, whereas the other variables were not. The adjusted hazard ratios for bladder cancer mortality for insulin users vs. nonusers ranged from 1.877 to 2.502 in different models (all P values < .05). Insulin use and smoking jointly increased the adjusted hazard ratio to 3.120 (95% confidence interval, 1.329-7.322).ConclusionsInsulin use is significantly predictive for bladder cancer mortality in patients with T2DM. Insulin use and smoking jointly increase the risk.