Recurrent Pneumomediastinum in Diabetic Ketoacidosis

The first steps in managing a patient with suspected anemia are to confirm the diagnosis and to determine the morphologic type. The normocytic normochromic type has many causes, two of the most common being chronic disease and drug therapy. The anemia of chronic disease is often mistaken for iron-deficiency anemia and treated with iron supplements.     

Massive Hemorrhage From Esophagogastric Tears

The Mallory-Weiss syndrome probably is more common than is generally recognized. Massive hemorrhage usually follows one or more bouts of violent retching and vomiting of nonbloody material. The possibility of esophagogastric tears should be kept in mind when operation is undertaken to control massive hemorrhage from the upper gastrointestinal tract, and a systematic examination of the cardio-esophageal area as well as of the stomach and duodenum should be carried out.

Eight cases of the syndrome are reported.     

Disability awareness training for disability professionals

Purpose : This article describes work at the Virginia School of the Deaf and Blind in Hampton, Virginia, USA. Disability sensitivity training in businesses and government organizations has become a more important activity in the United States since the Americans with Disability Act (ADA) of 1992 was published. That act of the US Congress required organizations to hire and make reasonable accommodations for the disabled. Issue : Lack of sensitivity or awareness of the plight of the disabled in business and government continues to be a distinct problem requiring attitude changes and training, but this problem can become acute even for professionals in organizations dedicated to the care and education of the disabled. Conclusion : Professionals tend to become inured to the hardships of others and lose sight of the need for both verbal and non-verbal sensitivity in the workplace. and training of professionals is vitally important and necessary, but in the real world of working with people who have disabilities more practical action type training is needed. It is far too easy for practitioners to lose sensitivity in both verbal and non-verbal communication     

Abduction pillow immobilization following hip surgery: a welcome alternative for selected patients

Background Studies have shown that when using a spica cast following hip surgery in children , there are associated complications such as soiling, pressure sores, and osteopenic fractures. Methods Charts were retrospectively reviewed for all patients who had undergone hip surgeries by one surgeon at one institution between 1999 and 2005. The method of post-operative immobilization (spica cast or abduction pillow) and complications were recorded for each patient. Results There was a total of 32 patients. Of these, 11—all of whom had a diagnosis of developmental dysplasia of the hip—were treated using a spica cast. In the 21 patients treated in an abduction pillow, 4 (19%) were switched to a spica cast for the following reasons: (1) distal femoral fracture as a result of vigorous resuscitation during a choking episode, (2) parental preference, (3) for added immobilization over concern of implant loss of fixation, and (4) concern of migration of the hip, which again migrated after being changed to a spica cast and eventually required a pelvic osteotomy. Conclusion It is our opinion that only one of these complications in the children treated with an abduction pillow (the case of possible implant migration) may have been avoided if the child had originally been placed in a spica cast. The child who was successfully resuscitated after a choking incident weeks after the surgery may have had a worse outcome if it had been in a spica cast. This incident occurred at home and the abduction pillow was easily and quickly removed to allow resuscitation. An abduction pillow is a welcome alternative to a spica cast following hip surgery for many patients with neuromuscular and syndromic conditions. However, in children with osteopenic bone at risk for implant failure and in children with unstable hip reductions, a spica cast may be preferable.     

Down-Regulation of Pro-Apoptotic Genes is an Early Event in the Progression of Malignant Melanoma

Introduction Down-regulation of apoptosis genes has been implicated in the development and progression of malignant melanoma. We used cDNA microarray to evaluate pro-apoptotic gene expression comparing normal skin to melanoma (thin and thick), nodal disease and distant metastases. Methods Twenty-eight specimens including skin (n = 1), thin melanoma (n = 6), thick melanoma (n = 7), nodal disease (n = 6), and distant metastases (n = 8), were harvested at the time of resection from 16 individuals. RNA was isolated and microarray analysis utilizing the Affymetrix GeneChip (54,000 genetic elements, U133A+B... levels) was performed. Mean level of expression was calculated for each gene within a sample group. Expression profiles were then compared between tissue groups. Student’s t-test was used to determine variance in expression between groups. Results We reviewed the expression of 54,000 genetic elements, of which 2,015 were found to have significantly altered expression. This represents 1,602 genes. Twenty-two pro-apoptotic genes were found to be down-regulated when compared to normal skin. Overall reduction was evaluated comparing normal skin to metastases with a range of 3.31–64.04-fold-decrease. When comparing the tissue types sequentially, the greatest fold-decrease in gene expression occurred when comparing skin to all melanomas (thin and thick) (p = 0.011). Subset analysis comparing normal skin to thin melanoma or thick melanoma, revealed the greatest component of overall reduction at the transition from thin to thick lesions (p = 0.003). Conclusion Sequential down-regulation of pro-apoptotic genes is associated with the progression of malignant melanoma. The greatest fold-decrease occurs in the transformation from thin to thick lesions.     

The induction of macrophage hemeoxygenase-1 is protective during acute kidney injury in aging mice

Aging is thought to be associated with a higher susceptibility to renal ischemia-reperfusion injury (IRI). To study whether defective induction of hemeoxygenase-1 (HO-1, a protective and anti-inflammatory enzyme) might contribute to this, we found that while 12-month-old mice had similar baseline renal function and HO-1 expression, the induction of HO-1 usually seen in ischemia-reperfusion was reduced. This was also associated with worsened renal function and acute tubular necrosis in the aged compared with young mice. In the older mice, heme arginate (HA) induced HO-1 in the cortex and medulla, significantly improved renal function, and reduced tissue injury. Cellular HO-1 induction in the medulla in response to injury or HA treatment was found to be interstitial rather than epithelial, as evidenced by its colocalization with macrophage markers. In vitro, HA treatment of primary macrophages resulted in marked HO-1 induction without impairment of classical activation pathways. Macrophage depletion, caused by diphtheria toxin treatment of 12-month-old CD11b-DTR transgenic animals, resulted in the loss of interstitial HO-1-positive cells and reversal of the protective phenotype of HA treatment. Thus, failure of HO-1 induction following renal IRI worsens structural and functional injury in older mice and represents a therapeutic target in the elderly. Hence, HO-1-positive renal macrophages mediate HA-induced protection in IRI.     

A Collision of Diseases: Chronic Lymphocytic Leukemia Discovered During Lymph Node Biopsy for Melanoma

Background

In the United States in 2012, there were 16,060 new cases of chronic lymphocytic leukemia (CLL). Often CLL is clinically occult and first detected during pathologic evaluation of the sentinel lymph node biopsy (SLNB). We reviewed our experience of patients with the coexisting diagnosis of melanoma and CLL.

Methods

An institutional review board-approved review was performed on patients with CLL and melanoma treated from 1995 to 2009 at Moffitt Cancer Center and compared with the incidence of melanoma and CLL in our tumor registry patients with breast, prostate, lung, and colon cancer.

Results

Fifty-two patients (44 males; median age, 71 years [range, 46–88]) were identified with concurrent diagnoses of melanoma and CLL. Twenty-two patients (42 %) had CLL on SLNB for their melanoma. Thirty-two patients (62 %) were diagnosed with melanoma before CLL. Concomitant or prior cancer diagnoses included nonmelanoma skin cancers (N = 29), prostate (N = 6), colorectal (N = 2), and Merkel cell carcinoma (N = 2). Five of 20 patients (25 %) had metastatic melanoma found at the time of SLNB. Patients with melanoma had a tenfold increase of CLL diagnosis compared with colorectal cancer patients, an eightfold increase compared to prostate cancer patients, and a fourfold increase compared with breast cancer patients.

Conclusions

We have confirmed an increased association of CLL and melanoma. This may be related to an underlying immunologic defect; however, there has been scant investigation into this phenomenon. Surgeons and pathologists should understand this occurrence and recognize that not all grossly enlarged or abnormal sentinel lymph nodes in melanoma patients represent melanoma.     

Insulin binding and action on bovine adipocytes

The present study was undertaken to determine whether bovine adipocytes could bind and respond to insulin. Adipose tissue from young bulls showed little response to physiological and higher concentrations of insulin over a 3-h incubation. In contrast, insulin did stimulate glucose uptake during prolonged incubations and also increased the activity of pyruvate kinase; in each case, half-maximum stimulation was observed with concentrations of about 0.5 ng/ml. Specific binding of [125I] iodoinsulin to bovine adipocytes was observed; the binding capacity was greater than that of young female rats determined under the same conditions. Bovine adipocytes internalized insulin. Incubation of bovine adipocytes with insulin resulted in a concentration-dependent loss of insulin receptors from the adipocyte surface. In summary, bovine adipocytes possess the capacity to both bind and respond to insulin; these findings are discussed in relation to a recent report to the contrary.