Case Report: Giant choledochal cyst

We report an adult female with a rare giant choledochal cyst. The patient presented following a normal pregnancy with the classical triad of an abdominal mass associated with jaundice and right upper quadrant abdominal pain. The cyst was excised using an intramural technique and biliary reconstruction achieved with a Roux-en-Y hepaticojejunostomy. Our patient has remained well with no evidence of malignancy over a 12 year review period. The aetiology and current management of this condition are discussed.     

Urinary Enzymes and Protein Patterns as Indicators of Injury to Different Regions of the Kidney

Urinary Enzymes and Protein Patterns as Indicators of Injuryto Different Regions of the Kidney. STONARD, M. D., GORE, C.W., OLIVER, G. J. A., AND SMITH, I. K. (1987). Fundam. Appl.Toxicol. 9, 339–351. Acute experimental models of renaldamage to the proximal tubular, glomerular, and papillary regionsof the rat were produced by administration of hexachloro 1:3-butadiene(HCBD), puromycin aminonucleoside (PAN), and 2-bromoethylamine(BEA), respectively. Several routine indicators of nephrotoxicity,the enzymes alkaline phosphatase and N-acetyl-ß-glucosaminidase,and the molecular weight pattern of protein excretion were determinedon urine samples. Tubular damage produced by HCBD or BEA wasdiscriminated both quantitatively and qualitatively from glomerulardamage produced by PAN. The latter was characterized by a pronouncedincrease in protein excretion, especially proteins with molecularweight >40,000 Da. In contrast, protein excretion in tubulardamage was raised only slightly and characterized by excretionof proteins of a wide range of molecular weights. Proximal tubulardamage caused by HCBD and papillary damage caused by BEA weredistinguished both by conventional urinalysis (volume and specificgravity) and by measurement of the two urinary enzymes. Alkalinephosphatase and glucose were markedly and transiently elevatedin proximal tubular damage and N-acetyl-ß-glucosaminidaseshowed a sustained elevation in papillary damage. It is concludedthat both selective urinary enzymes and the molecular weightpattern of urinary proteins can be used to provide diagnosticinformation about the possible site of renal damage.     

Comparative vaccination of cattle against Boophilus microplus with recombinant antigen Bm86 alone or in combination with recombinant Bm91

Cattle were vaccinated either with a single recombinant tick antigen, Bm86 or with a combination of two recombinant antigens, Bm86 and Bm91 from the tick Boophilus microplus . In three experiments, the responses of cattle to subsequent challenge with the tick were assessed. The addition of the Bm91 antigen enhanced the efficacy of the vaccination over that with Bm86 alone to a statistically significant degree. Moreover, co-vaccination with two antigens did not impair the response of cattle to the Bm86 antigen. Finally, responses of individual cattle to the two antigens were independent. All of these results may be relevant to the increase in efficacy expected from a dual antigen vaccine.     

Subcutaneously administered recombinant human β-interferon in the treatment of chronic hepatitis B virus infection

Background: Treatment of chronic replicative hepatitis B virus (HBV) infection is aimed at stopping viral replication and preventing the development of chronic liver disease. β-Interferon treatment has been less well studied than α-interferon. Methods: The efficacy and tolerability of a 6-month course of subcutaneously administered human recombinant β-interferon (rINF-β_ser) was studied and the results of a low-dose regime compared with a high-dose regime. Twenty patients (17 men and three women), aged 24–54 years, with chronic hepatitis B virus infection (all hepatitis B surface antigen-positive with detectable HBV-DNA in their sera for at least 3 months prior to therapy) were randomized into two treatment groups of 10 patients each. The low-dose group received 6×10⁶ U/dose and the high-dose group received 30×10⁶ U/dose, both groups receiving their respective doses three times a week initially for 1 month and continuing for a total of 6 months. Results: The treatment was well tolerated in both groups. None of the patients required dosage reduction or cessation of treatment because of side-effects. HBV-DNA decreased in all patients during treatment, demonstrating the anti-viral efficacy of rINF-β_ser, and was undetectable in 20 and 40% of patients receiving low-dose and high-dose regimes, respectively, at the end of 6 months treatment (P=N.S.). One year after completion of treatment, HBV-DNA was undetectable in 50 and 30% of patients in the low-dose and high-dose groups, respectively (P=N.S.). However, only one patient achieved seroconversion with loss of the hepatitis B surface antigen and appearance of an anti-hepatitis B ‘e’ antigen at the end of 18 months. Conclusion: This study shows that subcutaneously administered rINF-β_ser is well tolerated, but the optimal dose and duration of treatment still needs to be defined by further studies.     

Relationship of actin filament assembly to clearance of fibrinogen gold, GPIIb-IIIa complexes on spread platelets

Abstract. The present study has evaluated the influence of high concentrations of cytochalasins B and E on the detergent-resistant actin levels in fully spread platelets by PAGE gel electrophoresis, and the effects of the two inhibitors of new actin filament assembly on translocation of fibrinogen gold (Fgn/Au) labelled GPIIb-IIIa receptors on the surface-activated cells. Concentrations of 10^{- 4}m and 10^-5 m cytochalasin B and E reduced detergent-resistant actin in fully spread platelets to levels present in resting discoid platelets in suspension. Despite reduction of actin filaments to levels in resting cells, cytochalasin B did not prevent translocation of Fgn/Au from platelet margins into channels of the open canalicular system (OCS). Similar concentrations of cytochalasin E completely blocked translocation of receptor-ligand complexes and produced a patching phenomenon not observed in previous studies. Rinsing of the spread cells to remove cytochalasin, followed by incubation of the treated platelets in Hank's buffered salt solution (HBSS) restored levels of detergent-resistant actin to those found in untreated, spread platelets. Resting grids of 10 ⁵ m cytochalasin E-treated platelets on drops of HBSS for 15min restored their ability to clear FGN/Au linked to GPIIb-IIIa from exposed surfaces to the OCS, but 10^-4 m cytochalasin E-treated cells remained anergic after incubation on drops of HBSS. Thus a fully assembled cytoplasmic actin filament cytoskeleton does not appear to be essential for translocating receptor-ligand complexes on the platelet surface to the OCS, nor does its presence guarantee that the ability to clear GPIIb-IIIa receptors will be restored.     

LOCAL RADIOTHERAPY FOR PEDAL MANIFESTATIONS OF HLA-B27-RELATED ARTHROPATHY

Four males with characteristic foot manifestations of HLA-B27-relatedarthropathy are reported. The severity of this problem and itsrecalcitrance to standard therapies led to the use of localradiotherapy. The beneficial outcome and minimal short-termside effects of this treatment are discussed in relation toprevious experience with radiotherapy in ankylosing spondylitis. KEY WORDS: HLA-B27, Radiotherapy, Spondyloarthropathy, Enthesopathy     

THE IMPACT OF ALCOHOL ON THE ACUTE HOSPITAL SERVICE: PATIENT PRESENTATION, ADMISSION AND THE PERCEPTION OF ALCOHOL USE IN SUCH GROUPS

Patients presenting to an Emergency Department were assessedby a standard questionnaire and clinical examination as to thecontribution that alcohol made to their presentation and theperception of their alcohol use. Patients under the influenceof alcohol are more than twice as likely not to fill in simplequestionnaires and not to perceive their alcohol consumptionas different from non-drinking fellows. Emergency Departmentsare not the optimal site for the education and motivation ofdrinking patients to alter their future habits.     

Acute, Distribution, and Subchronic Toxicological Studies of Succinate Tartrates

The estimated single-dose oral toxicity (50% lethality) of succinatetartrates (ST) was 2–3 g/kg in rats. ST produced minimalto moderate dermal irritation but no evidence of systemic toxicityin a standard acute percutaneous toxicity test in rabbits. STwas not an eye irritant in a standard rabbit low-volume eyeirritation test ST was not genotoxic in a series of six genotoxicitytests. A 14-day oral gavage study in rats at a dose range of0.05–1.0 g ST/kg/day produced only gastric irritation.The no-observed-effect level (NOEL) for gastric irritation was0.1 g/kg for males and 0.05 g/kg for females. A 28-day percutaneoustoxicity study in rabbits produced minimal to moderate dermalirritation and no adverse systemic effects at a high dose of450 mg ST/kg/day. Single-dose absorption, distribution, andelimination (ADE) studies in male rats showed that 10–15%of an oral dose and 1–3% of a dermal dose were absorbed.Approximately 98% of the orally administered ST was eliminatedas ¹⁴C in urine, feces, or expired CO₂ after 72 hr. Approximately80% of the dermally absorbed ¹⁴C dose was eliminated in urine,feces, or expired CO₂ after 72 hr. In conclusion, no adverseeffects were noted in acute toxicity, genotoxicity, or subchronictoxicity studies conducted with ST.     

Developmental Toxicity of Dichloroacetonitrile: A By-Product of Drinking Water Disinfection

Developmental Toxicity of Dichloroacetonitrile: A By-productof Drinking Water Disinfection. SMITH, M. K., RANDALL, J. L.,STOBER, J. A., AND READ, E. J. (1989). Fundam. Appl. Toxicoi.12, 765–772. Dichloroacetonitrile (DCAN), a by-productof drinking water disinfection formed by reactlon of chlorinewith background organic materials, was evaluated for its developmentaleffects in pregnant Long-Evans rats. Animals were dosed by oralintubation on Gestation Days 6=18 (plug = 0) with 0, 5, 15,25, or 45 mg/kg/day. Tricaprylin was used as a vehicle. Thehighest dose tested (45 mg/kg) was lethal in 9% of the damsand caused resorption of the entire litter in 60% of the survivors.Embryolethality averaged 6% per litter at the low dose and 80%at the high dose and was statistically significant at 25 and45 mg/kg/day. The incidence of soft tissue malformations wasdose related and was statistically significant at doses toxicto the dam (45 mg/kg). These anomalies were principally in thecardiovascular (interventricular septal defect, levocardia,and abnormalities of the major vessels) and urogenital (hydronephrosis,rudimentary bladder and kidney, fused ureters, pelvic hernia,cryptorchidism) systems The frequency of skeletal malformations(fused and cemcal ribs) was also, dose related and significantlyincreased at 45 mg/kg. The no-observed-adverse-effect dose fortoxicity in pregnant Long-Evans rats was established by statisticalanalysis to be 15 mg/kg/day.