Acute interstitial nephritis due to cefoperazone

OBJECTIVE: To describe a case of cefoperazone-induced acute interstitial nephritis (AIN) in which the diagnosis was supported by renal biopsy. CASE SUMMARY: A 35-year-old woman presented to our hospital with decreased urine output and no past history of renal problems. Fifteen days prior to presentation, she had started treatment with intramuscular cefoperazone 1 g/day for a scalp infection. On day 12 of therapy, the patient noted decreased urine output, anorexia, and weakness, but she continued taking cefoperazone for 3 more days. Hemodialysis and oral prednisolone 1 mg/kg (30 mg twice daily) were started. Renal function returned to normal after 2 months of prednisolone treatment. DISCUSSION: Although AIN has been linked with other cephalosporins, as of June 18, 2004, to our knowledge, this is the first report of a cefoperazone-induced case. We based our diagnosis on the features of acute-onset renal failure, abnormal urinalysis findings, eosinophilia, inflammatory infiltrate in the interstitium, and recovery from renal failure after initiation of corticosteroid treatment. Application of the Naranjo probability scale indicated a probable relationship between the acute renal failure secondary to the possible AIN and cefoperazone therapy in this patient. CONCLUSIONS: This case indicates that cefoperazone, like other cephalosporins, can cause AIN. We recommend close monitoring of renal function in patients who are prescribed this drug.     

Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report.

Hypertrophic cardiomyopathy Left ventricular hypertrophy Left ventricular non-compaction Dilated cardiomyopathy Arrhythmogenic right ventricular cardiomyopathy Siderotic cardiomyopathy Restrictive cardiomyopathy Cardiac sarcoidosis Myocarditis Heart transplantation Pericardial diseasePericardial effusions Constrictive pericarditis Congenital abnormalities of the pericardium Cardiac tumoursValvular heart diseaseTechnical aspects Regurgitation Stenosis Prosthetic valves Cardiovascular magnetic resonance spectroscopyCosts and benefits of CMRCost implications of functional CMR Cost implications of CMR perfusion and viability testing Cost implications of coronary CMR Cost implications for the pharmaceutical industry Comparative test costs     

Chromogenic in situ hybridization for alpha6beta4 integrin in breast cancer: correlation with protein expression

The α6β4 integrin is the receptor for the basement membrane protein laminin-5. Recent studies suggest that α6β4 integrin expression in invasive breast carcinomas may be a poor prognostic factor. Because we have not had reliable results with commercially available antibodies for the immunohistochemical detection of α6β4 integrin in archival paraffin-embedded tissues, we designed a probe to detect β4 integrin subunit mRNA in paraffin sections. In situ hybridization for β4 mRNA was performed on paraffin-embedded tissue sections of 25 invasive breast carcinomas using a hyperbiotinylated oligonucleotide DNA probe. Immunohistochemical staining was performed on corrresponding frozen tumor sections using two commercially available antibodies to the β4 integrin subunit. All cases positive for β4 protein by one or both antibodies were also positive for β4 mRNA by in situ hybridization, but three cases with β4 mRNA expression were negative by immunohistochemistry with both antibodies. These findings suggest that in situ hybridization appears to be a sensitive method for detecting β4 integrin mRNA, but it appears to identify some cases that either lack β4 protein or express variants not recognized with commercial antibodies directed to particular extracellular or cytoplasmic domains.     

Improved outcome after laparoscopic cholecystectomy with ultrasonic dissection: a randomized multicenter trial

Background  

In conventional laparoscopic cholecystectomy, dissection with electrocautery starts at the triangle of Calot. In a randomized single-center trial, the fundus-first method (dome down) using ultrasonic dissection was faster, involved less pain or nausea, and had a shorter postoperative sick leave. This may relate to the fundus-first method or to the ultrasonic dissection.     

The methoxychlor metabolite, HPTE, inhibits rat luteal cell progesterone production

The methoxychlor metabolite, HPTE, was shown to inhibit P450-cholesterol side-chain cleavage (P450scc) activity resulting in decreased progesterone production by cultured ovarian follicular cells in previous studies. It is not known whether HPTE has any effect on progesterone formation by the corpus luteum.

Results

Exposure to 100 nM HPTE reduced progesterone production by luteal cells with progressive declines to <22% of control at 500 nM HPTE. Similarly, HPTE progressively inhibited progesterone formation and P450scc catalytic activity of hCG- or 8 Br-cAMP-stimulated luteal cells. However, HPTE did not alter mRNA and protein levels of P450scc. Compounds acting as estrogen (17β-estradiol, bisphenol-A or octylphenol), antiestrogen (ICI) or antiandrogen (monobutyl phthalate, flutamide or M-2) added alone to luteal cells did not mimic the action of HPTE on progesterone and P450scc activity. These results suggest that HPTE directly inhibits P450scc catalytic activity resulting in reduced progesterone formation, and this action was not mediated through estrogen or androgen receptors.     

A new variation: An anterior cruciate ligament attached to the accessory ossicle

Anatomic variations of the anterior cruciate ligament (ACL) are very rare. The prevalence of congenital aplasia or hypoplasia of the ACL is 0.017 per 1,000 live births. The normal ACL consists of the anteromedial (AMB) and posterolateral bundles (PLB). Together, they attach to a fossa on the posteromedial aspect of the lateral femoral condyle. The PLB fibrils are smaller and shorter than those of the AMB. We report an ACL variation that had not been previously described, in which the PLB was attached to an intraarticular accessory ossicle, without causing knee instability. The large accessory ossicle caused pain. We reviewed the anatomy, anomalies, and variation in the ACL.     

The presence of Epstein-Barr virus (EBV) in diffuse large B-cell lymphomas (DLBCLs) in Turkey: special emphasis on 'EBV-positive DLBCL of the elderly'

Accumulated evidence has shown the importance of Epstein-Barr virus in the pathogenesis of various lymphomas. This study aimed to determine the prevalence of Epstein-Barr virus expression and its effect on survival amongst diffuse large B-cell lymphoma (DLBCL) cases from two large tertiary care centres in Turkey with a particular interest in identifying cases of 'Epstein-Barr virus-positive DLBCL of the elderly'. Diffuse large B-cell lymphoma cases diagnosed between 1999 and 2009 were retrieved and 340 cases were used to construct tissue microarrays. The presence of Epstein-Barr virus small ribonucleic acids was examined by in situ hybridization using Epstein-Barr virus (EBV)-encoded small RNA (EBER) oligonucleotides. A total of 18 cases (5.3%) showed Epstein-Barr virus expression. Twelve cases were classified as Epstein-Barr virus-positive DLBCL of the elderly. Epstein-Barr virus-positive DLBCL cases showed a significantly inferior overall survival as compared with Epstein-Barr virus-negative cases (p < 0.001). In our study group Epstein-Barr virus expression is not prevalent in DLBCLs. Epstein-Barr virus-positive DLBCL of the elderly is also rare in the Turkish population. The presence of Epstein-Barr virus, however, is associated with poor prognosis.