Determination of serum ferritin in the evaluation of iron depletion and iron over load in chronic twin-to-twin transfusion syndrome

In two pairs of twins with twin-to-twin transfusion syndrome serum ferritin levels were determined in order to estimate body storage of iron. Serum ferritin levels in the donor twins were found to be markedly lower than in the recipients and were below the lower limit found in normal neonates. One of the recipients was hydropic. His ferritin level was elevated far above the upper limit of normal. These findings support the hypothesis that in chronic twin-to-twin transfusion, depletion of iron stores occurs in the donor while the recipient suffers from iron overload. Determination of ferritin levels may be useful in the investigation of the twin-to-twin transfusion syndrome.     

A case of endometrial stromal sarcoma with curvilinear calcification

BACKGROUND: Although many histopathological, clinical, and imaging findings of ESS have been described, intense calcifications have not been reported previously. CASE: A 54-year-old female was admitted with vaginal bleeding and abdominal pain. Gynecologic examination revealed a huge, firm pelvic mass extending up to the epigastrium. Transabdominal ultrasonography and computed tomography demonstrated a well-demarcated uterine mass containing heterogeneous solid and cystic areas and a centric curvilinear calcification. Histopathological diagnosis was established as undifferentiated high-grade endometrial stromal sarcoma. CONCLUSION: Endometrial stromal sarcomas should be considered in the differential diagnosis of uterine masses containing curvilinear calcifications.     

A new clinical model in pulmonary embolism and its correlation with V/P scan results.

The study was prospectively designed to assess the correlation between a new clinical model empirically developed for acute pulmonary embolism (PE) and ventilation/perfusion (V/P) scan results. One hundred sixty consecutive patients with suspected acute PE underwent clinical evaluation before V/P scintigraphy. The clinical probability of PE was categorized according to a structured clinical model empirically developed as low, intermediate, or high, and the results were compared with those of V/P scintigraphy. Forty, 61, and 59 patients were classified as low, intermediate, and high clinical probability, respectively. Seventy-five percent (30/40) of the patients with low clinical probability were also of low scintigraphic probability or had a normal result (r(s): 0.39, p=0.000); 28% (17/61) of the patients with intermediate clinical probability demonstrated intermediate scintigraphic probability (r(s): 0.20, p=0.012); and 68% (40/59) of the patients with high clinical probability were also of high scintigraphic probability (r(s): 0.43, p=0.000). Overall, the correlation of two scoring systems was statistically significant (r(s): 0.39, p=0.000). Unilateral leg swelling (p=0.027), syncope or near syncope (p=0.002), amputation of a hilar artery (p=0.007), and electrocardiographic signs of right ventricular overload (p=0.000) prevailed in patients with high scintigraphic probability. "Syncope-near syncope or hemodynamic collapse" PLUS "electrocardiographic signs of right ventricular overload or hypoxemia" combination had the most significant correlation with a high scintigraphic probability (r(s): 0.31; p=0.000). In conclusion, the new clinical model empirically developed was significantly successful to provide comparable results with V/P scan. This consistency was particularly prominent in patients with low or high clinical probability for PE.     

ORIGINAL ARTICLE: A Prospective Case–Control Study Analyzes 12 Thrombophilic Gene Mutations in Turkish Couples with Recurrent Pregnancy Loss

Citation Yenicesu GI, Cetin M, Ozdemir O, Cetin A, Ozen F, Yenicesu C, Yildiz C, Kocak N. A prospective case–control study analyzes 12 thrombophilic gene mutations in Turkish couples with recurrent pregnancy loss. Am J Reprod Immunol 2010; 63: 126–136 Problem Recurrent pregnancy loss (RPL) is a heterogeneous disorder. The contribution of specific thrombophilic genes to the pathophysiology of RPL has remained controversial. We evaluated the prevalences of 12 thrombophilic gene mutations among homogenous Caucasian couples with RPL and fertiles. Method of study This was a prospective case–control study evaluating 272 women with RPL and 152 of their male partners, and a control group of 56 fertile couples. We investigated mutations including FV Leiden, factor V H1299R, factor II prothrombin G20210A, F XIII V34L, β‐fibrinogen ?455G>A, plasminogen activator inhibitor‐1, GPIIIa L33P (HPA‐1 a/b L33P), MTHFR C677T, MTHFR A1298C, ACE I/D, Apo B R3500Q, and Apo E. Results Overall, heterozygous mutations of FV Leiden, FXIII V34L, GPIIIa L33P, Apo E4, and prothrombin G20210A and homozygous mutations of PAI‐1and MTHFR C677T were associated with RPL. There was no meaningful association between RPL and other studied genes. Conclusion In contrast to the other mutations and polymorphisms, FV Leiden, FXIII V34L, GPIIIa L33P, Apo E, prothrombin G20210A, PAI‐1 and MTHFR C677T gene mutations may help to identify the couples at risk for recurrent pregnancy loss.     

Prevalence of life-threatening arrhythmias in ED patients transported to the radiology suite while monitored by telemetry

OBJECTIVE: The aim of this study was to determine the prevalence of life-threatening arrhythmias in monitored ED patients while in the radiology suite. METHODS: This is a retrospective analysis at a tertiary care hospital with an ED census of 52,000 visits. The patient population consisted of 3,051 adult ED patients with a chief complaint of chest pain, who were monitored with telemetry while they were sent to the radiology suite, and who were ultimately admitted to the hospital. RESULTS: Of a total of 3,051 consecutive patients with a cardiac presentation who received a nonportable chest x-ray, no patients were found to have incurred a life-threatening arrhythmia while in the radiology suite. CONCLUSION: The prevalence of a cardiac arrhythmia occurring during transport or while within the radiology suite in our study was zero. We conclude that stable patients can probably be transported to radiology safely without the use of bedside telemetry.     

Extracellular adenosine regulates naive T cell development and peripheral maintenance

Adenosine produced as a byproduct of metabolic activity is present in all tissues and produces dose-dependent suppression of TCR signaling. Naive T cell maintenance depends on inhibition of TCR signals by environmental sensors, which are yet to be fully defined. We produced mice with a floxed adenosine A_2A receptor (A_2AR) gene, Adora2a, and show that either global A_2AR deletion or cre-mediated T cell deletion elicits a decline in the number of naive but not memory T cells. A_2AR signaling maintains naive T cells in a quiescent state by inhibiting TCR-induced activation of the phosphatidylinositide 3-kinase (PI3K)–AKT pathway, thereby reducing IL-7Rα down-regulation and naive T cell apoptosis. Patterns of IL-7Rα expression on T cells in chimeric mice reconstituted with Adora2a^+/+ and Adora2a^−/− bone marrow cells suggest that decreased IL-7Rα in naive T cells is a cell-intrinsic consequence of Adora2a deletion. In addition, A_2AR expression increases in early thymic T cell development and contributes to progression of double-negative thymic precursors to single-positive thymocytes with increased IL-7Rα expression. Therefore, A_2AR signaling regulates T cell development and maintenance to sustain normal numbers of naive T cells in the periphery.Adenosine is produced as a result of metabolic processes and has cell signaling roles that are mediated by four G-protein–coupled adenosine receptors: A₁, A_2A, A_2B, and A₃ (Fredholm et al., 2011). These receptors are antagonized by naturally occurring and widely consumed methylxanthines, caffeine and theophylline, as well as by more potent synthetic antagonists (Haskó et al., 2008; Fredholm et al., 2011; Linden and Cekic, 2012). Adenosine is constitutively produced and increases in response to cellular hypoxia and stress. It readily crosses cell membranes via nucleoside transporters to gain access to cell surface receptors (Yao et al., 2011). Extracellular adenosine is also produced from the degradation of adenine nucleotides by exonucleases. ATP and ADP are converted to AMP and adenosine after release to the extracellular space through membrane channels (Huang et al., 2007), from cell death, or as granular components of platelets, mast cells, or neurons. Therefore, adenosine is available in all tissues and organs and changes in concentration depending on the tissue type and physiological conditions.Naive and memory T cells are maintained in the periphery to provide appropriate antigen-specific recognition to eliminate pathogens and tumors. IL-7 signaling and TCR engagement by self-peptide–MHC molecules provide signals needed for the development, survival, and homeostatic proliferation of naive T cells. Memory T cells also rely on IL-7 for survival but use IL-15 for homeostatic proliferation (Surh and Sprent, 2000, 2008). Recent evidence suggests that naive T cells are actively maintained in a quiescent state that requires integration of proliferative and survival signals with signals from environmental cues. However, the nature of these environmental cues is not fully understood. Here we identify one such cue as adenosine. The A_2AR is the predominant adenosine receptor subtype expressed by T cells (Su et al., 2004) and is induced when these cells are activated (Lappas et al., 2005). A_2AR activation increases cAMP to suppress TCR signaling (Ohta and Sitkovsky, 2001; Lappas et al., 2005; Ohta et al., 2009; Linden and Cekic, 2012). In tissues, basal adenosine concentrations are high enough to engage A_2ARs (Su et al., 2004). We show that endogenous adenosine is sensed by A_2ARs as an environmental cue that prevents IL-7R down-regulation after TCR stimulation. This signaling pathway increases naive T cell survival.     

Expression of cathepsin D and E-cadherin in primary laryngeal cancers correlation with neck lymph node involvement

Objective  

The aim of this study was to investigate the relation between Cathepsin D (Cath-D) and E-Cadherin (E-Cad) expression levels in tumor tissue and neck lymph node metastasis. This attempt should be made to identify new factors that one could be useful in predicting clinical behavior.     

Does ventricular opening promote remote cerebellar haemorrhage?

Cerebellar haemorrhage after supratentorial craniotomy is a rare complication Because of its significant morbidity and mortality rates, being aware of this complication is important for early diagnosis. In a 30-year-old male with multiple intracranial cavernomas, remote cerebellar haemorrhage (RCH) was observed after removal of symptomatic left temporal lesion. The lateral wall of the temporal horn that was tightly attached to the cavernoma was also opened and excessive drainage of the CSF occurred. The haemorrhage is attributed to opening of the ventricle wall and excessive drainage of cerebrospinal fluid (CSF) during the procedure.