Hepatic adrenal rest tumor: Diagnostic pitfall and proposed algorithms to prevent misdiagnosis as lipid‐rich hepatocellular carcinoma

We present a case of adrenal rest tumor of the liver in which differential diagnosis from lipid rich‐hepatocellular carcinoma (HCC) was challenging. The patient was a 50‐year‐old woman in whom a 3‐cm tumorous mass was discovered in segment 7 of the liver during computed tomography evaluation of a uterine leiomyoma. The preoperative diagnosis was HCC, and subsegmental liver resection was performed. The tumor appeared as a well‐demarcated golden yellow nodule consisting of clear or partially eosinophilic cells arranged in a trabecular pattern. The initial impression of this lesion was that of clear cell type or lipid‐rich type HCC because it stained positive for Hep Par1, but negative for arginase‐1 and positive for CD56 which is one of the neuroendocrine markers. The lesion also stained positive for SF‐1 and 3β‐HSD, both of which are markers of adrenocortical tissue. The final diagnosis was hepatic adrenal rest tumor. Hepatic adrenal rest tumor should be considered in the differential diagnosis of segment 7 tumor. A diagnostic algorithm that includes immunohistochemical staining for CD56 and arginase‐1 is to rule out the possibility of lipid‐rich HCC.     

Clinical characteristics of influenza virus-induced lower respiratory infection during the 2015 to 2016 season

Background

Influenza A(H1N1)pdm09 virus infections often manifest severe respiratory symptoms, particularly in patients with a past history of allergic disease. Most of these findings were reported during the 2009 pandemic. The purpose of this study was to detail the clinical characteristics of influenza virus-induced lower respiratory infection (LRI) during the A(H1N1)pdm09-predominant 2015–2016 season.

The role of leukocyte depletion by in vivo use of leukocyte filter in lung preservation after warm ischemia

The oxygen metabolites of leukocytes have been implicated as playing the central role in reperfusion injury of preserved lung for transplantation. Furthermore, it is still unknown how leukotrienes take part in this process. Twelve mongrel dogs were used, divided into two groups. In group A, left thoracotomy and hilar stripping of the left lung was performed under anesthesia. During warm ischemia (two hours) and reperfusion (two hours), a filter was used three times between the femoral artery and vein, and quantitative in vivo blood filtration was performed. In group B, warm ischemia and reperfusion was done in the same fashion without filtration. As for tissue free radical assay, lipid peroxidation products were measured by means of thiobarbituric acid. Tissue leukotriene B4 and C4 levels were measured by radio immunoassay. In addition, peripheral blood count and tissue wet/dry ratio were analyzed. Significant leukocyte depletion of peripheral blood with leukocyte efflux from reperfused lung was observed in group A. Significant increase of tissue malondialdehyde (MDA) titers after reperfusion was observed in group B, whereas no significant fluctuation of tissue MDA titers was noted in group A. Concerning leukotriene B4 and C4, no significant increase was observed in either group. Tissue damage estimated by lung wet/dry ratio was considered to be controlled in group A compared with group B. Thus, the authors conclude that in vivo use of a leukocyte filter is efficient in removal of peripheral blood leukocytes and in preservation of reperfused lung after warm ischemia and that oxygen metabolites of leukocytes are considered to play a role in tissue damage in this process.     

Expression of reg protein in rat regenerating islets and its co-localization with insulin in the Beta cell secretory granules

Summary Regenerating islets can be induced by the administration of poly(ADP-ribose) synthetase inhibitors to 90% depancreatized rats. In screening a regenerating isletderived cDNA library, we previously isolated a novel gene, reg (regenerating gene), which encodes a 165-amino acid protein with a 21-amino acid signal sequence. In the present study, we have examined the expression and localization of reg protein in the regenerating islets by immunocytochemical techniques using a monoclonal antibody against a recombinant rat reg protein of 144 amino acids without the signal sequence. Light microscopy examination showed strong immunoreactivity for reg protein in the regenerating islets of the rats at two weeks and two months after the 90% pancreatectomy, whereas reg protein was almost undetectable in normal rat islets or in the islets of the rats one year after the pancreatectomy. Almost all the reg protein-positive cells were stained for insulin. By applying the immunogold technique at the ultrastructural level, it was demonstrated that both reg protein and insulin occur in the central granular core of the regenerating Beta cell secretory granules. These results suggest that reg protein is synthesized in and secreted from the regenerating Beta cells and that its expression is closely associated with Beta-cell regeneration.     

Influences of season and of temperature, photoperiod, and subcutaneous melatonin infusion on the glomerular filtration rate of ewes

Abstract: Influences of season and of temperature, photoperiod, and subcutaneous melatonin infusion on glomerular filtration rate (GFR) were measured in ewes. There was a seasonal difference of GFR between summer (June-August) and winter (December-February) in Tokyo (35°, 35°N); GFR was significantly ( P < 0.05) higher in summer (4.2 ± 0.3 ml/ min/kg) than in winter (3.0 ± 0.2 ml/min/kg). GFR was measured after exposure to three types of photoperiod, 24L: 0D, 12L: 12D, and 0L: 24D, for 7 to 8 days. The value for GFR obtained at 20°C was significantly lower ( P < 0.05) with 0L: 24D than with the other two photoperiodic conditions. GFR obtained during subcutaneous melatonin infusion (20μg/hr for 16 hr/ day for 7 days) with 24L: 0D conditions was significantly ( P < 0.05) lower (2.5 ± 0.1 ml/min/kg) than without infusion (3.8 ± 0.3 ml/ min/kg) and was about the same as that obtained in animals under 0L: 24D conditions. At 30°C, GFR exhibited no difference between the 3 photoperiodic conditions and was always lower than that found at 20°C. Possible influences of melatonin on GFR are discussed.     

Correction to: Detection of acute rib fractures on CT images with convolutional neural networks: effect of location and type of fracture and reader’s experience

Emergency Radiology -     

Hypolipidemic effects of guar gum and its enzyme hydrolysate in rats fed highly saturated fat diets.

The effects of guar gum and its enzyme hydrolysate as well as fructooligosaccharide on lipid metabolism were compared in rats fed high-fat diets employing lard or palm oil as dietary fat (25% in the diets). Guar gum and the enzyme hydrolysate greatly increased cecal volatile fatty acid contents to a similar extent. Fructooligosaccharide also increased the variable but to a lesser extent. Not only guar gum but also the hydrolysate and the oligosaccharide reduced serum cholesterol levels irrespective of dietary fat sources but to a lesser extent. The triglyceride-lowering effects of the hydrolysate and the oligosaccharide were comparable to that of guar gum. Although guar gum enzyme hydrolysate and fructooligosaccharide doubled the biliary bile acid excretion, these materials only slightly increased the activities of hepatic enzymes of cholesterol and bile acid synthesis. Guar gum and its hydrolysate suppressed 3-hydroxy-3-methylglutaryl-coenzyme A reductase activities in the ileum to one half the control value in the experiment where dietary fat was lard. The highly polymeric structure does not appear to be a prerequisite for nonabsorbable carbohydrate to alter lipid metabolism at least in rats fed high-fat diets.     

Accuracy of bedside electrocardiographic monitoring: a report on current practices of critical care nurses

Diagnostic criteria for many arrhythmias can be observed from any monitoring lead; however, other important criteria are "lead specific," such as the diagnostic QRS patterns in V1 that aid in distinguishing ventricular tachycardia from supraventricular tachycardia with bundle branch block or aberration. Therefore, it makes a great deal of difference which leads are selected for bedside monitoring. Our purpose was to determine which leads nurses select for monitoring, and the accuracy of lead placement. From a random sample of nurses who were members of the American Association of Critical-Care Nurses, 302 returned a monitoring questionnaire. Average critical care experience was 8.5 years. Lead II was most often selected (74%) for single-channel monitoring; lead II plus V1 (or MCL1) were most often selected (87%) for dual-channel monitoring. Only 37% of nurses demonstrated proper technique for obtaining their single lead of choice; even fewer (13%) demonstrated proper technique for obtaining their dual leads of choice. These results suggest that misdiagnosis of arrhythmias such a wide complex tachycardia in monitored patients may be caused by inappropriate lead selection as well as inaccurate lead placement.