Sclerosing lymphocytic lobulitis of the breast in a patient with Graves' disease.

A 43-year-old woman presented to the endocrinologist with symptoms and signs of typical thyrotoxicosis caused by Graves' disease. Review of systems revealed that she had recently discovered a lump in her left breast. Evaluation of the left breast lesion led to a core biopsy that showed sclerosing lymphocytic lobulitis. This breast disease, well recognized in the pathology literature, occurs in various autoimmine disorders, particularly type 1 diabetes mellitus, and has occasionally been reported in Hashimoto's thyroiditis. The patient described here represents the first published association of sclerosing lymphocytic lobulitis of the breast with Graves' disease.     

Outcomes following elective percutaneous coronary intervention without on-site surgical backup in a community hospital

Despite guidelines to the contrary, limited numbers of elective percutaneous coronary intervention (PCI) procedures without on-site surgical backup are being performed, particularly in Europe and Canada. In the United States, many hospitals are considering establishing on-site surgical programs, in part to facilitate PCI. At a hospital with only off-site surgical backup, 562 elective PCI procedures were performed on 489 consecutive patients. Of these, 551 (98.0%) were successfully completed without major in-hospital complications; 5 patients (1.0%) had in-hospital complications, and 4 (0.8%) were urgently transferred. It is concluded that elective PCI with off-site surgical backup is feasible and safe for selected patients under specific conditions.     

Electro-acupuncture modification of halothane anaesthesia in the dog

The effects of electro-acupuncture on minimum alveolar anaesthetic concentration (MAC) was studied during halothane anaesthesia in the dog. Following induction of anaesthesia, MAC was determined in duplicate. Ten dogs then received electro-acupuncture bilaterally at San Yin Chiao for 30 minutes. MAC was determined in duplicate while electro-acupuncture was continued. Electro-acupuncture significantly lowered MAC from 1.2 percent to 1.0 per cent (p< 0.01). A crossover experimental design was used in an additional eleven dogs. Here MAC was lowered from 1.17 per cent to 1.04 per cent (p < 0.05). Electro-acupuncture produces a small but statistically significant reduction in halothane MAC.     

Alterations in the postnatal development of the cerebellar cortex due to zinc deficiency. I. Impaired acquisition of granule cells

The effects of zinc deficiency on cerebellar development were investigated in suckling rats. In 21-day-old zinc-deficient rats the cerebellum as well as the whole brain was reduced in size. The cerebellar cortex was underdeveloped and showed a persistence of the external granule cell layer, a reduction in the thickness of molecular layer and a decrease in the area of the internal granule cell layer. Lobular variations were present. Along the posterior superior fissure there was approximately a 60% reduction in the number of granule cells and in the number of granule cells per Purkinje cell. It was suggested that the reduction in the number of granule cells was predominantly the result of impaired cell proliferation in the external granule cell layer. Comparisons with undernourished, pair-fed pups indicated that the effects of zinc deficiency could not be mediated totally through the reduced food consumption experienced by zinc deficient dams.     

Diagnosis of acute abdominal pain in older patients

Acute abdominal pain is a common presenting complaint in older patients. Presentation may differ from that of the younger patient and is often complicated by coexistent disease, delays in presentation, and physical and social barriers. The physical examination can be misleadingly benign, even with catastrophic conditions such as abdominal aortic aneurysm rupture and mesenteric ischemia. Changes that occur in the biliary system because of aging make older patients vulnerable to acute cholecystitis, the most common indication for surgery in this population. In older patients with appendicitis, the initial diagnosis is correct only one half of the time, and there are increased rates of perforation and mortality when compared with younger patients. Medication use, gallstones, and alcohol use increase the risk of pancreatitis, and advanced age is an indicator of poor prognosis for this disease. Diverticulitis is a common cause of abdominal pain in the older patient; in appropriately selected patients, it may be treated on an outpatient basis with oral antibiotics. Small and large bowel obstructions, usually caused by adhesive disease or malignancy, are more common in the aged and often require surgery. Morbidity and mortality among older patients presenting with acute abdominal pain are high, and these patients often require hospitalization with prompt surgical consultation.     

Evaluation of a pulmonary graphical display in the medical intensive care unit: an observational study

We developed a pulmonary graphic display that depicts pulmonary physiological variables for intubated, mechanically ventilated patients in a graphical format. The pulmonary graphical display presents multiple respiratory variables and changes are depicted by alterations in shape and color. Learning how this new technology will be integrated and accepted by users is an important step before it is introduced into the clinical arena. This study observed use and acceptance of the pulmonary graphical display by health care providers in an intensive care unit. Investigators noted that physicians, respiratory therapists, and nurses observed the pulmonary graphical display on average six, three, and one times, respectively, per patient room entry. Based on questionnaires, the pulmonary graphical display was perceived as useful, a desirable addition to current ICU monitors, and an accurate representation of respiratory variables.     

Ras pathway inhibition prevents neovascularization by repressing endothelial cell sprouting

Vascular networks develop from a growing vascular front that responds to VEGF and other guidance cues. Angiogenesis is required for normal tissue function, but, under conditions of stress, inappropriate vascularization can lead to disease. Therefore, inhibition of angiogenic sprouting may prevent neovascularization in patients with blinding neovascular eye diseases, including macular degeneration. VEGF antagonists have therapeutic benefits but also can elicit off-target effects. Here, we found that the Ras pathway, which functions downstream of a wide range of cytokines including VEGF, is active in the growing vascular front of developing and pathological vascular networks. The endogenous Ras inhibitor p120RasGAP was expressed predominately in quiescent VEGF-insensitive endothelial cells and was ectopically downregulated in multiple neovascular models. MicroRNA-132 negatively regulated p120RasGAP expression. Experimental delivery of α-miR-132 to developing mouse eyes disrupted tip cell Ras activity and prevented angiogenic sprouting. This strategy prevented ocular neovascularization in multiple rodent models even more potently than the VEGF antagonist, VEGF-trap. Targeting microRNA-132 as a therapeutic strategy may prove useful for treating multiple neovascular diseases of the eye and for preventing vision loss regardless of the neovascular stimulus.