Idiopathic Adrenal Hemorrhage in a Patient with Gestational Trophoblastic Neoplasia

BACKGROUND: Idiopathic unilateral adrenal hemorrhage is rare. Described is the first case reported in the setting of nonmetastatic gestational trophoblastic neoplasia. CASE: A primigravida presented with abdominal pain, fever, and a right upper quadrant mass during the workup for gestational trophoblastic neoplasia. She was diagnosed with idiopathic unilateral adrenal hemorrhage. She was treated with surgical resection and single-agent chemotherapy and had complete remission. CONCLUSIONS: Idiopathic unilateral adrenal hemorrhage is a rare condition and must be considered in the presentation of abdominal pain, fever, and an abdominal mass.     

Comparison of cytological features of myxopapillary ependymomas on crush preparations

Myxopapillary ependymoma (ME) is a rare neoplasm found predominantly in the sacro‐coccygeal region in adults and is characterized by its distinct epithelial and stromal components. From 1990 to April 2008, a total of 10 ME cases were recorded at our institution. Six out of 10 cases underwent frozen section examination with concomitant crush preparations, which forms the basis of this study. The clinical and cytologic findings in all six cases were reviewed. There were four males and two females. The age ranges from 15 to 36 years with a mean age of 27 years. The epithelial component of ME is strikingly similar for all six cases showing tumor cells appearing singly or in loose clusters, most with papillary branching. There was also presence of indistinct cell boundaries, tapered cytoplasmic prolongations, wispy/fragile cytoplasm, and uniform oval‐to‐fusiform shaped nuclei with an evenly distributed chromatin pattern. The stromal component was composed mainly of thick, metachromatic material and adenoid cystic‐like areas. One case showed rosette‐like structures. These aforementioned characteristics can be utilized to distinguish ME from other primary and metastatic tumors such as meningioma, adenoid cystic carcinoma, chordoma, mucinous adenocarcinoma, chondrosarcoma, and germ cell tumors. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Perceived Discrimination and Depressive Symptoms,Smoking, and Recent Alcohol Use in Pregnancy

Abstract: Background: Perceived discrimination is associated with poor mental health and health‐compromising behaviors in a range of vulnerable populations, but this link has not been assessed among pregnant women. We aimed to determine whether perceived discrimination was associated with these important targets of maternal health care among low‐income pregnant women. Methods: Face‐to‐face interviews were conducted in English or Spanish with 4,454 multiethnic, low‐income, inner‐city women at their first prenatal visit at public health centers in Philadelphia, Penn, USA, from 1999 to 2004. Perceived chronic everyday discrimination (moderate and high levels) in addition to experiences of major discrimination, depressive symptomatology (CES‐D ≥ 23), smoking in pregnancy (current), and recent alcohol use (12 months before pregnancy) were assessed by patients’ self‐report. Results: Moderate everyday discrimination was reported by 873 (20%) women, high everyday discrimination by 238 (5%) women, and an experience of major discrimination by 789 (18%) women. Everyday discrimination was independently associated with depressive symptomatology (moderate = prevalence ratio [PR] of 1.58, 95% CI: 1.38–1.79; high = PR of 1.82, 95% CI: 1.49–2.21); smoking (moderate = PR of 1.19, 95% CI: 1.05–1.36; high = PR of 1.41, 95% CI: 1.15–1.74); and recent alcohol use (moderate = PR of 1.23, 95% CI: 1.12–1.36). However, major discrimination was not independently associated with these outcomes. Conclusions: This study demonstrated that perceived chronic everyday discrimination, but not major discrimination, was associated with depressive symptoms and health‐compromising behaviors independent of potential confounders, including race and ethnicity, among pregnant low‐income women. (BIRTH 37:2 June 2010)     

Prevalence of nonfermenters in clinical specimens

One hundred and thirty three non fermenting gram negative bacilli isolated out of 625 different clinical specimens were identified and characterised. Samples were exudate from chronic suppractive otits media (341), diabetic foot (117) wound (116) and blood (51). Of these isolates Pseudomonas aeruginosa 105(78.94%) predominated followed by Acinetobacter sp 8 [6.1%], Pseudomonas putrifaciens 6(4.5%), Flavobacterium sp 6(4.5%), Xanthomonas maltophilia 5(3.75%), Alkaligenes sp 3 (2.25). 31 (23.30%) were resistant to commonly used antibiotics. Amikacin 85 (63.90%) was found to be more effective than fluoroquinolones (27.8-48.12%).     

Human liver glucuronidation of benzidine

Although glucuronidation is considered an important pathwayin aromatic amine-induced bladder cancer, benzidine glucuronidationhas not been assessed in humans. Glucuronidation of benzidinewas assessed with human liver microsomes and slices. Emulgen911-treated microsomes exhibited a K_m for benzidine of 0.8±0.06mM and a V_max of 4.2±0.7 nmol/mg protein/min. A varietyof agents were tested for their ability to inhibit benzidineN-glucuronide formation. At 0.25 mM, estriol, 17-epiestriol,bilirubin, hyodeoxycholic acid and cyproheptadine were goodinhibitors (<50% of control). Dose-dependent inhibition studieswith estriol, testosterone and 4-aminobiphenyl demonstratedthat each agent reached a plateau as its concentration was increased.When these agents were combined at maximal inhibitory concentrations,additive inhibition was observed. These results suggest thatmore than one UDP-glucuronosyltransferase metabolizes benzidine.The cDNA clones pUDPGT_h-1 and -2 encode transferases which metabolizehyodeoxycholic acid and estrogen derivatives, but neither transferasecatalyzed benzidine glucuronidation. Slices were used to assessmetabolism by intact tissue and converted [³H]benzidine (0.09mM) to N-acetyl-benzidine. N-Glucuronides of both benzidineand N-acetylbenzidine were observed and represented 14–37%of the total recovered radioactivity. The amount of N-acetylbenzidineN'-glucuronide observed was proportional to the amount of N-acetylbenzidineproduced. Thus, N-glucuronidation appears to represent a majorpathway for metabolism of benzidine in humans. The extent ofN-acetylation affects the proportion of benzidine and N-acetylbenzidineglucuronidated by human liver slices.     

Bronze baby syndrome: an animal model

We evaluated the appropriateness of an animal model for the bronze baby syndrome. Ligation of the common bile duct in adult Wistar rats induces an accumulation of porphyrins and copper in the liver and a 20% conversion of protoporphyrin IX into (Cu(II)-protoporphyrin IX. Upon irradiation of these animals with super-blue lamps, the plasma content of Cu(II)-protoporphyrin increases by about 30%. Cholestasis also increases the recovery of porphyrins in the urine, although light treatment of ligated rats further increases urinary porphyrin excretion. The spectroscopic changes induced by irradiation of sera of ligated rats are consistent with the formation of products that have the typical spectrum found in bronze baby syndrome patients, i.e. a reduced absorbance in the visible region and an increased absorption in near-UV and red spectral regions. The products responsible for the brown discoloration found in bronze baby syndrome seem to result from phototransformation of copper-porphyrins subsequent to an electron transfer between photoexcited bilirubin and the copper ion.     

Utilization of PD modalities: evolution

In the early 1960s, peritoneal dialysis (PD) was introduced as a form of long-term maintenance therapy in patients with end-stage renal disease (ESRD). We have come a long way since. Increasing understanding of peritoneal kinetic behavior, its innovative manipulation to meet patient needs, critical monitoring of clinical outcomes, and parallel development in technology have all contributed to the worldwide success of the therapy over the past four decades. In this article we review the evolution of the various PD modalities in the context of these factors.     

Mitomycin-C-augmented trabeculectomy for neovascular glaucoma. A preliminary report

PURPOSE: This study aimed to investigate the safety and efficacy of trabeculectomy with intraoperative mitomycin C (MMC) in the management of eyes with neovascular glaucoma (NVG). METHODS: Fifteen eyes of 14 patients with NVG were included in the study. NVG was secondary to central retinal vein occlusion (3 eyes), hemiretinal vein occlusion (2 eyes), proliferative diabetic retinopathy (8 eyes), branch retinal vein occlusion (1 eye) and idiopathic (1 eye). Preoperative retinal ablation was performed in eyes with evidence of posterior segment ischaemia. Following this, all eyes underwent trabeculectomy with intraoperative MMC (0.4 mg/ml for 3 minutes). Clinical outcome assessment included visual acuity, intraocular pressure (IOP), bleb appearance, identification of complications and antiglaucoma medications required to control IOP. RESULTS: The mean IOP decreased from 38.6 +/- 12.9 mmHg (range, 15-64 mmHg) to 17.4 +/- 9.33 mmHg (range, 4-34 mmHg) (P = 0.001). Preoperative visual acuity ranged from light perception to 6/9 in the affected eye. Thirteen (86.6%) of 15 eyes improved vision or retained preoperative vision, one (6.7%) eye lost light perception and one (6.7%) eye developed tractional retinal detachment two years after trabeculectomy. Ten (66.7%) of 15 eyes were classified as surgical success with a mean follow-up of 28.6 +/- 26.3 months (range, 2-82 months). None of the patients developed choroidal haemorrhage, hypotony maculopathy, late onset bleb leak or endophthalmitis. CONCLUSION: Trabeculectomy with intraoperative MMC is a good treatment modality in the management of eyes with NVG.     

Nitrosation and nitration of 2-amino-3-methylimidazo[4,5-f]quinoline by reactive nitrogen oxygen species

Both cooked red meat intake and chronic inflammation/infection are thought to play a role in the etiology of colon cancer. The heterocyclic amine 2-amino-3-methylimidazo[4,5-f ]quinoline (IQ) is formed during cooking of red meat and may be involved in initiation of colon cancer. Reactive nitrogen oxygen species (RNOS), components of the inflammatory response, contribute to the deleterious effects attributed to inflammation on normal tissues. This study assessed the possible chemical transformation of IQ by RNOS. RNOS were generated by various conditions to react with (14)C-IQ, and samples were evaluated by HPLC. Myeloperoxidase (MPO)-catalyzed reaction was dependent upon both H(2)O(2) and NO(2)(-). This reaction produced an azo-IQ dimer and IQ dimer along with two nitrated IQ products identified by ESI/MS. 2-Nitro-IQ was not detected. Product formation was inhibited by 2 mM cyanide. Reduction in nitrated products observed with 100 mM chloride was not altered with 0.5 mM taurine. Nitrated products were also produced by other conditions, ONOO(-) and NO(2)(-) + HOCl, which generate nitrogen dioxide radical. In contrast, conditions which generate N(2)O(3), such as diethylamine NONOate, produced only small amounts of nitrated products with the major product identified by MS and NMR as N-nitroso-IQ. MPO activation of IQ to bind DNA was dependent upon both H(2)O(2) and NO(2)(-). RNOS generated by ONOO(-) and DEA NONOate also activated IQ DNA binding. The nitrated IQ products were not activated by MPO to bind DNA. In contrast, N-nitroso-IQ was activated to bind DNA by MPO +/- NO(2)(-). HOCl activated N-nitroso-IQ, but not IQ. RAW cells produced N-nitroso-IQ and increased amounts of NO(2)(-)/NO(3)(-), when incubated with 0.1 mM IQ and stimulated with lipopolysaccharide and interferon gamma. Results demonstrate chemical transformation and activation of IQ by RNOS and activation of its N-nitroso product by biological oxidants, events which may contribute to initiation of colon cancer.