Gerota versus Zuckerkandl: the renal fascia revisited

In the medical literature, Gerota fascia is frequently used as a general term to describe both the anterior and posterior pararenal fascia. However, Zuckerkandl's name is also often used to describe either the anterior or posterior fascia. To resolve this confusion, the authors reviewed the original works by Gerota and Zuckerkandl. In 1883, Zuckerkandl described the posterior renal fascia but did not recognize the presence of the anterior renal fascia. In 1895, Gerota documented the presence of the anterior renal fascia and clearly assigned Zuckerkandl's name to the posterior renal fascia. Thus, the terms Zuckerkandl fascia and posterior renal fascia are synonymous, as are Gerota fascia and anterior renal fascia.     

Interstitial pneumonitis associated with azathioprine therapy

A 24-year-old female patient with rapidly progressive renal failure secondary to membrano-proliferative glomerulonephritis is thought to have subsequently had acute interstitial pneumonitis as a consequence of azathioprine therapy. The occurrence of the pulmonary injury coincided with the rapid onset of severe renal failure and was reversible with cessation of the drug. Accumulation of toxic metabolic products of azathioprine with subsequent injury to the pulmonary interstitium is suggested as the etiology. Azathioprine should be considered in the differential diagnosis of interstitial pneumonitis in all patients taking the drug.     

Arsenic intoxication as a cause of megaloblastic anemia

We have described a case of chronic arsenic intoxication associated with pancytopenia and megaloblastic erythropoiesis. The patient had the typical laboratory manifestations of effective erythorpoiesis due to a megaloblastic process, including macroovalocytes, mild pancytopenia, low reticulocyte index, increased marrow cellularity with erythroid hyperplasia, and morphologic evidence of megaloblastic maturation in the marrow. The patient's serum folate and vitamin B12 were normal, and the anemia regressed without therapy. Our case suggests that the combination of megaloblastosis with normoblastic or megaloblastic karyorrhexis,should raise the suspicion of arsenic intoxication in the mind of the observer. In addition, arsenic should be added to the list of agents causing a reversible megaloblastic anemia.     

Intrauterine growth retardation: evaluation by magnetic resonance. Work in progress

Eleven high risk fetuses between 32 and 37 menstrual weeks gestational age were examined by magnetic resonance (MR) imaging. Serial obstetrical sonograms, birth weights, and serial postnatal examinations were obtained in all subjects. Sagittal MR spin echo images obtained using TR = 0.5 sec and TE = 28 msec were useful for assessing subcutaneous fat. Prospective estimates of fetal fat stores correlated with neonatal outcome better than sonographic measurements of fetal growth parameters or actual birth weight. MR appears to be a safe and useful technique that offers information complementary to obstetrical sonography when IUGR is suspected.     

Malakoplakia of bone. An unusual cause of pathologic fracture in an immunosuppressed patient

Malakoplakia is a distinctive type of histiocytic inflammatory reaction that occurs most commonly in the urinary tract and is usually due to infection by coliform bacteria. A 68-year-old woman developed a pathologic fracture of the right femoral neck secondary to malakoplakia of bone. The patient had received multiagent chemotherapy for a malignant lymphoma prior to the development of malakoplakia. Chemotherapy-related leukopenia and hypogammaglobulinemia resulted in Escherichia coli cystitis and sepsis. Bacterial cultures of tissue from the femoral fracture site also grew E. coli. Presumably, hematogenous spread of the bacteria led to infection of the femoral neck. Prosthetic repair of the fracture and antibiotic therapy resulted in a good clinical response. This is the third case of malakoplakia involving bone that appears to have been reported in the literature. Malakoplakia should be considered in the differential diagnosis of lytic bone lesions that occur in immunosuppressed patients.     

Extraction, separation, and detections of 14C-diazepam and 14C-metabolites from brain tissue of mature and old rats

A rapid method for simultaneous determination of brain concentrations of diazepam and each of its three major metabolites in brain tissue by a reverse isotope dilution procedure is presented. Radiolabeled diazepam and metabolites were extracted from brain tissue of mature and senescent rats with ethyl ether. After the ether was evaporated the benzodiazepines were separated from the residue by passing the water soluble portion through C-18 bonded-phase extraction columns. High pressure liquid chromatography (HPLC) was used to separate the benzodiazepines from each other. Reverse isotope dilution analysis was used to quantify diazepam and its metabolites. The percent recovery of diazepam and its metabolites from the brain of mature or senescent rats did not vary significantly.     

Peripheral T-cell lymphoma

Peripheral T-cell lymphoma is the most common type of T-cell lymphoma seen in adults in the United States. Clinical data were reviewed from 134 cases of peripheral T-cell lymphoma diagnosed in three centers. The median age of the patients was 57 years (range, 4-97 years), 59% were male, and 36 patients (27%) had a history of a preceding disorder of the immune system. The tumors were grouped histologically into large cell (43%), mixed large and small cell (40%), and small cell (17%). The stage at diagnosis was I (7%), II (21%), III (22%), and IV (50%). B symptoms were present in 57%. The most frequent sites of extranodal involvement were bone marrow (35%), skin (13%), and lung (11%). Eighty patients were treated with a multiagent chemotherapy regimen with proven curative potential in aggressive non-Hodgkin's lymphomas and the remainder of the patients received less intensive chemotherapy (36 patients), radiotherapy (nine patients), or no treatment (nine patients). Fifty percent of the intensively treated patients achieved complete remission and the actuarial 4-year survival was 45%. However, the 4-year, disease-free survival in patients with Stage IV disease was only 10%. Although peripheral T-cell lymphomas appeared similar in many ways to their B-cell counterparts, disease-free survival by stage was low and patients with Stage IV disease had an especially poor outlook.