Hypertension due to co-existing paraganglioma and unilateral adrenal cortical hyperplasia

A rare case of combined unilateral adrenal hyperplasia and paraganglioma is reported. A 27-year-old woman presented with hypertension, palpitation, dizziness, and headache for about 3 months. Elevated plasma aldosterone with low renin and a high level of urine vanillylmandelic acid (VMA) were found. Computed tomography showed a microadenoma of the left adrenal gland and a well demarcated left retroperitoneal para-aortic mass. Adrenal vein sampling for aldosterone and renin levels suggested left adrenal lesion. Surgical removal of the left adrenal gland and para-aortic mass was performed. Pathologic examination of the resected left adrenal gland showed adrenal cortical hyperplasia and the left retroperitoneal para-aortic mass showed a paraganglioma. Postoperatively, blood pressure, plasma renin, aldosterone and urine VMA all returned to within normal ranges. The possible relationship of these two diseases is discussed.     

Two distinct destabilizing elements in the c-fos message trigger deadenylation as a first step in rapid mRNA decay

The mechanisms by which c-fos mRNA is targeted for decay have been examined. Rapid removal of the poly(A) tail occurs before the transcribed portion of the c-fos message is degraded. Identification of the determinants that mediate c-fos message deadenylation reveals that they coincide directly with previously characterized determinants of c-fos mRNA instability, one in the protein-coding region and the other an AU-rich element (ARE) in the 3'-untranslated region. Insertion of either of these c-fos instability elements into the stable beta-globin message confers the property of rapid deadenylation. Mutation of the ARE indicates that this sequence controls two steps in the process of c-fos mRNA degradation: removal of the poly(A) tail, which does not require intact AUUUA pentanucleotides within the ARE, and subsequent degradation of the transcribed portion of the message, which appears to be dependent on the AUUUA pentanucleotides. These results indicate that structurally distinct instability determinants within the transcribed portion of labile messages can function by promoting rapid removal of the poly(A) tail as a first step in the decay process.     

Serum levels of intercellular adhesion molecule-1 and E-selectin in patients with acute ischaemic stroke

To investigate the role of circulating intercellular adhesion molecule-1 (ICAM-1) and E-selectin in ischaemic stroke, serum levels of ICAM-1 and E-selectin were measured by ELISA in 51 patients with acute ischaemic stroke within 24 h, and in 25 age-matched healthy controls and 10 young healthy volunteers. Carotid Doppler ultrasonography showed a significant stenosis (>50%) of the carotid or vertebrobasilar artery in 11 of 51 stroke patients. Serum levels of ICAM-1 [mean (SE)] were higher (P <0.01) in patients with ischaemic stroke [381 (30) ng/ ml] than in age-matched controls [271 (27) ng/ml] and young controls [246 (6) ng/ml]. There was no significant difference in serum E-selectin levels [mean (SE)] among stroke patients, age-matched and young controls [47 (6), 39 (3), and 41 (3) ng/ ml, respectively; P = NS]. The leucocyte count [mean (SD)] was higher (P < 0.01) in patients with ischaemic stroke [8310 (2800)] than in age-matched controls [6040 (930)]. Serum levels of ICAM-1 and E-selectin did not significantly differ between patients with or without abnormal carotid or vertebrobasilar artery disease. In conclusion, serum ICAM-1 level and leucocyte count were elevated in acute ischaemic stroke within 24 h, while the E-selectin level did not change significantly. This finding suggests that adhesion molecules may play an important role in the post-rolling process of leucocyte-endothelial cell interaction in acute ischaemic stroke. Received: 14 September 1995 Received in revised form: 7 June 1996 Accepted: 26 June 1996     

The effect of collagenase-inhibitor complexes on collagenolytic activity of normal and inflamed gingival tissue

Abstract. The effect of serum inhibitors on determinations of collagenolytic activity in culture fluids of healthy (G.I.=0) and mildly inflamed (G.I.=1) gingival tissue was studied. Gingival biopsies obtained at the beginning of the experimental gingivitis period (G.I.=0) and after approximately three weeks of no oral hygiene (G.I.=1) were subjected to tissue culture procedures previously utilized for the determination of collagenolytic activity. Inhibition of collagenase activity was evaluated by denaturing scrum inhibitors retained in culture fluid with sodium thiocyanate or by adding culture fluid from normal and inflamed tissues to a partially purified collagenase preparation.
A decrease in collagenolytic activity was consistently demonstrable in untreated culture fluids of gingival tissue manifesting G.I.=1 as compared lo those exhibiting G.I.=0. When enzyme containing culture fluids were treated with NaSCN. however, no essential difference was detected. While culture fluids from healthy gingiva showed no inhibition of partially purified collagenase, culture fluids from tissues manifesting mild inflammation inhibited enzyme activity by approximately 60 %.
A number of cell types associated with the periodontium have the ability to produce a specific collagenase. The results of this investigation suggest, however, that in vitro determinations of collagenolytic activity in culture fluids of normal and inflamed tissues may be influenced by specific scrum inhibitors.     

Surgical Anatomy of the Recurrent Laryngeal Nerves and its Clinical Applications in Chinese Adults

PURPOSE: When removing the thyroid gland, great care must be taken to avoid damaging the recurrent laryngeal nerves (RLNs). The present study aims to present a clear picture of certain anatomical features of the RLNs in relation to the inferior thyroid artery (ITA), the tracheoesophageal groove (TE), Berry's ligament, and the inferior cornu of the thyroid cartilage in Chinese adults. METHODS: We removed a collective 120 RLNs from 60 Chinese adult cadavers (52 men and 8 women), and examined their anatomic course and relationship on both sides. RESULTS: The right and left RLNs were found in the tracheoesophageal groove in 78.3% and 91.3% of cases, respectively. Both RLNs were found posterior to and to the right of the ITA in 80% of cases, and one was found on the left side of the ITA in 91.7%. Most of the RLNs were within 3 mm of Berry's ligament, with a laryngeal entry point about 0.8 cm below and just anterior to the inferior horn of the thyroid cartilage. CONCLUSIONS: The inferior cornu of the thyroid cartilage is a reliable landmark in identifying the RLNs. Racial variations between Caucasians and Chinese may explain some anatomic differences.     

Isolated right diaphragmatic eventration mimicking congenital heart disease in utero

Diaphragmatic eventration is the upward displacement of the abdominal viscera secondary to a thin or paralytic diaphragm. Its clinical presentations and radiographic pictures are similar to those of diaphragmatic hernia. Prenatal diagnosis of diaphragmatic eventration is extremely rare. A pregnant woman was referred to us because of abnormal cardiac findings noted at 20 weeks of gestation. A diagnosis of partial anomalous pulmonary venous connection was made on the basis of our findings of right atrial enlargement with an abnormal vascular channel drainage to it. The infant was born via cesarean section at 40 weeks and developed complications of cyanosis immediately after birth. Postnatal imaging studies and surgical findings disclosed right side diaphragmatic eventration with liver and associated vasculature upward displacement into the right pleural cavity. The cardiac structure was otherwise normal. We conclude that when an abnormal vessel tracing and unexplainable cardiac chamber asymmetry is encountered, diaphragmatic eventration should be considered as one of the differential diagnoses. Correct recognition and transferral to the hospital for neonatal assistance may lead to timely and appropriate management of these fetuses.