Ewing's sarcoma of the ilium presenting as unilateral sacroiliitis.

We describe a 24-year-old man who presented with unilateral sacroiliac pain associated with constitutional symptoms. Subsequent biopsy and pathohistologic evaluation demonstrated Ewing's sarcoma. We emphasize a consideration of Ewing's sarcoma in the differential diagnosis of unilateral sacroiliac pain.     

Symptomatic adult polycystic liver disease in a young woman.

Adult polycystic liver disease is an entity that is striking for the presence of extraordinary hepatomegaly. Very rarely do patients under 40 years of age experience problems and only a minority of middle-aged patients manifest symptoms due to organ compression or biliary tree obstruction. The clinical course is usually benign, and no specific therapy is required. The onset of right upper quadrant pain, back pain, and shortness of breath prompted evaluation of a 32-year-old woman with progressive hepatomegaly. CT scan revealed a massive cyst-riddled liver with posterior displacement of the spleen, compression of the pancreas, and renal cysts. Prothrombin time, albumin, and liver enzyme values were normal except for a mildly elevated gamma-glutamyl transpeptidase.     

Directional coronary atherectomy at the Toronto and Mount Sinai Hospitals: report of the initial 120 procedures.

OBJECTIVE: To assess the procedural success and complication rates of the first 120 directional coronary atherectomy cases performed at two Toronto hospitals. DESIGN AND SETTING: Case series in tertiary referral centres. PATIENTS: One hundred and thirteen patients in whom 120 atherectomy procedures were attempted between July 1990 and April 1992. INTERVENTION: Directional coronary atherectomy. MAIN RESULTS: Angiographic success was obtained in 115 of 120 procedures (96%) involving 117 of 123 lesions (95%). Procedural success (angiographic success without death, myocardial infarction or coronary bypass surgery) was obtained in 110 of 120 procedures (92%). Adjunctive balloon angioplasty was required in 20 procedures (17%). There was one death at 36 h in an elderly patient who underwent an emergency procedure while in cardiogenic shock. Periprocedural non-Q wave myocardial infarction occurred in five patients. There were no Q wave myocardial infarctions. Three patients required coronary bypass surgery prior to discharge and vascular complications occurred in five patients. CONCLUSIONS: Directional coronary atherectomy can be performed with procedural success and complication rates comparable to conventional balloon angioplasty. Randomized trials are underway to determine if atherectomy results in a lower restenosis rate.     

A Buprenorphine Stabilization and Rapid-Taper Protocol for the Detoxification of Opioid-Dependent Patients

Management of hospitalized opioid-dependent patients can be problematic at times, especially when patients are medically unstable, elderly, or have acute or chronic pain syndromes. The authors report a case series of 65 patients detoxified on 74 separate occasions with the use of the partial μ-agonist buprenorphine. The buprenorphine was administered subcutaneously as an initial stabilization dose, after which patients received a rapid taper over approximately 6 days. Ninety-seven percent (n = 72) of the 74 episodes of detoxification were successfully managed with buprenorphine; 62% (n = 40) of the patients bad no symptoms of opioid withdrawal. All patients reported that this detoxification protocol was as comfortable or more comfortable than any previously encountered withdrawal experience. The results of this case series provide strong support for further studies of the role of buprenorphine in the short-term detoxification of hospitalized opioid-dependent patients.     

The early detection of nonpalpable breast carcinoma with needle localization. Experience with 500 patients in a community hospital.

During a 5-year interval, 500 women underwent 530 needle localizations (NL) for nonpalpable, mammographically suspicious breast lesions. These lesions were localized using the Homer Mammalok Breast Needle/Wire Localizer (Namic; Glens Falls, NY). Almost one half the NL (260/530) were performed for suspicious calcifications; 19 per cent (49/260) proved to be cancerous. Cancer (CA) was identified 90 times in 88 patients (17%); 64 per cent (58/90) were invasive and 36 per cent (32/90) were noninvasive carcinomas. Eighty per cent of the lesions were 1 cm or smaller. Eighty-four axillary dissections were done and only 7 patients (8%) had axillary metastasis. During the same time interval, 277 women underwent axillary dissection, with or without mastectomy, for palpable breast cancer. Ninety-one per cent (252/277) had invasive carcinomas and 38 per cent (104/277) had axillary metastasis. Estrogen receptor assays (ERA) and progesterone receptor assays (PRA) were similar for both patient populations. The authors conclude that NL is an effective, safe method of detecting highly curable, occult breast cancer. It can be done effectively at a community hospital with results very similar to large university studies.     

Effects of omalizumab, a humanized monoclonal anti-IgE antibody, on nasal reactivity to allergen and local IgE synthesis.

BACKGROUND: Treatment with omalizumab has been shown to reduce serum free IgE concentrations and to have beneficial effects on allergic airway disease. However, its effect on IgE synthesis is unknown. OBJECTIVE: To determine whether omalizumab therapy affects nasal reactivity to allergen and local IgE production. METHODS: Nineteen patients with perennial allergic rhinitis were treated with intravenous omalizumab every 2 weeks for 26 weeks in an open-label study. Serum free and total IgE concentrations were measured at baseline and every 2 weeks throughout the study. Nasal challenge to dust mite allergen was performed at baseline and after 12 and 24 weeks of treatment. Nasal lavage fluid obtained before and after each nasal challenge was evaluated for mite-specific antibodies, plaque-forming cells, and productive epsilon messenger RNA (mRNA). RESULTS: During treatment, serum free IgE concentrations were decreased by 97% to 99%, and the nasal response to allergen challenge was significantly reduced on days 80 and 164. The postchallenge increase in nasal lavage mite specific IgE was significantly reduced by treatment with omalizumab on day 168. IgE plaque-forming cells and productive epsilon mRNA were not significantly affected by omalizumab treatment. CONCLUSIONS: Omalizumab treatment markedly reduced serum free IgE and the clinical response to nasal allergen challenge. However, the absence of an effect on IgE-secreting B cells and epsilon mRNA in nasal lavage fluid suggests that omalizumab treatment for 6 months does not significantly modulate synthesis of nasal IgE.     

Aromatic residues affecting permeation and gating in dSlo BK channels

 Structural determinants of permeation in large unit conductance calcium-activated potassium channels (BK channels) were investigated. Y293 and F294 in the P-region of dSlo were substituted by tryptophans. Compared to wild-type channels, Y293W channels displayed reduced inward unitary currents while F294W channels exhibited normal inward current amplitudes but flickery kinetics. Both mutations produced changes in current/voltage relations under bi-ionic conditions. Sensitivity to block by external tetraethylammonium (TEA) was affected in both channels, and the voltage dependence of TEA block was increased in F294W channels. Both mutations also affected gating by shifting the half-maximal activation voltage of macroscopic conductance/voltage relations to more positive potentials, and eliminating a slow component of deactivation. The double mutant did not produce ionic currents. These data are consistent with a model in which Y293 contributes to a potassium-binding site close to the outer mouth of the dSlo pore, while F294 contributes to an energy barrier near this site. Received: 16 September 1997 / Received after revision: 20 November 1997 / Accepted: 21 November 1997