Familiar Hyperkalaemic Acidosis

We evaluated a 26-years-old man with hyperkalaemic acidosis,apparently inherited as an autosomal dominant trait. Type IIpseudohypoaldosteronism was suggested by normal aldosteroneproduction and renal sodium conservation. The cause of acidosisin this syndrome is unknown. Both urinary ammonium excretionand bicarbonate threshold were low during hyperkalaemia. Aftercorrecting the hyperkalaemia ammonium excretion was normal,but bicarbonate threshold remained low. Maximum bicarbonatereabsorption, urine to blood pCO₂ gradients, and minimum urinepH were normal. These findings suggest that hyperkalaemia mightcontribute to the acidosis by limiting urinary buffer, but thatthe primary defect is reduced mineralocorticoid effect on hydrogenion and secretion. When the poorly reabsorbed anion, sulphate,was infused, hydrogen ion and potassium secretion were normal.When the relatively reabsorbable anion, chloride, was infused,potassium secretion was decreased. Thesefinding suggest thatthe attenuated mineralocorticoid effect on hydrogen ion secretionis due to increased reabsorptive avidity for chloride in thedistal nephron. To determine if this defect caused resistanceto mineralocorticoid we increased mineralocorticoid by dietarysodium restriction and later administered desoxycorticosteroneand fludrocortisone. Both endogenous and exogenous mineralocorticoidcaused increased net acid excretion and corrected the acidosis,indicating no resistance to mineralocorticoid. Hydrochlorothiazide50 mg daily promptly corrected the acidosis and the hyperkalaemiaby increased urinary potassium excretion. We conclude that theacidosis of type II pseudohypoaldosteronism is due in part toattenuation of the voltage-dependent moiety of mineralocorticoid-drivenacidification caused by enhanced distal chloride reabsorption.Suppression of ammoniagenesis by hyperlkalaemia exaggeratesthe acidosis. The acidosis and hyperkalemia are corrected byhydrochlorothiazide. ¹Present address: Department of Medicine, Naval Medical Center,Okinawa The opinions and assertions contained herein are the privateones of the authors and are not to be construed as officialor reflecting the views of the Naval Medical Command or theUnited States Navy. ³Present address: 28 Deerpath Dr.,New Hartford, NY 13413, USA     

Attenuation of lipopolysaccharide-induced acute lung injury by treatment with IL-10

Background and objective:   The aim of this study was to characterize the changes in neutrophils and cytokines in BAL fluid following acute lung injury (ALI), and to determine the protective effect of post-injury treatment with IL-10.
Methods:   A rat model of ALI was established by evenly spraying LPS (16 mg/kg) into the lungs followed by observation for 48 h. Histological changes and the kinetics of neutrophil infiltration were evaluated in the injured lungs. The cytokines (TNF-α, IL-6, IL-10 and interferon-γ) and macrophage-inflammatory protein (MIP-2) were measured in BAL fluid by ELISA. The activation of BAL fluid neutrophils was investigated after treatment with IL-10 in vitro . The protective effect on histology and MIP-2 levels of intra-tracheal instillation of IL-10 12 and 16 h after LPS treatment was studied in vivo.
Results:   Intra-tracheal instillation of LPS caused significant lung injury and the activation of neutrophils. The levels of TNF-α and IL-6 in BAL fluid peaked at 8 and 16 h after LPS instillation respectively. IL-10 levels reached a maximum at 16–24 h, at the beginning of resolution of tissue injury. IL-10 inhibited the activation of neutrophils in vitro and MIP-2 induction in vivo . IL-10 had a protective effect if it was administered 12 but not 16 h after LPS.
Conclusions:   Neutrophils appeared to play an important role in ALI. Time-dependent treatment with IL-10 after intra-tracheal instillation of LPS was effective in protecting rats from ALI, probably by suppressing pulmonary infiltration with activated neutrophils.     

Lymphoepithelioma-like salivary gland carcinoma in Taiwan: a clinicopathological study of nine cases demonstrating a strong association with Epstein–Barr virus

Aims : Lymphoepithelioma-like carcinoma (LELC) of the salivary glands is a rather rare tumour. Previous studies have shown its strong association with Epstein–Barr virus (EBV) among Chinese and Eskimos. We tested this observation with nine Chinese patients with salivary gland LELC in Taiwan including one with coexisting nasopharyngeal carcinoma (NPC) and studied the prognostic significance of their histopathological features. Methods and results : This series showed a predilection for female patients and parotid glands with a median age of 50 years. Three patients died 18.5–26 months after the diagnosis including the case with NPC. Six patients were alive without recurrence for 14–45 months with a median follow-up of 34.5 months. Histopathologically, the tumours showed either lobular or diffuse growth pattern. Granulomas and/or germinal centres were observed in most cases and both B- and T-cells were found in the lymphoid infiltrates, indicating that the salivary gland LELC was capable of inducing a strong host immune reaction. Microscopic growth pattern, lymph node metastasis, and presence or absence of granulomas and/or germinal centres seemed to be important prognostic factors. Both salivary gland LELC and NPC shared similar histopathological appearance and positive immunostaining for epithelial membrane antigen and cytokeratin AE1 but not AE3. Granulomas and amyloid might occur in both tumours. A nasopharyngeal examination is indicated in patients with salivary gland LELC to exclude the possibility of coexisting or metastatic NPC. All nine cases showed positive nuclear signals for EBV-encoded RNA by in situ hybridization including the case with NPC. Conclusions : Our study and the previously published studies show that the association of salivary gland LELC and EBV is strongly related to racial and geographical factors.     

Impact of Acupuncture Therapy in Postoperative Aortic Dissection Patients with Cerebral Infarction: A Case Study

正Introduction Aortic dissection is a life-threatening disease that can produce a variety of symptoms and complications.Patients at high risk for mortality,such as individuals with aortic regurgitation,cardiac tamponade,or myocardial infarction,should be treated by surgery as soon as possible,especially in cases with acute ascending aortic dissections(Stanford type A).However,patients with aortic dissection may suffer adverse outcomes that lead     

Multiple extragenital adenomatoid tumors in the mesocolon and omentum

Adenomatoid tumors are benign mesothelial neoplasms most commonly found in the male and female genital tracts. Extragenital adenomatoid tumors are rare, most of them being solitary tumors. To our knowledge, only one case of multiple extragenital adenomatoid tumors, involving the liver and peritoneum, has been reported to date. Here we report another case of multiple extragenital adenomatoid tumors involving the mesocolon and omentum. A 47‐year‐old woman presented with a delayed menstrual period. Ultrasonography revealed a left adnexal mass, and surgical resection was attempted at a local hospital. The patient was transferred to our hospital without resection due to the intraoperative finding of multiple peritoneal tumors. At our hospital, an 8.0×7.5×6.0 cm tumor at the mesocolon of the sigmoid colon and three omental nodules measuring up to 2.5×2.0×1.7 cm were resected. Grossly, they were well circumscribed, gray‐tan and elastic with small cystic spaces. Microscopically, they were composed of tubules and anastomosing channels lined by flattened or cuboidal cells with bland nuclei. Immunohistochemically, the tumor cells were positive for pan‐cytokeratin AE1/AE3, vimentin, cytokeratin 5/6 and calretinin. The postoperative course was uneventful, and the patient was well 10 months after the operation. Despite their rarity, adenomatoid tumors should be included in the differential diagnosis of multiple intra‐abdominal tumors.