Mammographic features of tuberculous axillary lymphadenitis

The clinical and mammographic findings of 10 patients with pathologically proven tuberculous axillary lymphadenitis were reviewed. The cases were identified from 10 173 mammograms performed over 6 years at Maharaj Nakorn Chiang Mai University Hospital. The 10 patients were aged 31-65 years. All cases were initially diagnosed to have breast carcinoma with axillary nodal metastases. Eight patients presented with axillary swelling, while two presented with breast enlargement. None of these cases had a palpable breast mass. Associated supraclavicular, cervical or groin nodes were found in seven cases, and two patients had evidence of pulmonary tuberculosis. All lesions were unilateral, affecting the right side in eight cases and left side in two cases. On mammogram, the axillary nodes were enlarged and homogeneously dense. The nodes were sized 2.5-5 cm. Nodal margins were variable. Some nodes were matted. Macrocalcifications were noted in three cases. Ipsilateral breast oedema without mass or microcalcifications was present in two cases. Patients with tuberculous axillary lymphadenitis have large homogeneously dense nodes with either well- or ill-defined margins. It is impossible to differentiate tuberculous from malignant nodes. The presence of macrocalcifications might suggest tuberculous axillary lynphadenitis. Biopsy of enlarged axillary nodes is necessary to determine its aetiology.     

Clinics in diagnostic imaging (43). Right adrenal myelolipoma

A 53-year-old woman who presented with drug-induced jaundice and urinary tract infection was incidentally found to have a large abdominal mass. Radiographs and ultrasonography showed a large fatty mass located between the right lobe of the liver and the right kidney. Diagnosis of right adrenal myelolipoma was made on computed tomography. The patient was treated conservatively. The causes of large fatty masses of the abdomen in adults are discussed, with emphasis on the imaging appearances of myelolipoma, renal angiomyolipoma, cystic teratoma and liposarcoma.     

Dose-related effect of intranasal corticosteroids on treatment outcome of persistent allergic rhinitis

OBJECTIVES: To evaluate the efficacy of the self-adjustable dosing regimen and explore potential dose-response relationships of intranasal corticosteroids in persistent allergic rhinitis. STUDY DESIGN: Prospective cohort study. SUBJECTS AND METHODS: Sixty-nine persistent allergic rhinitis patients were treated with 220 mcg of intranasal triamcinolone acetonide for 28 days. Patients with mild, intermittent symptoms were instructed to use the medication only after symptoms occurred once a day. Patients with symptoms that lasted more than 1 day and/or interrupted daily activities/sleep were instructed to continue the morning daily dose until they were symptom-free for 24 hours before stopping usage. RESULTS: All nasal symptom scores and peak expiratory flow index (PEFI) showed statistically significant improvements after treatment. At 28 days after treatment, the number of puffs and weight of steroids used were positively correlated with percentages of improvement in total symptoms score (TSS) and PEFI (rho = 0.529, r = 0.571 and rho = 0.350, r = 0.509 respectively). When at least 1400 mcg or 44 puffs were used, 60% TSS and 10% PEFI improvement were achieved. CONCLUSION: A self-adjustable dosing approach proved to be an efficacious approach to controlling allergic rhinitis.     

Development of multiplex PCR for the detection of total coliform bacteria for Escherichia coli and Clostridium perfringens in drinking water

Multiplex PCR amplification of lacZ, uidA and plc genes was developed for the simultaneous detection of total coliform bacteria for Escherichia coli and Clostridium perfringens, in drinking water. Detection by agarose gel electrophoresis yielded a band of 876 bp for the lacZ gene of all coliform bacteria; a band of 147 bp for the uidA gene and a band of 876 bp for the lacZ gene of all strains of E. coli; a band of 280 bp for the p/c gene for all strains of C. perfringens; and a negative result for all three genes when tested with other bacteria. The detection limit was 100 pg for E. coli and C. perfringens, and 1 ng for coliform bacteria when measured with purified DNA. This assay was applied to the detection of these bacteria in spiked water samples. Spiked water samples with 0-1,000 CFU/ml of coliform bacteria and/or E. coli and/or C. perfringens were detected by this multiplex PCR after a pre-enrichment step to increase the sensitivity and to ensure that the detection was based on the presence of cultivable bacteria. The result of bacterial detection from the multiplex PCR was comparable with that of a standard plate count on selective medium (p=0.62). When using standard plate counts as a gold standard, the sensitivity for this test was 99.1% (95% CI 95.33, 99.98) and the specificity was 90.9 % (95% CI 75.67, 98.08). Multiplex PCR amplification with a pre-enrichment step was shown to be an effective, sensitive and rapid method for the simultaneous detection of these three microbiological parameters in drinking water.     

Computed tomography of biliary cystadenoma and biliary cystadenocarcinoma

INTRODUCTION: Biliary cystadenoma (BCA) and biliary cystadenocarcinoma (BCAC) are rare biliary ductal neoplasms of the liver. This study aims to describe the computed tomography (CT) findings of these neoplasms and to distinguish between both entities. METHODS: We retrospectively reviewed the CT findings of five patients with proven BCA and seven patients with proven BCAC at our institution from July 2000 to August 2006. The CT parameters were analysed, including number, size, location, and characteristics of the cystic lesion: presence and number of internal septation, calcifications and enhanced mural nodule. RESULTS: All 12 patients had a solitary, large well-defined intrahepatic cystic lesion. Lesions in all five patients with proven BCA (100 percent) and six patients with proven BCAC (86 percent) had a multilocular appearance. The remaining patient with proven BCAC had a unilocular lesion. Smooth, thin septa and walls were found in five patients with BCA (100 percent). The enhanced mural nodule at the septum or wall was identified in seven patients with BCAC (100 percent) but was not found in the BCA patients (p-value is less than 0.001). The other parameters including size, location and number of septa had no statistically significant differences between BCA and BCAC. CONCLUSION: BCA and BCAC should be considered in the differential diagnosis, when a solitary large well-defined multilocular intrahepatic cystic lesion is detected in a middle-aged woman. The presence of an enhanced mural nodule is the most important finding to suggest BCAC.     

Primary and metastatic mucinous adenocarcinomas of the ovary: Evaluation of the diagnostic approach using tumor size and laterality

OBJECTIVE: To evaluate the usefulness of the recently proposed algorithm (Seidman JD, Kurman RJ, Ronnett BM. Primary and metastatic mucinous adenocarcinomas in the ovaries: incidence in routine practice with a new approach to improve intraoperative diagnosis. Am J Surg Pathol 2003; 27: 985-93 [5]) that classifies mucinous adenocarcinomas of the ovary as primary when they were unilateral > or =10 cm and as metastatic when they were unilateral <10 cm or bilateral. METHODS: Malignant ovarian neoplasms, which were resected in Chiang Mai University Hospital between 1992 and 2003, were histologically reviewed. Mucinous adenocarcinomas involving the ovary were identified. The medical records and radiologic materials were reviewed in correlation with the pathologic features to identify the primary site. RESULTS: There were 74 cases of mucinous adenocarcinomas; 16 were primary ovarian; 52, metastatic; and 6 of indeterminate primary site (primary versus metastatic). Primary mucinous adenocarcinomas had a mean size of 16.4 cm and bilateral involvement in 13%. Metastatic mucinous adenocarcinomas had a mean size of 11.7 cm and bilateral involvement in 77%. Excluding the 6 tumors of indeterminate primary site, the proposed algorithm correctly classified primary and metastatic tumors in 84% of 68 cases. Of 21 unilateral mucinous adenocarcinomas > or =10 cm, 62% were primary ovarian. Of 5 unilateral tumors <10 cm, 80% were metastatic. Of 42 bilateral mucinous adenocarcinomas, 95% were metastatic. CONCLUSION: The algorithm provided high accuracy in the overall prediction of primary and metastatic mucinous adenocarcinomas of the ovary, with major strength in the identification of metastatic tumors by bilaterality or size <10 cm. However, the prediction of primary mucinous adenocarcinomas by unilaterality and size > or =10 cm was less reliable than previously reported. Due to the overlapping features between primary and metastatic tumors and the higher frequency of the latter, the possibility of metastases should always be borne in mind in the evaluation of mucinous adenocarcinomas of the ovary.     

Evaluation of an improved acid hydrolysis-HPLC assay for the acetyl content in chitin and chitosan

Functional properties of the amino polysaccharides, chitin and chitosan, vary significantly with their acetyl content. The acid hydrolysis-HPLC method offers good accuracy and precision to assay the acetyl content regardless of the solubility of the sample. In this research, the hydrolysis parameters were changed, and the analytical method was counterchecked with other methods. Complete hydrolysis was achieved by mixing chitosan with 1.4 mM oxalic acid and 12 M sulfuric acid followed by treatment at 110 degrees C for 40 min. A sealed glass ampule was used instead of a vacuum hydrolysis tube. The acetic acid released during acid hydrolysis was measured quantitatively by HPLC. A high correlation (r(2) = 0.98) was obtained between the modified HPLC assay and the solid-state (13)C CP/MAS NMR method for the samples of various crustacean sources with a wide range of acetyl contents. The modified HPLC method was also highly correlated (r(2) = 0.99) with the first derivative UV method for soluble chitosan.     

Open-labeled pilot study of cysteine-rich whey protein isolate supplementation for nonalcoholic steatohepatitis patients

Background and Aims:  Glutathione (GSH) depletion contributes to liver injury and development of steatohepatitis. Undenatured cysteine-rich whey protein isolate has been clinically proven to raise GSH in several patient groups. The aim of this study was to evaluate the effect of oral supplementation with whey protein on patients with nonalcoholic steatohepatitis (NASH).
Methods:  In an open-labeled clinical trial, 38 patients (18 male, 20 female; mean age 48 ± 14 years) with NASH confirmed by computed tomography measurements and liver biochemistries were given with a daily dose of 20 g whey protein isolate for 12 weeks.
Results:  A significant reduction in alanine aminotransferase (ALT) (64 ± 72 vs 46 ± 36, P  = 0.016) and aspartate aminotransferase (AST) (45 ± 49 vs 33 ± 18, P  = 0.047) were observed. Plasma glutathione and total antioxidant capacity increased significantly at the end of study (53 ± 11 vs 68 ± 11, P  < 0.05 and 1.26 ± 0.10 vs 2.03 ± 0.10, P  < 0.05). Liver attenuation index improved from −13.4 ± 11.1 to −9.7 ± 13.1 ( P  = 0.048). Hepatic macrovesicular steatosis decreased significantly after 12 weeks of supplementation (33.82 ± 12.82 vs 30.66 ± 15.96, P  = 0.046). Whey protein isolate was well tolerated. No serious adverse events were observed.
Conclusions:  The results indicate that oral supplementation of cysteine-rich whey protein isolate leads to improvements in liver biochemistries, increased plasma GSH, total antioxidant capacity and reduced hepatic macrovesicular steatosis in NASH patients. The results support the role of oxidative stress in the pathogenesis of this disease.