Iron overload manifesting as apparent exacerbation of hepatic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation.

Iron overload presenting as exacerbation of hepatic graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation has not been previously described. We report 6 patients with established hepatic GVHD in whom iron overload (median serum ferritin, 7231 mug/dL; median transferrin saturation, 77%) resulting from a lifetime median of 20 units of packed red blood cell transfusions was manifested by worsening of liver function. Liver biopsies performed in 4 patients confirmed severe iron overload and also hepatic GVHD. Analysis for the C282Y and H63D hemochromatosis gene mutation was negative for the homozygous state in all 6 patients. Erythropoietin-assisted phlebotomy resulted in normalization of liver function at a median of 7 months and of serum ferritin at a median of 11 months. Immunosuppressive therapy was successfully tapered in all 4 patients who completed the phlebotomy program, and this supported the impression that iron overload, rather than GVHD, was the principal cause of liver dysfunction. At a median follow-up of 50 months (range, 18-76 months) from the transplantation and 25 months (range, 5-36 months) from ferritin normalization, all 4 patients require maintenance phlebotomy. We conclude that iron overload can mimic GVHD exacerbation, thus resulting in unnecessary continuation or intensification of immunosuppressive therapy for GVHD, and that maintenance phlebotomy is necessary after successful iron-reduction therapy.     

Adrenergic signalling between rat taste receptor cells

In taste buds, synaptic transmission is traditionally thought to occur from taste receptor cells to the afferent nerve. This communication reports the novel observation that taste receptor cells respond to adrenergic stimulation. Noradrenaline application inhibited outward potassium currents in a dose-dependent manner. This inhibition was mimicked by the β agonist isoproterenol and blocked by the β antagonist propranolol. The α agonists clonidine and phenylephrine both inhibited the potassium currents and elevated intracellular calcium levels. Inwardly rectifying potassium currents were unaffected by adrenergic stimulation. Experiments using the RT-PCR technique demonstrate that lingual epithelium expresses multiple α (α1a, α1b, α1c, α1d, α2a, α2b, α2c) and β (β1, β2) subtypes of adrenergic receptors, and immunocytochemistry localized noradrenaline to a subset of taste receptor cells. Collectively, these data imply strongly that adrenergic transmission within the taste bud may play a paracrine role in taste physiology.     

The vascular anatomy of the lumbrical muscles in the hand.

The lumbrical muscles are located in the midpalm, dorsal to the palmar aponeurosis. The main function of these muscles is an indirect contribution to interphalangeal joint extension by decreasing the flexor effect of the flexor digitorum profundus muscle. Due to their minor biomechanical functions and suitable constructions, these muscles have been preferred in reconstructive surgery as local transposition flaps or pedicled flaps. Despite the surgical and clinical importance, vascular anatomical studies of these muscles are not well represented in the current literature. This study was performed in the Department of Anatomy of the Faculty of Medicine of the Ege University. Thirty-four cadaver hands, injected with red-coloured latex were used, and we aimed to describe the morphometry and vascular anatomy of the lumbrical muscles. We measured the length and width of the muscles, after removing their epimisium, and the diameter and length of the arteries to the muscles. The outcomes of our study determined that the length and width of the lumbrical muscles were reduced significantly from radial towards ulnar sides. The lumbrical muscles were supplied from both their palmar and dorsal surfaces by both superficial and deep palmar arches and/or their branches. We also described the level of entry of the dominant arteries for each lumbrical muscle and measured the size of the vessels and muscles to guide some surgical approaches. This anatomical study could guide for some surgical approaches and reduce the deficiency about the vascular anatomical patterns of the lumbrical muscles in the literature.     

Multiple primary malignant neoplasms in urologic patients

Methods: Second primary cancers constitute approximately 9–10% of malignancies diagnosed in the United States. We aimed to show the risk and incidance of second primary tumor occuring associated to urologic tumors and show the distrubution of tumors in Tracia region. We retrospectively examined the patients' files with the diagnosis of malignant disease between the years 1985–2000. Hazard function analysis was performed to estimate the relative risk of secondary malignancy occuring. Age, sex and tumor number were examined to find out if they affect on mortality rate. Results: A total number of 25 MPMNs were diagnosed. In 52 percent of the cases the second primary neoplasm developed within six months. The relative risk of development of a second neoplasm is found as increasing 1.111 times per month. The incidence of secondary malignancy occuring in the patients with one tumor was found as 6.31%. Age (p < 0.001) and tumor number (p < 0.001) are found as statistically effective predictor on mortality rate where the sex is not. Conclusions: In the patients with a primary tumor not only the metastasis must be investigated but also second primary tumors should be taken in to consideration. This revised version was published online in August 2006 with corrections to the Cover Date.     

Effect of pentoxifylline on veno-occlusive priapism-induced corporeal tissule lipid peroxidation in a rat model

Objective: To investigate whether pentoxifylline could play a role in attenuation of the hazardous effects of ischemia/reperfusion on corporeal tissue in a rat model of veno-occlusive priapism (VOP). Materials and methods: Placebo and pentoxifylline were given to eight groups of rats prior to priapism being induced by a vacuum constrictive device for durations of 6 and 12 h, respectively. Half of the groups of rats that underwent the same duration of priapism (ischemic) were subjected to 1 h of detumescence after band removal (reperfusion). One group underwent no manipulation and no drug administration and served as a baseline determination (control). Corporeal homogenates were examined for lipid peroxidation (LP) derived malondialdehyde (MDA) accumulation via thiobarbituric acid assay. Results: MDA concentration differed significantly between VOP rats and controls (P < 0.001) but did not differ significantly between ischemic-only groups and reperfused groups (P > 0.05). In the pentoxifyllinepretreated groups, although MDA accumulation tended to be slightly lower than in the placebo groups, the difference was not statistically significant (P > 0.05) either in the 6- or 12-h duration priapic groups. Conclusions: LP, an indicator of radical oxygen metabolite (ROM) induced injury, occurs in rat corporeal tissue during and after abolishment of VOP. Single-dose pentoxifylline pretreatment failed to exert a protective effect on corporeal tissue in a rat model of VOP in terms of attenuation of LP.     

The Value of Lung Injury Score in Assessing the Outcome of Patients with Rib Fracture

Background and Purpose:   

Management of rib fractures constitutes a major part of the trauma workload of any unit. Rib fractures result in disrupted chest wall mechanics and ventilatory insufficiency. The ability of a lung injury scoring system to predict the degree of respiratory dysfunction after rib fractures was evaluated.     

Therapy of primary fallopian tube cancer--a retrospective study of 30 cases]

Between the years 1968-1988 30 patients with primary carcinoma of the fallopian tube were treated in the Department of Obstetrics and Gynecology of the University of Kiel. In 27 cases the initial treatment consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy. In 3 cases where the patients had undergone surgical treatment in another hospital a second operation for completion was performed. 2 patients received no further treatment after surgery. Postoperative radiotherapy was given to 20 patients and a combined treatment with radiation and polychemotherapy was implemented in 5 cases. Postoperative treatment in 3 patients was poly-chemotherapy alone. The 5-year-survival rate taking all tumor stages and modes of therapy employed into consideration was 36.7%. In analysing the survival rate for small numbers as directly related to postoperative treatment a 5-year-survival rate for radiotherapy of 35% (7/20) and for radiation therapy plus poly-chemotherapy of 40% (2/5) was found. After operative treatment followed by poly-chemotherapy alone one of three patients survived after 5 years.