Biomedical subjects
Publications and source records attributed to A Dekker.
Disulfiram is used commonly as reinforcement in the treatment of chronic alcoholism. Although the drug is generally considered safe, there are reports of side effects including psychosis and hepatitis. We report a case of fatal fulminant hepatitis caused by the use of disulfiram in a man with previously normal hepatocellular function.
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1. Effects of corticotropin-(1--24)-tetracosapeptide on the endogenous phosphorylation of proteins and lipids were studied in a membrane/cytosol fraction prepared from a lysed crude mitochondrial/synaptosomal fraction. 2. The labelling of proteins and lipids was monitored by incubation of the subcellular fraction for 10s with [gamma-32P]ATP. 3. The phosphorylation of proteins was dose-dependently inhibited by the peptide (40% of control incubations at 100 microM-corticotropin). 4. Of the membrane phospholipids only phosphatidylinositol phosphate, phosphatidylinositol bisphosphate and phosphatidic acid became labelled. Corticotropin dose-dependently increased the formation of phosphatidylinositol bisphosphate and inhibited the production of phosphatidic acid (470% and 50% respectively of control incubations, at 100 microM of the peptide) and had no effect on phosphatidylinositol phosphate. 5. Phosphatase activity was observed to act on phosphatidylinositol bisphosphate, phosphatidylinositol phosphate and phosphoprotein but not on phosphatidic acid. 6. Corticotropin interacted with the kinases rather than with the phosphatases. 7. The formation of phosphatidylinositol bisphosphate and phosphatidic acid was maximal at 1--10mM-Mg2+ in the absence of Ca2+, and the production of phosphatidylinositol phosphate was maximal at 30mM-Mg2+. 8. The basal value of lipid phosphorylation decreased with increasing Ca2+ concentration. 9. Ca2+ abolished the effect of corticotropin on phosphatidylinositol bisphosphate formation (470%, 190% and 100% of control incubations at respectively 0, 0.1 and 1 mM-Ca2+). 10. The data provide evidence that the effects of corticotropin on protein phosphorylation and on polyphosphoinositide metabolism in brain membranes are related.
This is a report of a 22-year-old woman with treated anorexia nervosa who died of complications of acute gastric dilatation-that is, infarction and perforation with severe and irreversible shock. Binge eating and drinking, precipitated by emotional crises, contributed to her acute gastric dilatation. This complication of anorexia nervosa has been previously reported, but, unlike the others, this case ended fatally. The literature is reviewed.
A series of patients with fatal progressive systemic sclerosis was reviewed with regard to pathologic, clinical, and serologic evidence of thyroid disease. Histologic evidence of severe fibrosis of the thyroid gland was found significantly more frequently in 56 progressive systemic sclerosis cases (14%) compared to an age and sex matched control autopsy series (2%) from the same institution. Based on determination of serum free thyroxine, free triiodothyroxine (T3), thyroid stimulating hormone, and reverse T3, 27 patients were classified as euthyroid (11), euthyroid sick (9), and hypothyroid (7). Patients with hypothyroidism more frequently had subcutaneous calcinosis. Raynaud's phenomenon, esophageal hypomotility, sclerodactyly, and multiple telangiectasias (the CREST syndrome variant of progressive systemic sclerosis); all thyroid glands from the hypothyroid patients had fibrosis, but lymphocytic infiltration was an infrequent finding. Six hypothyroid patients had high titers of serum antithyroid antibodies, suggesting autoimmune thyroid disease. Thyroid gland fibrosis and hypothyroidism, possibly of autoimmune pathogenesis, are thus frequent and often unsuspected findings in progressive systemic sclerosis.
A 61-year-old man with a primary thyroid plasmacytoma was studied. Intracytoplasmic monoclonal immunoglobulin (IgG-kappa) was demonstrated in tissue sections, using the immunoperoxidase technique. After histologic diagnosis of plasmacytoma, serum immunoelectrophoresis revealed a monoclonal component (IgG-kappa). Roentgenographic skeletal survey and bone marrow examination gave normal results. The patient received postoperative therapy with radiation and drugs. As of this writing, he is alive 20 months after diagnosis, without evidence of tumor.
A patient with hepatitis B induced chronic active hepatitis and cirrhosis had hepatocellular carcinoma and poorly differentiated lymphocytic malignant lymphoma localized in the liver. Whereas a close relationship between hepatitis B viral infection, chronic active hepatitis, macronodular cirrhosis, and hepatocellular carcinoma is now recognized, no such association has been reported with primary hepatic malignant lymphoma, which is a distinctly rare entity. In a large autopsy population that we reviewed systemic malignant lymphoma rarely occurred in association with cirrhosis. Such an association has been noted in other studies, however. We speculate half if an association exists between malignant lymphoma and cirrhosis it might have an immunologic basis such as seen in certain autoimmune diseases.
A series of 108 prospectively collected human pancreata were evaluated histologically for the presence of acinar cell and ductal lesions. Foci of dysplastic acinar cells were present in 44% of the series. Some of the focal acinar cell abnormalities were similar to atypical acinar cell nodules which have been described in carcinogen-treated experimental animals. The incidence of nodules was higher among patients with a history of heavy cigarette smoking than among nonsmokers, and among patients with a history of alcohol abuse than among abstainers. The presence of dysplastic acinar cell nodules in a pancreas seemed unrelated to the presence of cancer in other sites, or diabetes. Ductal epithelial abnormalities were more frequent than focal acinar cell dysplasia.
In a series of 28 patients with solitary solid thyroid masses, 10 of the patients had a mass surrounded by a rim of decreased echoes or by an echo-free rim, previously termed the halo sign. Eight of these lesions were benign, being either adenomas or benign nodules; however, two halos were also demonstrated surrounding proven carcinomas. The presence of the halo in both benign and malignant disease is illustrated, and the possibility of pericapsular inflammatory infiltrate as its underlying anatomic correlate is suggested.
In three patients we used B-scan ultrasonography to guide the placement of an aspirating needle, which allowed rapid and accurate cytologic diagnosis of retrobulbar orbital neoplasms. This technique spares the patient the greater costs, inconvenience, and morbidity of more invasive procedures.
Biopsies were done for seven patients who had blinding optic nerve tumors or inflammations, using the fine needle aspiration technique guided by the CT scan. Cytologic material was recovered in this manner in all cases, which allowed the rendering of diagnoses. This allowed for therapeutic planning with minimal therapeutic invasion.
The initial development of algorithms for the analysis of multicolor multicellular images of liver tissue sections is described. Using a three-color image recorded by an automated light microscope, a sequence of cellular logic operators was applied to the task of differentiating between hepatocyte and leukocyte nuclei in a section taking advantage of both spatial and chromatic features, namely, that hepatocyte nuclei usually appear larger than those of leukocytes and, in red illumination, are likely to be more transparent. Optimally, the developed algorithms properly differentiated 90% of the hepatocyte nuclie and 85% of the leukocyte nuclie; this performance level appears to equal that of a microscopist. The microscopist, however, rarely analyses all cells; thus, computer differentiation of cells eventually may provide an important new dimension to clinical histopathology.
Fifteen orbital tumors have been evaluated with the fine-needle aspiration biopsy (FNAB) technique. The best indication for FNAB is supposed malignant orbital disease. The technique has not been helpful in tumors or inflammatory disease with a high fibrous content. Lesions that are suspected of being pseudotumors are not recommended for FNAB since, even in histologic sections, they are notoriously difficult to distinguish from well-differentiated lymphocytic malignant lymphoma. Benign encapsulated tumors should not be subjected to FNAB.
Cytological verification of the angiographic, sonographic, and/or intraoperative diagnosis of pancreatic or ampullary carcinoma may be achieved by fine-needle aspiration biopsy (FNAB). Fifteen biopsies were done in 13 patients, 12 of whom were thought to have pancreatic carcinoma clinically. The FNAB specimen confirmed this in 11 of them. Also, one equivocal (suspicious), two false-negative, and no false-positive results were recorded. Complications were not seen. In addition, four patients with ampullary carcinoma had pancreatoduodenectomy on the basis of FNAB specimens. Since this method is more accurate and is safer and simpler than the traditional wedge or core biopsy of suspected pancreatic or ampullary tumors, and since it may eliminate the need for laparotomy in selected cases, we consider it the preferred method for immediate diagnosis of these neoplasms.
Cells isolated from human serous effusions were cultured in vitro. Monolayers of large multipolar cells were established. Antisera to the cultured cells were prepared in rabbits and rats. The antisera were absorbed with human red cells, liver powder and MOLT-4F cell line lymphocytes. Specificity of the absorbed antisera for human mesothelial cells were demonstrated in an indirect immunofluorescence assay. The antisera were used to confirm the diagnosis of mesothelioma in two cases. In both the patients, the morphologically identifiable malignant cell populations in the effusions stained positively with the antimesothelial cell serum thus establishing their mesothelial origin. Normal nonmesothelial tissue and known nonmesothelial tumors failed to react with the antisera thus confirming the specificity of the antisera.
Traditionally half of the cell population of the adult parathyroid gland is considered to be stromal fat. A marked decrease of stromal fat has been observed at autopsy of adult patients, the functional significance of which is unknown. In order to investigate this phenomenon, the stromal and parenchymal fat of the parathyroid glands of 33 adult patients who died with no known hormonal abnormalities were evaluated. Stromal fat was much less than 50 per cent, i.e., less than 10 per cent., in the majority of cases, while parenchymal fat was ample in all cases. This finding, especially if compared to cases with hyperparathyroidism, indicates the lack of functional specificity of change in stromal fat, whereas, alteration in parenchymal fat appears to be a better anatomical register of normal or abnormal parathyroid function.