Our patient, an 83-year-old man, suddenly experienced acute lumbago and was prescribed bed rest. Later, pneumonia was diagnosed, even though he had no predisposing illness, and endophthalmitis developed in both eyes. Cultures of anterior chamber and vitreous specimens were positive for group B streptococcus. Treatment with systemic antibiotics, to which this bacteria is sensitive, was begun and his condition gradually improved. Nevertheless, the patient became blind in his right eye and the eye was enucleated. Histopathologic examination showed metastatic endophthalmitis with retinal detachment. Multiple microabscesses were found in the thickened choroid. We speculated that organisms disseminating from the microabscesses had caused the metastatic endophthalmitis.

Aged↗

PubMedDate not supplied

Obturator hernia: the usefulness of emergent computed tomography for early diagnosis.

The diagnosis of obturator hernia is difficult, and delayed treatment is associated with serious complications. Recently, computed tomography (CT) has been used successfully for establishing a correct diagnosis. We encountered nine cases of obturator hernia from 1988 to 1997. All the patients were elderly women. In six of them, a correct diagnosis was established by emergent CT scan. In two of the remaining cases, diagnosis could not be established because of unavailability of CT, and the other patient was diagnosed correctly based on clinical features, including a positive Howship-Romberg sign. Surgical repair was performed successfully. One patient died postoperatively because of septicemia associated with anastomotic leakage. Our cases indicate that emergent CT scan is useful for the diagnosis of obturator hernia, particularly in elderly patients presenting with ileus of unknown origin.

Aged↗

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Iatrogenic superior mesenteric arteriovenous fistula: ultrasonographic, CT and angiographic features and histological findings of the liver biopsy.

Iatrogenic superior mesenteric arteriovenous fistula is rare. We treated a patient with this problem 6 years after small bowel resection for intestinal obstruction. The symptoms and signs were those of intestinal ischaemia and portal hypertension with an abdominal bruit. Ultrasonography and enhanced computerized tomography of the abdomen suggested the presence of superior mesenteric arteriovenous fistula, with a dilated portal vein and a communication between the dilated superior mesenteric vein and its artery. The exact location of the fistula was then determined by selective superior mesenteric arteriography. The fistula was ligated in an emergency operation to prevent cardiac or renal failure and to relieve portal hypertension. Liver biopsy showed no cirrhotic changes, but fibrosis was seen around the portal veins. We describe here not only the diagnostic arteriographic findings of superior mesenteric arteriovenous fistula, but also the interesting and suggestive ultrasonographic and computed tomographic findings. Early correction of such fistulas is recommended to prevent cardiac or liver failure.

Adult↗

PubMedDate not supplied

Regurgitation of bile acids in rat liver under bile drainage: quantitative analysis by taurine or ursodeoxycholate loading test.

In rats with an interrupted enterohepatic circulation of bile acids, levels of serum taurine-conjugated bile acids were increased significantly 3 h after intravenous administration of taurine. Similarly, serum taurine- or glycine-conjugated ursodeoxycholic acid (UDCA) was increased significantly 2 h after UDCA administration. These findings suggested that the administered taurine or UDCA was taken up into hepatocytes and utilized to form conjugated bile acids, which were thereafter regurgitated into the systemic circulation from the liver. The proportion of regurgitated taurine-conjugated bile acids relative to total serum bile acids measured by taurine loading (30%) almost coincided with that of regurgitated taurine- or glycine-conjugated UDCA relative to total serum bile acids measured by UDCA loading (31.6%). Thus, the present study showed conclusively that at least 30% of serum bile acids are derived from newly conjugated bile acids that are regurgitated from the liver in rats with bile fistula.

Animals↗

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Effects of colchicine on the synthesis and transport of albumin: a combined electron cytochemical and autoradiographic study.

We investigated the intracellular transport of albumin in the livers of rats treated with colchicine using immunoperoxidase study as well as combined immunoelectron microscopy and autoradiography with [3H]-leucine. Immunoreaction of albumin was observed in all hepatocytes. Its subcellular location was in the rough endoplasmic reticulum, Golgi apparatus and lysosomes. After the injection of [3H]-leucine through the portal vein, a combined technique revealed accumulated grains on the albumin-positive Golgi apparatus or the albumin-positive vesicles in the vicinity of the Golgi apparatus. These findings suggest that albumin transport from the Golgi apparatus to sinusoids is disturbed by colchicine. Enzyme histochemistry showed many acid phosphatase-positive lysosomes in hepatocytes of the liver treated with colchicine. Albumin retained in the vicinity of the Golgi apparatus may be digested by lysosomes. An in situ hybridization study with isotopes revealed the presence of silver grains for albumin mRNA in all hepatocytes of livers treated or untreated with colchicine; there was no significant difference in the number of silver grains in the two groups. Therefore, colchicine has very little effect on albumin synthesis in the liver.

Albumins↗

PubMedDate not supplied

Mixed medullary and follicular carcinoma of the thyroid: report of two cases with an immunohistochemical study.

Two cases of mixed medullary and follicular carcinoma of the thyroid (MFC) and two cases of thyroid carcinoma resembling MFC are reported with a description of their histological and immunohistochemical features. Two cases of MFC with lymph node metastasis were histologically distinguishable from each other because one had a follicular structure filled with a thyroglobulin (TG)-positive colloid-like substance and the other did not have it. Although one of the thyroid carcinomas resembling MFC was similar to the case of MFC with a follicular structure in its primary lesion, it showed no lymph node metastasis. The metastatic lesion of the thyroid carcinoma resembling MFC consisted of TG-positive cells and neighboring calcitonin (CT)-positive cells. However the primary lesion exhibited the typical features of papillary carcinoma except for the presence of a small lesion which stained negatively for both TG and CT. The two types of tumor were not intermingled in a single tumor. These cases of thyroid carcinoma resembling MFC have a possibility of being MFC. However they should not be classified as MFC because lymph node metastasis or the coexistence of medullary carcinoma and follicular carcinoma in their primary lesion was not proved.

Adenocarcinoma↗

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Complete response to docetaxel and carboplatin combination chemotherapy for a stage IV uterine papillary serous carcinoma: a case report.

We report a case of a stage IV uterine papillary serous carcinoma (UPSC) with multiple organ metastases. The patient was treated with docetaxel and carboplatin combination chemotherapy. After five courses, uterine tumor, Douglas tumor, lymphadenopathy, and distant metastases on magnetic resonance imaging or computed tomography scan were completely resoluted. Moreover, endometrial biopsy showed no carcinoma tissues after six courses. We suggest that this regimen may be effective for treatment of advanced-stage UPSC.

Adult↗

PubMedDate not supplied

Placental site trophoblastic tumor presenting as subaponeurotic metastasis.

Cases of metastatic placental site trophoblastic tumor (PSTT) have a very poor prognosis because these tumors tend to be less sensitive to chemotherapy than other types of gestational trophoblastic disease. We describe the case of a 25-year-old woman who presented with occipital tumor and abnormal vaginal bleeding. Hysterectomy, bilateral salpingo-oophorectomy, and occipital tumor removal revealed a primary PSTT in the uterus, with ovarian and occipital subaponeurotic metastases. She received etoposide, methotrexate, actinomycin-D/cyclophosphamide, vincristine chemotherapy and had a complete clinical remission. Fifteen months later, she had a recurrent subaponeurotic occipital tumor invading the cranium and underwent tumor removal along with cranial bone followed by local irradiation. She was then treated with etoposide, cis-platinum/etoposide, methotrexate, actinomycin-D chemotherapy and again had a remission for 5 months. The patient, however, had a left parietal subaponeurotic tumor, invading the dura mater, and received local irradiation. Soon after, she developed left orbital bone metastasis, treated by local irradiation. These bone metastases responded to the radiation completely. However, multiple organ metastases were found, and she died of the disease. This represents the first case of PSTT with initial subaponeurotic metastasis in a living patient. New modalities of treatment for high-risk or metastatic PSTT need to be developed.

Adult↗

PubMedDate not supplied

MR imaging of non-CNS fetal abnormalities: a pictorial essay.

The recent popularity of prenatal magnetic resonance (MR) imaging has been associated with the development of ultrafast MR imaging techniques such as the single-shot fast spin-echo sequence. However, the majority of previous reports have concerned the fetal central nervous system (CNS) and chest disorders. MR imaging can demonstrate non-CNS fetal anatomy and pathologic conditions clearly. With its excellent tissue contrast, MR imaging provides information that supplements that provided by ultrasonography (US), especially in cases of neck, chest, and gastrointestinal lesions. Because of its large field of view, MR imaging allows evaluation of the relationship between a large lesion and adjacent structures. MR imaging should be considered if the diagnosis of a suspected non-CNS lesion is unclear at fetal US. MR imaging plays an important complementary role to US in cases of non-CNS fetal lesions and will be further accepted for fetal imaging in the future.

Abdomen↗

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Blink reflex excitability recovery curves in patients with dysfunctions after facial nerve palsy.

The blink reflex excitability recovery curves were studied in 12 patients with postparalytic facial dysfunctions (PPFD) and 12 healthy control subjects. The inhibitory effects of the conditioning stimuli on the ipsilateral R2 and contralateral R2 responses observed in control subjects were significantly less in patients with PPFD. The enhanced recovery of the R2 responses was similar on the affected side and unaffected side in the patients. These results indicate that patients with PPFD have an increased excitability of central interneurons which mediate the R2 pathway. It is suggested that not only changes in the peripheral facial nerve but also changes in the central nervous system may contribute to the onset of PPFD.

Adult↗

PubMedDate not supplied

Cytologic features of solid and cystic tumor of the pancreas.

OBJECTIVE: To describe the cytologic features of solid and cystic tumor of the pancreas. STUDY DESIGN: Cytologic features of four cases of solid and cystic tumor of the pancreas (SCT) were reported and compared with those of three cases of islet cell tumor of the pancreas. RESULTS: Aspiration and imprint cytology of the tumor cells obtained from three cases of SCT showed papillary structures or rosette formations in part and demonstrated uniformly round to oval nuclei that contained finely granular chromatin, a fairly distinct nucleolus and a scant to moderate amount of granular or vesicular cytoplasm. Another case of SCT consisted of multinucleated giant cells with coherent chromatin as well as mononuclear cells with nuclear grooves. Islet cell tumor consisted mainly of clustered or isolated uniform mononuclear cells with rosette formations but without a papillary structure and occasional multinucleated giant cells in all cases. The nuclei of islet cell tumors had peculiar, fine chromatin aggregates with a "salt-and-pepper" appearance and slightly enlarged nucleoli. CONCLUSION: SCT is cytologically distinguishable from islet cell tumor in spite of having many cytologic features in common with it.

Adenoma, Islet Cell↗

PubMedDate not supplied

Rhabdomyosarcoma of the urachus. A case report.

BACKGROUND: Rhabdomyosarcoma of the urachus is extremely rare, and only two cases have been reported. Cytologic, histologic, immunochemical and electron microscopic findings in embryonal rhabdomyosarcoma of the urachus are presented. CASE: Embryonal rhabdomyosarcoma of the urachus developed in a 2-year-old boy. Imprint smears prepared prior to a histologic examination for a rapid report contained many malignant cells isolated or in clusters in a myxoid background. They were uniformly small, with round to oval nuclei and scant cytoplasm, and immunohistochemically positive for desmin and alpha-sarcomeric muscle actin but negative for myoglobin. This tumor was diagnosed cytologically as embryonal rhabdomyosarcoma because of its skeletal muscle origin and because of its similarity to one of the so-called small round cell tumors of childhood. Histologic examination confirmed the cytologic diagnosis. CONCLUSION: Cytologic, histologic and electron microscopic findings were identical to those described previously for embryonal rhabdomyosarcoma at other sites. In immunochemical examinations, cytologic samples fixed in ethanol are more useful than histologic ones fixed in formalin. Then, in order to differentiate poorly differentiated rhabdomyosarcoma from other small round cell tumors in children, desmin and alpha-sarcomeric actin, rather than myoglobin, are recommended.

Actins↗