Definitive treatment for persistent hypoparathyroidism in a kidney transplant patient: parathyroid allotransplantation

Post-surgical hypocalcemia is usually a transitory complication in thyroid and parathyroid surgery that can be resolved quickly, although it becomes a delicate matter when the problem persists. Parathyroid transplantation is the choice of treatment; however, the associated immunosuppression can cause side effects. The following case study shows the transplantation of parathyroid tissue from a patient with secondary hyperparathyroidism to another kidney transplant patient with severe hypocalcemia that was medically intractable. The graft is functioning after 2 years.

Recognizing the clinical features of Trisomy 13 syndrome

Recognition of the clinical features of Trisomy 13 syndrome, a common autosomal trisomy, provides the basis for diagnostic testing and counseling of families. This article provides a systematic guide to physical assessment and photographs to enhance recognition of this genetic disorder. The principles of numerical chromosomal abnormalities as related to trisomies are reviewed. An abnormal development of the forebrain, holoprosencephaly, is the most common cranial abnormality in infants with Trisomy 13. The embryology and implications of holoprosencephaly are described. A discussion of antenatal diagnosis of Trisomy 13 and delivery room management is also provided. The diagnosis of Trisomy 13 is confirmed antenatally or after delivery with genetic testing. Prognosis of infants with Trisomy 13 and implications for the infants development are described.

Primitive leiomyosarcoma of the breast: case report and review of the literature

Sarcomas of the breast account for under 1% of breast tumours. Leiomyosarcomas are less common, being a subgroup of sarcomas of the breast. Only 23 cases with immunohistochemical or electron microscopy confirmation are reported in the literature. The case of a 58-year-old woman with a leiomyosarcoma 4 cm in diameter in the upper external quadrant of the right breast is presented. Mammography and sonography were compatible with a fibroadenoma or phylloides tumour, and fine-needle aspiration (FNA) suggested medullary carcinoma. The patient underwent a Madden-type modified radical mastectomy and axillary lymphadenectomy. Adjuvant chemotherapy was implemented with Adriamycin (four cycles of 21 days). One year after surgery the patient is tumour free.

Development of a new method for the determination of nitrosamines by micellar electrokinetic capillary chromatography

A new method was developed for separation and quantification of nitrosamines by micellar electrokinetic capillary chromatography (MEKC). The effects of composition of the buffer, concentration of sodium dodecyl sulfate (SDS), gamma-cyclodextrin (CD) and pH on the separation and migration times of the nitrosamines were investigated. The different instrumental variables affecting sensitivity and resolution, such as power supply, injection mode and wavelength for measurement, were carefully optimized. The direct application of this method to aqueous synthetic samples allowed the separation and determination of nitrosamine mixtures at the mg x L(-1) level. The calibration curves revealed a linear range between 0.25 and 10 mg x L(-1), with detection limit (DL) varying from 0.16 to 0.27 mg x L(-1), quantification limit (QL) varying from 0.52 to 0.90 mg x L(-1), and RSD relative standard deviation (RSD) from 4.5% to 8.5%. The proposed method was successfully applied to the determination of dimethylnitrosamine (DMN), diethylnitrosamine (DEN), N-nitrosopyrrolidine (NPYR), N-nitrosomorpholine (NMOR) and N-nitrosopiperidine (NPIP).

Does the standard vs piggyback surgical technique affect the development of early acute renal failure after orthotopic liver transplantation?

The objective of this study was to evaluate the effect of the surgical technique on postoperative renal function during the first week after liver transplantation (OLT). We performed a retrospective study of 184 consecutive OLT. Criteria for acute renal failure were: serum creatinine >1.5 mg/dL, an increase by 50% in the baseline serum creatinine, or oliguria requiring renal replacement therapy. The distribution of patients according to the surgical technique was: standard (n=84), venovenous bypass (n=20), and piggyback (n=80). Other variables analyzed were: intraoperative requirement for blood products, treatment with adrenergic agonists, intraoperative complications, and postreperfusion syndrome. Univariate analysis showed the following parameters to be significantly related to postoperative renal failure: intraoperative fresh frozen plasma and cryoprecipitate requirements, intraoperative complications, postreperfusion syndrome, need for noradrenaline or dobutamine, standard surgical technique versus piggyback (39% vs 18%, P<.01) and venovenous vs piggyback (50% vs 18%, P<.01). Logistic regression analysis identified the following variables as having independent prognostic value: (1) Standard surgical technique vs piggyback (OR=3.3, P=.01); (2) venovenous vs piggyback (OR=4.7, P=.02); and (3) >20 U cryoprecipitate requirement (OR=1.04, P=.01). In conclusion, compared with the piggyback technique, the standard surgical technique appears to be an independent risk factor for postoperative acute renal failure. When venovenous bypass is used in patients who do not tolerate trial clamping of inferior vena cava, it does not reduce the incidence of postoperative renal failure. Finally, the piggyback technique significantly reduces the probability of acute renal failure after liver transplantation.

Determination of nitrosamines in preserved sausages by solid-phase extraction-micellar electrokinetic chromatography

A new methodology for extraction, pre-concentration and analysis of nitrosamines in meat derived products was developed. The samples (canned sausages) were distilled in vacuum steam and the nitrosamines were pre-concentrated by solid-phase extraction with active carbon. Then, micellar electrokinetic chromatography was used for the separation and determination of the different nitrosamines contained in a real sample and gas chromatography with mass spectrometry detection was used as the confirmation technique. The method allowed the determination of nitrosamine compounds at trace levels with relative standard deviation ranging from 4.0 to 22%.

A method for screening total mercury in water using a flow injection system with piezoelectric detection

An automatic microgravimetric screening system based on piezoelectric detection and the use of acidic stannous chloride as reductant was developed for the fast detection and determination of total mercury in water. Reduced mercury is detected as an amalgam by using a gold-coated piezoelectric crystal, the sensor subsequently being regenerated by passing it through a peroxydisulfate solution. The gold-coated piezoelectric crystal is a highly efficient retention unit for the main soluble mercury species (inorganic, complexed, and organometallic) previously reduced to elemental mercury and is free of interferences from other metal ions. This detector exhibits good sensitivity: it allows the determination of mercury at sub-parts-per-billion concentration levels (0.30-1.00 microg/L). The precision, expressed as relative standard deviation, was +/- 2.7% (n = 11; P = 0.05) at 0.5 microg/L total mercury. The proposed method was successfully used as a rapid screening method for mercury monitoring in natural waters.

Respiratory mechanics in very low birth weight infants during continuous versus intermittent gavage feeds

This study was designed to determine whether respiratory mechanics in stable, very low birth weight infants changed after replacing intermittent feeds with continuous feeding. We measured static respiratory system compliance, respiratory system resistance, functional residual capacity (FRC), and tidal volume immediately before feeds and at 20, 60, and 120 min after feeds, and again the next day on continuous feeds. Patients selected for enrollment into the study needed to fulfill the following criteria: 1) birth weight and postnatal weight < 1,500 g, 2) no need for mechanical ventilation, positive airway pressure, or supplemental oxygen, 3) receiving and tolerating at least 100 mL/kg/day of intermittent gavage feeds, and 4) no change in methylxanthine or diuretic dosage for 3 days before the study. Respiratory mechanics were measured using the SensorMedics 2600 Pediatric Pulmonary Cart (Yorba Linda, CA). We studied 16 infants (gestational age 28.3 +/- 3.7 weeks, mean +/- SD) at a postnatal age of 10-82 days. The average interindividual coefficient of variance was 20 +/- 2% for static compliance, 35 +/- 6% for resistance, 18 +/- 3% for FRC, and 19 +/- 3% for tidal volume. Repeated-measures analysis of variance did not reveal any significant difference in respiratory mechanics with intermittent vs. continuous feeding. The data suggest that static respiratory mechanics in stable, very low birth weight infants are not affected by changing enteral feeds from intermittent gavage to a continuous schedule.

Intracranial metastases from an ovarian dysgerminoma in a 2-year-old dog

A 2-year-old, intact female rottweiler was presented for signs of lethargy. A mass was ultrasonographically observed, cranial and lateral to the left kidney. Exploratory laparotomy revealed a mass in the left ovary that was diagnosed histopathologically as an ovarian dysgerminoma. Two weeks after surgery, the dog was readmitted with signs of peripheral vestibular disease that progressed to central vestibular disease. Magnetic resonance imaging of the brain revealed the presence of a mass in the caudal fossa. The histopathological diagnosis of the mass was metastases from the ovarian dysgerminoma.

Factors that affect recurrence after incisional herniorrhaphy with prosthetic material

OBJECTIVE

To evaluate the risk factors for recurrence after prosthetic incisional herniorrhaphy.

DESIGN

Retrospective study.

SETTING

Tertiary referral centre, Spain.

PATIENTS

246 patients who had incisional herniorrhaphy with a prosthetic material (polypropylene) between 1990 and 1997

INTERVENTIONS

A reinforcement mesh was inserted when the hernia was more than 5 cm. In incisional hernias less than 5 cm the reinforcement mesh was inserted when the repair was under tension or when tissues were noted to be weak during the operation.

MAIN OUTCOME MEASURES

Age, sex, obesity, the presence of bronchial disease, previous repair of the incisional hernia, type of surgery, size and site of hernia and presence of local complications during the immediate postoperative period.

RESULTS

Mean (SD) follow-up was 77 (6) months (minimum follow up two years). The hernia recurred in 43 cases (17%) (mean time of recurrence 10 (8) months). Age over 60 years, previous herniorrhaphy, size of hernia, and postoperative local complications were significant risk factors (p < 0.01) in both the univariate and multivariate analyses.

CONCLUSIONS

Patients at the greater risk of recurrence are those aged over 60 years, with large, recurrent hernias and who develop local complications during the postoperative period.

Presenilin-1-associated abnormalities in regional cerebral perfusion

OBJECTIVE

To investigate the influence of the presenilin-1 gene (PS-1) mutation on regional cerebral perfusion, SPECT was evaluated in 57 individuals. The subjects were members of a large pedigree from Colombia, South America, many of whom carry a PS-1 mutation for early-onset AD.

METHODS

Members of this large kindred who were cognitively normal and did not carry the PS-1 mutation (n = 23) were compared with subjects who were carriers of the mutation but were asymptomatic (n = 18) and with individuals with the mutation and a clinical diagnosis of AD (n = 16). Cerebral perfusion was measured in each subject using hexamethylpropyleneamine oxime SPECT. The data were analyzed in two ways: 1) Mean cerebral perfusion in each of 4320 voxels in the brain was compared among the groups using t-tests (t-maps); and 2) each individual received a weighted score on 20 vectors (factors), based on a large normative sample (n = 200), using a method known as singular value decomposition (SVD).

RESULTS

Based on t-maps, subjects with the PS-1 mutation who were asymptomatic demonstrated reduced perfusion in comparison with the normal control subjects in the hippocampal complex, anterior and posterior cingulate, posterior parietal lobe, and anterior frontal lobe. The AD patients demonstrated decreased perfusion in the posterior parietal and superior frontal cortex in comparison with the normal control subjects. Discriminant function analysis of the vector scores derived from SVD (adjusted for age and gender) accurately discriminated 86% of the subjects in the three groups (p < 0.0005).

CONCLUSION

Regional cerebral perfusion abnormalities based on SPECT are detectable before development of the clinical symptoms of AD in carriers of the PS-1 mutation.

Recurrent papillary thyroid cancer: analysis of prognostic factors including the histological variant

OBJECTIVE

To analyse the factors that influence the development of recurrent papillary thyroid carcinoma, including the histological variant.

DESIGN

Retrospective study.

SETTING

Teaching hospital, Spain.

SUBJECTS

200 patients who had papillary thyroid cancers resected between 1970 and 1995.

MAIN OUTCOME MEASURES

Prognostic factors and disease-free interval assessed by univariate and multivariate analysis.

RESULTS

All patients were followed up for a mean of 9 years (range 4-29). 54 patients presented with recurrent disease (27%) of whom 19 (35%) died of their disease. 5-year, 10-year, and 15-year survival for those with recurrent disease were 75%, 68%, and 60%, respectively. The corresponding figures for the whole series were 93%, 90%, and 84%. The significant variables on multivariate analysis were completeness of resection (p = 0.002), extrathyroid involvement (p < 0.002), presence of lymph node metastases (p = 0.002), and histological variant of the carcinoma (P < 0.001).

CONCLUSION

Using these risk factors it is possible to draw up a prognostic index and classify patients as being at low, medium, or high risk of recurrence.

Entamoeba histolytica: monoclonal antibody against the beta1 integrin-like molecule (140 kDa) inhibits cell adhesion to extracellular matrix components

We describe a monoclonal antibody (3C10) against the beta1 integrin-like molecule which immunoprecipitates two polypeptides of 140 and 155 kDa from detergent-soluble extract of Entamoeba histolytica. The 140-kDa polypeptide has been described as a beta subunit of the amoebic fibronectin receptor as it is recognized by an anti-integrin beta1 (human) monoclonal antibody in immunoblot assay. The receptor molecules were localized with the 3C10 monoclonal antibody in intracellular and surface membranes of E. histolytica trophozoites by immunofluorescence and immunogold labeling methods. Significant inhibitions of cell adhesion on extracellular matrix proteins such as fibronectin (56%) (P < 0.001) and collagen (50%) (P < 0.001) and partial inhibition on laminin (23%) (P > 0.1) were achieved by the monoclonal antibody.

Construction and evaluation of ion selective electrodes for nitrate with a summing operational amplifier. Application to tobacco analysis

In this paper, the construction and evaluation of an electrode selective to nitrate with improved sensitivity, constructed like a conventional electrode (ISE) but using an operational amplifier to sum the potentials supplied by four membranes (ESOA) is described. The two types of electrodes, without an inner reference solution, were constructed using tetraoctylammonium bromide as sensor, dibutylphthalate as solvent mediator and PVC as plastic matrix, the membranes obtained directly applied onto a conductive epoxy resin support. After the comparative evaluation of their working characteristics they were used in the determination of nitrate in different types of tobacco. The limit of detection of the direct potentiometric method developed was found to be 0.18 g kg(-1) and the precision and accuracy of the method, when applied to eight different samples of tobacco, expressed in terms of mean R.S.D. and average percentage of spike recovery was 0.6 and 100.3%, respectively. The comparison of variances showed, on all ocassions, that the results obtained by the ESOA were similar to those obtained by the conventional ISE, but with higher precision. Linear regression analysis showed good agreement (r=0.9994) between the results obtained by the developed potentiometric method and those of a spectrophotometric method based on brucine, adopted as reference method, when applied simultaneously to 32 samples of different types of tobacco.

Intestinal metaplasia in patients with columnar lined esophagus is associated with high levels of duodenogastroesophageal reflux

OBJECTIVE

To evaluate the rate of duodenogastroesophageal reflux in patients with columnar lined esophagus compared with patients with gastroesophageal reflux disease without columnar lined esophagus, and to analyze whether it is related to the presence of specialized columnar epithelium in the metaplastic segment.

SUMMARY BACKGROUND DATA

The carcinomatous degeneration of columnar lined esophagus originates from a specialized columnar epithelium. The appearance of this metaplastic phenomenon is clearly related to severe prolonged gastroesophageal reflux, but only some of these patients finally develop columnar lined esophagus. For this reason other factors have been suggested, particularly the role played by the reflux of duodenal contents into the esophagus.

METHODS

The authors studied 15 healthy volunteers (control group), 10 patients with reflux symptoms but without endoscopic lesions, 20 patients with reflux esophagitis without columnar lined esophagus, and 35 patients with columnar lined esophagus (complicated with ulcers or stenosis in 8 cases), of whom 22 had intestinal metaplasia. To assess the reflux of duodenal contents into the esophagus, all the patients underwent Bilitec 2000 and 24-hour esophageal pH monitoring.

RESULTS

The presence of bilirubin in the material refluxed into the esophagus was greater in the patients with columnar lined esophagus than in the rest of the groups. Likewise, duodenogastroesophageal reflux was greater in the columnar lined esophagus patients who had intestinal metaplasia.

CONCLUSIONS

Duodenogastroesophageal reflux may play a major role in the development of columnar lined esophagus, especially in patients with intestinal metaplasia.

Clinical and cerebral blood flow changes in catatonic patients treated with ECT

OBJECTIVE

To determine changes in clinical manifestations and cerebral blood flow (CBF) before and after administration of ECT to patients with catatonia due to schizophrenia or mood disorders.

METHODS

A sample of nine patients who met DSM-IV criteria for catatonia was studied. Patients received between 5 and 15 sessions (thrice per week) of ECT. Severity of catatonia was measured with the Modified Rogers Scale (MRS). Changes in CBF were measured with a brain single positron emission computer tomography (SPECT) that was performed 1 week before the first ECT and 1 week after the last ECT.

RESULTS

Catatonia was due to schizophrenia in five patients and mood disorders in four patients. There were no significant clinical and brain SPECT differences between these two groups before treatment. Pre- vs. post-ECT comparisons showed significant reduction of catatonic symptoms in both groups. However, patients with mood disorders needed less ECT sessions and showed greater clinical improvement. Brain SPECT showed significant increase in CBF in parietal, temporal, and occipital regions in patients with mood disorder and no significant changes in patients with schizophrenia.

CONCLUSIONS

These results support the efficacy of ECT for treatment of catatonic patients, especially secondary to mood disorders, which seem to be correlated with improvements in CBF.