A rare cause of urinary retention: Iliac artery aneurysms

Internal iliac artery aneurysms are rare, but with a mortality approaching 50% in those that rupture, prompt diagnosis is essential. Often presentation is nonspecific; a wide variety of symptoms and signs have been encountered, illustrating a challenge in identification. We report a case of ruptured internal iliac artery aneurysm presenting as urinary retention. The importance of maintaining a broad differential in cases of urinary retention is clearly highlighted.

Murine lupus strains differentially model unique facets of human lupus serology

Systemic lupus erythematosus (SLE) is a polygenic autoimmune disease characterized by the production of anti-nuclear autoantibodies that lead to subsequent end organ damage. Previous array-based studies in patients with SLE have shown that high immunoglobulin (Ig)G anti-nuclear autoantibody reactivity was associated with severe renal lupus, whereas IgM polyreactivity was associated with less severe disease. To ascertain how different murine lupus strains recapitulate these different autoantibody profiles seen in patients, serum from New Zealand black (NZB)/NZ white (W) F(1), Murphy Roths large (MRL)/lpr, NZ mixed (M)2410 and BXSB strains were compared using a comprehensive array-based screen. The array results were verified using enzyme-linked immunosorbent assays (ELISAs). Serum from MRL/lpr mice exhibited high levels of IgG anti-nuclear antibodies as well as anti-glomerular antibodies and variable levels of antibodies to myosin, Matrigel and thyroglobulin. Elevated anti-nuclear IgG antibodies were associated with severe nephritis in this strain. In contrast, NZM2410 mice exhibited lower IgG autoantibody levels with less severe nephritis but a significantly higher polyreactive IgM autoantibody profile. ELISA analysis confirmed these results. The NZB/NZW F(1) and BXSB strains exhibited an intermediate serological profile. Hence, just as in patients with SLE, whereas strong IgG reactivity to nuclear antigens is associated with severe renal disease, a polyreactive IgM seroprofile is also less ominous in murine lupus.

Cooperation between p53 and the telomere-protecting shelterin component Pot1a in endometrial carcinogenesis

Type II endometrial cancer (EMCA) represents only 10% of all EMCAs, but accounts for 40% of EMCA-related mortality. Previous studies of human tumors have shown an association between Type II tumors and damaged telomeres. We hypothesized that the lack of murine Type II EMCA models is due to the extremely long telomeres in laboratory mouse strains. We previously showed that telomerase-null mice with critically short telomeres developed endometrial lesions histologically resembling endometrial intraepithelial carcinoma (EIC), the accepted precursor for Type II EMCA. However, these mice did not develop invasive endometrial adenocarcinoma, and instead succumbed prematurely to multi-organ failure. Here, we modeled critical telomere attrition by conditionally inactivating Pot1a, a component of the shelterin complex that stabilizes telomeres, within endometrial epithelium. Inactivation of Pot1a by itself did not stimulate endometrial carcinogenesis, and did not result in detectable DNA damage or apoptosis in endometrium. However, simultaneous inactivation of Pot1a and p53 resulted in EIC-like lesions by 9 months indistinguishable from those seen in late generation telomerase-null mice. These lesions progressed to invasive endometrial adenocarcinomas as early as 9 months of age with metastatic disease in 100% of the animals by 15 months. These tumors were poorly differentiated endometrial adenocarcinomas with prominent nuclear atypia, resembling human Type II cancers. Furthermore, these tumors were aneuploid with double-stranded DNA breaks and end-to-end telomere fusions and most were tetraploid or near-tetraploid. These studies lend further support to the hypothesis that telomeric instability has a critical role in Type II endometrial carcinogenesis and provides an intriguing in-vivo correlate to recent studies implicating telomere-dependent tetraploidization as an important mechanism in carcinogenesis.

Magnetic Meckel's: an unusual case report of foreign body ingestion

Foreign body ingestion in children is common. Most items pass spontaneously, however rarer cases may result in obstruction and or perforation. Ingestion of multiple magnetic items can be more troublesome, as a consequence of the ability of the items to attract across different sections of bowel, or by coalescing to form a larger foreign body. Very few cases of foreign body ingestion have led to the presentation of a complicated Meckel's diverticulum. We present of a case of an adolescent boy with intestinal obstruction secondary to multiple magnetic foreign body ingestion and sequestration within a Meckel's diverticulum.

Cor triatriatum sinister with situs inversus totalis in an infant

Cor triatriatum sinister is a rare congenital cardiac malformation characterized by a membrane in the left atrium which separates the left atrium into the proximal and distal chambers. Association of cor triatriatum is extremely rare with situs inversus totalis. Here we report a rare case of cor triatriatum sinister with situs inversus totalis in a 5 month old female infant.

Ablative therapies for colorectal liver metastases: a systematic review

AIM

The standard treatment for colorectal liver metastases (CRLM) is surgical resection. Only 20-30% of patients are deemed suitable for surgery. Recently, much attention has focused on ablative therapies either to treat unresectable CRLM or to extend the margins of resectability. This review aims to assess the long-term outcome and complication rates of various ablative therapies used in the management of CRLM.

METHOD

A literature search was performed of electronic databases including Medline, Cochrane Collaboration Library and the National Library of Medicine's ClinicalTrials.gov. Inclusion criteria were ablation for CRLM with minimum 1 year follow-up and >10 patients, published between January 1994 and January 2010.

RESULTS

In all, 226 potentially relevant studies were identified, of which 75 met the inclusion criteria. Cryotherapy (26 studies) had local recurrence rates of 12-39%, with mean 1-, 3- and 5-year survival rates of 84%, 37% and 17%. The major complication rate ranged from 7% to 66%. Microwave ablation (13 studies) had a local recurrence rate of 5-13%, with a mean 1-, 3- and 5-year survival of 73%, 30% and 16%, and a major complication rate ranging from 3% to 16%. Radiofrequency ablation (36 studies) had a local recurrence rate of 10-31%, with a mean 1-, 3- and 5-year survival of 85%, 36% and 24%, with major complication rate ranging from 0% to 33%.

CONCLUSION

Ablative therapies offer significantly improved survival compared with palliative chemotherapy alone with 5-year survival rates of 17-24%. Complication rates amongst commonly used techniques are low.

Cord coiling, umbilical cord insertion and placental shape in an unselected cohort delivering at term: relationship with common obstetric outcomes

BACKGROUND

The position of the placental cord insertion, its shape and cord coiling are thought to be associated with perinatal outcome. This study derives indices describing the relationship of cord insertion to the placental centre, the shape of the placenta and cord coiling in placentas from unselected term pregnancies. Further, we investigate these indices in pregnancies affected by pre-eclampsia (PET), pregnancy induced hypertension (PIH), gestational diabetes mellitus (GDM) and delivery of a small for gestational age (SGA) baby.

DESIGN/METHODOLOGY

Eight hundred and sixty one unselected women with singleton pregnancy delivering at 37-42 weeks were prospectively recruited to this study. Placental axes and their relationship with the cord insertion were measured using digital photography and proprietary software. From these, the cord centrality (distance of umbilical cord insertion from the centre) and placental eccentricity (deviation of the placental shape from circular) were derived. The cord coiling index (number of coils in the cord divided by the length of cord in cm) was also calculated from manual measurements.

RESULTS

The mean value of cord centrality index was 0.36 (SD = 0.21) and of placental eccentricity 0.49 (SD = 0.17). Left direction of umbilical cord coiling was more common than right (79% vs 16.4%) The mean cord coiling index was 0.20 (SD = 0.09) coils/cm. The indices were constant between 37 and 42 weeks and were no different in the non-affected population compared to women with pre-eclampsia (n = 17), PIH, (n = 27), GDM (n = 38) or delivery of an SGA baby (n = 54).

CONCLUSION

The cord centrality index that we derive suggests that the cord insertion is most commonly 'off centre', and eccentricity index that the placental shape is elliptical. Therefore, contrary to widely held belief, the cord does not normally insert centrally nor is the placenta normally round in shape. There is a preponderance of left sided coiling. There was no difference for any of the indices between the non-affected pregnancies and pregnancies affected by pre-eclampsia, PIH, GDM and SGA.

HIV induces both a down-regulation of IRAK-4 that impairs TLR signalling and an up-regulation of the antibiotic peptide dermcidin in monocytic cells

HIV-infected individuals have an increased risk of invasive bacterial infections, even at early clinical stages with relatively normal CD4(+) T-cell counts. The pathogenic mechanisms behind this are not fully understood. However, an increasing number of studies indicate that HIV may impair the innate immunity to bacteria by infecting key cells of the monocyte/macrophage lineage. In this study, the effects of HIV infection on the protein profile of undifferentiated monocyte-like THP-1 cells were examined by a mass spectrometric approach based on stable isotope labelling with amino acid in cell culture (SILAC). We identified 651 proteins, of which nine proteins were down-regulated and 17 proteins were up-regulated in HIV-infected THP-1 cells as compared to uninfected controls. Most remarkably, the IL-1 receptor associated kinase 4 (IRAK-4), which is essential for virtually all TLR signalling, was suppressed, whereas the precursor for the antibiotic peptide Dermcidin was up-regulated in HIV-infected cells. Upon stimulation of either TLR2 or TLR4, the HIV-infected THP-1 cells displayed reduced TNF-alpha secretion. The HIV-induced down-regulation of IRAK-4 was reconfirmed in monocyte-derived macrophage cell cultures. These data suggests that HIV may impair the TLR signalling cascade for pathogen recognition in cells of the monocyte/macrophage lineage and thus, may reduce the ability of the innate immune system to sense invading pathogens and initiate appropriate responses.

Ultrasound structural fetal anomaly screening: an update

Screening for fetal anomalies by an ultrasound scan was introduced in many maternity units in the UK in the late 1970s and has become routine in most since then although there is little uniformity as to how the scan is performed and when it is offered. Up to 5% of babies are born with a congenital abnormality. In this review article we will focus on what is already known about screening for the commonest and most serious structural fetal anomalies at the 11-14 and 18-23 week scans, and discuss new techniques that promise to improve the accuracy of screening and diagnosis. Chromosomal abnormalities, "soft markers" and biochemical screening are beyond the scope of this review.

Inhibition of human breast cancer cell growth and enzymatic activity by a fermented nutraceutical: an in vitro and in vivo study

Human breast cancer cell lines MCF-7 (ER-positive) and Hs578T (ER-negative) were cultured and one lot incubated for 48 h with 5-50 mug/ml of a fermented phytocompound (MK: Manda-Koso, Innoshima, Japan). In vitro, it appeared a dose-dependent decrease of cell viability (5-57%) in MK group in both cell lines (P < 0.001, plateau: 30 microg/ml), decreased beta-galactosidase activity, enhanced apoptosis, and inversely increased Bax/Bcl2 ratio (P < 0.01) with an upregulation of p53 (P < 0.05). In the in vivo model, Balb-c mice were inoculated with tumor cells and the treatment group was fed with 20 mg of MK. Tumor weight in MK-fed group was time-course reduced by 22% to 51% at 2 and 4 weeks, respectively (P < 0.05) with increased survival (P < 0.05). Tumour tissue of MK-fed mice showed a downregulated Bcl-2 with increased Bax/Bcl-2 ratio, reduced PCNA, and activated caspase 3. Although more studies are ongoing to foster the clinical applicability of MK integrated within a rational chemopreventive and therapeutic strategy, a p53-mediated mechanism is likely to play a relevant role, besides its reported antioxidant capacity, NK cell activity enhancement, cancer-cytostatic activity properties.

Safety of neoadjuvant oxaliplatin-based chemotherapy (N-FOLFOX) in patients undergoing resection of colorectal liver metastases (R-CLM). Interim results

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Background: Oxaliplatin-5-fluorouracil-leucovorin (FOLFOX) has significant activity against CRC in both the metastatic and adjuvant settings. Consequently, neoadjuvant FOLFOX (N-FOLFOX) is being investigated in R-CLM. This has raised concerns regarding the safety and rate of post-operative complications (P-OCs) with N-FOLFOX, specifically, development of sinusoidal dilatation (SD), fibrosis and steatosis. This single-center cohort study was conducted to prospectively evaluate safety of N-FOLFOX in R-CLM patients. Methods: Planned total sample size is 40 patients [20 N-FOLFOX; 20 no chemotherapy (N-C)]. The N-C group consists of patients undergoing surgery for other hepatic pathology. Normal liver was examined by light (LM) and electron (EM) microscopy for SD, perisinusoidal fibrosis, and steatosis/necrosis; severity was graded from 0 (absent) to 2. The rate of P-OCs, hospital stays, and liver function tests (LFTs) were assessed. Results: At the time of this analysis, 20 patients (10 N-FOLFOX; 10 N-C) have undergone surgery. In the N- FOLFOX group, median number of cycles of N-FOLFOX was 6, with 2 patients receiving only 4 cycles. The median time between completion of N-FOLFOX and surgery was 6 weeks. There were no statistical differences between N-FOLFOX and N-C groups in potentially confounding factors, including previous chemotherapy, alcohol consumption, medical history, or concomitant medications. Number of patients with SD was 8 in each group (all were grade 1 except for 1 patient in N-C who had grade 2). Steatosis was seen in 7 and 6 patients in N-FOLFOX, and N-C groups, respectively (2 patients in each group were grade 2; remaining were grade 1). Fibrosis was noted in only 1 patient in N-C group. No nodular regeneration was observed in either group. There was a subjective loss on EM of mitochondria and Golgi apparatus/body with N-FOLFOX. Median post-operative hospital stay was 12 days in both groups. Conclusions: N-FOLFOX appears to have no clinically significant deleterious effects on normal liver architecture, function, or recovery post-surgery in R-CLM patients. The study is ongoing to accrue up to 40 patients; updated data will be presented.

No significant financial relationships to disclose.