Rabia Mir

Resolution of intestinal cryptosporidiosis after treatment of AIDS with AZT

Intestinal cryptosporidiosis commonly results in severe protracted diarrhea that contributes significantly toward morbidity and mortality in patients with acquired immunodeficiency syndrome. No satisfactory therapy for cryptosporidiosis currently exists. We describe a patient with severe secretory diarrhea and malabsorption who had clinical, microbiologic, and histologic resolution of cryptosporidiosis after therapy with zidovudine.

Aspirin Enhances the Benefits of Late Reperfusion on Infarct Shape A Possible Mechanism of the Beneficial Effects of Aspirin on Survival After Acute Myocardial Infarction

BACKGROUND The time window of the benefits of late reperfusion on infarct shape is limited. In rats, these benefits diminish in a wave front over time, with minimal benefits when reperfusion follows 16 hours of coronary occlusion. The mechanism of the benefits of aspirin on survival after acute myocardial infarction is unknown. The purpose of this study was to test the ability of aspirin to enhance the benefits of late coronary artery reperfusion on infarct shape and to examine the mechanism of the benefits of aspirin on infarct shape. METHODS AND RESULTS Rats were entered into two different protocols, the morphometric and the histological protocols. In the morphometric protocol, rats were randomized into two groups: the aspirin group, in which rats underwent left coronary artery occlusion followed by treatment with aspirin (12 mg/kg i.v.), and the control group, in which rats underwent left coronary artery occlusion followed by treatment with placebo. Rats in both groups were reperfused 8 hours after coronary occlusion. Rats in the aspirin group received aspirin in the drinking water (12 +/- 2 mg/kg daily). Morphometric analysis was performed 2 weeks after acute myocardial infarction. In the histological protocol, rats underwent the same randomization, coronary occlusion, and reperfusion protocols. Hearts were removed 24 hours after coronary occlusion, and microvessels were assessed for patency. Infarct size expressed as a percent of circumference was similar in the aspirin and placebo treatment groups (28 +/- 2% versus 33 +/- 3%, P = NS). Septal thickness was also similar in both groups (1.8 +/- 0.1 versus 2.1 +/- 0.1 mm, P = NS for aspirin versus placebo). The aspirin-treated group had thicker infarcts compared with the placebo-treated group (0.8 +/- 0.1 versus 0.5 +/- 0.1 mm, P < .05) and less expanded infarcts (expansion index, 1.2 +/- 0.1 versus 2.0 +/- 0.2, P < .05). Aspirin was associated with increased patency of the microvessels in the infarcted area compared with the placebo group (96% versus 64% of microvessels patent, P < .001). CONCLUSIONS Aspirin enhances the benefit of late coronary artery reperfusion on infarct shape after 8 hours of coronary occlusion. The benefits of aspirin on infarct shape after late reperfusion are related to increased patency of the microvessels in the infarcted area.

Immunohistochemistry of Hodgkin's disease. A study of 20 cases

An immunoperoxidase study of 20 cases of Hodgkins disease demonstrated universal staining of Reed Sternberg cells and their mononuclear variants for both kappa and lambda light chains and, in all but one case, for IgG. Staining for IgA and albumin was variable and for IgD and IgM uniformly negative. A double staining procedure using two different chromogens produced the paradoxical finding of both light chain types within the same cell, but these could only be demonstrated sequentially and not simultaneously, suggesting a blocking phenomenon. The above findings coupled with the demonstration of muramidase and/or alpha‐1‐antitrypsin in Reed‐Sternberg cells and their mononuclear variants in all but two cases studied favor a histiocytic origin for these cells. This characteristic profile of results is also very helpful in distinguishing Hodgkins disease from other neoplasms which mimic Hodgkins disease because of the presence of Reed‐Sternberg‐like cells. Cancer 52:2064‐2071, 1983.

The rationale against routine subtotal parathyroidectomy for primary hyperparathyroidism

Abstract Our therapeutic approach to the treatment of primary hyperparathyroidism has been the resection of only the abnormally enlarged parathyroid gland, the normal-appearing parathyroids being left intact. During the past twenty-five years we have operated on 292 patients with primary hyperparathyroidism. In all cases the serum calcium levels returned to within normal limits during the immediate postoperative period, and there were no instances of permanent hypoparathyroidism. To determine the long-term efficacy of this therapeutic approach, a retrospective study of 101 patients operated on for primary hyperparathyroidism during a nine year period from July 15, 1965 through June 30, 1974 was made. Of the 101 patients, eight were dead and nine could not be located. Of the remaining eighty-four patients, only two required reoperation because of recurrent hypercalcemia; one had MEA-I and eventually three and a half glands were removed, and the other had recurrent hypercalcemia after a three year normocalcemic interval, and after a second operation with resection of an enlarged parathyroid gland, he has remained normocalcemic. The other eighty-two patients (97 per cent of those reevaluated and 82 per cent of the total operated on) have remained symptom-free and normocalcemic for periods ranging from three to twelve years. Only one patient (if we exclude the patient with MEA-I) has elevated serum parathormone levels with borderline levels of serum calcium. Our results suggest that the optimal surgical treatment of primary hyperparathyroidism, except for cases of MEA, is resection of only the abnormally enlarged parathyroid glands after exploration and identification of all four glands in every case. If all four glands are enlarged, three and a half should be resected.

Tubulointerstitial nephritis associated with minimal self reexposure to rifampin

We report the case of a 27-year-old Asian man who self-medicated with two capsules of rifampin 1 year after completing a continuous course of chemotherapy for tuberculosis that included that drug. He developed flank pain and edema and presented with uremia requiring dialysis; despite this, he had a serum potassium of only 3.5 mEq/L. Renal biopsy showed interstitial infiltrate with inflammation of the tubules. Renal function began to improve after a 3-week course of prednisone. This case is remarkable for the severity of the renal failure despite such a minimal self-exposure.

Hemangiopericytoma of the colon

A patient with a hemangiopericytoma of the colon is discussed. This is the second such case reported in the English medical literature. Soon after discovery of the tumor, the patient presented with a colonic intussusception with the tumor serving as the lead point. This was reduced by a hypaque enema, but the intussusception recurred twice more, being reduced again by hypaque enema and finally having to be reduced by colonoscopy. At surgery a left hemicolectomy with primary anastomosis was performed. The microscopic, ultrastructural, and pathologic aspects of hemangiopericytoma are discussed with special attention to lesions of the gastrointestinal tract.

Early angiotensin converting enzyme inhibitor therapy enhances the benefits of late coronary artery reperfusion on infarct expansion.

BackgroundIndividually, both late reperfusion and early angiotensin converting enzyme (ACE) inhibitor treatment prevent infarct expansion after acute myocardial infarction. ObjectiveTo examine the effect and mechanism of early post‐myocardial infarction ACE inhibitor treatment, when used in combination with late coronary artery reperfusion, on infarct expansion. MethodsSprague–Dawley rats underwent 8 h of coronary occlusion followed by permanent reperfusion. The treatment group received enalapril, started 1 h after coronary occlusion and continued for 13 days. A control group received placebo. Two weeks after acute myocardial infarction, hemodynamic, morphometric and histologic analyses were performed. ResultsHemodynamic parameters were similar in both groups (P  = NS). Infarct size was similar in the ACE inhibitor and placebo treatment groups (44 ± 4% compared with 39 ± 4%, P  = NS). Septal thickness was also similar in the two groups (2.8 ± 0.3 mm compared with 2.7 ± 0.3 mm, P = NS). The ACE inhibitor‐treated group had thicker infarcts than those in the placebo‐treated group (0.93 ± 0.07 mm compared with 0.76 ± 0.04 mm, P  < 0.05) and these infarcts were less expanded (expansion index 1.17 ± 0.12 compared with 1.57 ± 0.12, P  < 0.05). ACE inhibitor treatment was associated with hypertrophy of viable myocytes within the scar compared with placebo treatment (cell diameter 11.1 ± 0.5 m compared with 8.9 ± 0.4 m, P  < 0.01). ConclusionsEarly post‐myocardial infarction ACE inhibitor treatment enhances the benefits of late coronary reperfusion on infarct expansion. The benefits may be related to hypertrophy of still‐viable myocytes within the infarcted zone.

Primary Dermatofibrosarcoma Protuberans, Fibrosarcomatous Variant, Metastatic Report of a Case and Literature Review

Dermatofibrosarcoma protuberans (DFSP), a rare low-grade mesenchymal subcutaneous neoplasm, is characterized by a propensity for local recurrence in up to 50% of patients but has a low metastatic potential. The reported incidence of metastases in a large series was 0-9%. The metastasis is usually a late event and often follows local recurrences. The presence of fibrosarcomatous areas (FS) within DFSP (DFSP-FS) increases the risk for local recurrence and metastases. We report a patient who developed metastatic disease in the lungs 6 months after complete excision of DFSP-FS of the thigh without local recurrence.

Endometrioid Cystadenofibroma Developing in Juxtahepatic Endometriosis A Case Report

A 32-year-old woman presented with acute right upper quadrant pain. A computerized tomogram disclosed a 15.5 cm multicystic mass in the subhepatic space adherent to the liver. A hepatic hydatid cyst and metastasis from an ovarian carcinoma were considered as possible diagnoses. Surgical removal led to a diagnosis of an endometrioid cystadenofibroma in conjunction with endometriosis. To our knowledge, this is the first report of an endometrioid cystadenofibroma arising in juxtahepatic endometriosis.