Candida fungus balls in the common bile duct. Unusual manifestation of disseminated candidiasis.

Disseminated candidiasis appearing as Candida fungus balls in the common bile duct developed in a patient with acute myelogenous leukemia. The patient had received broad-spectrum antimicrobial therapy for fever of unclear origin and subsequently manifested signs of liver cell dysfunction. A percutaneous transhepatic cholangiogram demonstrated three radiolucent defects in the distal part of the common bile duct, which proved to be fungus balls at operation. The liver was studded with microabscesses that disclosed C albicans on biopsy. The biliary tract fungus balls were removed surgically, and the patient was treated with 2,001 mg of intravenously administered amphotericin B over a 2 1/2-month period. No evidence of Candida infection is evident eight months after completion of therapy.

Vascular rings of the thoracic aorta in adults.

Vascular rings have been well documented to cause respiratory and gastrointestinal symptoms in infants and children. Few reports document symptomatic vascular rings in adults, and most have emphasized dysphagia as the predominant symptom. We present the case of a 36-year-old white male with a double aortic arch and progressive dyspnea on exertion. This led us to review previous reports of vascular rings in adults. Criteria for review consisted of anatomically complete vascular rings of the aortic arch in adults age 18 years or older. We identified 25 prior cases for review and included our recent patient. The most common vascular ring anomalies in our review of adults is double aortic arch (n = 12; 46%) followed by right aortic arch with aberrant left subclavian artery and ligamentum arteriosum (n = 8; 30%). Of 24 patients (66%), 16 were symptomatic. Reported symptoms involving the respiratory tract (n = 10 of 24; 42%) included dyspnea on exertion (n = 5), bronchitis (n = 2), recurrent pneumonia, stridor, and unspecified respiratory ailment (n = 1 each). Dysphagia was less common, occurring in eight patients (33%). Previously proposed mechanisms for respiratory tract symptoms include tracheomalacia, static or dynamic compression of the airways, intravascular volume infusion, and aspiration. We also propose exercise-induced dilatation of the aortic arch and age-dependent changes in thoracic compliance as potential mechanisms of dyspnea.

Role of early edema in the development of regional seizure-related brain damage.

Kainic acid-induced seizures produced early (2 hr) generalized edema and later (24 and 48 hr) necrotic edema in temporal cortex and hippocampus as measured by specific gravity changes. Mannitol given during the seizure partially protected against the early edema and prevented the necrotic edema indicating early edema may play a role in later brain damage. However, H2O intoxication, causing much greater generalized edema than the kainic acid-induced seizures, caused no necrotic edema in temporal cortex or hippocampus at 48 hr. Thus it appears that mannitol protection against kainic acid-induced brain damage may be by a mechanism in addition to dehydration.

Comparative enzymatic properties of avian liver and skeletal muscle D-fructose-1,6-bisphosphate 1-phosphohydrolase.

The enzymatic properties of purified preparations of chicken liver and chicken skeletal muscle fructose bisphosphatases (D-fructose-1,6-bisphosphate 1-phosphohydrolase, EC 3.1.3.11) were compared. Both enzymes have an absolute requirement for Mg2+ or Mn2+. The apparent Km for MgCl2 at pH 7.5 was 0.5 mM for the muscle enzyme and 5 mM for the liver enzyme. Fructose bisphosphate inhibited both enzymes. At pH 7.5, the inhibitor constants (Ki) were 0.18 and 1.3 mM for muscle and liver fructose bisphosphatases, respectively. The muscle enzyme was considerably more sensitive to AMP inhibition than the liver enzyme. At pH 7.5 and in the presence of 1 mM MgCl2, 50% inhibition of muscle and liver fructose bisphosphatases occurred at AMP concentrations of 7 X 10(-9) and 1 X 10(-6) M, respectively. EDTA activated both enzymes. The degree of activation was time and concentration dependent. The degree of EDTA activation of both enzymes decreased with increasing MgCl2 concentration. Ca2+ was a potent inhibitor of both liver (Ki, 1 X 10(-4) M) and muscle (Ki, 1 X 10(-5) M) fructose bisphosphatase. This inhibition was reversed by the presence of EDTA. Ca2+ appears to be a competitive inhibitor with regard to Mg2+. There is, however, a positive homeotropic interaction among Mg2+ sites of both enzymes in the presence of Ca2+.

Spontaneous hemoperitoneum in two patients with myeloproliferative disorders.

Spontaneous hemoperitoneum developed in two patients with hitherto undiagnosed myeloproliferative disorders. No other known etiology could be attributed to the two patients described. The report of these two patients suggests that the diagnosis of a myeloproliferative disorder should be considered in the evaluation of patients with spontaneous hemoperitoneum.

Progression of follicular large cell lymphoma to Burkitt's lymphoma.

Histologic progression of lymphoma into more aggressive cell types is well documented. We describe a patient who had the histologic and cytogenetic features of Burkitt's lymphoma after 15 years of therapy for follicular large cell lymphoma. To the best of our knowledge, this clinical progression with histologic and cytogenetic confirmation has not been reported.

Prevalence of aortocoronary graft marker use and the factors affecting this decision.

BACKGROUND: Despite quantifiable evidence that aortocoronary graft marker (ACGM) insertion is associated with a beneficial impact at postoperative angiography, the choice whether or not to insert them at the time of bypass surgery remains optional. METHODS: A one-time anonymous membership survey of the Society of Thoracic Surgeons was used to determine the prevalence of ACGM use and obtain demographic data regarding (1) the type of ACGM inserted, (2) reasons influencing the decision as to whether or not to use ACGMs, and (3) the occurrence of possible related complications. RESULTS: Thirty-nine percent (1,405 of 3,558) and 37% (198 of 531) were returned from within and outside the Unites States, respectively. Sixty percent of US respondents routinely insert ACGMs in the majority of their individual cases. The most frequent reason to not insert ACGMs was a "lack of perceived benefit." CONCLUSIONS: The majority of respondents practicing within the United States routinely insert ACGMs at the time of surgery. As no complication directly attributable to the use of graft markers has been reported, further study is warranted to determine the actual complication rate, although it is expected to be low.

Effects of various high-fat diets on myocardial contractility and morphology in rats.

The effects of various high-fat diets (20% w/w) containing commercially available fats and oils (butter, corn oil, corn oil margarine, canola oil, canola oil margarine, soybean oil, soybean oil margarine, sunflower oil, sunflower oil margarine) on myocardial contractility and morphology and on plasma lipids were investigated in male Sprague-Dawley rats fed the diets for 16 weeks. Diets containing corn oil caused significantly (P less than or equal to .05) higher plasma total cholesterol levels than diets containing butter. Significant differences were also determined in lipoprotein levels. Plasma triglyceride levels were significantly (P less than or equal to .05) higher with butter than with sunflower oil or sunflower margarine. No significant differences among the groups occurred in blood pressure, heart rate, or myocardial contractility. Histological evaluation revealed that animals fed canola oil had the highest incidence and severity of myocarditis and fibrosis and that the degree of cardiac lipidosis was not correlated to the erucic-acid content of the diet. Myocardial damage was significantly (P less than or equal to .05) negatively correlated with stearic and palmitic acids and positively correlated with oleic acid. The results indicate that diets low in saturated fats may have adverse long-term effects on the heart.

A possible role for taurine in osmoregulation within the brain.

Intracranial microdialysis was used to measure changes in extracellular amino acids within the rat brain during local osmotic alteration of the extracellular microenvironment or during systemic water intoxication. Increased cellular hydration produced by either of these methods was accompanied by a marked increase in extracellular taurine levels without affecting the other amino acids measured. With local osmotic alteration, this increase was osmolarity dependent and reversible. The specificity, sensitivity, and reversibility of the increase in extracellular taurine strongly suggest a functional role in osmoregulation in the brain under normal as well as pathological conditions.