A Rare Cause of Abdominal Pain.

CASE: A 54 year old woman with hypothyroidism presented with right flank pain that began acutely one week prior to presentation. She was told initially she had a urinary tract infection and treatment resulted in mild symptomatic improvement. The pain returned and she presented to another Emergency Department (ED); and was told the pain was due to constipation. She returned to the ED the next day when her pain worsened and her labs were notable for WBC of 19,000/uL, BUN/Cr of 28/0.75 mg/dL, AST of 31 U/L, ALT of 92 U/L and total bilirubin of 0.6 mg/dL. RUQ ultrasound was notable for dilation of the common bile duct. Given concern for choledocholithiasis, she was started on cefepime and metronidazole. MRCP demonstrated a distended gallbladder without stones and a small amount of pericholecystic fluid. Also noted were two areas of increased signal in the right kidney, concerning for neoplasia or infarction. Contrasted abdominal Computed tomography showed a moderate size area of hypodensity, consistent with renal infarct. Workup for embolic source of the infarction was unrevealing. Renal artery angiogram demonstrated a spontaneous dissection of the superior branch of the right renal artery. PCI was not performed due to risk of jeopardizing the other vessels and so she was managed medically with rivaroxaban along with hydrochlorothiazide and metoprolol succinate to keep her systolic blood pressure below 140 mmHg. The morning after the procedure, the patient told the treatment team that her grandson liked to jump from a height and she would catch him on her right side. This was felt to be a likely etiology of her spontaneous dissection. At the time of discharge, her pain was improved and repeat angiogram performed eight weeks later noted healing of the dissection. DISCUSSION: Spontaneous renal artery dissection is a rare cause of abdominal pain and often presents a diagnostic and therapeutic challenge. This case highlights the importance of considering alternate etiologies of localized abdominal pain when other common pathologies have been excluded.

Oral Health of New Zealand Service Personnel in WW1.

BACKGROUND AND OBJECTIVES: During the First World War, 10% of New Zealand's population served in the armed forces, and around one in five of those were killed. In commemoration of 100 years since WW1, this study uses retrospective data to report on the oral health of NZ service personnel. METHODS: 325 Pakeha, 165 Maori and 150 Samoan male recruits who served in the NZ Expeditionary Force between 1914 and 1918 were randomly selected and their personnel files accessed through Archives New Zealand. RESULTS: The oral health of recruits was described as 'good' for 44%, 'pass' for 38%, 'pass with false teeth' for 5% and 'poor' for 13%. Dental health was documented at enlistment for a decreasing proportion of soldiers as the war progressed, dropping from 96% during 1914-15, to 54% in 1916 and 22% in 1917-18 (p < 0.001). Significantly more soldiers who enlisted in 1917-18 had poor dental health (44%) than those who enlisted during 1916 (20%) and 1914-15 (8%) (p < 0.001). By ethnicity, Maori had the best dental health, followed by Samoan and Pakeha recruits (p < 0.001). On average, dental health was poorer among the lower ranks and among recruits of low socio-economic status; and soldiers from major cities had better oral health than those from rural areas; however, these differences were not statistically significant in this sample. CONCLUSIONS: Enlistment criteria appear to have been loosened as the war progressed, perhaps to accept more soldiers into service. Poor oral health was reported for approximately 1 in 7 accepted recruits. Maori appear to have had better oral health.

Mitigation of 5-fluorouracil-induced liver damage in rats by vitamin C via targeting redox-sensitive transcription factors.

Adverse complications associated with antineoplastic drug-based cancer therapy are the major clinical drawbacks. Oxidative stress and inflammation play a major role in the damage due to cancer therapy. In the current study, we investigated the modulatory effect of vitamin C (Vit. C) on liver toxicity induced by 5-fluorouracil (5-FU) in rats. Animals were divided into four groups. Animals in group I received vehicle. Oral gavage of Vit. C (500 mg kg-1 body weight (b.wt.)) was given to the animals in group III and group IV. 5-FU (150 mg kg-1 b.wt.) was injected intraperitoneally to the animals in group II and group III. Findings of the present study revealed that oral administration of Vit. C significantly ameliorated the level of lipid peroxidation and the activity of myeloperoxidase. Vit. C administration markedly reduced the activation of nuclear factor κB and expression of cyclooxygenase 2, whereas nuclear translocation of nuclear factor erythroid 2-related factor 2 was increased. Hepatic histopathological analyses further supported the protective effect of Vit. C. Findings of the current study demonstrate that the toxic free radicals and inflammatory mediators generated due to chemotherapy play a critical role in 5-FU-induced hepatic damage. Attenuating action of Vit. C may be due to the modulation of redox-sensitive transcription factors and associated target molecules.

Isolation of a highly active photosystem II preparation from Synechocystis 6803 using a histidine-tagged mutant of CP 47.

Site-directed mutagenesis was used to produce a Synechocystis mutant containing a histidine tag at the C terminus of the CP 47 protein of Photosystem II. This mutant cell line, designated HT-3, exhibited slightly above normal rates of oxygen evolution and appeared to accumulate somewhat more Photosystem II reaction centers than a control strain. A rapidly isolatable (<7 h) oxygen-evolving Photosystem II preparation was prepared from HT-3 using dodecyl-beta-d-maltoside solubilization and Co2+ metal affinity chromatography. This histidine-tagged Photosystem II preparation stably evolved oxygen at a high rate (2440 micromol O2 (mg chl)-1 h-1), exhibited an alpha-band absorption maximum at 674 nm, and was highly enriched in a number of Photosystem II components including cytochrome c550. Fluorescence yield analysis using water or hydroxylamine as an electron donor to the Photosystem II preparation indicated that virtually all of the Photosystem II reaction centers were capable of evolving oxygen. Proteins associated with Photosystem II were highly enriched in this preparation. 3,3',5, 5'-Tetramethylbenzidine staining indicated that the histidine-tagged preparation was enriched in cytochromes c550 and b559 and depleted of cytochrome f. This result was confirmed by optical difference spectroscopy. This histidine-tagged Photosystem II preparation may be very useful for the isolation of Photosystem II preparations from mutants containing lesions in other Photosystem II proteins.

Reconstructive microsurgery: reviewing the past, anticipating the future.

This article gives an overview of reconstructive microsurgery It is written for residents and fellows training in plastic and microsurgery and practitioners who are intimately involved in the clinical practice of complex reconstructions. The authors describe the highlights of the history of microsurgery and relevant clinical principles. The final portion of this article is designed to elucidate some of the tremendous advances in limb transplantation and the future directions of microsurgery.

Location of the apex of the lower central incisor.

Clinicians have always had difficulty finding the apex of the lower central incisor on a lateral cephalometric radiograph. This study was undertaken to define the radiographic anatomy surrounding the true apex. Standard cephalograms were taken of 38 skulls with metallic markers in the socket apex of 1 lower central incisor. Similar cephalograms were taken with the lower central incisor apex positioned in the central ray of the x-ray source. The comparison of the marked apices in the complete skulls and their separate mandibles showed that there was no distortion. Measurements from the markers to the lingual and labial symphyseal borders located the apices labial of center.

Random mutagenesis in the large extrinsic loop E and transmembrane alpha-helix VI of the CP 47 protein of Photosystem II.

The intrinsic chlorophyll-protein CP 47 is a component of Photosystem II which functions in both light-harvesting and oxygen evolution. Using the Escherichia coli mutator strain XL-1 Red, we introduced mutations at 14 sites in the large extrinsic loop E of CP 47 and its adjacent transmembrane alpha-helix VI. Four mutant cell lines were recovered in which the histidyl residues 455H, 466H and 469H were altered. The cell lines H455T, H455Y, H469Y, and the double mutant F432L,H466R exhibited phenotypes that supported the identification of the histidyl residues 455H, 466H and 469H as chlorophyll ligands. Four additional mutant cell lines were recovered which contained mutations at positions 448R in the large extrinsic loop of CP 47. These mutants, R448K, R448Q, R448S, and R448W, exhibited variable phenotypes ranging from moderate alteration of photoautotrophic growth and oxygen evolution rates to a complete inhibition of these parameters. Those mutants exhibiting photoautotrophic growth and oxygen evolution capability under standard conditions were unable to grow photoautotrophically or evolve oxygen when grown at low chloride concentrations. Finally, a mutant cell line exhibiting a substitution at position 342G was recovered. The mutant G342D exhibited moderate alterations of photoautotrophic growth and oxygen evolution. In addition to these alterations, mutants were recovered in which deletions and insertions (leading to frame shifts) and stop codons were introduced. These mutants uniformly lacked the ability to either grow photoautotrophically or evolve oxygen.

Adult rhabdomyosarcoma of the gall bladder: case report and review of published works.

A 90 year old woman with alveolar rhabdomyosarcoma of the gall bladder is described. The patient died with tumour metastasis four months after diagnosis despite complete excision of the tumour. The histological, immunohistochemical, and ultrastructural features of the tumour are summarised and published works are reviewed.

Wegener's look-alike.

We describe a 75-year-old woman with a maxillary sinus mass who was evaluated for Wegener's granulomatosis (WG). After further examination, she was diagnosed with plasma cell granuloma. This benign tumor should be noted as a look-alike for WG.