Diagnosis of clinically unsuspected gallbladder rupture by peritoneal fluid cytology. A case report.

BACKGROUND: Rupture of the biliary system resulting in bile ascites may occur spontaneously or as a complication of inflammatory disease, biliary tract manipulation or trauma. Leakage of bile into the peritoneal cavity can cause severe chemical peritonitis, requiring rapid surgical intervention. CASE: A 64-year-old male status post total laryngectomy for squamous cell carcinoma developed abdominal pain and ascites. Diagnostic paracentesis was performed, and bile pigment was noted on cytologic examination, raising the possibility of biliary rupture. This was confirmed radiographically, and the patient underwent exploratory laparotomy, where a ruptured gallbladder was found and cholecystectomy performed. CONCLUSION: Recognition of bile pigment on cytologic examination of ascitic fluid followed by measurement of ascitic fluid bilirubin levels can alert clinicians to the presence of clinically unsuspected bile peritonitis in patients with rupture of the biliary system.

Sialadenoma papilliferum of the palate: case report and literature review.

Sialadenoma papilliferum (SP) is a rare tumor of salivary gland ducts which bears a strong histologic resemblance to the more common syringocystadenoma papilliferum (SCAP). We report a case occurring on the palate of a 50-year-old man, and review the clinical and histologic features of this tumor. Because of the histologic similarities between these two tumors and squamous papillomas, polymerase chain reaction (PCR) for human papilloma virus (HPV) DNA was performed on this tumor and on two cases of SCAP, with negative results. To our knowledge, this is the first case report of SP in the dermatopathology literature.

A polymorphism in a region with enhancer activity in the second intron of the human apolipoprotein B gene.

A 443-base pair fragment (+622 to +1064) from the second intron of the human apolipoprotein B gene was shown to contain a tissue-specific enhancer when placed in front of an apolipoprotein B promoter-chloramphenicol acetyltransferase construct in transfection experiments. To identify potential regulatory mutations in this region of the gene, DNA from various subjects was examined for the presence of point mutations by means of chemical cleavage of mismatched heteroduplexes. An A----G substitution within the second intron of the gene at position +722 was identified in three unrelated subjects and confirmed by DNA sequencing. Although the base substitution was contained within a nuclear protein-binding site, as determined by DNase I footprinting, it did not appear to affect the protein/DNA interaction in its vicinity, as shown by gel retardation experiments. The single base substitution at position +722 abolishes a StyI restriction site, thus creating a StyI polymorphism. Using allele-specific oligonucleotides, we screened the DNA of 172 subjects for the presence of this polymorphism: two other subjects carrying the polymorphism were found. In each of the five unrelated subjects, the polymorphism was associated with the same haplotype.