3,4-methylenedioxymethamphetamine (MDMA): an important cause of acute hepatitis.

BACKGROUND: MDMA, i.e. 3,4-methylenedioxymethamphetamine ("Ecstasy"), occasionally produces significant hepatotoxicity in humans. It is characterized by a wide range of variability in clinical expression, ranging from asymptomatic liver injury, as observed by altered liver function tests, to acute hepatic failure. Prognostic factors that may predict the outcome of this condition remain unknown. CASE REPORT: We report a case of a 19-year-old male who presented deeplyjaundiced two weeks after ingestion of two tablets of Ecstasy. The clinical picture, laboratory data, and morphological studies were consistent with acute hepatitis. There was no evidence for a viral, alcoholic, metabolic, or autoimmune etiology of the disease. A mild clinical course with complete recovery after two months was observed. The presence of All molecule was confirmed in the patient. CONCLUSIONS: The possible association of specific human leukocyte antigen (HLA) phenotypes and MDMA-induced hepatotoxicity needs future evaluation.

Effect of aerobic training on plasma levels and subcutaneous abdominal adipose tissue gene expression of adiponectin, leptin, interleukin 6, and tumor necrosis factor alpha in obese women.

Adipocytokines secreted by adipose tissue are suggested to play a role in the development of obesity-related complications. Regular aerobic exercise has been shown to reduce the risk of metabolic complications in obese subjects. The aim of this study was to investigate the effect of aerobic training on gene expression in subcutaneous abdominal adipose tissue (SCAAT) and on plasma levels of several adipocytokines in obese women. Twenty-five obese sedentary premenopausal women (body mass index, 32.18 +/- 3.17 kg/m(2)) underwent a 12-week aerobic exercise program, with a frequency of 5 d/wk and intensity corresponding to 50% of individual maximal oxygen consumption (V(.-)(O(2)max)) consisting of 2 sessions per week of supervised aerobic exercise and 3 sessions per week of home-based exercise on a bicycle ergometer. Before and after the aerobic training, (V(.-)(O(2)max)) and body composition were measured and plasma and SCAAT biopsy samples (in a subgroup of 8 subjects) were obtained for determination of plasma and messenger RNA levels of adipocytokines (leptin, adiponectin, interleukin 6, tumor necrosis factor alpha). The aerobic training resulted in an increase of subjects' V o(2)max by 12.8% (24.6 +/- 3.9 vs 27.7 +/- 4.8 mL x min(-1) x kg(-1), P < .05). Body weight and fat mass were reduced by 5.9% (88.5 +/- 8.2 vs 83.3 +/- 7.7 kg, P < .001) and 6.4% (38.8 +/- 4.2% vs 36.3 +/- 4.6%, P < .001), respectively, and the revised QUantitative Insulin sensitivity ChecK Index (QUICKI) increased (0.43 +/- 0.06 vs 0.48 +/- 0.06, P < .05) during the aerobic training. No aerobic training-induced changes in messenger RNA levels of the investigated genes in SCAAT were observed. A decrease of plasma leptin (24.3 +/- 8.7 vs 18.1 +/- 8.3 ng/mL, P < .05) was detected, whereas plasma levels of other cytokines remained unchanged. In moderately obese females, 3 months' aerobic training did not promote changes in the adipose tissue gene expression or plasma levels of the adipocytokines (except for leptin) involved in a regulation of lipid and carbohydrate metabolism.

Early cancer in congenital choledochal cyst.

We report a case of 35-yr-old woman with early cancer in congenital choledochal cyst. She had a five-year history of intermittent right upper abdominal pain and intermittent jaundice. In this period she had a few abdominal ultrasonographies, but the cholelithiasis had not been found. Now, she was admitted to our hospital because she felt right upper abdominal pain with slight jaundice and subfebrile temperature four weeks ago. Abdominal ultrasonography showed enormous dilatation of the common bile duct, which was suspected as choledochal cyst. Computed tomography and endoscopic retrograde cholangiopancreatography revealed cystic dilatation of extrahepatic bile duct. An anomalous pancreaticobiliary junction was not found. The patient with congenital choledochal cyst was operated on. The excision of choledochal cyst was done with hepaticojejunostomy Roux-en-Y. There were no lymph nodes metastases. On the central part of choledochal cysts mucosa, it was shown a white plain area of thickness 0.3 cm and 0.8 cm in diameter. Histologically it was well-differentiated tubular adenocarcinoma, which was limited to the mucosa and which did not penetrate to other parts of the bile duct wall. From our knowledge, only small number cases of early cholangiocarcinoma in choledochal cyst were until now reported. Nearly eight years after the operation the patient feels very well, and has optimal working ability (Karnofsky 100%).

Some observations of the structure of the choroid plexus and its cysts.

The structure of the choroid plexus was studied in five normal human embryos, three normal fetuses and three fetuses with choroid plexus cysts. These were detected by ultrasound and the fetuses were karyotypically normal. The choroid plexus appears in the lateral cerebral ventricles at the seventh developmental week. The early structure is lobulated with vessels running in the mesenchymal stroma and forming capillary nets under the single-layered ependymal epithelium. This embryonal structure is converted into the fetal type during the ninth developmental week as the embryonal capillary net is replaced by elongated loops of wavy capillaries that lie under regular longitudinal epithelial folds. The choroid plexus cysts exhibited accumulation of fluid within distended mesenchymal stroma and did not show the wavy folds on this surface, which was smooth. Within this connective tissue of the cyst wall were distended angiomatous interconnecting thin-walled capillaries. Therefore, filled cavities were not lined by any epithelium. We suggest that fetal choroid plexuses cysts (at least in many cases) are in fact pseudocysts exhibiting angiomatous patterns of capillaries in their walls.

Salmonella infection-associated acute rhabdomyolysis. Some pathogenic considerations.

Rhabdomyolysis is a syndrome characterized by extended myolysis, elevation of serum aminotransferases and creatine kinase, and myoglobinuria. It is a rare but well-established complication of a spectrum of infectious diseases. Salmonella infections have been connected with this syndrome as well. We present here the case of a 58-year-old female affected by Charcot-Marie-Tooth (CMT) disease, a type of hereditary neuropathy, who presented with acute renal failure and rhabdomyolysis syndrome in the course of Salmonella infantis gastroenteritis. We formed some considerations on the pathogenesis of rhabdomyolysis in this specific setting based on certain experimental works on the Salmonella pathogenic cycle. We concluded that the calcium-dependent mechanism coupled with a predisposing factor might be of major significance in the development of this complication.