Isolation of a new quinic acid derivative and its antibacterial modulating activity.

BACKGROUND AND THE PURPOSE OF THE STUDY: The species Hymenocrater calycinus, belongs to the plant family Lamiaceae and grows wildly in the north-east of Iran. Previously, the antimicrobial activity of the plant extracts was reported. In the present study, the bioactivity-guided fractionation of the methanol extract of H. calycinus and the combination effects of the isolated compound with cell wall active agents against S. aureus and E. coli was investigated. METHODS: Column and thin layer chromatographic methods were used for isolation and purification and spectroscopic data (MS, (1)H- and (13)C-NMR, HMQC, HMBC and (1)H-(1)H COSY) were employed for identification of the compound isolated from the extract. A disk diffusion method was used to determine the antibacterial activity of the isolated compound against S. aureus and E. coli in comparison with 7 different antibiotics. RESULTS: The isolated compound 1 was identified as 3-(3, 4- dihydroxyphenyl) lactic acid 2-O-quinic acid. Compound 1 (500 µg/disc) enhanced antibacterial effect of ampicillin, ciprofloxacin, vancomycin and cefepime against S. aureus and activated the effects of ampicillin and vancomycin against E. coli. CONCLUSION: Results showed that the compound 1 was not active against both tested strains at any concentration below 1 mg/disk, and as a result the enhancing effect of the compound could be due its association with antibiotics.

Free radical scavenging and lipid peroxidation activity of the Shahani black grape.

The present study was designed to evaluate antioxidant activity of different parts of Shahani black grape berries. The antioxidant activity of grape berry juice, seed and skin extracts were measured by the inhibition of lipid peroxidation (Ferric Ammonium Thiocyanate) and free radical scavenging activity (2, 2-diphenyl-l-picrylhydrazyl) methods. Vitamin E and Butylated Hydroxy Toluene (BHT) were used as reference values. The free radical scavenging capacity of grape extracts followed this order: seed methanol extract> skin extract> grape juice> seed hexane extract. Meanwhile, inhibitions of lipid peroxidation of seed methanol and hexane extracts were the highest, grape skin extract activity was intermediate and that of grape juice was the lowest. It seems that the antioxidant activity of samples from grape seed and skin extracts to be mainly based on inhibition of lipid peroxidation, whereas the Antioxidant Activity of grape juice is based on free radical scavenging activity. The results indicate that Shahani black grape has potent antioxidant activity specially on lipid peroxidation and has beneficial effects on human health and help to prevent disease which are caused by free radicals.

Role of transrectal ultrasonography in evaluating the cause of azoospermia.

OBJECTIVE: To assess the role of transrectal ultrasonography in the investigation of azoospermia, a significant cause of infertility. METHODS: Over a 2-year period, 35 patients with azoospermia underwent an infertility workup, which included transrectal ultrasonography. RESULTS: Sonograms of 10 of the 35 patients were normal; 8 patients had enlarged seminal vesicles containing cysts, 6 had ejaculatory duct dilation, 5 had seminal vesicle calcification, 3 had seminal vesicle atrophy-hypoplasia and 3 patients had midline prostatic cysts. CONCLUSION: Transrectal sonography is a useful modality to evaluate seminal duct abnormalities, some of which may cause azoospermia.

New pyrrolizidine alkaloids from Heliotropium crassifolium.

Heliotropium crassifolium Boiss, (Boraginaceae) from a population of Ilam, western region of Iran was studied for pyrrolizidine alklaoids (PAs). Four alkaloids have been identified: europine 1, europine N-oxide 2 and a new pyrrolizidine alkaloids ilamine 3 and its N-oxide 4, respectively. Their structures were elucidated by IR, 1H-NMR and EIMS data.

Nonoperative management of splenic injuries: have we gone too far?

HYPOTHESIS: Patients with severe blunt injuries to the spleen have a high likelihood of failing nonoperative management of splenic injuries (NOMSI). DESIGN: Review of medical records, helical computed tomographic imaging data, and trauma registry data. SETTING: Academic level I trauma center at a large county hospital. PATIENTS: A total of 105 patients with blunt trauma to the spleen, admitted between January 1995 and December 1998, who survived more than 48 hours and had complete records. Of these patients, 53 (56%) were selected for NOMSI. The splenic injury was graded by the Organ Injury Scale of the American Association for the Surgery of Trauma (grades I to V, with grade V being the worst possible injury). MAIN OUTCOME MEASURES: Failure of NOMSI, defined as the need for operation to the spleen after a period of nonoperative management. RESULTS: Compared with patients who had successful NOMSI, the 29 patients (52%) in whom NOMSI failed were older and more severely injured. They also required extra-abdominal operations more frequently, underwent transfusion with more units of blood while being managed nonoperatively, and had higher grades of splenic injury. Splenic injury grade III or higher and transfusion of more than 1 U of blood were identified as independent risk factors for failure of NOMSI. The existence of both risk factors predicted failure in 97% of cases. The grading by computed tomography correlated well with the actual injury to the spleen as seen at operation. CONCLUSIONS: In patients with high-grade splenic injuries who require a transfusion of more than 1 U of blood, NOMSI is very likely to fail. Decreasing the threshold for operation or intensifying the monitoring is highly recommended for such patients.

Perirenal lucency ("kidney sweat"): a new sign of renal failure.

OBJECTIVE: This study describes a new sonographic finding in renal failure: perirenal lucency, which we call the "kidney sweat" sign. MATERIALS AND METHODS: During 1 year at our institution, 502 renal sonograms were obtained. Sonography evaluated 330 patients with renal failure. All of the examinations were retrospectively analyzed. RESULTS: An extracapsular hypoechoic rim was present in 47 (14%) of the 330 patients with renal failure. The finding, when present, was always bilateral. The hypoechoic rim was not present in the remaining 283 patients with renal failure. Forty (85%) of the 47 patients had kidneys that were hyperechoic compared with the liver. Twenty-eight (60%) of the 47 patients had kidneys that were hyperechoic compared with the spleen. In 15 (32%) of the 47 patients, the kidneys were small. Ascites was present in 11 (23%) of the 47 patients. Of the 283 patients with renal failure whose sonograms did not show the hypoechoic rim, 76 patients had normal sonographic findings. The remaining 207 patients with renal failure who did not show the kidney sweat sign had hydronephrosis, stones, cysts, echogenic kidneys, small kidneys, or ascites. CONCLUSION: An extracapsular hypoechoic rim is found in patients with renal failure. We call this finding "kidney sweat." We believe, but cannot currently prove, that the kidney sweat sign represents edema. It is an additional sonographic finding in patients with renal failure.

Abdominal computed tomography for the diagnosis of intra-abdominal sepsis in critically injured patients: fishing in murky waters.

HYPOTHESIS: Abdominal computed tomographic (ACT) scans are useful in the evaluation of sepsis of unknown origin in patients with major trauma. DESIGN: Prospective case series of consecutive patients. SETTING: Intensive care unit of level I academic trauma center. PATIENTS: Eighty-five critically injured patients admitted to the intensive care unit in 32 months (6% of all intensive care unit admissions) who developed sepsis of unknown origin. INTERVENTIONS: One hundred sixty-one ACT scans. MAIN OUTCOME MEASURES: Sensitivity and specificity of the ACT scans, number of patients subjected to changes in treatment following an ACT scan. RESULTS: Forty-nine patients (58%) had an intraabdominal focus of infection identified on ACT scan. Penetrating trauma and emergent laparotomy were the only independent factors associated with abnormal findings on ACT scan. The sensitivity and specificity of the test were 97.5% and 61.5%, respectively. Overall, 59 patients (69%) benefited from treatment changes after an ACT scan. CONCLUSION: Abdominal computed tomographic scans reliably identify intra-abdominal foci of infection in patients with major trauma evaluated for sepsis of unknown origin.

Iatrogenic bowel obstruction caused by balloon-inflated feeding tubes.

OBJECTIVE: To determine whether balloon-inflated feeding tubes may be a cause of bowel obstruction. METHODS: Evaluation of 10 patients with balloon-inflated feeding tubes who experienced cramping, nausea and vomiting. Conventional radiography of the abdomen was performed in all patients, a fluoroscopic barium examination in 6 patients, and computed tomographic scanning of the abdomen and pelvis in 4 patients. RESULTS: All patients had a bowel obstruction caused by the inflated balloon. Deflating the balloon relieved the obstructive symptoms immediately. CONCLUSION: Balloon-inflated feeding tubes can cause bowel obstruction.

Predicting the need for thoracoscopic evacuation of residual traumatic hemothorax: chest radiograph is insufficient.

BACKGROUND: The early removal of large residual posttraumatic hemothorax by videothoracoscopy is increasingly used to avoid the late sequelae of trapped lung and empyema. Plain chest radiography (CXR) is the tool most frequently used to select such cases for operation. Our recent experience has demonstrated that what appears to be a large retained hemothorax on CXR may turn out to be intrapulmonary or extrapleural conditions not amenable to thoracoscopic removal. Our objective was to evaluate the accuracy of CXR in detecting significant residual hemothorax and compare its clinical value to thoracic computed tomography (CT) when used to select patients for thoracoscopic evacuation. METHODS: All patients requiring tube thoracostomy for traumatic hemothorax were prospectively evaluated during a 22-month period (n = 703). Patients who, on the second day after admission, demonstrated opacification on CXR involving more than the costophrenic angle were evaluated by thoracic computed tomography for the presence of undrained fluid. Second-day CXR (CXR2) results were compared with the CT findings. Incorrect interpretation was defined as a difference of more than 300 mL between the two readings. All CXR2 and CT results were reviewed in the same fashion by a radiologist blinded to the surgeon's interpretations. Data on injury mechanism, hemodynamic status, laboratory values, interventions, and outcome were collected prospectively. RESULTS: Fifty-eight patients had clinically significant opacifications on CXR2. The surgeon's and radiologist's CXR2 interpretations were incorrect in 48 and 47% of the cases, respectively. The CT interpretations by the two specialists were in agreement in 97% of the cases. Management that would have been instituted on the basis of CXR2 findings was changed in 18 cases (31%). Twelve patients (21%) required early thoracoscopic evacuation of undrained collections. There was good correlation between the CT estimation and the thoracoscopically retrieved amount of blood. CONCLUSION: Although CXR is useful as a screening tool, it cannot be used to reliably select patients for surgical evacuation of retained traumatic hemothorax. Decision-making should be based on thoracic CT findings.

Ovarian vein thrombosis: a common incidental finding in patients who have undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy with retroperitoneal lymph node dissection.

OBJECTIVE: Our objective was to use CT to determine the frequency of ovarian vein thrombosis in patients who have undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy with retroperitoneal lymph node dissection. SUBJECTS AND METHODS: With contrast-enhanced conventional CT of the abdomen and pelvis, we ruled out recurrent malignant disease in 50 patients who in the previous 3-20 months had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy with retroperitoneal lymph node dissection. Thirty of these patients had ovarian cancer (60%), 15 (30%) had cervical cancer, and five (10%) had endometrial cancer. RESULTS: In 40 (80%) of the 50 patients, contrast-enhanced CT revealed ovarian vein thrombosis. No surrounding stranding to suggest phlebitis was seen in any of the patients. None of the patients reported symptoms that would suggest pulmonary embolism. CONCLUSION: Ovarian vein thrombosis is a common incidental finding in patients who have undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy with retroperitoneal lymph node dissection. No treatment is necessary in cases uncomplicated by thrombophlebitis or pulmonary embolism.

Pleomorphic lobular carcinoma of the breast: clinicopathologic features of 12 cases.

Pleomorphic lobular carcinoma (PLC) of the breast was recently identified as a histologic variant of infiltrating lobular carcinoma (ILC) with a poor prognosis. Twelve cases identified from a large series of breast carcinomas were studied retrospectively. Of 11 cases with adequate follow up, 9 were fatal. This was significantly worse than either infiltrating ductal carcinoma (IDC) or classical ILC (P < or = .002), even when stratified by axillary lymph node status. Among the fatal cases, the median survival time was 2.1 years, significantly shorter than that for classical lobular, but not ductal, carcinoma A distinctive pattern of in situ carcinoma, which has been described as PLC in situ, was identified in 7 of the 12 patients. This in situ component was composed of tumor cells with nuclear atypia, cytologically similar to the invasive tumor. Most PLCs lacked estrogen and progesterone receptors and stained with BRST-2, an antibody to gross cystic disease fluid protein-15, suggesting the presence of apocrine differentiation. In summary, PLC has many of the histologic features of ILC but has anaplastic nuclei, abundant cytoplasm, and apocrine differentiation. PLC is often aneuploid, usually lacks steroid receptors, and has a significantly poorer prognosis than does classical ILC.

High-resolution CT pulmonary findings in adults with Gaucher's disease.

The purpose of this study was to illustrate high-resolution computed tomography (HRCT) findings in symptomatic adult Gaucher's disease patients. Five adult patients with Gaucher's disease experienced dyspnea. These patient were first evaluated by chest X-ray (CXR) followed by HRCT. The chest X-ray on one patient demonstrated a calcified granuloma. Two patients had interstitial disease only seen on HRCT, and two patients had a combination of interstitial and alveolar disease giving a mosaic pattern better illustrated on HRCT. HRCT can be used following CXR to evaluate lung pathology in symptomatic adult Gaucher's disease patients.

Accuracy of CT in estimating extent of pancreatic necrosis.

The objective of this study was to determine whether nonenhancing pancreatic lesions are accurate in estimating pancreatic necrosis. Twenty-six consecutive abdominal computed tomography (CT) examinations performed over a 3-year period that met the CT criteria for pancreatic necrosis were reviewed. Follow-up CTs in three of 26 patients demonstrated pancreatic enhancement, indicating viable parenchyma, within the previously nonenhancing regions. All three patients had undergone surgical debridement in that area. Twenty-three cases demonstrated either no change or enlargement of the nonenhancing pancreatic lesions. Follow-up ranged from 1 week to 26 months. While CT is accurate in diagnosing pancreatic necrosis, lack of enhancement in CT may occasionally overestimate the extent of necrosis. Nonenhancing, viable but at-risk tissue may be present adjacent to frankly necrotic tissue. Surgical debridement may facilitate recovery of this viable tissue, which may enhance normally on follow-up CT.

Gray-scale and color flow sonography of pancreatic ductal adenocarcinoma.

PURPOSE: Current sonographic technology has enhanced imaging. This study analyzes the sonographic findings in a large series of patients with pancreatic ductal adenocarcinoma. METHODS: The sonograms of 62 patients with pathologically confirmed pancreatic ductal adenocarcinoma were retrospectively analyzed. RESULTS: Tumors were an average of 4.5 x 3.5 cm in cross section. The largest lesion was 14.0 x 9.0 cm, and the smallest was 1.8 x 1.1 cm. Forty-three tumors (69%) were located in the head of the pancreas, 1 (2%) at the junction of the head and body, and 16 (26%) in the body or tail; 2 lesions (3%) were diffuse. Tumors were ovoid or spherical in 37 patients (60%) and irregular in 25 (40%). Forty tumors (65%) markedly deformed the shape of the gland. Six lesions (10%) caused no glandular contour abnormality and were visualized only because tumor echogenicity differed from that of the normal pancreas. Thirty-four tumors (55%) were homogeneously hypoechoic compared with the normal pancreas, 2 (3%) were homogeneously hyperechoic, 1 (2%) was isoechoic, and 25 (40%) had heterogeneous echotextures. Many of the heterogeneous tumors were predominantly hypoechoic with areas of varied echogenicity. Calcifications were noted in 4 patients (6%) and small intratumoral cystic areas in 9 patients (15%). Postobstructive pseudocysts were found in 4 patients (6%). Color Doppler flow information was available for 19 patients; internal flow was detected in only 1 tumor (5%). Vascular occlusion was found in 3 patients and circumferential vascular encasement in 8; the tumors in these patients were unresectable. Tumors were noted to touch vessels in another 6 patients. CONCLUSIONS: Current sonographic equipment allows the demonstration of new findings in pancreatic carcinoma. Color Doppler sonography can define tumor involvement of blood vessels and potentially affect clinical staging and treatment decisions.

Routine pre-contrast CT for liver lesion detection. A re-examination.

OBJECTIVE: Re-examination of routine pre-contrast computed tomography (CT) through liver. MATERIALS AND METHODS: 852 abdominal CTs including pre- and post-contrast images were retrospectively reviewed regarding detection of hepatic lesions. RESULTS: 103 cases demonstrated hepatic abnormalities. More liver lesions were identified post-contrast in 89; equal numbers were seen pre- and post-contrast in 10; more lesions were seen pre-contrast in one case. Tiny calcifications were detected only pre-contrast in three cases. CONCLUSIONS: Routine pre-contrast scanning through liver is not cost-effective.

Is cryosurgical ablation appropriate for treating hepatocellular cancer?

OBJECTIVE: To examine the feasibility and efficacy of cryosurgical ablation as treatment for patients with cirrhosis with unresectable hepatocellular carcinoma. DESIGN: Retrospective case series. SETTING: A tertiary public hospital and a cancer center. PATIENTS: Twelve patients with cirrhosis with hepatocellular carcinoma (stage II, 2; stage III, 1; stage IVA, 7; stage IVB, 2). INTERVENTIONS: Cryosurgical ablation of all identifiable tumors. Nine patients treated with curative intent were included in the survival analysis, and 3 were treated for palliation. Five patients were treated with preoperative intra-arterial chemoembolization. MAIN OUTCOME MEASURES: Perioperative complications and the effects of tumor stage and chemoembolization were examined. Patient survival and disease-free interval were calculated by life-table analysis. RESULTS: No perioperative deaths occurred and 1 patient had 2 postoperative complications: pneumonia and biloma. The mean survival has been 19 months after cryosurgical ablation and 29 months after diagnosis. Three of the 9 patients treated with curative intent died with recurrence at a mean of 17 months after cryosurgical ablation. Four patients are alive with recurrence at a mean of 19 months after cryosurgical ablation and 38 months after diagnosis. Two patients with stage II disease have no evidence of recurrence 10 and 32 months after cryosurgical ablation. CONCLUSIONS: Cryosurgical ablation is feasible and safe for treatment of hepatocellular carcinoma in patients with cirrhosis. The technique is primarily palliative but may provide a possibility of cure in patients with lower-stage disease.

CT of focal hepatic injury due to surgical retractor.

OBJECTIVE: This study reports the CT appearance of changes in the liver due to retractor injury during surgery for upper gastrointestinal malignancy. SUBJECTS AND METHODS: Ten patients underwent CT examination of the abdomen before (n = 6) and after (n = 10) IV contrast enhancement 2-6 months after surgical resection of malignancy involving the gastric cardia. At each operation, a modified Weinberg's retractor was placed under the lateral segment of the left lobe of the liver to retract it and expose the esophagogastric junction. RESULTS: A sharply marginated, focal, hypodense lesion with no mass effect was shown in the lateral segment of the left lobe of the liver on unenhanced scans in six patients. Irregular enhancement was present after contrast injection in all 10 patients. All patients had a normal preoperative CT of the liver. No patient revealed clinical or laboratory evidence of liver metastasis or abscess. CONCLUSION: Focal hepatic injury due to intraoperative retraction has a typical location and CT appearance that can aid in recognition of the injury.

Tall cell papillary thyroid cancer: incidence and prognosis.

BACKGROUND: The tall cell variant (TCV) of papillary thyroid cancer is reported to have a poor prognosis. This study examines the incidence and end result of surgical treatment of TCV. METHODS: In this study, 240 thyroid cancers treated over a 23-year period at two hospital centers are reviewed. A total of 153 patients with papillary cancer were available for follow-up. All microscopic slides were re-examined. RESULTS: Of the total 183 papillary cancers, 19 (10.4%) were TCV. The remainder were usual papillary or other papillary cancer variants. Patient age, tumor size, lymph node and soft-tissue involvement, recurrence, and death rates were evaluated. Multivariate statistical analysis disclosed that TCV histology, as well as age and tumor size, were significant predictors of recurrence. CONCLUSION: Despite a high rate of recurrence in TCV cases over age 50 (6/9), there were no recurrent TCVs in cases under age 50 (0/8). Pathologists and surgeons must develop an increased awareness of this entity and implications for more radical treatment in the older age group.