Immunohistochemical characteristics of ganglionated plexuses in the human gallbladder

Indirect triple immunolabelling techniques were used to identify the presence of choline acetyl-transferase (ChAT), neuronal nitric oxide synthase (nNOS), Dopamine beta-hydroxylase (DβH), neuromedin U-8 (NMU-8), and neuropeptide Y (NPY) in the ganglionated plexuses of the human gallbladder. Of all the intrinsic cholinergic neurons examined, NMU-8-immunoreactive (-IR) neurons appeared to be the most populous, followed closely by neurons containing NPY-IR. nNOS-IR neurons were often observed to coexist with ChAT, NMU, and NPY. Occasionally, these nNOS positive neurons were seen triple labeled with ChAT, NMU-8, and NPY. Results also indicate that not all nNOS and NMU-8-IR coexistent neurons express NPY immunoposi-tivity. Our findings suggest that these intrinsic neurons may be categorized into a distinct population of neurons that express both inhibitory and excita-tory capabilities.Intrinsic cholinergic neurons that were ChAT-IR displayed a spectrum of immunopositivity. Interestingly, a small subpopulation of these neurons ap-peared to be extremely weak ChAT-IR or simply ChAT-immunonegative. These occasionally obser-ved ChAT-immunonegative neurons at times ex-pressed single immunopositivity for NMU-8 or nNOS, while more frequently, these ChAT-immunonegative neurons were found to be single immunopositive, or at times, double immunopositi-ve for NMU-8-, NPY-, or nNOS-IR.Dopamine beta-hydroxylase (DβH) antibodies were used to confirm the lack of intrinsic sympat-hetic innervation in the human gallbladder. As suspected, in all the sections examined, DβH-IR neu-rons were not detected. The only indication of DβH immunopositivity was noted among delicate fibers surrounding the neurons and blood vessels within the organ

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Gastrointestinal variant of Lemierre's syndrome complicating ruptured appendicitis.

Fusobacterium necrophorum is a non-spore-forming, obligate anaerobic, filamentous, gramnegative bacillus that frequently colonizes the human oral cavity, respiratory tract, and gastrointestinal tract. Fusobacterium species have rarely been implicated in cases of gastrointestinal variant of Lemierre's syndrome. We describe a case of F. necrophorum bacteremia associated with suppurative porto-mesenteric vein thrombosis (PVT) following acute ruptured appendicitis. In addition, we list the documented twelve cases of Fusobacterium pylephlebitis. Recanalization of the porto-mesenteric veins and relief of the extrahepatic portal hypertension were achieved with early empiric antibiotic and local thrombolytic therapy. Our patient's case underscores the importance of recognizing Fusobacterium bacteremia as a possible cause of suppurative PVT after disruption of the gastrointestinal mucosa following an acute intraabdominal infectious process. Early treatment of this condition using anticoagulation and endovascular thrombolysis as adjunctive therapies may prevent PVT complications.

Streptococcus agalactiae toxic shock-like syndrome: two case reports and review of the literature.

We present 2 patients with Streptococcus agalactiae toxic shock-like syndrome and review another 11 well-reported cases from the literature. Streptococcal toxic shock-like syndrome is a devastating illness with a high mortality rate, therefore we stress the importance of early supportive management, antimicrobial therapy, and surgical intervention. Toxic shock-like syndrome is likely to be underestimated in patients with invasive Streptococcus agalactiae infection who present with shock. Early diagnosis requires high suspicion of the illness, along with a thorough mucocutaneous examination. Streptococcus agalactiae produces uncharacterized pyrogenic toxins, which explains the ability of the organism to cause toxic shock-like syndrome.

Palatal mucormycosis in patients with hematologic malignancy and stem cell transplantation.

We present two patients with acute myelogenous leukemia who developed palatal mucormycosis, as well as a review of 15 well described reported cases of the same condition in patients who had hematologic malignancy and had undergone hematopoietic stem cell transplantation. Early diagnosis of palatal mucormycosis requires high suspicion of the disease along with a thorough oral examination. Mucormycosis is a devastating disease with a high mortality rate, thereby stressing the importance for early appropriate antifungal therapy in immunocompromised patients with palatal lesions while awaiting the results of histopathology and cultures.