RESUMO
This is a case report on a patient with an unusual presentation and clinical course of priapism. It further discusses treatment options with reflection on current literatures and guidelines. 48 year old patient presented with a history of more than 50 episodes of priapism, each lasting for five minutes. Patient had history of brain tumor that was resected and had since been in remission. On examination and further biochemistry assessment revealed conflicting clinical findings, making it difficult to ascertain the type of priapism in this case. The patient, however, recovered from the acute attacks of priapism after 24 hours of conservative management and no obvious cause had been identified on post-discharge follow-up. Priapism, despite being rare, is a medical emergency. This case report reflected upon the limitations of treatment guidelines and the lack of level one evidence to support treatment decisions.
RESUMO
Disorders of sex development (DSD), previously termed intersex, are uncommon, and are usually, but not always, diagnosed at birth. Issues of gender assignment, psychosexual development and the potential for malignant change in a dysgenetic gonad need to be considered. Here, we report a rare presentation of advanced malignancy in an abdominal gonad associated with the formation of a uterus in an adult male with a previously undiagnosed DSD.
Assuntos
Transtornos do Desenvolvimento Sexual/cirurgia , Gônadas/cirurgia , Histerectomia/métodos , Neoplasias de Tecido Gonadal/cirurgia , Diagnóstico Diferencial , Transtornos do Desenvolvimento Sexual/genética , Transtornos do Desenvolvimento Sexual/patologia , Gônadas/patologia , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Neoplasias de Tecido Gonadal/genética , Neoplasias de Tecido Gonadal/patologia , FenótipoRESUMO
We report a case of ureteric stricture formation in a 40-year-old woman after laparoscopic salpingo-oophorectomy and ureterolysis for removal of a large benign ovarian cyst. Ten days postoperatively, she was examined for gradually increasing loin pain and was found to have a short-segment ureteric stricture. She was initially treated conservatively by placement of a ureteric stent. The stent was removed after 6 weeks, and the ureteric obstruction reoccurred. She was subsequently successfully treated by endoscopic ureterotomy.
Assuntos
Ovariectomia/efeitos adversos , Ureter/patologia , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Adulto , Constrição Patológica , Endoscopia , Feminino , Humanos , Laparoscopia , Cistos Ovarianos/cirurgia , Ovariectomia/métodos , Stents , Obstrução Ureteral/etiologia , Obstrução Ureteral/patologiaRESUMO
Abstract Combinatorial library screening offers a rapid process for identifying potential therapies to toxins. Hinge peptide libraries, which rely on conformational diversity rather than traditional molecular diversity, reduce the need for huge numbers of syntheses and screening steps and greatly expedite the discovery process of active molecules. Hinge peptide libraries having the structures: Acetyl-X1-X2-hinge-X3-X4-NH2 (capped) and X1-hinge-X2-X3 (uncapped), where X1 through X4 are near-equimolar mixtures of twelve L-amino acids and hinge = 4-aminobutyric acid, were screened for inhibitory activity in bioassays for botulinum neurotoxins A and B (BoNT/A, BoNT/B) and saxitoxin. The zinc protease activity of the reduced light chains of BoNT/A and /B was assayed by measuring the cleavage of synthetic substrates. Saxitoxin activity was measured by the restoration of the viability of neuroblastoma cells treated with ouabain and veratridine. Deconvolution of libraries was accomplished by fixing one position at a time beginning with the C-terminus. Primary library subsets in which position 4 was fixed showed moderate levels of inhibition for BoNT/A. Secondary library subsets showed stronger inhibition in the bioassays. In each of the bioassays, inhibitory potency was stronger when the second position to be fixed was on the opposite side of the hinge, rather than on the same side with respect to the C-terminus, suggesting that the hinge facilitates the interaction of side chains. Inhibitors for all three of the toxins studied were discovered within library subsets, although not necessarily in primary subsets. These studies demonstrate that (1) the best strategy for deconvoluting hinge peptide libraries is by fixing residues alternately on each side of the hinge moiety, and (2) it is essential to investigate secondary subsets even when primary subsets are inactive. The present findings support the concept that the increased flexibility imposed by the inclusion of a central hinge residue in small peptides increases the opportunity for side chain interactions, providing a distinct advantage for hinge peptide libraries over conventional peptide libraries. Hinge peptide libraries are a rich source of novel ligands for modulation of biomechanisms. The library subsets uncovered in this study may possess peptides that will lead to effective therapies to neurotoxin poisoning.