Uretero-iliac artery aneurysm fistula: A rare but fatal cause of haematuria.

Visible haematuria from an uretero-iliac artery aneurysm fistula (UIAF) offers a diagnostic challenge and early accurate diagnosis can have a significant impact on prognosis. We report a 90 year old gentleman who presented with visible haematuria and clot retention. He required catheterisation, bladder washout and a blood transfusion. Subsequent imaging revealed an abdominal aortic aneurysm and bilateral iliac artery aneurysms with left sided hydronephrosis and hydroureter. There was no radiological evidence of a fistula between the left ureter and iliac aneurysm. Due to associated co-morbidity surgical intervention was not deemed suitable. Although his haematuria initially settled he developed catastrophic haematuria and died. Post-mortem confirmed UIAF causing fatal haemorrhage. In this report we discuss the diagnostic challenges and management options for this condition.

Pitfalls of hormonal injection therapy in prostate cancer.

AIMS: To highlight that clinicians should not solely rely on serum prostate specific antigen (PSA) elevation to assume hormone resistant prostate cancer status, in patients on long-acting luteinising hormone releasing hormone (LHRH) agonist injection for prostate cancer. METHODS: A retrospective observational report. RESULTS: Three not uncommon case scenarios of falsely raised PSA were encountered with the use of LHRH injections. In these case scenarios, serum testosterone level has served as a useful indicator of compliance to LHRH therapy. CONCLUSION: Where there are suspicions of non-compliance or inappropriate LHRH administration, the clinician should make a detailed evaluation of the patient's therapy. Unnecessary anxiety in patients and inappropriate referral for further aggressive cancer therapy could be avoided.

Non-invasive in vivo imaging in small animal research.

Non-invasive real time in vivo molecular imaging in small animal models has become the essential bridge between in vitro data and their translation into clinical applications. The tremendous development and technological progress, such as tumour modelling, monitoring of tumour growth and detection of metastasis, has facilitated translational drug development. This has added to our knowledge on carcinogenesis. The modalities that are commonly used include Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Positron Emission Tomography (PET), bioluminescence imaging, fluorescence imaging and multi-modality imaging systems. The ability to obtain multiple images longitudinally provides reliable information whilst reducing animal numbers. As yet there is no one modality that is ideal for all experimental studies. This review outlines the instrumentation available together with corresponding applications reported in the literature with particular emphasis on cancer research. Advantages and limitations to current imaging technology are discussed and the issues concerning small animal care during imaging are highlighted.

Fine needle aspiration cytology (FNAC) in the diagnosis of granulomatous lymphadenitis.

OBJECTIVE: To determine the final histological and clinical diagnosis of patients with granulomatous lymphadenitis on fine needle aspiration cytology (FNAC). METHOD: A retrospective cohort study was carried out over a five year period in a tertiary referral hospital. FNAC of 22 patients with granulomatous lymphadenitis was reviewed and correlated with the final histological diagnosis and clinical outcome. RESULTS: Fourteen cases (64%) underwent surgical biopsy for histological assessment. A definitive diagnosis on FNAC with ancillary investigations was achieved in 82% (18 out of 22) of the cases: four Hodgkin's lymphoma, two non-Hodgkin's lymphoma (NHL), five tuberculosis (TB), two toxoplasmosis, one sarcoidosis and four benign reactive changes. CONCLUSION: A significant number of cases of FNAC diagnosed granulomatous lymphadenitis have an identifiable underlying cause. Patients with reactive cytological changes, who clinically appear benign, can avoid unnecessary surgery.

Deposition fractions of 218Po in diffusion chambers.

After radon gas diffuses into a diffusion chamber, 218Po will be formed. Due to its short half-life, a fraction f of 218Po decays before deposition onto available inner surfaces of the chamber, and the deposition fraction (1-f) represents the part which decays after deposition. In the present work, f has been experimentally determined for six diffusion chambers with different materials and dimensions using the radial distribution of track density on the LR115 detectors inside the diffusion chambers. For all the six studied diffusion chambers, f was found to be approximately 0.4. Therefore, the deposition fraction does not depend on the shape and dimensions of the diffusion chambers, the surface to volume ratios or the internal surface materials of the diffusion chambers.

Sensitivity of LR115 detector in diffusion chamber to 222Rn in the presence of 220Rn.

Determination has been made of the sensitivity of LR115 type 2-track detectors (in units of m) to 222Rn, measured in the presence of 220Rn. Measurements have been made by means of a widely used diffusion chamber while Monte Carlo simulations have also been conducted. The experimentally derived sensitivities for 222Rn and 220Rn were found to be 0.470+/-0.022 and 0.486+/-0.042 m, respectively. For Monte Carlo simulations, the sensitivities to 222Rn gas were found to range from 0.618 x 10(-2) m (assuming that all 218Po progeny decay before deposition onto the internal walls of the diffusion chamber) to 0.405 x 10(-2) m (assuming that all 215Po progeny are deposited on the internal walls of the same containment vessel before decaying). The sensitivity to 220Rn gas of 0.465 x 10(-2) m found from Monte Carlo simulations agrees to within uncertainty with experimental findings. The experimentally derived sensitivity value for 222Rn indicates that 30% of the 218Po progeny decay before deposition onto the internal walls of the diffusion chamber.

American ginseng (Panax quinquefolius L) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus.

BACKGROUND: Despite a lack of medical evidence to support its therapeutic efficacy, the use of herbal medicine has increased considerably. Ginseng, one of the most widely used herbs, is hypothesized to play a role in carbohydrate metabolism and diabetes mellitus. We therefore undertook a preliminary short-term clinical study to assess whether American ginseng (Panax quinquefolius L) affects postprandial glycemia in humans. DESIGN: On 4 separate occasions, 10 nondiabetic subjects (mean [+/-SD] age, 34+/-7 years; mean [+/-SD] body mass index [BMI], 25.6 +/- 3 kg/m2) and 9 subjects with type 2 diabetes mellitus (mean [+/-SD] age, 62 +/- 7 years; mean [+/-SD] BMI, 29 +/- 5 kg/m2; mean [+/-SD] glycosylated hemoglobin A1c, 0.08+/-0.005) were randomized to receive 3-g ginseng or placebo capsules, either 40 minutes before or together with a 25-g oral glucose challenge. The placebo capsules contained com flour, in which the quantity of carbohydrate and appearance matched the ginseng capsules. A capillary blood sample was taken fasting and then at 15, 30, 45, 60, 90, and 120 (only for subjects with type 2 diabetes mellitus ) minutes after the glucose challenge. RESULTS: In nondiabetic subjects, no differences were found in postprandial glycemia between placebo and ginseng when administered together with the glucose challenge. When ginseng was taken 40 minutes before the glucose challenge, significant reductions were observed (P<.05). In subjects with type 2 diabetes mellitus, the same was true whether capsules were taken before or together with the glucose challenge (P<.05). Reductions in area under the glycemic curve were 18%+/-31% for nondiabetic subjects and 19+/-22% and 22+/-17% for subjects with type 2 diabetes mellitus administered before or together with the glucose challenge, respectively. CONCLUSIONS: American ginseng attenuated postprandial glycemia in both study groups. For nondiabetic subjects, to prevent unintended hypoglycemia it may be important that the American ginseng be taken with the meal.

American ginseng improves glycemia in individuals with normal glucose tolerance: effect of dose and time escalation.

OBJECTIVE: We studied the effect of escalating the dose and administration time of American ginseng (AG, Panax quinquefolius L.) in nondiabetic individuals to achieve further improvements in glucose tolerance seen previously when 3 g of AG was taken 40 minutes before a 25 g glucose challenge. METHODS: Ten nondiabetic individuals (6M:4F; mean +/- STD: age = 41 +/- 13 years, BMI = 24.8 +/- 3.5 kg/m2, FBG = 4.5 +/- 0.1 mmol L(-1)) on 12 separate occasions, randomly received 0 (placebo), 3, 6 or 9 g of ground AG root at 40, 80, or 120 minutes before a 25 g oral glucose challenge. Capillary blood glucose was measured prior to ingestion of AG or placebo capsules and at 0, 15, 30, 45, 60 and 90 minutes from start of challenge. RESULTS: Compared with the placebo, 3, 6 and 9 g of AG reduced (p<0.05) postprandial incremental glucose at 30, 45 and 60 minutes; also, 3 and 9 g of AG did so at 90 minutes. At 60 minutes, 9 g of AG reduced incremental postprandial glucose relative to 3 g of AG (p<0.05). All AG doses reduced (p<0.05) area under the incremental glucose curve (3 g, 26.6%; 6 g, 29.3%; 9 g, 38.5%). AG taken at different times did not have an additional influence on postprandial glycemia. CONCLUSIONS: In nondiabetic individuals, 3, 6 or 9 g of AG taken 40, 80 or 120 minutes before a glucose challenge similarly improved glucose tolerance.

Marrow neutrophil mass in patients with nonhematological tumor.

The state of granulocytopoiesis was assessed in 15 patients with metastatic carcinoma without infection, overt protein-calorie malnutrition, splenomegaly, or prior chemotherapy. Seven patients had decreased total marrow neutrophil mass, accompanied by proportional reduction in marrow proliferative and nonproliferative neutrophil pool, without increased numbers or proliferative capacity of marrow CFC or myeloid mitotic index. Four patients had decreased MGR assessed with hydrocortisone, but only one had reduced marrow nonproliferative neutrophil pool. Neither MGR nor blood neutrophil count correlates significantly with nonproliferative neutrophil pool or the number of band and segmented neutrophils in the bone marrow. The blood neutrophil count, however, correlates significantly with total marrow neutrophil mass (r = 0.69, p less than 0.01) and proliferative neutrophil pool (r = 0.68, p less than 0.01). These findings suggest that reduced marrow neutrophil mass is common in patients with metastatic carcinoma in the absence of overt protein-calorie malnutrition and that the reduced marrow neutrophil mass is most likely due to depressed granulocytopoiesis.

Serum inhibitor activity of granulocyte-macrophage colony formation in patients with cancer.

The serum inhibitor activities of granulocyte-macrophage colony formation were evaluated by the in vitro culture technique in 60 patients with cancer and control subjects including 24 normal adults and 27 patients with a variety of nonneoplastic disorders. The inhibitor activity in cancer patients (mean, 59%) was significantly higher (p less than 0.001) than was that in normal adults (mean, 31%) and patients with nonneoplastic diseases (mean 36%). There was no difference in the inhibitor activity between the latter two groups of subjects. There was no correlation between the serum inhibitor activity in cancer patients and the histological type or primary site of tumor, the estimated duration of extent of disease, and serum albumin levels. Preliminary observations indicated that the inhibitor activity may be associated with serum lipoproteins. There was no significant difference in serum colony-stimulating activity among cancer patients, normal subjects, and patients with nonneoplastic diseases.

The proliferative states of circulating granulopoietic stem cells in man.

The fraction of granulocyte-macrophage colony-forming cells (CFC) in DNA synthetic phase in blood from 25 normal adults and those in blood and bone marrow from 8 haematologically normal subjects were evaluated by in vitro culture of cells with and without prior exposure to 3H-thymidine (12.5 muCi) for 1 h at 37 degrees C. The exposure of blood cells from normal adults to 3H-thymidine resulted in 26 +/- 10% reduction in colony formation and in 14 +/- 10% reduction in cluster formation. There was no difference in the magnitude of reduction in colony formation following exposure to 3H-thymidine by cells in blood and those in bone marrow in 6 of the 8 haematologically normal subjects. These findings indicated that about one fourth of the circulating CFC in normal adults are in proliferative state and that significant difference in proliferative states between CFC in blood and those in bone marrow probably does not exist in the majority of haematologically normal subjects.

Surface structure of Azotobactervinelandii cysts as revealed by freeze-cleaving.

Micrographs of freeze-cleaved Azotobacter vinelandii cysts reveal that the surface is composed of several overlapping layers. This observation is consistent with the previously proposed structure of the outer cyst coat.