Two cases of methanol poisoning: CT and MRI features.

Methanol poisoning in Australia is now very rare as methanol has been removed from methylated spirits. In acute intoxication methanol may result in a wide range of damage to the central nervous system. Few cases have been imaged with MRI. We present two cases and their striking neuroimaging findings with a discussion of the published work on methanol poisoning.

Three-dimensional gadolinium-enhanced magnetic resonance breath-hold FLASH imaging in the diagnosis and staging of renal cell carcinoma.

Renal cell carcinoma accounts for 2% of all reported cancers. Its apparent incidence is increasing due to the more widespread use of cross-sectional imaging and as a result, tumours are being detected at an earlier stage. It is hoped that this improvement in early detection will result in a significant increase in survival rates. Radiological diagnosis and staging have a critical role in triaging patients' -treatment. Although computed tomography (CT) and ultrasound are well established in the evaluation of renal cell carcinoma, magnetic resonance (MR) techniques are still rapidly developing. In our institution breath-hold three-dimensional (3D) gadolinium-enhanced fast low-angled single shot (FLASH) spoiled gradient-echo sequence imaging has become an integral part of staging for renal cell carcinoma. In this article, we review our experience of the use of this emerging technique in the diagnosis and staging of renal cancer.

Analysis of cathepsin D in human breast cancer: usefulness of the processed 31 kDa active form of the enzyme as a prognostic indicator in node-negative and node-positive patients.

The relative amounts of the precursor (52 kDa) and processed (31,27 kDa) forms of cathepsin D have been analyzed by Western blotting in biopsied breast tissue cytosols from 134 lesions from invasive breast cancer patients, 24 lesions from patients with ductal carcinoma in situ (DCIS), 227 lesions from benign breast disease patients, and 28 lesions from normal control subjects. The mean relative percentage amount of the 31 kDa form was significantly increased (p < 0.001) in the invasive breast cancer group compared to the other three groups. In addition, the mean relative percentage amount of the 31 kDa form was significantly increased (p < 0.05) in node-positive compared to node-negative breast cancer patients. In the benign breast disease group, patients with proliferative-type disease had a significantly increased (p = 0.02) mean relative percentage amount of the 31 kDa form of cathepsin D compared to patients with nonproliferative-type disease. Invasive breast cancer patients were followed for up to 75 months to determine if the relative percentage amount of the 31 kDa form of cathepsin D was predictive of disease-free and overall survival. Although the amount of the 31 kDa form was not predictive of disease-free survival, patients in the 'high' 31 kDa group (> 18%) were significantly (p < 0.05) more likely to die than patients in the 'low' 31 kDa group (< or = 18%). The 12 patients who died were all node-positive and in the high 31 kDa group. It thus appears that the relative amount of the processed, active 31 kDa form of cathepsin D is a useful prognostic indicator, at least in node-positive breast cancer patients.

Guidewire entrapment during Greenfield filter deployment.

Prevention of pulmonary embolism by inferior vena cava filter has long been established. The Greenfield filter continues to be modified to improve deployment methods. A new filter design allows insertion through tortuous anatomy. We present, by way of a case report, a unique complication related to this design. The filter design, deployment technique, and the rationale behind them are discussed. Suggestions for avoiding this problem are provided.

Alpha 1-antitrypsin deficiency deaths in the United States from 1979-1991. An analysis using multiple-cause mortality data.

OBJECTIVE: To describe trends of reported alpha 1-antitrypsin deficiency mortality in the United States from 1979-1991. METHODS: We analyzed death certificate reports in the multiple-cause mortality files compiled by the National Center for Health Statistics. RESULTS: Of the 26,866,600 deaths that occurred during the 13-year period, 1,930 had alpha 1-antitrypsin deficiency listed as a cause of death. Over this period, we would have expected 5,400 to 13,400 persons with this condition to die. The age-adjusted mortality rate with reported alpha 1-antitrypsin deficiency listed increased 86%, from 4.3 per 10 million in 1979 to 8.0 per 10 million in 1991. alpha 1-Antitrypsin deficiency mortality rates were higher among whites than among blacks or persons of other races. alpha 1-Antitrypsin deficiency was listed in 2.7% of all deaths with obstructive lung disease among persons aged 35-44 years old and in 1.2% of all deaths listing hepatic disease among children aged 1 to 14 years old. CONCLUSIONS: alpha 1-Antitrypsin deficiency is an important risk factor for obstructive lung disease and hepatic disease in the United States, and it was reported with increasing frequency through the study period, although it is still likely underreported.

Evaluating and treating active patients for anemia.

Anemia affects many active patients, from young female recreational athletes to elite male competitors. The treatment may simply be iron supplementation, but the causes of iron-deficiency anemia are many, including poor nutrition, exercise-induced hemoglobinuria or hematuria, gastritis, hemorrhoids, peptic ulcer disease, angiodysplasia, and adenocarcinoma. Therefore, physicians need to do a thorough evaluation that includes a medical history, family medical history, drug history, physical exam, and referral to a gastroenterologist if necessary.

Sickle Cell Trait.

In brief A 20-year-old black male college brief athlete with sickle cell trait developed excruciating calf, thigh, and lower back pain after running 1½ miles in very hot, humid conditions. His creatine kinase peaked above 23,000 U/L and urine myoglobin levels were high; the diagnosis was exertional rhabdomyolysis. The patient's condition improved after hospitalization with aggressive rehydration. About 2 weeks later, with aggressive hydration and limitations on distances run without stopping, he returned to full activity. Athletes with known sickle cell trait should take preventive measures to avoid developing exertional rhabdomyolysis.