ABSTRACT
Due to the limited data on diabetic ketoacidosis and brain edema (DKA/BE) in children/adolescents and the lack of recent data on adults with type 1 diabetes (T1D), we addressed the question of whether neuroinflammation was present in the fatal DKA of adults. We performed immunohistochemistry (IHC) studies on the brains of two young adults with T1D and fatal DKA and compared them with two teenagers with poorly controlled diabetes and fatal DKA. C5b-9, the membrane attack complex (MAC) had significantly greater deposits in the grey and white matter of the teenagers than the young adults (p=0.03). CD59, a MAC assembly inhibitory protein was absent, possibly suppressed by the hyperglycemia in the teenagers but was expressed in the young adults despite comparable average levels of hyperglycemia. The receptor for advanced glycation end products (RAGE) had an average expression in the young adults significantly greater than in the teenagers (p=0.02). The autophagy marker Light Chain 3 (LC3) A/B was the predominant form of programmed cell death (PCD) in the teenage brains. The young adults had high expressions of both LC3A/B and TUNEL, an apoptotic cell marker for DNA fragmentation. BE was present in the newly diagnosed young adult with hyperglycemic hyperosmolar DKA and also in the two teenagers. Our data indicate that significant differences in neuroinflammatory components, initiated by the dysregulation of DKA and interrelated metabolic and immunologic milieu, are likely present in the brains of fatal DKA of teenagers when compared with young adults.
Subject(s)
Biomarkers/metabolism , Diabetes Mellitus, Type 1/genetics , Diabetic Ketoacidosis/genetics , Neurogenic Inflammation/genetics , Adolescent , Adult , Autophagy , Brain/physiopathology , Brain Edema/diagnosis , Brain Edema/etiology , Brain Edema/genetics , CD59 Antigens/genetics , CD59 Antigens/metabolism , DNA Fragmentation , Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/complications , Gene Expression Regulation , Humans , Immunohistochemistry , In Situ Nick-End Labeling , Inflammation Mediators/metabolism , Microtubule-Associated Proteins/genetics , Microtubule-Associated Proteins/metabolism , Neurogenic Inflammation/etiology , Young AdultABSTRACT
Adrenal schwannoma is a rare type of adrenal incidentaloma, an adrenal lesion found incidentally, usually on imaging or autopsy. Computed tomography and magnetic resonance imaging are tools used to evaluate adrenal lesions. The diagnosis of adrenal schwannoma, however, cannot be made on imaging alone. Surgical resection is the primary means of management of adrenal schwannomas, as it is not possible to distinguish the schwannoma from malignant entities simply based on imaging. Histopathologic features of adrenal schwannomas are similar to those of schwannomas found at other sites. Conventional schwannomas, consisting of alternating Antoni A and Antoni B areas as well as Verocay bodies, have distinct microscopic features and can be readily distinguished from other entities. Cellular schwannomas, on the other hand, consist only of intersecting fascicles of spindle cells or Antoni A areas, resulting in a wide differential diagnosis. Ancillary studies such as immunohistochemical analysis and electron microscopy can help to provide a specific diagnosis.
Subject(s)
Adrenal Gland Neoplasms/pathology , Adrenal Glands/pathology , Incidental Findings , Neurilemmoma/pathology , Adrenal Gland Neoplasms/metabolism , Adrenal Glands/surgery , Biomarkers, Tumor/metabolism , Female , Humans , Immunohistochemistry , Male , Microscopy, Electron, Transmission , Neurilemmoma/metabolismABSTRACT
The effectiveness of previously untested disaster plans was demonstrated during the aftermath of the crash of Delta Airlines Flight 191 at D/FW International Airport on Friday, August 2, 1985. These plans, in effect for years and subjected to periodic review, were as yet untried before this first disaster at D/FW International since tsl opening. This paper outlines the disaster plans, the actual problems encountered, the logistics of a disaster of this kind, and insights gained from the experience
