Acute renal infarction secondary to left ventricular thrombus, masquerading as a renal calculus--a case report and brief review of literature.

Acute embolic renal infarction is an entity that is often misdiagnosed as a renal calculus because of similar presenting symptoms. This leads to delay in the initiation of treatment and to increased morbidity. Few case reports exist relating cardiac emboli to acute renal infarction. The authors present a patient with a renal embolism secondary to left ventricular thrombus. A brief review of the literature highlighting the importance of clinical suspicion in making an accurate diagnosis, the utility of various diagnostic studies, and comparison of various treatment options is presented.

Evidence-based advertising? A survey of four major journals.

BACKGROUND: Pharmaceutical advertisements are an important means of bringing drug information to physicians. Most advertisements are intended only to raise awareness, though there are those that do seek to persuade through presentation of research findings. Researchers have questioned the quality of the research reported in advertisements and wonder whether these advertisements would lead to improper prescribing. METHODS: A consecutive 6-month sample of advertisements in 4 general medical journals, 3 from the United States and 1 from Canada, were reviewed to determine how research results are presented in pharmaceutical advertisements. RESULTS: During this time there were 187 distinctive advertisements, with 43 data presentations in the 33 advertisements that contained quantitative research results. These results were examined using a critical appraisal worksheet. References to randomization and blinding were found in less than one half of the 43 data presentations. P values were frequently provided, but confidence intervals and references to power and number needed to treat were not provided in any of the advertisements. CONCLUSIONS: Descriptions of research in pharmaceutical advertisements were brief and incomplete, and they inconsistently provided the basic design and statistical information needed to judge the results reported. More detail could make these advertisements more meaningful to critical readers.

Of pills and pillows: pseudopigmentation in a patient taking amiodarone.

Blue discoloration of the skin can alarm patients and physicians alike. Blue coloring may, however, have a trivial and easily correctable cause, as is shown in the following case.

Metastatic lung cancer presenting as cholecystitis.

We report the case of a 69-yr-old patient with inoperable cancer of the lung who later developed acute cholecystitis-related to metastasis to the gallbladder wall. Secondary malignancies of the gallbladder are discussed.

Retroperitoneal abscess presenting as emphysema of the thigh.

Leg pain may be a presenting symptom of intra-abdominal disease. I report a case of subcutaneous emphysema of the thigh that was a complication of diverticular perforation and abscess formation. Healthy leg muscle was found at operation, showing that myonecrosis need not necessarily be present even with finding of extensive gas accumulation.

Intracellular acidification of gastrula ectoderm is important for posterior axial development in Xenopus.

There is evidence suggesting that pHi elevation can induce differentiation to cement gland, an extremely anterior structure, during the early development of Xenopus laevis (Picard, J. J. (1975) J. Embryol. exp. Morphol. 33, 957-967; Sive, H. L., Hattori, K. and Weintraub, H. (1989) Cell 58, 171-180). We wanted to investigate whether axial development or neural induction are mediated in Xenopus via regulation of pHi. Our interest was stimulated further because certain signal transduction pathways, which are thought to mediate anterior neural induction (Otte, A. P., Van Run, P., Heideveld, M., Van Driel, R. and Durston, A. J. (1989) Cell 58, 641-648; Durston and Otte (1991), Cell-Cell Interactions in Early Development, pp. 109-127), are also known to modify the activity of proton extruders (Mitsuka and Berk (1991) Am. J. Physiol. 260, C562-C569; Wakabayashi, S., Sardet, C., Fafournoux, P., Counillon, L., Meloche, S., Pages, G. and Pouysségur, J. (1993) Rev. Physiol. Biochem. Pharmacol. Vol. 119, pp. 157-186). We therefore measured pHi in explants of gastrula ectoderm and neurectoderm and identified ion exchangers that regulate pHi in these tissues. The measurements showed that pHi decreases in explants of both neurectoderm and uninduced ectoderm during the time course of gastrulation, this pHi decrease thus fails to correlate with neural induction. One important regulator of this cytoplasmic acidification is the Na+/H+ exchanger. The pHi set point, at which the acid extrusion activity of this alkalizing exchanger is shut off, shifts to more acidic values during the time course of gastrulation, thus permitting cytoplasmic acidification. We found also that preventing cytoplasmic acidification and thereby elevating pHi in late gastrula cells led to the specific suppression of posterior development. Neural induction and anterior development were unaffected by treatments leading either to an elevation of or a decrease in pHi. These findings indicate that the cellular processes mediating anterior development and neural induction are pHi tolerant, while the signals mediating posterior development require a sustained pHi decrease for their action, suggesting that downregulation of pHi is necessary for posterior axial development.

Heterotopic ossification and deep venous thrombosis: concurrence (?), bleeding complications, and caval interruption.

Diagnosis and treatment of apparent deep venous thrombosis in a patient with spinal cord injury can be difficult. Heterotopic ossification in the paralyzed limbs of such patients can mimic deep venous thrombosis and can even produce false-positive findings on venograms. Anticoagulation, in turn, can be associated with soft tissue hemorrhage that may resemble thrombophlebitis and further confound interpretation of venograms. We have presented a case in which all these phenomena were present and in which a remaining risk of embolism was successfully managed through placement of a Greenfield filter.