Intraparotid lymph node tuberculosis.

PROBLEM: Parotid gland Mycobacterial infection is a rare disease that causes parotid swelling without disease-specific manifestations. CASE REPORT: We present a case of intraparotid lymph node tuberculosis that mimicked a tumour. Computed tomography of the head and neck indicated a left parotid enlargement involving two intraparotid lymph nodes. The cervical lymph nodes of the ipsilateral posterior triangle and the submandibular and jugulodigastric areas were also enlarged. Contrast enhancement indicated homogenous tissue with no necrotic areas. A biopsy revealed a caseating granuloma most likely due to tuberculosis. A purified protein derivative test gave strong positive results (35 mm). After one month of antituberculous treatment, the cervical lymphadenopathy and left parotid lumpiness disappeared. CONCLUSIONS: Tuberculous parotitis and neoplasms have similar clinical manifestations. In patients with a mass in the parotid gland, a high clinical suspicion of underlying tuberculosis is crucial for establishing an accurate diagnosis and the proper management.

Cavernous haemangioma of the left nasal cavity.

Cavernous haemangioma of the nose is a rare lesion but it has to be added to the differential diagnosis of an intra-nasal bleeding mass. A high index of suspicion, upon computed tomography delineation of the extent of the mass, including the presence of bone remodelling plus histological evaluation can be usefully employed to define an accurate diagnosis. In the present case of an adult female with a huge cavernous haemangioma arising from the mucosa of the left middle nasal meatus, the two most interesting points were the rarity as a site of occurrence of this tumour and the successful extirpation of this lesion with the minimally invasive trans-nasal endoscopic technique. We recommend the minimal invasive trans-nasal endoscopic technique for adequate exposure, sufficient control of bleeding and for complete removal of a nasal haemangioma reaching the nasopharynx and paranasal sinuses.

Needle-knife papillotomy: a safe and effective technique in experienced hands.

BACKGROUND/AIMS: Results from studies evaluating needle-knife papillotomy are conflicting. The aim of this retrospective study was to assess the safety and efficacy of needle-knife papillotomy as a precut procedure to achieve biliary access during ERCP. METHODOLOGY: During a period of seven years, ERCP was performed 938 times. During this time, needle-knife papillotomy was carried out in 68 patients, with complete follow-up obtained in all patients. The follow-up concentrated on the safety and efficacy of the procedure and short-term complications. RESULTS: Cannulation of the common bile duct was successful immediately after needle-knife papillotomy in 44 patients (66%), during a second ERCP in 18 patients (26%), and in a third ERCP in 2 patients (3%) achieving a total cannulation rate of 94%. There were no needle-knife papillotomy related deaths. Complications included bleeding in 5 patients (7%), and pancreatitis in 3 patients (4%). All complications were managed conservatively. CONCLUSIONS: Our experience indicates that needle-knife papillotomy is a versatile, effective and safe technique of gaining biliary access in patients in whom deep cannulation proves impossible and biliary access is considered essential.

The effect of indwelling endoprosthesis on stone size or fragmentation after long-term treatment with biliary stenting for large stones.

BACKGROUND: Endoscopic biliary stenting is often used for large or difficult common bile duct (CBD) stones, but the effect of indwelling endoprosthesis on size or fragmentation of stones after long-term treatment with biliary stenting has not been formally established. We compared the stone size or fragmentation of common bile duct stones after a long period of biliary stenting. METHODS: Endoscopic biliary endoprosthesis was performed for 49 high-risk patients with CBD stones too large or difficult to be extracted by conventional endoscopic means. Bile duct drainage was established in all the patients without complications. Of the patients, 24 died with endoprosthesis in situ all from causes unrelated to biliar disease; 22 underwent a second and three patients a third attempt at stone extraction. The largest stone diameter was >12 mm in all patients. RESULTS: In 11 of 25 patients (44%) the endoprosthesis allowed resolution of the problem of unextractable common bile duct stones. Four patients showed no existence of stent, and ERCP complete stone clearance from the CBD on programmized appointment after endoprosthesis insertion. Reduced size or fragmentation of stones was obtained in seven patients, and the stones could be removed endoscopically. The remaining 14 patients demonstrated no significant change in the size or fragmentation of their stones, and endoprostheses were replaced. CONCLUSIONS: These results suggest that endoscopic endoprosthesis for large or difficult CBD stones is an effective method to clear the duct in selected cases, as well as an important definitive treatment in high-risk patients.

Male splenic-gonadal fusion of the continuous type: sonographic findings.

A new case of splenic-gonadal fusion in an 8-year-old boy is reported in which the sonographic findings were highly suggestive to include the condition in the differential diagnosis. A separate mass with medium-level echoes and a homogeneous echo texture, surrounded by a clearly visible echogenic capsule, was found in contact with the lower pole of the left testis. The particular character of this congenital anomaly is emphasized and the pathogenesis, diagnosis, and treatment are discussed.

Treatment of proctalgia fugax with botulinum A toxin.

Two recent studies described a temporal association between a high-amplitude and high-frequency myoelectrical activity of the anal sphincter and the occurrence of proctalgia, which suggest that paroxysmal hyperkinesis of the anus may cause proctalgia fugax. We describe a single case of proctalgia fugax responding to anal sphincter injection of Clostridium botulinum type A toxin. The presumed aetiology of proctalgia fugax is discussed and the possible mechanism of action of botulinum toxin (BTX) in this condition is outlined. Botulinum A toxin seems to be a promising treatment for patients with proctalgia fugax, and further trials appear to be worthwhile for this condition, which has been described as incurable.

Studies on the pigeon red blood cell metabolism.

1. Pigeon erythrocyte was found to depend on the glycolytic and pentose phosphate pathway for most of its energy production in the form of adenosine triphosphate and reducing potential, since there was no detectable activity of any of the citric acid cycle (TCA) cycle enzymes measured. 2. The absence of detectable amounts of 2,3-diphosphoglyceric acid (2-3-DPG) indicated that there is no direct relationship between the active glycolytic system and the function of these cells. 3. A comparison of the mass action ratios with the equilibrium constants of the glycolytic reactions showed that hexokinase, phosphofructokinase and pyruvate kinase reactions are displaced from equilibrium, implying that these are the key regulatory enzymes of glycolysis in pigeon erythrocytes. 4. The changes in the concentrations of the glycolytic metabolites under hypoxic conditions that stimulate the flux through the glycolytic pathway were found to be consistent with the above hypothesis. 5. Flux measurements of the pentose phosphate pathway showed that it metabolizes only 3.4% of the total glucose consumed by the resting erythrocyte. 6. Hypoxic conditions resulted in a stimulation of the pentose phosphate pathway by as much as four-fold, whilst the glycolytic pathway was not stimulated by more than about twice.

Regulation and rate of the hexose monophosphate shunt in Rana ridibunda erythrocytes.

1. Resting rates of Rana ridibunda erythrocyte glucose consumption and 14CO2 production from 1-14C-glucose were found to be significantly lower than the respective values in human erythrocytes. 2. In the presence of 1-14C-glucose Methylene Blue stimulated 14CO2 production 7-fold, while in the presence of 6-14C-glucose Methylene Blue stimulated 14CO2 production 1.2-fold. 3. The Km of G-6-PD for G-6-P and NADP were 29 and 12 microM, respectively while the Km of 6-PGD for 6-PG and NADP were 83 and 32 microM, respectively. The Ki of G-6-PD and 6-PGD for NADPH were 80 and 12 microM, respectively. 4. Excess amounts of NADP resulted in a significant decrease of 14CO2 production from 1-14C-glucose in total haemolysates. 5. ATP, ADP and fructose diphosphate inhibited both G-6-PD and 6-PGD, the latter being more sensitive than G-6-PD to their inhibitory effect, 2,3-DPG and reduced and oxidized glutathione showed a marked inhibitory effect on 6-PGD, while the phosphorylated trioses inhibited only G-6-PD. 6. Physiological concentrations of oxidized glutathione decreased the inhibition exercised by NADPH on G-6-PD. 7. The possible role of the two dehydrogenases in the regulation of the HMS is discussed.

A new glucose 6-phosphate dehydrogenase variant (G6PD Thessaloniki) in a patient with idiopathic myelofibrosis.

A new deficient glucose 6-phosphate dehydrogenase (G6PD) variant, G6PD Thessaloniki, which was found in the red blood cells of a 70-year-old woman who had idiopathic myelofibrosis, is described. G6PD Thessaloniki had a low Michaelis constant (Km) for G6P (20 microM), high Km for NADP (10.1 microM), normal pH optimum, reduced heat stability, decreased electrophoretic mobility (96-98% of the normal), increased 2-deoxy-G6P and decreased galactose 6-phosphate utilization. Several other enzymatic activities measured in the patient's red blood cells were normal. Studies of red blood cell survival and glucose utilization gave evidence of haemolysis caused by defective glucose utilization by the pentose phosphate pathway. The only son of the patient had normal G6PD in his red blood cells. In an attempt to investigate the origin of G6PD Thessaloniki, heat stability tests of G6PD extracted from the patient's skin have been performed.

Total body haematocrit iron kinetics and erythrocyte life span in pigeons (Columba livia).

1. The mean pigeon erythrocyte life span was found to be 17-25 days by Cr51-labeled erythrocytes and 21 +/- 3.4 days by iron kinetics. 2. Total red blood cell volume has been calculated by Cr51-labeled erythrocytes while total plasma volume was determined both by a dye method and iron kinetic data. From these results total blood volume and total body haematocrit were found to be 0.090 +/- 0.002 ml/g body wt and 36 +/- 4.3%, respectively. 3. Venous haematocrit, haemoglobin concentration, erythrocyte count, mean corpuscular haemoglobin concentration, plasma iron and red blood cell iron have also been measured. 4. A significant difference between total body and venous haematocrit and a short mean red blood cell life span, due to ageing and to random destruction of erythrocytes were shown. 5. The above observations are compared with analogous available data for human beings and their physiological significance is discussed.