Localized myxedema histologically mimicking spindle cell lipoma.

In this report, a 55-year-old woman with Graves disease and exophthalmos had a recurrent nodule on the foot. Her initial biopsy and excision specimens were believed to be consistent with spindle cell lipoma, which aligned with her early tumor-like clinical morphology. Her tumor recurred after excision, which is not consistent with spindle cell lipoma. As her condition progressed, her clinical morphology became more consistent with localized myxedema and her biopsies were congruent, securing clinicopathologic correlation. With standard treatment for localized myxedema, she improved significantly. This case emphasizes how clinicians need to have high suspicion for localized myxedema in patients with history of Graves disease and exophthalmos. It also emphasizes how localized myxedema should be included in the histologic differential diagnosis for spindle cell lipoma with prominent myxoid stroma, particularly in those not responding to treatment as anticipated.

Growth differentiation factor 15 as a predictor of adverse renal outcomes in patients with immunoglobulin A nephropathy.

BACKGROUND: Growth differentiation factor 15 (GDF 15) has recently been reported as a useful prognostic marker in patients with chronic inflammatory disease and heart disease. AIM: To evaluate the role of GDF 15 as a potential prognostic predictor of renal outcome in immunoglobulin A nephropathy (IgAN). METHODS: In total, 212 patients in the Chungnam National Hospital glomerulonephritis cohort, who were diagnosed as biopsy-proven IgAN between March 2010 and June 2014, were included. GDF Fifteen was analysed by the enzyme-linked immunosorbent assay. Cut-off values of the GDF 15 and the hazard ratio of it resulting in haemodialysis within 2 years were analysed. RESULTS: The level of serum GDF 15 was negatively correlated with the initial eGFR. A serum GDF 15 level of more than 496.32 pg/mL showed 90% sensitivity and 72.9% specificity to predict the possibility of it resulting in haemodialysis within 2 years. In addition, a GDF 15 level higher than 490.4 pg/mL showed 63.64% sensitivity and 65% specificity to predict a decline in eGFR > 30 mL/min within 1 year of follow up. Moreover, initial serum GDF 15 level was associated with the development of interstitial fibrosis/tubular atrophy. CONCLUSIONS: Initial serum GDF 15 level showed an inverse correlation with serum eGFR and was associated with worse renal outcome. Our results suggested that GDF 15 may play a role as a potential prognosticator in IgAN.

Strength of the 18F(p,alpha)15O resonance at Ec.m. = 330 keV.

Production of the radioisotope 18F in novae is severely constrained by the rate of the 18F(p,alpha)15O reaction. A resonance at E(c.m.)=330 keV may strongly enhance the 18F(p,alpha)15O reaction rate, but its strength has been very uncertain. We have determined the strength of this important resonance by measuring the 18F(p,alpha)15O cross section on and off resonance using a radioactive 18F beam at the ORNL Holifield Radioactive Ion Beam Facility. We find that its resonance strength is 1.48+/-0.46 eV, and that it dominates the 18F(p,alpha)15O reaction rate over a significant range of temperatures characteristic of ONeMg novae.

Insights into the three-dimensional structure of the oculomotor nuclear complex and fascicles.

The authors report the case of a patient with an ischemic lesion in the left midbrain. The patient presented with paresis of left inferior rectus, pupil, right superior rectus, convergence and transiently, of the left medial rectus. A lesion in the left dorsal midbrain close to the oculomotor nuclear complex, selectively involving the fascicles innervating the above muscles, is proposed. Fine magnetic resonance sections showed a consistent lesion in the left paramedian dorsal midbrain. A detailed, three-dimensional, schematic computer model of the oculomotor nucleus and fascicles was constructed. Using this model, the authors topographically validate the putative site of the lesion. The medial rectus subnucleus is divided into three subgroups, A, B, and C. Subgroup C is thought to be the site of the majority of neurons controlling convergence. In the above model, the putative lesion is closer to subgroup A than to C; this suggests that subgroup A, rather than subgroup C, may have a higher concentration of neurons involved in convergence.