ABSTRACT
A 66-yr-old man with a history of squamous cell carcinoma and small cell carcinoma of the lung presented with nausea, vomiting, and abdominal pain. After passing black stools, he underwent upper endoscopy which showed gastric ulceration. A gastric brushing was performed which showed numerous nonseptate, ribbon-like hyphae with right-angle branching. The cytologic features permitted a diagnosis of a zygomycotic infection which was confirmed by histologic examination. Despite appropriate antifungal therapy, the patient expired. To the best of our knowledge, this is the first case of gastric zygomycosis diagnosed by brushing cytology. We believe that gastric brushing cytology allows for rapid diagnosis of zygomycotic mycoses, due to the distinctive morphology of these organisms; however, histologic examination is still required for assessment of invasion.
Subject(s)
Stomach Ulcer/diagnosis , Zygomycosis/diagnosis , Aged , Cytodiagnosis/methods , Cytological Techniques , Fatal Outcome , Humans , Male , Stomach Ulcer/drug therapy , Stomach Ulcer/microbiology , Stomach Ulcer/pathology , Zygomycosis/drug therapy , Zygomycosis/pathologyABSTRACT
Although previous studies have not demonstrated a clear correlation between interleukin (IL) 2 receptor levels and immunological events after transplantation, many still suggest that these levels have clinical utility. A total of 759 serial measurements of both IL-2R and creatinine were compared over time and correlated with rejection episodes, clinical course, and immunosuppression. The profiles for the 40 patients showed several patterns, including correlation with changes in creatinine levels or with renal dysfunction, peaks in the absence of clinical findings, and discordant IL-2R and creatinine levels. Wide baseline variations in IL-2R levels confounded comparison of mean values and definition of a statistically significant rise. While tending to correlate with immunological events, elevations in IL-2R also occurred in clinically normal patients. IL-2R appears to lack specificity for immunological events. Thus, we conclude that IL-2R measurement does not have clinical diagnostic utility for monitoring renal transplant recipients.
Subject(s)
Kidney Transplantation/physiology , Receptors, Interleukin-2/metabolism , Cadaver , Creatinine/blood , Graft Rejection/blood , Graft Rejection/prevention & control , Humans , Immunosuppressive Agents/therapeutic use , Kidney/chemistry , Kidney Transplantation/immunology , Prednisolone/therapeutic use , Solubility , Tissue DonorsABSTRACT
Total parenteral nutrition with parenteral lipid emulsion is being used with increased frequency in malnourished pregnant women. Placentas examined in 20 reported cases of maternal hyperalimentation with lipid emulsions have been described as normal. We report a case of a 31-year-old pregnant woman who received total parenteral nutrition with daily lipid emulsions for 8 weeks. Intrauterine fetal death was diagnosed at 22 weeks' gestation. The tan-yellow, pale placenta showed vacuolated syncytial cells and Hofbauer cells, which stained for fat by the oil red O stain, in the chorionic villi. To our knowledge, this is the first reported case of fat deposits in the placenta associated with intravenous lipid emulsions.
