ABSTRACT
The athletic performance supplement industry is a multibillion-dollar business and one popular category claims to increase nitric oxide (NO) production. We report three patients presenting to the emergency department with adverse effects. A 33-year-old man presented with palpitations, dizziness, vomiting, and syncope, after the use of NO(2) platinum. His examination and electrocardiogram (ECG) were normal. The dizziness persisted, requiring admission overnight. A 21-year-old man with palpitations and near syncope had used a "nitric oxide" supplement. He was tachycardic to 115 bpm with otherwise normal examination. Laboratory values including methemoglobin, and ECG were unremarkable. He was treated with 1 L of saline with no change in heart rate. He was admitted for observation. A 24-year-old man presented after taking NO-Xplode with palpitations and a headache. His examination, laboratory values, and ECG were normal. He was discharged. The purported active ingredient in these products is arginine alpha-ketoglutarate (AAKG), which is claimed to increase NO production by supplying the precursor L-arginine. The symptoms could be due to vasodilation from increased levels of NO, though other etiologies cannot be excluded. AAKG containing supplements may be associated with adverse effects requiring hospital admission.
Subject(s)
Arginine/analogs & derivatives , Dietary Supplements/adverse effects , Ketoglutaric Acids/adverse effects , Adult , Arginine/adverse effects , Arginine/metabolism , Arrhythmias, Cardiac/chemically induced , Blood Pressure/drug effects , Citrulline/metabolism , Dizziness/chemically induced , Electrocardiography , Heart Rate/drug effects , Humans , Male , Methemoglobin/metabolism , Nitric Oxide/metabolism , Young AdultABSTRACT
A series of 23 needle biopsies of neuroendocrine tumors occurring in the liver is described. Aspirate smears, core biopsies, and touch preparations were examined. Eighteen of the 23 patients had been previously diagnosed: 9 patients had been correctly identified as having a neuroendocrine tumor, and 9 patients had been originally misdiagnosed. Five of the patients in this series had no previously identified neoplasia. Immunohistochemical staining confirmed the neuroendocrine nature of the tumors in each of the cases. On the basis of cytomorphology, these cases were subtyped as either round cell type, spindle cell type, or polygonal cell type. The polygonal cell type of neuroendocrine tumor, as well as rare examples of the round cell type, demonstrated features similar to well-differentiated hepatocellular carcinoma and adenocarcinomas, and may present a diagnostic dilemma. Characteristic cytologic attributes of the polygonal cell type of neuroendocrine tumor which aid in its distinction from well-differentiated hepatocellular carcinoma include eccentrically located "plasmacytoid" nuclei and cellular discohesion. Findings on core needle biopsy which further identify the neuroendocrine tumors are thick fibrous stroma or small "nests" of tumor cells. The additional use of immunohistochemical staining provides reliable evidence of the cell of origin in confusing cases. Attention to these considerations will aid in the cytologic diagnosis of neuroendocrine tumors.
Subject(s)
Cytodiagnosis , Liver Neoplasms/diagnosis , Neuroendocrine Tumors/diagnosis , Adenocarcinoma , Adult , Aged , Biopsy, Needle , Carcinoma, Hepatocellular , Diagnosis, Differential , Female , Humans , Immunohistochemistry , Liver Neoplasms/pathology , Male , Middle Aged , Neuroendocrine Tumors/pathology , Retrospective StudiesABSTRACT
A case is presented of an elderly man with a striking and unusual form of colonic schistosomiasis consisting of extensive large nodules on the serosal surface of the distal large bowel. The nodules were composed almost entirely of Schistosoma mansoni ova surrounded by thick bands of fibrous tissue. Although the English language literature describes various manifestations of intestinal and abdominal schistosomiasis, nowhere is there an adequate description of this unusual presentation, which might be confused with subserosal metastatic malignancy or diverticulosis during surgical examination.
Subject(s)
Colonic Diseases/pathology , Schistosoma mansoni , Schistosomiasis/pathology , Aged , Animals , Colonic Diseases/parasitology , Humans , Male , Schistosoma mansoni/isolation & purification , Schistosomiasis/parasitologyABSTRACT
Prolactin and LH concentrations were measured in the plasma of female canaries sampled during the breeding cycle and after disruption and reinitiation of incubation behaviour. The late incubation period was characterized by low LH and high prolactin concentrations, and canaries separated from their nests at this stage showed an increased in LH and a decline in prolactin within 3 h. In one experiment mean (+/- S.E.M.) concentrations before and 24 h after nest deprivation were: prolactin 397 +/- 86 and 18 +/- 5 micrograms/l; LH 1.04 +/- 0.21 and 2.03 +/- 0.17 micrograms/l. Female canaries which abandoned their nests after the eggs had been removed also showed an increase in LH together with a fall in prolactin 24 h after egg removal. When nest-deprived canaries were allowed to resume incubation, plasma prolactin increased again within 5 h and after 2 days had reached levels normal for incubating birds (398 +/- 46 micrograms/l). Concentrations of LH changes more gradually but had decreased 2 days after the resumption of incubation. Thus prolactin and LH show inverse changes after the disruption and reinitiation of incubation behaviour; it is not clear, however, if the change in one is dependent on the other or if both hormones are responding to the same external stimulus.
