Giant ileocolic intussusception in an adult induced by a double ileal lipoma: a case report with pathologic correlation.

Intussusception in adults is rare, accounting for less than 5% of all cases. Unlike the childhood variant, adult intussusception is often associated with a small bowel lesion acting as the "lead point." We herein report an uncommon case of giant intussusception secondary to 2 separate lipomatous lesions located in the ileum, in an adult admitted to our hospital for acute severe abdominal pain.

Coronary atherosclerosis burden is not advanced in patients with ß-thalassemia despite premature extracardiac atherosclerosis: a coronary artery calcium score and carotid intima-media thickness study.

BACKGROUND: Thalassemic patients demonstrate an increased rate of extracardiac vascular complications and increased carotid wall intima-media thickness (cIMT), but very low prevalence of coronary artery disease (CAD). We investigated the atheroma burden by assessing the coronary artery calcium (CAC) and cIMT in these patients. METHODS: We examined 37 patients with ß-thalassemia and 150 healthy control volunteers with multi-detector computer tomography (CT) and ultrasonography to determine CAC score and cIMT, respectively. RESULTS: Propensity score matching (C-statistic: 0.88; 95% CI: 0.83-0.93) resulted in 27 pairs of patients; severe CAC was observed in 2 (7.4%) and 0 of ß-thalassemia patients and healthy volunteers respectively (P = 0.5). Median calcium score was 0 (0-0) in ß-thalassemia patients and 0 (0-4) in healthy volunteers (P = 0.8). Median intima-media thickness was higher in ß-thalassemia patients compared to control group [0.45 (0.06-0.65) vs. 0.062 (0.054-0.086); P = 0.04]. CONCLUSIONS: Patients with ß-thalassemia in comparison with healthy control subjects exhibit similar CAC score and increased cIMT. Our findings indicate a disparate rate of progression of atherosclerosis between coronary and extracardiac arteries in these patients lending support to the epidemiological evidence.

Vascular Complications Following Transradial and Transulnar Coronary Angiography in 1600 Consecutive Patients.

BACKGROUND: Major, noncoronary complications are rarely encountered following transradial coronary procedures. METHODS AND RESULTS: Among 1600 prospectively studied patients with complete follow-up, 7 patients experienced major complications following coronary forearm procedures corresponding to an incidence of 0.44%. We found inadvertent symptomatic intramyocardial contrast medium injection, 2 cases with compartment syndrome of which 1 was managed surgically, exertional hand ischemia due to radial artery occlusion, a large ulnar artery pseudoaneurysm, an ulnar arteriovenous fistula, and 1 critical hand ischemia due to late occlusion of the distal brachial artery. CONCLUSIONS: Although infrequent, surveillance for major complications should be encouraged after forearm coronary procedures.

Oval cell proliferation in cirrhosis in rats. An experimental study.

AIM: Oval cells are liver stem cells involved in liver regeneration following liver damage. Previous studies have shown that pretreatment with a hepatocyte inhibitor is required to allow full oval cell activation. This study investigates whether oval cells develop and proliferate in a model of experimental liver fibrosis without pretreatment with a known hepatocyte inhibitor. METHODS: The study comprised 66 male Wistar rats divided into two groups: A (n = 6): controls; and B (n = 60): CCl(4) injection (intraperitoneally 2 mL/kg bodyweight 1:1 volume in corn oil twice weekly). Rats were sacrificed at four, eight and 12 weeks. Liver tissues were evaluated for the degree of fibrosis (Masson's trichrome), cell proliferation (Ki67 antigen), expression of alpha-fetoprotein (AFP) mRNA (RT-PCR and in situ hybridization), AFP protein (Western blot) and cytokeratin-19. Cells with morphologic features of oval cells that were cytokeratin 19 (CK19)+ and AFP mRNA+ were scored in morphometric analysis. RESULTS: Oval cells were present in all 66 specimens; their percentage was higher in group B compared to group A (P < 0.001). AFP mRNA and protein expression increased as fibrosis advanced. Similarly, the numbers of CK19+, AFP mRNA+ and Ki67+ oval cells were higher in advanced fibrosis stages. CONCLUSION: This study demonstrates that oval cells develop and proliferate in a model of experimental liver fibrosis without pretreatment with a known hepatocytic inhibitor. However, further research is warranted in order to identify the exact molecular mechanisms involved in this process.

Application of a new guiding system in percutaneous biopsies.

We herein describe the application of a new guiding system designed for percutaneous biopsies. The guiding system set is composed of a 0.41 mm (27G) stainless steel guide stylet and a 22G Chiba needle. Following the initial insertion of the Chiba needle, the stylet is advanced via the needle toward the lesion. The stylet serves either as a guide for the Chiba needle or as an exchange wire for the introduction of larger or cutting biopsy needles. The stylet can also be curved prior to its insertion to facilitate access to lesions which require needle redirection. The technique was applied to 117 cases (54 thoracic, 31 abdominal, 21 pelvic, and 11 vertebral lesions.) The main advantage of the stylet is its small diameter, rendering it atraumatic and permitting multiple punctures for the successful final targeting of the lesion. With this guiding set we achieved targeting of difficult lesions. Furthermore, larger needles were more easily introduced in locations that posed technical difficulties. No major complications were observed. The complication rate was comparable to that of the conventional biopsy technique. The technique using the guide stylet was easily performed and could be applied to almost all organs.

A case of hepatocellular carcinoma arising within large focal nodular hyperplasia with review of the literature.

Focal nodular hyperplasia (FNH) is a relatively rare benign hepatic tumor, usually presenting as a solitary lesion; however, multiple localizations have also been described. The association of FNH with other hepatic lesions, such as adenomas and haemangiomas has been reported by various authors. We herein report a case of a hepatocellular carcinoma arising within a large focal nodular hyperplasia, in a young female patient.

Intracerebral haemorrhage as a rare complication of HSV-1 meningoencephalitis: case report and review of the literature.

We present a case of herpetic meningoencephalitis confirmed by PCR in a 22-y-old male, with accompanying appearance of a large intracerebral haematoma as a complication. Despite the impressive imaging findings, the final outcome of the patient's progress was favourable.

The potential role of TGFbeta1, TGFbeta2 and TGFbeta3 protein expression in colorectal carcinomas. Correlation with classic histopathologic factors and patient survival.

PURPOSE: This study investigates the expression of tumor growth factors TGFbeta1, TGFbeta2 and TGFbeta3 in tissue material from patients with colorectal carcinoma and evaluates their correlation with known prognostic markers and patient survival. PATIENTS AND METHODS: The study included 124 patients with colorectal carcinoma. According to the TNM classification of malignant tumors, 26 tumors were identified as being stage I, 30 stage II, 48 stage III, and 20 stage IV, whereas 106 tumors were low-grade and 18 high-grade malignancies. On paraffin sections, the streptavidin-biotin technique using antibodies against TGFbeta1, TGFbeta2 and TGFbeta3 was applied. Morphological and immunohistochemical results were correlated with clinicopathologic parameters. RESULTS: TGFbeta1 protein was expressed in 88 out of 124 (71%) carcinomas, whereas TGFbeta2 and TGFbeta3 proteins were detected in all tumors examined. Normal colonic mucosal epithelial cells expressed TGFbeta2 (significantly less as compared to neoplastic cells; p < 0.01) and TGFbeta3 (p > 0.05 compared to neoplastic cells), but not TGFbeta1. Statistical analysis revealed a higher expression of TGFbeta1 in low-grade carcinomas (p = 0.009) and a higher presence of TGFbeta2 in advanced tumors (p = 0.008). TGFbeta1 expression was related with increased disease-free and overall survival (p < 0.05 each). The presence of TGFbeta2 was correlated with worse prognosis (p < 0.05). Cox analysis revealed that besides tumor grade and stage, TGFbeta1 expression constituted an independent prognostic factor. CONCLUSION: This study shows that in adenocarcinomas of the colon, there is a differential expression of TGFbeta1, TGFbeta2 and TGF3. TGFbeta1 may be implicated in the pathogenesis of these tumors, since it is expressed only in neoplastic but not in normal cells. TGFbeta1 is related with an increased disease-free and overall survival and constitutes an independent prognostic factor. In advanced stages, TGFbeta2 seems to be involved in tumor progression and is related with worse prognosis.

Dexamethasone incorporating liposomes: an in vitro study of their applicability as a slow releasing delivery system of dexamethasone from covered metallic stents.

AIM: To investigate the possibility of covering PET-covered commercially available metallic stents, with liposomal dexamethasone that will act as a slow releasing drug-depot at the site of interest. METHODS: Large multilamellar (MLV), sonicated (SUV) and dried reconstituted (DRV) liposomes entrapping dexamethasone were prepared by thin film hydration, sonication and the DRV method, respectively, and applied on stents using a simple evaporation technique. Drug encapsulation and retention in liposomes were measured by HPLC. The presence of liposomes on the stent surface was confirmed by scanning electron microscopy, while the release of dexamethasone and lipid from the liposome-covered stent was evaluated under different conditions (flow rate, presence of plasma proteins), in an in vitro assembly that was developed to simulate in vivo conditions. RESULTS: The release of dexamethasone from liposome-covered stents ranged from 25% to 50% after 48 h of incubation in buffer, depending on the type of liposome. The release was highest from stents covered with DRV liposomes. When increasing the flow rate from 2 to 6 ml/min a slight increase in release of drug was observed, while a higher release was measured when stents were incubated in plasma proteins. Liposome size does not affect liposome placement on stents. CONCLUSION: The basic characteristics that should be considered when preparing liposomes to cover stents should be their drug loading capacity and their stability under the conditions prevailing at the site of interest. By preparing the appropriate formulation, it is possible that liposomal drugs may be used to cover stents and serve as drug releasing depots at the site of interest. Further in vitro and in vivo studies are needed in order to exploit the possible applications of this methodology.