Gastric metastasis from an alveolar soft part sarcoma in a child: case report and review of the literature.

The authors report a child with alveolar soft part sarcoma who developed significant anemia due to gastrointestinal blood loss. Evaluation revealed the source of bleeding as a gastric metastasis, which was successfully removed. A brief review of gastrointestinal involvement by alveolar soft part sarcoma is discussed.

Bilateral adrenal myelolipomas in a woman with chronic anticoagulation, postmenopausal uterine bleeding, primary hyperparathyroidism and hyperthyroidism.

Adrenal myelolipomas are rare, usually benign unilateral tumors. Their management has controversially been discussed. The authors here present a 53-year-old African American female Jehovah's witness with postmenopausal uterine bleeding on chronic anticoagulation and episodic right flank pain who was found to have bilateral myelolipomas in addition to primary hyperparathyroidism. In collaboration with gynecology, midline laparotomy was performed to remove uterus and both ovaries in addition to the right adrenal gland for a 62 × 79 mm myelolipoma. An open biopsy of the left adrenal mass measuring 42 × 43 mm revealed myelolipoma and ruled out malignancy. Pathology confirmed bilateral myelolipomas, endometrial polyps, and leiomyomata uteri. After an uneventful recovery, the patient then underwent a right inferior parathyroidectomy for parathyroid adenoma. This case illustrates the challenges in deciding when to surgically intervene for bilateral adrenal myelolipoma and, for the first time, associates various other endocrinopathies, although no known endocrine neoplasia syndrome variant was present.

Reactivity of commercial benzodiazepine immunoassays to phenazepam.

Phenazepam is a long acting benzodiazepine that is not controlled in Canada, the United States or many European countries. The abuse of phenazepam has gained recent attention due to the number of hospitalizations and fatalities resulting from overdose. The compound is relatively potent with recommended doses of 0.5-1.0 mg, or 1/10th the recommended dose of diazepam, and is easy to obtain locally or from international suppliers via the internet. Increased risk of phenazepam overdose is attributed to its potency and the forms in which it is supplied. Individuals without scales or balances are prone to estimate dose amounts of powder visually, which can result in significant errors. The detection of phenazepam has been described using various methods including GC, GC/MS and LC/MS, but no data regarding the sensitivity of commercially available immunoassays exist. In this study, phenazepam-spiked urine samples were analyzed using five commercial instruments and two point of care devices. The concentrations of phenazepam required for detection ranged from 140-462 ng/mL, which is comparable to those of other benzodiazepines. Laboratorians and clinicians should be confident that phenazepam will be detected via most commercial drugs of abuse screens in patients after significant ingestion.