Appendicular myxoglobulosis; a rare form of appendicular mucocele.

Myxoglobulosis is a particular, rare, form of appendicular mucocele, characterized by the presence of numerous, occasionally calcified, globules that are grouped together like grapes, and look like pearls or fish eggs, in the appendicular lumen. The diagnosis of myxoglobulosis is most often fortuitous, but sometimes, can be made in the face of acute appendicitis or another setting of abdominal pain. Imaging (sonography or computerized tomography (CT)) is highly suggestive when it shows a cystic, encapsulated, oblong, well-delineated mass, containing (heterogeneous, liquid, and viscous) mucus with calcified globules. In contrast to acute appendicitis, the wall of the appendix is thin (<6mm) and there is no peri-appendicular inflammation. Long-term complications are similar to other appendicular mucoceles, including invagination, bleeding, perforation, peritonitis and peritoneal pseudomyxoma.

International collaborative study for the calibration of the Ph. Eur. somatropin chemical reference substance batches 3 and 4 (BSP108).

An international collaborative study was carried out for the establishment of replacement batches for the European Pharmacopoeia (Ph. Eur.) Somatropin Chemical Reference Substance (CRS) batch 2. The study was organised within the framework of the Biological Standardisation Programme (BSP) of the Council of Europe and the European Commission. Seventeen laboratories from Europe, North America, South America and Australia took part in the collaborative study. The study aimed at calibrating the somatropin content of 2 candidate preparations and demonstrating their suitability to serve as a reference substance in the tests for identification, for related proteins, for dimers and related substances of higher molecular mass (HMM), for charged variants distribution and for the assay of somatropin, as prescribed by the current Ph. Eur. monographs 0950 Somatropin bulk solution, 0951 Somatropin and 0952 Somatropin for injection. Based on the results summarised herein the Ph. Eur. Commission adopted in January 2012 candidate preparation b (cCRS-b, Sample D) as somatropin CRS batch 3 with an assigned content of 3.86 mg of somatropin monomer per vial, and candidate preparation a (cCRS-a, Sample C) as somatropin CRS batch 4 with an assigned content of 2.59 mg of somatropin monomer per vial.

Determination of somatropin charged variants by capillary zone electrophoresis - optimisation, verification and implementation of the European pharmacopoeia method.

Measurement of somatropin charged variants by isoelectric focusing was replaced with capillary zone electrophoresis in the January 2006 European Pharmacopoeia Supplement 5.3, based on results from an interlaboratory collaborative study. Due to incompatibilities and method-robustness issues encountered prior to verification, a number of method parameters required optimisation. As the use of a diode array detector at 195 nm or 200 nm led to a loss of resolution, a variable wavelength detector using a 200 nm filter was employed. Improved injection repeatability was obtained by increasing the injection time and pressure, and changing the sample diluent from water to running buffer. Finally, definition of capillary pre-treatment and rinse procedures resulted in more consistent separations over time. Method verification data are presented demonstrating linearity, specificity, repeatability, intermediate precision, limit of quantitation, sample stability, solution stability, and robustness. Based on these experiments, several modifications to the current method have been recommended and incorporated into the European Pharmacopoeia to help improve method performance across laboratories globally.

Renal biopsy with forceps through the femoral vein.

PURPOSE: To evaluate the usefulness of a new technique of transvascular renal biopsy with a flexible forceps in high-risk patients and compare its results with those reported for other techniques of renal biopsy. PATIENTS AND METHODS: Sixteen transfemoral renal biopsies were performed in 13 high-risk patients. Indications included severe bleeding disorders, combined renal-hepatic biopsy, morbid obesity, solitary kidney, and poor clinical condition. The technique was performed through the femoral vein; a 7-F Mullins introducer sheath was placed in a subcortical renal vein, and the biopsy was performed with a flexible biopsy forceps. RESULTS: Renal tissue was obtained in 15 of 16 procedures (93.7%) with at least one glomerulus in 14 of 16 (87.5%), and at least six glomeruli in 11 of 16 procedures (69%). Samples adequate for diagnosis were obtained in 13 of 16 procedures (81%). Mean number of glomeruli per procedure was 12.6 (range, 0-39). Aside from transient hematuria in two patients, no other complications were known to have occurred. CONCLUSIONS: Transfemoral renal biopsy is a safe technique for acquisition of renal samples in high-risk patients. The procedure can be performed at the same time as other vascular techniques. The histopathologic results, although worse than those obtained with the percutaneous approach, are better than those reported with other transvascular techniques.

Blood-borne spread of a benign giant cell tumor from the radius to the soft tissue of the hand.

A unique case of giant cell tumor of the distal epiphysis of the radius that spread to the soft tissue of the hand after an en bloc excision is reported. Three months after the excision, 27 cutaneous-subcutaneous tumoral nodules, ranging from 0.3 to 1.5 cm in diameter, were observed spreading from wrist to fingers on both hand aspects. Microscopically, the tumor tissue displayed the pattern of a benign giant cell tumor. Multiple tumor tissue emboli were lodged in venules of the soft tissue between nodules and in a small vein. The findings suggest that the tumor emboli arrived at the hand through a mechanism of retrograde embolism through the superficial veins.

A triple autoimmune association.

We present a female patient affected by the triple association of rheumatoid arthritis, amyloidosis and Sicca Syndrome. The individual pathological features are well documented. We discussed the rarity of this presentation and some pecularities of the case such as the presence of a true Sicca Syndrome with lymphoid infiltration of the salivary glands to distinguish it from other amyloid patients with Sicca Syndrome due to the infiltration of exocrine gland by amyloid.

Eosinophil inflammatory reaction in isolated organs.

Twenty-nine cases of eosinophilic infiltration of isolated organs or tissues, not associated with allergic history, were revised. Sixteen were men and 13 women, the mean age was 39.3 years. The presenting symptoms were related with an inflammation of the target organ or tissue in 25 cases. Nineteen cases had histories of acute or chronic inflammation of the same organ or tissue. Blood eosinophilia was marked in 3 cases of Loeffler's syndrome. Morphologically, eosinophilic infiltration of isolated organs or tissues can be diffuse, focal or polyp-nodular. Charcot-leyden crystals were found in macrophages or between the eosinophilic infiltrate. The present authors believe that some of these lesions are due to a local allergic reaction to any of the different substances liberated in old foci of inflammation of the target organ or tissue. This is based on: 1) Many cases have no allergic history. 2) Blood eosinophilia is unusual in all cases but Loeffler's syndrome. 3) Many patients had personal history of inflammation of the target organ. 4) The eosinophil has a short life span, and 5) Eosinophilic infiltration is more frequent in organs where inflammation is usual. The performance of appropriate sensibility allergic tests in all patients with eosinophilic infiltration of isolated organs is emphasized, in order to probe the validity of our hypothesis.