Primary lymphoma of the liver: a case report and review.

The case of a previously healthy man who developed primary non-Hodgkin's lymphoma of the liver is presented. Biopsy confirmed that the tumour was of the diffuse large cell type and was of apparent T-cell origin. The diagnosis of these rare tumours is suggested by the presence of a hepatic mass without lymphadenopathy, splenomegaly or bone marrow involvement, as well as normal carcinoembryonic antigen and alpha-fetoprotein levels. However, histological examination of tissue is essential to confirm the diagnosis. The response to treatment varies, but surgical resection and/or chemotherapy can result in prolonged remissions. The literature on this topic is briefly reviewed.

Growth hormone and hexarelin prevent endothelial vasodilator dysfunction in aortic rings of the hypophysectomized rat.

The endothelial vasodilation mechanism(s) has been investigated in aortic rings of hypophysectomized male rats as well as hypophysectomized rats treated for 7 days with growth hormone (GH, 400 microg/kg, s.c.) or hexarelin (80 microg/kg, s.c.). Tissue preparations from intact animals were taken as controls. The results obtained indicate that the release of 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha) from aortic rings of hypophysectomized rats was markedly reduced (51%; p<0.01) as compared with that of control preparations; the peak response to cumulative concentration of endothelin-1 (ET-1, from 10(-11) to 10(-5) M) was increased 2.4-fold (p<0.01) versus controls; the relaxant activity of acetylcholine (ACh, from 10(-10) to 10(-4) M) in norepinephrine-precontracted aortic rings was reduced by 39.5+/-4.4%. Pretreatment of hypophysectomized rats with GH or hexarelin markedly antagonized the hyperresponsiveness of the aortic tissue to ET-1 and allowed a consistent recovery of both the relaxant activity of ACh and the generation of 6-keto-PGF1alpha. Collectively these findings support the concept that dysfunction of vascular endothelial cells may be induced by a defective GH function. Because a replacement regimen of GH restored the somatotropic function and increased plasma insulin-like growth factor-I (IGF-I) concentrations in the hypophysectomized rats, it is suggested that IGF-I may have protected the vascular endothelium acting as a biologic mediator of GH action. In contrast to GH, hexarelin replacement neither increased body weight nor affected the plasma concentrations of IGF-I, indicating that its beneficial action on vascular endothelium was divorced from that on somatotropic function and was likely due to activation of specific endothelial receptors.

Growth hormone-independent cardioprotective effects of hexarelin in the rat.

We previously reported that induction of selective GH deficiency in the rat exacerbates cardiac dysfunction induced by experimental ischemia and reperfusion performed on the explanted heart. In the same model, short-term treatment with hexarelin, a GH-releasing peptide, reverted this effect, as did GH. To ascertain whether hexarelin had non-GH-mediated protective effects on the heart, we compared hexarelin and GH treatment in hypophysectomized rats. Hexarelin (80 microg/kg sc), given for 7 days, prevented exacerbation of the ischemia-reperfusion damage induced by hypophysectomy. We also demonstrate that hexarelin prevents increases in left ventricular end diastolic pressure, coronary perfusion pressure, reactivity of the coronary vasculature to angiotensin II, and release of creatine kinase in the heart perfusate. Moreover, hexarelin prevents the fall in prostacyclin release and enhances recovery of contractility. Treatment with GH (400 microg/kg sc) produced similar results, whereas administration of EP 51389 (80 microg/kg sc), another GH-releasing peptide that does not bind to the heart, was ineffective. In conclusion, we demonstrate that hexarelin prevents cardiac damage after ischemia-reperfusion, and that its action is not mediated by GH but likely occurs through activation of specific cardiac receptors.

Novel hexarelin analogs stimulate feeding in the rat through a mechanism not involving growth hormone release.

Growth hormone-releasing peptides (GHRPs) are a class of small peptides that stimulate growth hormone (GH) release in several animal species, including the human. Moreover, GHRPs injected into the brain ventricles stimulate feeding in the rat. The aim of this study was to evaluate the GH-releasing properties of a series of novel GHRP analogs and the possible existence of functional correlations between the GH-releasing activity and the effects on feeding behavior. Two well-known hexapeptides, GHRP-6 and hexarelin, given s.c., dose dependently stimulated both GH release and feeding behavior in satiated rats. However, in a series of tri-, penta- and hexapeptide analogs of hexarelin, some compounds were active either on GH release or on eating behavior. Interestingly, even minor structural modifications resulted in major changes of the pharmacological profile. We conclude that GHRPs have orexigenic properties after systemic administration which are largely independent from the effects they exert on GH release.

Duodenal obstruction by a gallstone (Bouveret's syndrome) managed by endoscopic stone extraction: a case report and review.

Gastric outlet obstruction caused by a large gallstone in the duodenum or pylorus (Bouveret's syndrome) is a rare complication of gallstone disease. The presenting symptoms are often nonspecific and include nausea, vomiting, epigastric pain and a history of gallbladder disease. Although the diagnosis is established only at surgery in many cases, preoperative recognition by imaging techniques and endoscopy is desirable. Surgical treatment aims at removal of the ectopic gallstone, closure of the fistula and cholecystectomy. A case of Bouveret's syndrome is presented where endoscopic extraction of the duodenal gallstone was accomplished providing definitive treatment for this patient.

Bacterial oesophagitis in an immunocompromised patient.

Bacterial oesophagitis is an uncommon and poorly described entity affecting particularly the immunosuppressed patient. The diagnosis rests on the demonstration of bacterial invasion of the oesophageal wall in the absence of other pathological processes. The causative organisms usually are Gram-positive cocci and there may be associated bacteraemia. The case report describes a leukaemic patient with bacteraemic bacterial oesophagitis.

An unusual case of gastric diverticulosis.

Gastric diverticula are usually single and most frequently occur in the juxta-cardiac region of the stomach. Prepyloric diverticula generally are rare, single, and usually acquired. We describe a patient with multiple prepyloric diverticula and pyloric stenosis diagnosed by upper gastrointestinal x-ray studies and endoscopy. To our knowledge, this association has not been reported previously.

[Formaldehyde-fixed human varicose vein bioprosthesis with siliconized inner surface for hemodialysis. Clinical analysis of 165 transplants]. / Formaldehydfixierte innenflächensilikonierte Humane-Varizen-Vene (HVV)-Bioprothese zur Hämodialyse. Klinische Analyse von 165 Transplantaten.

With the submitted study of 165 HVV-vessel-transplantations the marking properties like reduced immunogenity, primary athrombogenicity, form fixated vascular lumen, ability for punction, flow reduction and stability for storage were possible to prove. Few complications (thromboses, aneurysms, infections) and also low rate of revision marks the long-term progress of this bioprosthesis. It will be stated with emphasis, that the use of this vascular device is indicated, if the patient's veins for creation of an arteriovenous vascular access is not available. In long-term progress the rate of function is better in comparison with other similar or synthetic materials for prostheses.

Anticonvulsant-induced marrow suppression and immune thrombocytopenia.

Phenytoin and carbamazepine are rarely associated with serious hematologic side effects but can include impairment of either humoral or cell-mediated immunity. We describe a patient who developed severe granulocytopenia while taking phenytoin. The phenytoin was replaced by carbamazepine and the patient subsequently developed erythroid hypoplasia, neutropenia and persistent thrombocytopenia. In vitro studies demonstrated a phenytoin-dependent antigranulocyte antibody directly implicating phenytoin in the leukopenia. An extremely high titre of platelet-associated IgG was found which was independent of the presence of carbamazepine. Autoantibodies directed against the patient's red cells, granulocytes and lymphocytes were also demonstrated. In vitro marrow culture studies failed to detect cellular or humoral inhibitors and were suggestive of a stem cell defect. These studies indicate that anticonvulsant therapy can result in sustained humoral abnormalities as well as in nonimmune mediated marrow suppression.

Spontaneous intramural esophageal hematoma. Diagnosis by CT scanning.

We describe a patient who suffered a spontaneous intramural esophageal hematoma while taking aspirin and dipyridamole. The diagnosis was initially made at endoscopy, with confirmation by computed tomography (CT). CT scanning was particularly valuable in both the diagnosis and in the follow-up of this lesion. As the prognosis for a spontaneous intramural esophageal hematoma is good with conservative management, its specific definition by computed tomography should facilitate proper management decisions.

Coexistence of rheumatoid arthritis in married couples: a search for etiological factors.

Epstein-Barr virus (EBV) and the genetic marker HLA-DR4 both appear to play a role in the etiology of rheumatoid arthritis (RA). Antibodies to viral capsid antigen and the early antigen complex of the EB virus as well as the HLA phenotype were studied in 6 families. Both spouses had classical or definite RA but none of their offspring, all adult, had any evidence of RA. At least 1 spouse of each couple had DR4 and this phenotype was found in 4 of the 8 offspring. All parents and their offspring had been infected with EBV. This study supports the association of DR4 and RA. The presence of DR4 in 4 normal adult offspring was not associated with the absence of primary infection or enhanced levels of EBV-specific antibodies.