Hemoperitoneum from spontaneous bleeding of a uterine leiomyoma: a case report.

Bleeding from uterine leiomyoma is a rare cause of hemoperitoneum. In most cases bleeding is a result of trauma or torsion. Spontaneous rupture of a superficial vein is extremely rare. Fewer than 100 cases have been reported. Our patient is a 44-year-old black woman who presented in the emergency room with acute onset of epigastric pain. Past medical and surgical history was not contributory except for a uterine "fibroid." In the emergency room, the patient's abdomen became diffusely tender. Her pregnancy test was negative, and the abdominal ultrasound showed fluid in the peritoneal cavity. The patient became hemodynamically unstable, and there was a significant drop of the hemoglobin/hematocrit. A surgical consultation was requested, and the patient underwent exploratory laparotomy. A subserosal uterine leiomyoma was found, with an actively bleeding vein on its dome. The leiomyoma was excised and 3 liters of blood and blood clots were evacuated from the peritoneal cavity. The patient was premenopausal and had a known leiomyoma. The clinical course was similar to that of previously reported cases. Although extremely rare, when there is no history of trauma, pregnancy, or other findings, spontaneous bleeding from uterine leiomyoma should be in the differential diagnosis. Emergent surgical intervention is recommended to establish the diagnosis and stop the hemorrhage.

Predictive model of the effect of CO2, pH, temperature and NaCl on the growth of Listeria monocytogenes.

The growth responses of L. monocytogenes as affected by CO2 concentration (0-100% v/v, balance nitrogen), NaCl concentration (0.5-8.0% w/v), pH (4.5-7.0) and temperature (4-20 degrees C) were studied in laboratory medium. Growth curves were fitted using the model of Baranyi and Roberts, and specific growth rates derived from the curve fit were modelled. Predictions for specific growth rate, doubling time and time to a 1000-fold increase could be made for any combination of conditions within the matrix. Predictions of growth from the model were compared with published data and this showed the model to be suitable for predicting growth of L. monocytogenes in a range of foods packaged under a modified atmosphere.

Demonstration of hypoperfusion surrounding intracerebral hematoma in humans.

We undertook this study to determine whether ischemic regions are present that may contribute to poor outcome after intracerebral hemorrhage (ICH) in humans. Hypoperfusion around an ICH has not been reported in humans. Brain computed tomography (CT) and (99m)Tc-HMPAO brain single photon emission computed tomography (SPECT) perfusion studies were carried out 51 +/- 12 hours after supratentorial ICH in seven patients selected from a referral hospital over an 8-month period. The widest diameters of the hematoma on CT and of reduced perfusion on SPECT were measured and compared. The diameters of reduced perfusion were measured at the 40% and 20% reduced count levels compared with the contralateral side. Reduced perfusion in and around the hematoma was seen in all seven cases. The diameters of ICH on CT (mean, 53 +/- 12 mm) were comparable to the diameters of 40% reduction of counts (mean, 61 +/- 14 mm) measured by SPECT. The mean diameter of brain demonstrating 20% reduction in counts was 76+/-19 mm, which was 43% greater than the hematoma diameter on CT (p = .004). In conclusion, substantial regions of reduced perfusion surround ICH in humans, which might contribute to poor outcome and be amenable to anti-ischemic therapy.

Shear-induced platelet aggregation in normal subjects and stroke patients.

Elevated levels of shear stress that occur in stenotic arteries may induce platelet aggregation and initiate thrombosis. Shear-induced platelet aggregation (SIPA) was studied in groups of ischemic stroke patients and normal subjects using a viscometric-flow cytometric technique. Twenty-three patients who sustained an ischemic stroke that was not of cardiac origin were included in this study, and were classified either as atherosclerotic (n = 15) or as lacunar (n = 8) stroke patients. The results show that shear stresses at the levels which occur in arteries partially occluded by atherosclerosis or vascular spasm strongly activate and aggregate platelets, and this response is much more pronounced in non-lacunar stroke patients who had documented atherosclerotic disease of their cerebral vessels. SIPA is not affected by the time of blood drawing after the onset of stroke suggesting that these platelet abnormalities are not transient but chronic. Furthermore, the extent of platelet activation detected by an anti-P-selectin monoclonal antibody and the proportion of neutrophil-platelet aggregates circulating in vivo are significantly higher in the atherosclerotic stroke patients studied at least one month after the onset of stroke. The results indicate that the enhanced platelet responses observed in atherosclerotic stroke patients are not consequences of ischemia, and therefore both platelet activation and elevated SIPA may be considered as important risk factors for stroke. The methodology developed in this work may be useful for characterization of platelet reactivity, and may contribute to our understanding of thrombotic mechanisms.

Case report: malignant mesenchymoma of the mediastinum.

Malignant mesenchymoma is a malignant tumor arising in the soft tissues of the body. It is a rapidly growing tumor prone to recurrences and occasional metastasis. It occurs at all ages and locations but has a preference for the extremities and the retroperitoneum.

Expression of the Escherichia coli cell division gene sep cloned in a lambda Charon phage.

The Escherichia coli cell division gene sep, which probably codes for one of the penicillin-binding proteins, has been cloned into lambda Charon 10 to form a viable sep+ transducing phage. After infection with this hybrid phage, penicillin-binding protein 3 was overproduced and incorporated into the E. coli inner membrane.