Hemobilia caused by a ruptured hepatic cyst: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hemobilia is a rare cause of upper gastrointestinal bleeding. More than 50% of hemobilia cases are related to iatrogenic trauma from hepatobiliary procedures, and needle biopsy of the liver represents the most common cause. A minority of hemobilia cases are due to hepatobiliary disorders such as cholangitis, hepatobiliary cancers, choledocholithiasis, and vascular abnormalities in the liver. The classic presentation of hemobilia is the triad of right upper quadrant (biliary) pain, obstructive jaundice, and upper gastrointestinal bleeding. We report a rare case of hemobilia caused by a spontaneous hepatic cyst rupture, where our patient presented without the classical symptoms, in the absence of therapeutic or pathological coagulopathy, and in the absence of spontaneous or iatrogenic trauma.</p> <p>Case presentation</p> <p>A 91-year-old African-American woman was referred to our out-patient gastroenterology clinic for evaluation of mild epigastric pain and intermittent melena. An abdominal computed tomography scan was remarkable for multiple hepatic cysts. Esophagogastroduodenoscopy revealed multiple blood clots at the ampulla of Vater. Endoscopic retrograde cholangiopancreatography showed a single 18 mm-sized filling defect in the common hepatic duct wall at the junction of the right and left hepatic duct, adjacent to one of the hepatic cysts. The ruptured hepatic cyst communicated to the bile ducts and was the cause of hemobilia with an atypical clinical presentation.</p> <p>Conclusion</p> <p>Hemobilia is an infrequent cause of upper gastrointestinal bleeding and rarely occurs due to hepatic cyst rupture. To the best of our knowledge, this is only the second case report in the literature that describes hemobilia due to hepatic cyst rupture. However, it is the first case in the literature of hemobilia due to hepatic cyst rupture in the absence of iatrogenic or spontaneous trauma, and in the absence of a spontaneous or pathological coagulopathy.</p

Effect of powder metallurgy synthesis parameters for pure aluminium on resultant mechanical properties

In this work, pure aluminium powders of different average particle size were compacted, sintered into discs and tested for mechanical strength at different strain rates. The effects of average particle size (15, 19, and 35 μm), sintering rate (5 and 20 °C/min) and sample indentation test speed (0.5, 0.7, and 1.0 mm/min) were examined. A compaction pressure of 332 MPa with a holding time of six minutes was used to produce the green compacted discs. The consolidated green specimens were sintered with a holding time of 4 h, a temperature of 600 °C in an argon atmosphere. The resulting sintered samples contained higher than 85% density. The mechanical properties and microstructure were characterized using indentation strength measurement tests and SEM analysis respectively. After sintering, the aluminium grain structure was observed to be of uniform size within the fractured samples. The indentation test measurements showed that for the same sintering rate, the 35 μm powder particle size provided the highest radial and tangential strength while the 15 μm powder provided the lowest strengths. Another important finding from this work was the increase in sintered sample strength which was achieved using the lower sinter heating rate, 5 °C/min. This resulted in a tangential stress value of 365 MPa which was significantly higher than achieved, 244 MPa, using the faster sintering heating rate, 20 °C/min

Hamartomas, teratomas and teratocarcinosarcomas of the head and neck: Report of 3 new cases with clinico-pathologic correlation, cytogenetic analysis, and review of the literature

<p>Abstract</p> <p>Background</p> <p>Germ-cell tumors (GCT) are a histologically and biologically diverse group of neoplasms which primarily occur in the gonads but also develop at different extragonadal sites in the midline of the body. The head and neck region including the upper respiratory tract is a very rare location for such tumors in both children and adults, which can cause diagnostic and therapeutic difficulties.</p> <p>Methods</p> <p>We describe here two new cases of multilineage tumors including sinonasal teratocarcinosarcoma [SNTCS], and congenital oronasopharyngeal teratoma (epignathus) and compare their features with those of a new case of a rare salivary gland anlage tumor [SGAT], an entity for which the pathogenesis is unclear (i.e. hamartoma versus neoplasm). We correlate their presenting clinico-pathological features and compare histologic and cytogenetic features in an attempt to elucidate their pathogenesis and biologic potentials.</p> <p>Results and discussion</p> <p>Cytogenetic analysis revealed chromosomal abnormalities only in the case of SNTCS that showed trisomy 12 and 1p deletion. Both cytogenetic abnormalities are characteristically present in malignant germ cell tumors providing for the first time evidence that this rare tumor type indeed might represent a variant of a germ cell neoplasm. The SGAT and epignathus carried no such cytogenetic abnormalities, in keeping with their limited and benign biologic potential.</p> <p>Conclusion</p> <p>The comparison of these three cases should serve to emphasize the diversity of multilineage tumors (hamartomas and GCT) of the upper respiratory tract in regards to their biology, age of presentation and clinical outcomes. Malignant tumors of germ cell origins are more likely to affect adults with insidious symptom development, while benign tumors can nevertheless cause dramatic clinical symptoms which, under certain circumstances, can be fatal.</p

Carbon-nitrogen interactions in European forests and semi-natural vegetation - Part 1: Fluxes and budgets of carbon, nitrogen and greenhouse gases from ecosystem monitoring and modelling

The impact of atmospheric reactive nitrogen (N$_{r}$) deposition on carbon (C) sequestration in soils and biomass of unfertilized, natural, semi-natural and forest ecosystems has been much debated. Many previous results of this dC/dN response were based on changes in carbon stocks from periodical soil and ecosystem inventories, associated with estimates of N$_{r}$ deposition obtained from large-scale chemical transport models. This study and a companion paper (Flechard et al., 2020) strive to reduce uncertainties of N effects on C sequestration by linking multi-annual gross and net ecosystem productivity estimates from 40 eddy covariance flux towers across Europe to local measurement-based estimates of dry and wet N$_{r}$ deposition from a dedicated collocated monitoring network. To identify possible ecological drivers and processes affecting the interplay between C and N$_{r}$ inputs and losses, these data were also combined with in situ flux measurements of NO, N$_{2}$O and CH$_{4}$ fluxes; soil NO$_{3}$̅ leaching sampling; and results of soil incubation experiments for N and greenhouse gas (GHG) emissions, as well as surveys of available data from online databases and from the literature, together with forest ecosystem (BASFOR) modelling. Multi-year averages of net ecosystem productivity (NEP) in forests ranged from -70 to 826 gCm$^{-2}$ yr$^{-1}$ at total wet+dry inorganic N$_{r}$ deposition rates (N$_{dep}$) of 0.3 to 4.3 gNm$^{-2}$ yr$^{-1}$ and from -4 to 361 g Cm$^{-2}$ yr$^{-1}$ at N$_{dep}$ rates of 0.1 to 3.1 gNm$^{-2}$ yr$^{-1}$ in short semi-natural vegetation (moorlands, wetlands and unfertilized extensively managed grasslands). The GHG budgets of the forests were strongly dominated by CO$_{2}$ exchange, while CH$_{4}$ and N$_{2}$O exchange comprised a larger proportion of the GHG balance in short semi-natural vegetation. Uncertainties in elemental budgets were much larger for nitrogen than carbon, especially at sites with elevated N$_{dep}$ where N$_{r}$ leaching losses were also very large, and compounded by the lack of reliable data on organic nitrogen and N$_{2}$ losses by denitrification. Nitrogen losses in the form of NO, N$_{2}$O and especially NO$_{3}$̅ were on average 27%(range 6 %–54 %) of N$_{dep}$ at sites with N$_{dep}$ 3 gNm$^{-2}$ yr$^{-1}$. Such large levels of N$_{r}$ loss likely indicate that different stages of N saturation occurred at a number of sites. The joint analysis of the C and N budgets provided further hints that N saturation could be detected in altered patterns of forest growth. Net ecosystem productivity increased with N$_{r}$ deposition up to 2–2.5 gNm$^{-2}$ yr$^{-1}$, with large scatter associated with a wide range in carbon sequestration efficiency (CSE, defined as the NEP = GPP ratio). At elevated N$_{dep}$ levels (> 2.5 gNm$^{-2}$ yr$^{-1}$), where inorganic N$_{r}$ losses were also increasingly large, NEP levelled off and then decreased. The apparent increase in NEP at low to intermediate N$_{dep}$ levels was partly the result of geographical cross-correlations between N$_{dep}$ and climate, indicating that the actual mean dC/dN response at individual sites was significantly lower than would be suggested by a simple, straightforward regression of NEP vs. N$_{dep}$

A scanning tunneling microscopy (STM) investigation of complex formation between cytochrome P450(cam) and putidaredoxin.

We have previously reported the scanning tunnelling microscopy (STM) imaging under buffer of the heme monooxygenase cytochrome P450(cam) from Pseudomonas putida [Faraday Discuss. 116 (2000) 1]. We describe here the adsorption and STM imaging under buffer of complexes of a mutant of cytochrome P450(cam), K344C, and wild-type putidaredoxin (Pdx) on gold(111). The images of Pdx on its own on gold(111) are not uniform, presumably due to multiple orientations of protein adsorption because of the presence of five or more cysteines on the protein surface. STM imaging of a 1:1 mixture of P450(cam)-K344C/Pdx showed a regular array of pairs of different-sized proteins 20-25 A apart arranged in rows across the gold(111) surface which we attribute to the P450(cam)/Pdx complex. The images of the pairs are more regular than those of Pdx on its own, probably as a result of complex formation with P450(cam) partly overcoming the heterogeneity of Pdx adsorption. As far as we are aware this is the first report of STM imaging of a protein/protein complex, and the first direct observation of P450(cam)/Pdx complex formation which is a key step in the catalytic cycle of P450(cam) catalysis. The redox centers of the two proteins are ca. 20 A apart, too far for rapid intracomplex electron transfer. Whether the observed complex is competent for electron transfer or physiologically relevant is not known, and further work is in progress to elucidate the protein-protein interaction

The electrochemistry and scanning tunnelling microscopy of the flavoprotein, putidaredoxin reductase from Pseudomonas putida

Cyclic voltammetry studies of putidaredoxin reductase (PdR) were carried out on 1-hexanethiol- and 1-dodecanethiol-modified gold electrodes, and the effect of NAD+/NADH were investigated. Electron transfer rate constants were calculated for both electrode modifiers, and a catalytic reduction current was observed in the presence of NAD+ at dodecanethiol-modified gold surfaces. Complementary in situ scanning tunnelling microscopy images of the electrode surface at high resolution were obtained in fluid which show that the PdR molecules are immobilised in a highly uniform manner on the modified gold surface. The results suggest that the immobilised enzyme is both electrochemically and catalytically active. © 2003 Elsevier Science B.V. All rights reserved

Early recurrent left atrial myxoma in a teenager with de novo mutation of Carney complex

We report a case of an extremely early recurrence of left atrial myxoma in a 13-year-old girl. On hospital admission, the clinical presentation was of cerebral embolism with noticeable spotty skin pigmentation and hypertelorism. The left atrial myxoma originated from the roof of the left atrium. The histology specimen showed typical finding of a myxoma. Six months later a new intracardial mass was evacuated, the postoperative result showing the same type of myxomatous tissue. Genetic investigations demonstrated Carney complex. The genetic analysis of the child's family was negative, demonstrating de novo mutation of this rare disorder

A scanning tunnelling study of immobilised cytochrome P450cam.

A site-specifically engineered surface cysteine residue, located in a region where the haem moiety is closest to the surface, is used to anchor cytochrome P450cam enzyme molecules covalently to a gold electrode. More reproducibly ordered adsorption, at high coverage, occurs with this K344C mutant than with the wild-type enzyme. The subsequently formed close-packed monolayer arrays have been probed by scanning tunnelling microscopy under ambient conditions and under aqueous (buffered) solution at high resolution. Initial indications suggest that the immobilised enzyme is both electrochemically addressable and catalytically active