Prepared by
Seda Demiroluk,
M.D., Department o f Microbiology, School o f
Medicine, Marmara University, Istanbul, Turkey.
Eugene Hsin Y, Wen-Chien Ko, Yin-Ching Chuang,
Ta-Jen Wu. Suppurative acinetobacter baumanii
thyroiditis with bacterem ic pneum onia: C ase
report and review. Clin Infect Dis 1998;27:1286-
1290.
S u p p u ra tiv e th y ro id itis is ra re an d th e m a jo r p a th o g e n s are; S ta p h y lo c o c c u s an d S tre p to c o c c u s sp e c ie s . T h is re p o rt d e s c rib e s a c a s e c a u s e d by A c in e ta b a c te r b a u m a n ii, w h ic h has n e v e r b e fo re b e e n re p o rte d .
In th e c a s e ; a 7 0 -y e a r-o ld m an w h o w a s a h e a vy s m o k e r w ith m ild o b s tru c tiv e lung d is e a s e , had rig h t fla n k s o re n e s s fo r 2 d a y s fo llo w e d by s e v e re n e c k pain, fe v e r a n d c h ills . P h y s ic a l e x a m in a tio n re v e a le d a b o d y te m p e ra tu re of 3 8 .5 °C and an e ry th e m a to u s n o n flu c ta n t m a s s o v e r th e rig h t lobe of th e th y ro id .
L a b o ra to ry d a ta in c lu d e d a W B C c o n u t of 1 3 .9 0 0 /m m 3 (1 3 % b a n d fo rm s, 8 3 % n e u tro p h ils ), 6 -8 R B C s p e r high p o w e r field (H P F ) ad 8 -1 0 W B C s /H P F in u rine, a T4 (th yro xin e ) level o f 1 2 .2 p g /d L (n o rm a l; 4 .5 -1 2 .5 p g /d L ) a T 3 (triio d o th y ro n in e ) le ve l o f 106.3 n g /d L (80- 1 87ng/dL), a T S H (th ro id -s tim u la tin g h o rm o n e ) le ve l o f 0 .2 4 p U /m L (0 .5 -5 .6 U /m L ), n e g a tiv e H IV s c re e n in g an d a n u m e ro u s P M N L in a th y ro id a s p ira te (5m L). T he c h e s t ra d io g ra p h s h o w e d h y p e rin fla te d lungs, and a ra d io g ra p h o f th e a b d o m e n re v e a le d rig h t u re th e r sto n e s w ith h y d ro n e p h ro s is . B oth s o n o g ra p h y o f th e th y ro id a n d C T o f th e n e c k s h o w e d a h y p o d e n s e /h e te ro g e n e o u s h y p o e c h o ic le sio n (3 .7 c m x 2 .7 c m ) in th e rig h t lo b e o f th y ro g lo s s a l d u c t re m n a n ts . T h e io d in e 131 (131 I) th y ro id sc a n a nd th e 9 9 m T c s o d iu m p e rte c h n e ta te n e c k s c a n s h o w e d no u p ta k e in th e th y r o id b e d s . U n d e r th e im p re s s io n o f th e o c c u re n c e o f s u p p u ra tiv e th y r o id itis , p a re n te ra l a m p ic illin /s u lb a c ta m a n d g e n ta m ic in w e re a d m in is te re d until bo th b lo o d and th y ro id a s p ira te c u ltu re s re v e a le d A. b a u m a n ii g ro w th . A t th a t tim e th e a n tib io tic s w e re c h a n g e d to c ip ro fla x a c in a n d a m ika cin .
T w o w e e k s la te r, th e c h e s t ra d io g ra p h s h o w e d m u ltip le p n e u m o n ic p a tc h e s w ith a n o rm a l flo ra in th e
s p u tu m . T h e g a lliu m 6 7 c itra te (6 7 G a ) s c a n s h o w e d a c c u m u la tio n o f th e ra d io tra c e r b ila te ra lly in th e lo w e r lo b e s o f th e lu n g s (b u t no u p ta k e in th e th y ro id ). No p a th o g e n s w e re c u ltu re d fro m th e in itia l u rin e s p e c im e n o b ta in e d on a rriv a l. By re p e a te d a s p ira tio n o f th e th y ro id an d 5 w e e k s ' p a re n te ra l c ip ro flo x a c in tre a tm e n t th e p a tie n t c o n d itio n im p ro v e d . T h e th y ro id le s io n s h ra n k a nd th e p n e u m o n ic p a tc h e s re s o lv e d . A lth o u g h th e o rig in o f A. b a u m a n ii w a s u n d e te rm in e d , a u th o rs n o te a s u s p ic io n fo r a n u rin a ry tra c t o rigin.
Romanello R, De San tis F, Caione R. A Case of
Botulism due to an infected traumatic injury. Eur J
Clin Microbiol Infect Dis 1998;17:295-296.
T h is re p o rt is d e s c rib in g a c a s e o f b o tu lis m a fte r a tra u m a tic injury.
In th e c a s e ; a 6 1 -y e a r-o ld fa rm e r w a s a d m itte d to th e e m e r g e n c y d e p a r tm e n t o f T ra u m a C e n te r fo r tre a tm e n t o f a s e rio u s leg in ju ry th a t o c c u rre d w h ile u sin g a g ric u ltu ra l e q u im e n t. O n a d m is s io n th e p a tie n t p re s e n te d w ith an a m p u ta tio n o f th e lig h t le g b e lo w th e k n e e a n d th e s u rg e ry w a s p e rfo rm e d im m e d ia te ly . A fte r s u rg e ry a n tib io tic tre a tm e n t (C e fiz o x im e 3 g /d a y ) w a s s ta r te d a n d a n ti- g a n g r e n e s e ru m w a s a ls o a d m in is te re d . O n d a y 7, th e p a tie n t te m p e ra tu re w a s 3 9 °C a n d a c re p itu s in th e s tu m p a p p e a re d , a ttrib u te d to ga s g a n g re n e . T re a tm e n t w ith i.v. im ip e n e m (3 g /d a y ), n e tilm ic in (3 0 0 m g /d a y ) an d m e tro n id a z o le (1 .5 g /d a y ) w a s s ta rte d a nd fo llo w e d b y a s in g le h y p e rb a ric o x y g e n tre a tm e n t. 3 d a y s la te r, th e p a tie n t c o n d itio n w o rs e n e d ; re s p ira to ry d is tre s s e n s u e d , fo llo w e d b y th e a p p e a ra n c e o f o th e r n e u ro lo g ic a l s y m p to m s ; in c lu d in g p to s is , e x tr in s ic a n d in tr in s ic b ila te ra l o p h th a lm o p a re s is , h y p o s th e n ia o f th e lim b s a n d d y s p h a g ia . T h e n e u ro lo g ic a l d ia g n o s is w a s m y a s th e n ifo rm s y n d ro m e o f a to x ic n a tu re . 2 d a y s later, th e p a tie n t w a s tra n s fe rre d to th e in te n s iv e c a re unit. He p re s e n te d w ith fe v e r, s lu rre d sp e a c h , and s ig n s o f d e h y d ra tio n as w e ll a s p re v io u s n e u ro lo g ic a l s y m p to m s . T re a tm e n t c o n s is te d o f re o p e n in g th e stu m p , d ra in in g th e pu s, d e b rid in g th e n e c ro tic skin, c le a n in g firs t w ith h y d ro g e n p e ro x id e a n d th e n w ith a n tis e p tic s o lu tio n s , p lu g g in g th e o p e n s tu m p w ith io d e fo rm ic g a u z e a n d a d m in is te rin g i.v. m e tro n id a z o le . H y p e rb a ric o x y g e n th e ra p y w a s re p e a te d .
Medicine elsewhere
A fte r 24 h o u rs , v e n tila to ry s u p p o rt an d n a s o tra c h e a l In tu b a tio n w e re re q u ire d to re lie v e in c re a s in g re s p ira to ry d iffic u ltie s . C ra n ia l c o m p u te riz e d a xia l to m o g ra p h ic s c a n a n d b ra in n u c le a r m a g n e tic re s o n a n c e im a g e w e re n o rm a l.
E le c tro e n c e p h a lo g ra m s s h o w e d irre g u la r peaks. Due to p e rs is ta n c e o f th e n e u ro lo g ic a l sy m p to m s , a te st w a s c a rrie d o u t w ith p ro s tig m in e , w ith n e g a tiv e results. A p re s u m p tiv e d ia g n o s is o f b o tu lis m w a s m ade. The p a tie n t w a s tre a te d w ith a n tib o tu lin a l s e ru m A BE .
A fra g m e n t o f n e c ro tic m a te ria ls w a s ta k e n fo r cu ltu re an d s e ru m s a m p le s w e re a n a ly s e d a t th e N a tional C e n tre fo r B o tu lis m D ia g n o s is , by s ta n d a rd m ethods. T h e c u ltu re s o f n e c ro tic m a te ria l w e re n e g a tiv e fo r C. b o tu lin u m , b u t s e ru m s a m p le s w e re p o s itiv e fo r ty p e B b o tu lin a l to xin .
A fte r 20 d a ys, th e p a tie n t w a s d is c h a rg e d from ho sp ita l w ith o u t an y s ign o f re s id u a l n e u ro g ic a l disa b ility.
T h e a u th o rs m e n tio n th a t; th e p re s e n c e o f re c e n t injury site a n d a h is to ry la c k in g in g e s tio n o f sp o ile d c a n n e d fo o d s , as w e ll a s d e v e lo p m e n t o f c ra n ia l n e rv e s p a ls ie s s h o u ld a le rt th e p h y s ic ia n to th e p o s s ib ility of w o u n d b o tu lis m . S u ita b le tre a tm e n t w h ic h in c lu d e d e b r id e m e n t o f th e w o u n d , re m o v a l o f th e d e v a s c u la riz e d tis s u e th a t w o u ld fa c ilita te a n a e ro b ic c o n d itio n s a n d v e n tila to ry s u p p o rt c a re m u s t be im p le m e n te d p ro m p tly to p re v e n t d e a th d u e to re s p ira to ry fa ilu re . A c c o rd in g to th e ir o p in io n , bo tu lina l a n tito x in sh o u ld be a d m in is te re d as s o o n as p o s s ib le a fte r o n s e t o f s y m p to m s .
Prepared by
Berrak Ç. Yeğen,
M. D., Department o f Physiology, School o f
Medicine, Marmara Universiy, İstanbul, Turkey
Scott R B , Kirk D, MacNaughton W K, Meddings J B .
GLP-2 augments the adaptive response to m assive
intestinal resection in rat. Am J Physiol 1998;275
(Gastrointest Liver Physiol 38): G911-G921.
S h o rt b o w e l s y n d ro m e is a c lin ic a l c o n d itio n c h a ra c te riz e d b y ra p id in te s tin a l tr a n s it an d m a la b s o rp tio n in in d iv id u a ls w h o h a v e ha d a c o n g e n ita l or, m o re c o m m o n ly , an a c q u ire d lesion le a d in g to in te s tin a l re s e c tio n . All la ye rs o f th e bow elw a ll h a v e b een sh o w n to p a rtic ip a te in a h yp e rp la stic a d a p tiv e re s p o n s e to in te stin a l resection. T h e re are stru c tu ra l, fu n c tio n a l, and c y to k in e tic a d a p ta tio n s of th e m uco sa , w ith a u g m e n ta tio n o f m uco sa l surface area. Id e n tific a tio n o f fa c to rs re g u la tin g the a d aptive h y p e rp la s tic re s p o n s e to re s e c tio n w o u ld im p ro ve the clin ica l c a re of p a tie n ts w ith s h o rt bow el s y n d ro m e and re d u ce th e ir u tiliz a tio n of h e a lth c a re re sources. A p re v io u s re p o rt of a p a tie n t w ith a g lu c a g o n o m a w ho p re s e n te d w ith m a s s iv e e n la rg e m e n t of th e sm all bow el th a t a b a te d a fte r s u rg ica l rem oval of the tum or, p ro m p te d a n a ly s is o f th e re la tio n s h ip b e tw e e n in te stin a l p ro g lu c a g o n -d e riv e d p e p tid e s and intestinal e p ith e lia l p ro life ra tio n .
T o d e te rm in e w h e th e r tr e a tm e n t w ith a p o te n t p ro te a s e -re s is ta n t a n a lo g o f h u m a n g lu c a g o n -lik e p e p tid e 2 (G L P -2 ) m ig h t in c re a s e th e a d a p tiv e re s p o n s e to m a s s iv e in te stin a l re se ctio n , rats w ere d iv id e d in to re s e c te d (75 % o f th e m id je ju n o ile u m re m o v e d ), sham re se cte d , an d n o n s u rg ic a l groups. W ith in e ach g ro u p , a n im a ls w e re a ss ig n e d to 21 d ays of tre a tm e n t w ith the G L P -2 a n a lo g (0.1 pg/g) or the v e h ic le a lo n e s u b c u ta n e o u s ly tw ic e daily. F ood intake, w e ig h t gain, je ju n a l and ileal d ia m e te rs , to ta l and m u c o s a l w e t w e ig h ts p e r c e n tim e te r, c ry p t depths, and villu s he ig hts, m u co sa l s u c ra s e a ctivity, m illig ra m s of pro te in p e r c e n tim e te r and m ic ro g ra m s of D NA per c e n tim e te r, and D -X y lo s e a b s o rp tio n w e re m easured.
T h e re w as a s ig n ific a n t in c re a s e in d ia m e te r, total and m u c o s a l w e t w e ig h ts p e r c e n tim e te r, c ry p t-v illu s h e ig h t, s u c ra s e a c tiv ity , m illig ra m s o f D N A p e r c e n tim e te r in both th e je ju n u m and ileum in re sp o n se to re s e c tio n and a s ig n ific a n t a d d itiv e re s p o n s e to the G L P -2 a n a lo g in th e je ju n u m but not in th e ileum . The ratio of mg of protein/cm to pg of DNA/cm o f m uco sa w a s n o t d iffe re n t a m o n g g ro u p s , c o n s is te n t w ith h y p e rp la s ia . In re s p o n s e to re s e c tio n , D -X y lo s e a b s o rp tio n w a s s ig n ific a n tly re d u ce d ; how ever, the G L P -2 an a log e n h a n c e d th e a b s o rp tiv e c a p a c ity in co n tro l a n im a ls and re sto re d th e re duced ca p a c ity in re s e c te d an im a ls.
T h u s th e G L P -2 a n a lo g in d u ced m u co sa l h yp e rp la sia and s ig n ific a n tly e n h a n c e d both th e rate and the m a g n itu d e o f th e p ro x im a l in te s tin a l a d a p tiv e re sp o n se to m a s s iv e re se c tio n . T h e lack of b e n e fit of c u rre n t th e ra p e u tic m o d a litie s and th e in c re m e n ta l tro p h ic e ffe c t o f th e G L P -2 a n a lo g c o m p a re d w ith th e ada p tive re s p o n s e to re s e c tio n a lo n e s u g g e s ts th a t a w ell- d e s ig n e d th e ra p e u tic a l tria l o f th e G L P -2 an a log in h u m a n s h o rt bo w e l s y n d ro m e is w a rra n te d . S u c c e s s in such a h u m a n tria l w o u ld p o te n tia lly re d u c e both the m o rb id ity an d m o rta lity o f in d iv id u a ls w ith sh o rt bow el s yn d ro m e .
Prepared by
Mizir Kurtel
M.D., Department o f Physiology, School o f
Medicine, Marmara University, Istanbul, Turkey
Boros M, Massberg S, Branyi L et. al. Endothelin-1
induces leukocyte adhesion in subm ucosal
venules
of
the
rat
sm all
intestine.
Gastroenterology 1998 ;114:103-114.
T h e e n d o th e lin s (E T s) a re a fa m ily o f 2 1 -a m in o a c id p e p tid e s p ro d u c e d b y v a s c u la r e n d o th e lia l c e lls . E n d o th e lin -1 (E T -1 ) is th e m o s t p o w e rfu l v a s o c o n s tric to r k n o w n to d a te , and it m a y p a rtic ip a te in re g u la tio n o f th e s m o o th m u s c le to n e in m a n y system s. T h e p la s m a le v e ls of ET-1 a re e n h a n c e d d u rin g e x p e rim e n ta l a n d c lin ic a l is c h e m ia , h y p o x ia , sepsis, and b a c te re m ia s u g g e s tin g th a t it m a y m e d ia te v a s o c o n s tric tio n o f re g io n a l v a s c u la r b e d s d u rin g th e s e c o n d itio n s . In a d d itio n to th is, it has been p ro p o s e d that, th e re le a s e of ET-1 an d a c tiv a tio n o f le u k o c y te s a re in v o lv e d in th e p a th o p h y s io lo g y of g a s tro in te s tin a l l/R in ju rie s. T h e a im o f his s tu d y w a s to d e fin e th e in v iv o re la tio n b e tw e e n ET-1 and e n d o th e lia l c e ll-le u k o c y te in te ra c tio n s .
A n e s th e tiz e d ra ts w e re s tu d ie d to c h a ra c te riz e th e m ic ro v a s c u la r e ffe c ts o f in c re a s in g d o s e s o f local a nd s y s te m ic in fu s io n s o f ET-1 in all la ye rs of an ileal s e g m e n t. L e u k o c y te - e n d o th e lia l in te ra c tio n s w e re m o n ito re d w ith in tra v ita l flu o re s c e n c e v id e o m ic r o s c o p y . T h e E T -A re c e p to r-s e le c tiv e a n ta g o n is t B Q 6 1 0 , th e novel E T -A re c e p to r a n ta g o n is t E T R -P L /fl p e p tid e , an d th e E T -B re c e p to r a n ta g o n is t IR L 1 0 3 8 w e re u sed to in v e s tig a te th e ro le s o f re c e p to r s ubtypes.
T h e fu n c tio n a l c a p illa ry d e n s ity of th e m u c o s a w a s d e c re a s e d by in tra v e n o u s E T-1. A fte r 30 m in u te s , th e ro llin g fra c tio n o f le u k o c y te s re a c h e d 9 0 % in th e p o s tc a p illa ry v e n u le s , an d th e n u m b e r o f a d h e re n t le u k o c y te s w a s in c re a s e d a fte r 90 m in u te s. E T -A an d E T-B re c e p to r a n ta g o n is ts , in h ib ite d th e ET-1 in d u c e d le u k o c y te ro llin g h o w e v e r, E T -A a n ta g o n is ts w e re m o re e ffe c tiv e th a n E T -B a n ta g o n is t. B oth E T -A re c e p to r a n ta g o n is ts p re v e n te d ET-1 in d u c e d firm a d h e sio n . In c o n c lu s io n , th e re s u lt o f th is s tu d y in d ic a te s th a t ET- 1 m ig h t a c t a s a p ro m o te r o f le u k o c y te ro llin g and a d h e s io n th ro u g h a p re d o m in a n tly E T -A re c e p to r m e d ia te d m e c h a n is m in th e s u b m u c o s a l v e n u le s of th e in te s tin a l c irc u la tio n . T h e s e d ata, to g e th e r w ith th e o b s e rv a tio n s o f e le v a te d p la s m a le v e ls d u rin g c e rta in p a th o lo g ie s , s u g g e s t a th e ra p e u tic p o te n tia l fo r
ET-re c e p to r a n ta g o n is ts fo r th e in h ib itio n not o n ly of m ic ro v a s c u la r d y s fu n c tio n b u t a ls o o f in te ra c tio n s of P M N s w ith e n d o th e lia l ce lls .
Prepared by
İnci Alican
M.D., Ph.D., Departm ent o f Physiology, School o f
Medicine, Marmara University, İstanbul, Turkey
W allace J L , Bak A, M cKnight W, Asfaha S, Sharkey
K A ,
MacNaughton
W K.
C y clo o xyg e n a se
1
contributes to inflammatory resp onses in rats and
m ice: Im plications for gastrointestinal toxicity.
Gastroenterology 1998;115:101-109.
T h e u s e o f n o n s te r o id a l a n ti- in fla m m a to r y d ru g s (N S A ID s ) fo r tre a tm e n t o f in fla m m a tio n a n d p ain re m a in s lim ite d by th e ir a b ility to c a u s e u lc e ra tio n and b le e d in g in th e g a s tr o in te s tin a l tra c t. T h e c h a ra c te riz a tio n o f tw o is o fo rm s o f th e p rin c ip a l e n z y m e re s p o n s ib le fo r p ro s ta g la n d in (P G ) s y n th e s is , c y c lo o x y g e n a s e (C O X ), h a s led to th e p ro p o s a l th a t s e le c tiv e in h ib ito rs o f th e in d u c ib le is o fo rm (C O X -2 ) w o u ld be e ffe c tiv e a n ti-in fla m m a to ry a nd a n a lg e s ic a g e n ts w ith o u t c a u s in g g a s tro in te s tin a l in ju ry. T h is p ro p o s a l is b a s e d o n th e fin d in g th a t th e m a jo r is o fo rm o f C O X e x p re s s e d in th e n o rm a l s to m a c h is C O X -1 , w h e re a s C O X -2 is e x p re s s e d o n ly at v e ry low le v e ls in m o s t tis s u e s b u t is r a p id ly in d u c e d a t s ite s o f in fla m m a tio n .
In th e p re s e n t s tu d y , th e a n ti-in fla m m a to ry e ffe c ts of a n u m b e r o f a g e n ts w ith v a ry in g d e g re e s o f in vitro s e le c tiv ity o f C O X -2 vs. C O X -1 (N S -3 9 8 , n im e s u lid e , D u P 6 9 7 an d e to d o la c ) w e re c o m p a re d an d th e s e d ru g s w e re e x a m in e d w h e th e r th e y c o u ld re d u c e in fla m m a tio n in d e p e n d e n t o f e ffe c ts on C O X -1 . F inally, th e e ffe c ts o f a s ta n d a rd N S A ID (in d o m e th a c in ) and a s e le c tiv e C O X -2 in h ib ito r (N S -3 9 8 ) on in fla m m a to ry re s p o n s e s in m ic e in w h ic h th e g e n e fo r C O X -2 had b e e n d is ru p te d w e re d e te rm in e d .
M a le W is ta r ra ts w e re u s e d to a s s e s s th e s e le c tiv ity of C O X -2 in h ib ito rs (N S -3 9 8 , n im e s u lid e , D u P 6 9 7 and e to d o la c ) on c a rra g e e n a n - in d u c e d p a w in fla m m a tio n . T h e ro le o f C O X -1 in in fla m m a tio n w a s a ls o a s s e s s e d in C O X -2 -d e fic ie n t m ice.
S ig n ific a n t a n ti- in fla m m a to r y e ffe c ts w e re o n ly o b s e rv e d at d o s e s o f th e d ru g s th a t in ih ib ite d C O X -1 . A t th e s e d o s e s , th e d ru g s a ls o s ig n ific a n tly
Medicine elsewhere
s u p p re s s e d g a s tr ic p ro s ta g la n d in s y n th e s is an d e lic ite d g a s tric m u c o s a l e ro s io n s . T h e d e g re e o f s u p p re s s io n o f p ro s ta g la n d in s y n th e s is at th e site of in fla m m a tio n c o rre la te d s ig n ific a n tly w ith in h ib itio n of C O X -1 b u t n o t C O X -2 .
T h e re s u lts o f th is s tu d y s u g g e s t th a t a lth o u g h s e le c tiv e b lo c k a d e o f C O X -2 m a y s p a re g a s tro in te s tin a l PG s y n th e s is an d th e re fo re n o t c a u s e d e n o v o in ju ry, it m a y a ls o b e less e ffe c tiv e in re d u c in g in fla m m a tio n c o m p a re d w ith w h a t ca n be a c h ie v e d w ith c o m b in e d in h ib itio n o f C O X -1 an d C O X -2 . A t least
in s o m e ca se s, P G s d e riv e d fro m C O X-1 c o n trib u te s ig n ific a n tly to th e g e n e ra tio n o f in fla m m a tio n , In such c a se s, s ig n ific a n t a n ti-in fla m m a to ry e ffe cts are only o b s e rv e d at d o s e s o f d ru g s th a t p ro d u c e in h ibition of both COX-1 and C O X -2 . A t th e s e d o se s th e drugs are c a p a b le o f s ig n ific a n tly s u p p re s s in g g a s tric PG s y n th e s is , c a u s in g g a s tric d a m a g e and, as show n p re v io u s ly , e x a c e rb a tin g p re e x is tin g g a stro in te stin a l d a m a g e . T h e s e s tu d ie s th e re fo re ra is e q u e s tio n s re g a rd in g th e p re m is e s on w h ich th e d e v e lo p m e n t of h ig h ly s e le c tiv e in h ib ito rs o f C O X -2 as g a stro in te s tin a l- s p a rin g a n ti-in fla m m a to r a g e n ts a re based.
22 - 26 S ep tem b er 1999, Snow m ass Village C olorado, USA
Biology of Potassium Channels: From Molecules to Disease
C o n t a c t : T h e A m e r i c a n P h y sio lo g ic a l S o c i e t y 9 6 5 0 Rockville Pike , B e t h e s d a MD 2 0 8 1 4 - 3991Tel.: 3 0 1 - 5 3 0 71 71 F a x : 3 0 1 - 5 7 1 8 3 13 E-mail: m e e t i n g s @ a p s . f a s e b . o r g
■Mk _ak_ jsk.
26 - 29
S eptem b er 1999, San Francisco, California, USA39th Interscience Conference on Antimicrobial
Agents and Chemotherapy (ICAAC)
C o n t a c t: A S M , M e e t i n g s D e p a r t m e n t , 1 3 2 5 M a s s a c h u s e t t s A v e n u e , NW, W a s h i n g t o n , DC
2 0 0 0 5 - 4 1 7 1 , US A
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25 - 30 O cto b er 1999, Antalya, Turkey
The 5th National Congress of Anatomy
(with international participation)
C o n t a c t : A s s o c Prof. Dr. M u z a ff e r S i n d e l
A k d e n iz Uni versity, F a c u lty of M e dic in e , R e p a r t m e n t of A n a t o m y 0 7 0 7 0 A n ta ly a , T u r k e y Tel.: 9 0 2 4 2 2 2 7 4 4 8 5 F ax : 9 0 2 4 2 2 2 7 4 4 82
E-mail: a n a t o m i @ m e d . a k d e n i z . e d u . t r
7 - 1 1 N o vem b er 1999, Chicago II, USA
American Public Health Association
127th Annual Meeting and Exposition Continuing Education Program 1999
C o n t a c t : A P H AP O Bolt 8 5 0 8 0 R i c h m o n d VA 2 3 2 8 5 - 41 6 1 F ax : 4 1 0 6 2 6 - 1 5 0 9
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1 5 - 2 0 July 2000, Florence, Italy
VII World Conference on Clinical Pharmacology
and Therapeutics / 4th Congress of The
European Associtaion for Clinical Pharmacology
C o n t a c t: Scie nt ific S e c r e t e r i a t C T P 2 0 0 0
C / O Institute of P h a r m a c o l o g y Policlinico B o r g o R o m a I - 3 7 1 3 4 , V e r o n a , Italy Tel.: + 3 9 - 0 4 5 - 5 0 0 4 0 8 / 8 0 7 4 8 9 9 F ax : + 3 9 - 0 4 5 5 8 1 1 1 1
E-mail: g p v e l o @ f a r m a . u n i v r . i t
A N S W E R T O P H O T O Q U I Z
B ila te ra l s o lid m a s s e s w h ic h a re h ig h lig h te d by s u rro u n d in g a s c ite s re p la c e b oth o v a rie s . T h e re a re se g m e n ta l w all th ic k e n in g an d a m a s s p ro je c tin g into th e lu m e n of th e c o rp u s o f th e s to m a c h . T h is w a s c o n firm e d b y m u ltip le b io p s ie s v ia e s o p h a g o g a s tro d u o d e n o s c o p y . B io p s y re su lt re v e a le d g a s tric a d e n o c a rc in o m a . A t la p a ro to m y , e n la rg e d tu m o r w h ic h is a m e ta s ta tic o v a ria n tu m o r of th e G l tra c t c a n c e r (c o lo n :s to m a c h = 2 :1 ). It m a y a ls o a ris e by th e sp re a d o f o th e r m u c in o u s a d e n o c a rc in o m a such a s th o s e of th e b re a s t, p a n c re a s a n d g a llb la d d e r. K ru k e n b e rg tu m o r o c c u rs in 2 -7 % o f fe m a le s w ith g a s tric c a n c e r. T h e s e tu m o rs a n te d a te th e d is c o v e ry o f th e p rim a ry le s io n in up to 2 0 % . It c o m p ris e s 6 % of
