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Biomedical subjects

A Adesokan

Publications and source records attributed to A Adesokan.

18 recordsLinked to original sources

Investigations on human immunodeficiency virus type 1 integrase/DNA binding interactions via molecular dynamics and electrostatics calculations.

The complete three-dimensional structure of the active site region of the human immunodeficiency virus type 1 (HIV-1) integrase (IN) is not unambiguously known. This region includes a flexible loop comprising residues 141-148 and the N-terminal portion of the helix alpha-4, which contains E152, the third catalytic residue, and Y143, which plays a secondary role in catalysis. Relatively high B-factors exist for most of the residues in the aforementioned region. The HIV-1 IN belongs to the polynucleotidyl transferase superfamily, whose members have been proposed to use two divalent metal ions for catalysis. Although only the position of the first metal ion has been determined crystallographically for the HIV-1 IN, we recently have proposed a binding site for the second metal ion. Based on this information, we have performed two 500-psec molecular dynamics simulations of the catalytic domain of the HIV-1 IN containing two Mg(2)+ ions. In one of the simulations, we included a dianionic phosphate group (HPO(4)(2)-) in the active site to mimic a portion of the DNA backbone of a substrate for the integration reaction. Electrostatics calculations and ionization state predictions were carried out on representative structures taken from the molecular dynamics simulations. Different conformational behaviors of the enzyme were observed, depending upon whether two Mg(2)+ ions were bound or two Mg(2)+ ions plus phosphate. The electrostatic calculations performed on the dynamical structures provide a further refinement about which regions of the catalytic domain of the HIV-1 IN may be involved in the DNA binding.

Avian Sarcoma Viruses↗

Malignant ovarian sex cord tumor with annular tubules in a patient with Peutz-Jeghers syndrome: a case report.

The majority of ovarian sex cord tumors with annular tubules (SCTAT) are benign neoplasms that arise sporadically. In patients who have Peutz-Jeghers syndrome (PJS), ovarian SCTAT is often an incidental finding. Malignant behavior in SCTAT has heretofore been reported only in sporadic cases. We report a case of bilateral, malignant SCTAT developing in a 47-year-old woman who had PJS, originally diagnosed as adenocarcinoma on cervicovaginal cytology. Cervicovaginal and peritoneal fluid cytologic preparations were characterized by pseudopapillary clusters and three-dimensional tubes of tumor cells with scanty cytoplasm and high nuclear: cytoplasmic ratio. Examination of surgical resection specimens revealed bilateral, solid ovarian tumors composed of simple and complex annular tubules with hyaline cores, typical of SCTAT. Tumor emboli were present within salpingeal lymphovascular spaces and in both right and left pelvic lymph nodes. Flow cytometry of tumor cells demonstrated a diploid phenotype. This case represents the first documented example of bilateral, malignant SCTAT arising in a patient who had PJS, presenting with an atypical cervicovaginal smear.

Female↗

Pyogenic spondylodiskitis: a radiologic/pathologic and culture correlation study.

BACKGROUND: Intervertebral disk tissue is resistant to hematogenous infection because of its avascularity. However, spondylodiskitis is being diagnosed with increasing frequency because of advancement in magnetic resonance imaging technology. There is a dearth of information regarding the bacteriology, histomorphologic features, and radiopathologic correlation of spondylodiskitis. DESIGN: The study population consisted of 20 patients diagnosed as having spondylodiskitis by magnetic resonance imaging with and without gadolinium 67 enhancement and bone scans with technetium Tc 99m or gallium citrate Ga 67. Twenty-seven biopsy and debridement specimens were obtained from these patients. The specimens were cultured for microorganisms and also processed for histopathologic testing. Tissue sections were examined with hematoxylin-eosin and stains for infectious agents (Gomori's methenamine-silver, Gram, and Ziehl-Neelsen stains). RESULTS: Where intervertebral disk tissue was present (23 of 27 cases), the morphologic changes included vascularization (with or without granulation tissue), myxoid degeneration, and necrosis. Chronic osteomyelitis was present in all 27 specimens and was associated with acute osteomyelitis in 7 cases (25%). Twenty-one of 27 cases had positive culture results (mostly pyogenic bacteria), but special stains revealed microorganisms in sections of the disk in only 4 cases (3 cases with gram-positive cocci and 1 with yeast consistent with Blastomyces). Florid acute inflammation was present in all the 4 cases. CONCLUSION: Histopathologic features of acute spondylodiskitis include vascular proliferation, myxoid degeneration, and necrosis of the disk tissue with adjacent chronic osteomyelitis. Acute inflammation is variable and when florid is usually associated with identifiable organisms on histologic examination. At biopsy, tissue should be submitted for culture, since culture has a high sensitivity and specificity for detecting the etiologic organism.

Adult↗

Urinary cytologic findings in patients with benign and malignant adenomatous polyps of the prostatic urethra.

CONTEXT: Urethral adenomatous polyps with prostatic epithelium (also known as benign prostatic epithelial polyps [BPEPs]) are a documented cause of hematuria, dysuria, and hematospermia, conditions that may prompt cytologic evaluation of urine. DESIGN: The urine cytologic test findings in 5 cases of biopsy-proven BPEPs and in 1 case of prostatic ductal adenocarcinoma (PDA) that presented as a urethral polyp were retrospectively evaluated. Immunocytochemical stain for prostate-specific antigen (PSA), prostatic acid phosphatase (PAP), and high-molecular-weight cytokeratin (34betaE12) were used in evaluation of the lesions. RESULTS: In 4 of 5 cases of BPEPs, clusters of bland columnar cells with uniform, oval nuclei were seen. Positive immunostaining for PSA and PAP confirmed the prostatic origin of the clusters in 2 cases. One urine sample contained abundant goblet cells and extracellular mucin, consistent with intestinal metaplasia coexisting in the bladder biopsy specimen. The urine sample in the fifth case of BPEPs contained no columnar cells. The last case had multiple urine cytologic evaluations that demonstrated PSA-positive, malignant-appearing clusters of columnar cells. A biopsy specimen of the polyps was described as a high-grade prostatic intraepithelial neoplasm in adenomatous polyp. However, in this patient, PDA was diagnosed on transurethral resection of the prostate specimen 4 years after the initial urine cytologic test. CONCLUSION: Benign prostatic epithelial polyps should be considered in the differential diagnosis of clusters of columnar cells in urine cytologic testing. Cells with malignant nuclear features should instigate a careful search for a (prostatic) neoplasm, which may present as urethral polyps (e.g., PDA). Stains for PSA or PAP are useful adjuncts in differential diagnosis of this condition.

Acid Phosphatase↗

Acrometastasis in renal cell carcinoma.

Acrometastasis is rare and may occur as the primary manifestation of an occult malignant tumor. Clinically, it may mimic benign osteoarthritic diseases, thus resulting in misdiagnosis and improper treatment. We describe a patient with renal cell carcinoma that presented itself as a case of chronic osteomyelitis after trauma to a finger. Such a lesion presents diagnostic challenges to both clinicians and histopathologists.

Bone Neoplasms↗

Tubulovillous adenoma of the urinary bladder.

We report a case of vesical tubulovillous adenoma that occurred in a background of protracted chronic cystitis with intestinal-type glandular metaplasia and extensive cellular atypia (dysplasia) in the flat mucosa. Flow cytometry analysis showed DNA aneuploidy in the adenoma. Increased expression of the tumor suppresser gene, p53, and also of cellular proliferation markers (proliferating cell nuclear antigen and MIB-1) were detected in the villous adenoma and in the dysplastic regions of the flat metaplastic mucosa. These findings provide insight into the biology of intestinal metaplasia and also lend support to the theory of the chronic irritation-metaplasia-dysplasia-carcinoma sequence.

Adenoma, Villous↗

Blastomycosis of the lumbar spine: case report and review of the literature, with emphasis on diagnostic laboratory tools and management.

We report on the conservative and surgical management of a patient with blastomycosis of the lumbar spine, causing severe and crippling deformity. The diagnosis was made through biopsy. Curative removal, reconstruction and realignment of the spine were achieved. Imaging modalities were highlighted, with a detailed discussion of the histology and conservative and surgical management. We emphasize the importance of early, aggressive treatment of blastomycosis to prevent deformity and disability, and to enable identification of the best management of a destructive lesion with deformity. This case demonstrates that empirical treatment should not be used in cases of unusual sinus and abscess locations. Specific diagnosis and early treatment are indicated to prevent dreadful complications and spinal deformity resulting from blastomycosis. Aggressive antifungal therapy can cure the disease but does not control complications related to deformity. The latter can only be addressed by surgical reconstruction. We review the literature of surgical treatment, focusing on abscess drainage, bone fusion and posterior instrumentation in the absence of addressing the deformity component.

Adult↗

Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis.

Spondylodiscitis normally heals itself, but it can cause bone destruction leading to deformity and often pain. Debridement of these infections by percutaneous transpedicular discectomy with access from adjacent caudal pedicles can accelerate natural healing and prevent progression to bone destruction and deformity. We outline this technique and discuss a series of 28 patients treated using a percutaneous transpedicular approach to obtain culture and histopathology specimens, permit drainage and antibiotic irrigation, and provide a channel for granulation tissue to invade the infected space. This procedure is safe and effective, but it is contraindicated for epidural abscess or granulation tissue-induced neurocompression and it is ineffective against extensive bone destruction.

Adolescent↗

Testicular "tumor" of the adrenogenital syndrome: a case report of an unusual association with myelolipoma and seminoma in cryptorchidism.

BACKGROUND: Males with congenital adrenal hyperplasia may develop bilateral testicular masses in early adult life. These are not malignant and generally regress with corticosteroid therapy. The authors report a case occurring in a 44-year-old man with associated seminoma and myelolipoma in an undescended testis. METHODS: The testicular tumors were analyzed by histologic, flow cytometric, and ultrastructural techniques. RESULTS: The tumors in both testes were comprised of polygonal cells with abundant granular eosinophilic cytoplasm, occasionally with brown (lipochrome) pigment and round nuclei of various sizes with prominent nucleoli. These cells were grouped into nodules by dense and sometimes thick fibrous trabeculae in the right testis. The areas corresponding to the fibrous trabeculae in the left (intraabdominal) testis were replaced by mixture of hematopoietic (myeloid) and fatty tissue in various proportions characteristic of myelolipoma. The left testis also had a well demarcated tumor that was diagnostic of seminoma. Electron microscopy demonstrated abundant smooth endoplasmic reticulum, a moderate number of mitochondria with tubulovesicular cristae, lipid droplets, and lipofuscin granules in the polygonal cells. No Reinke's crystals were observed. The patient received corticosteroids for his adrenocorticoid deficiency and also underwent external beam irradiation to the retroperitoneum for seminoma. CONCLUSIONS: This case illustrates an unusual presentation of a testicular tumor in a patient with the adrenogenital syndrome as well as with myelolipoma and seminoma in a cryptorchid testis. The possibility of an associated neoplasm that could be potentially fatal should be considered whenever a testicular tumor of the adrenogenital syndrome continues to grow despite adequate hormonal treatment.

Adrenal Gland Neoplasms↗

Sensitivity and specificity of triphenyl tetrazolium chloride in the gross diagnosis of acute myocardial infarcts.

OBJECTIVE: Myocardial infarction is the most common cause of sudden death in the United States. However, the identification of early myocardial infarcts at necropsy is frequently difficult, since unequivocal gross changes of infarcts do not become apparent for 24 to 48 hours following myocardial ischemic injury. The use of dyes, such as nitro-blue tetrazolium and 2,3,5 triphenyl tetrazolium chloride (TTC), that identify the dehydrogenase-deficient infarcted myocardium has been shown, largely by animal studies, to be very helpful in the macroscopic diagnosis of such cases. Such animal studies could not be directly extrapolated to human autopsy studies, however, because of the assumption that autolysis may invalidate the histochemical assessment of myocardial enzymatic changes after death. This study was carried out to evaluate the sensitivity and specificity of TTC in the gross diagnosis of acute myocardial infarction in the human population. DESIGN: The TTC stain reactions were correlated with histologic findings in the hearts of 638 consecutive adult autopsies. RESULTS: Of the 638 hearts examined by TTC, 174 hearts stained positive for acute infarction; histology confirmed myocardial infarction in 140 hearts. Histologic examination revealed acute infarcts in 41 of the remaining 464 cases that had stained negatively with TTC. The use of TTC in the macroscopic diagnosis of acute myocardial infarcts in the human population was found to have a diagnostic sensitivity of 77.4% and a specificity of 92.6%. The predictive value of a positive test was 80.5%, and that of a negative test was 91.2%. CONCLUSIONS: The overall diagnostic efficiency of the TTC test (ie, number of patients correctly identified) was 88%. These results show that the TTC test is a reliable, sensitive, and specific adjunct in the examination of the human heart at necropsy.

Adolescent↗

Healing response of the canine prostate to Nd:YAG laser radiation.

The objective of the study was to characterize the healing response of the canine prostate to laser thermal injury. The study included 20 canine prostates that underwent transurethral laser radiation. The prostates were retrieved 1 hr after laser radiation in 7 dogs (acute group), and from 3 days to 9 weeks in 13 dogs (chronic group). Two distinct features were observed. First, reepithelialization of the prostate urethra resulted from mobilization of proliferating epithelial cells from acinar and ductal prostatic epithelium into the cavity surface, and not from the edges of the wound at the bladder neck. Squamous cell metaplasia was a prominent feature of reepithelialization. Second, the healing process in the canine prostate was relatively unimpeded. The large glandular component provided abundant germinal epithelial growth, and the absence of stromal elements allowed for complete sloughing of necrotic tissue without residual eschars. Further, the lesions in the chronic group had a tendency to be larger than those in the acute group, suggesting that extended delayed necrosis may occur at deep prostatic tissue layers.

Animals↗

Arterial bullet embolism resulting in delayed vascular insufficiency: a rationale for mandatory extraction.

This paper reports a case of migrating intravascular bullet embolus that initially produced no symptoms but resulted in an above-knee amputation 14 months after its entry into a peripheral artery. The missile entered through a penetrating gunshot wound to the abdominal aorta and later became lodged in the left popliteal artery. However, the bullet fragment migrated further into the posterior tibial artery with consequent vascular insufficiency requiring a supracondylar amputation of the left lower extremity 14 months later. Emphasis is placed on the need for a high index of suspicion for bullet embolism, aggressive search for any bullets unaccounted for, and early surgical removal of all confirmed arterial emboli.

Adult↗

Recurrent massive hemothorax in Rendu-Osler-Weber syndrome.

We report a case of Rendu-Osler-Weber syndrome, occurring as sudden death after two episodes of massive hemothorax. Autopsy revealed massive hemothorax resulting from spontaneous rupture of one of three subpleural arteriovenous malformations. Review of the patient's hospital records showed that she had had a massive spontaneous hemothorax 13 years earlier that was managed conservatively. This case emphasizes the importance of early therapeutic (surgical or radiologic) intervention in the treatment of pulmonary arteriovenous malformations.

Arteriovenous Malformations↗

The arthroscopic appearance of lipoma arborescens of the knee.

Lipoma arborescens is a rare intra-articular lesion consisting of a villous lipomatous proliferation of the synovial lining. This case report draws attention to the history, physical findings, and arthroscopic appearance of lipoma arborescens, a rare lesion of the synovial lining of the knee. Arthroscopically, the lesion appears as a synovial lesion with numerous fatty-appearing globules and villous projections. In addition, magnetic resonance imaging is a valuable tool to differentiate the lesion from rheumatoid arthritis, pigmented villonodular synovitis, and synovial chondromatosis in those patients who present with a chronic, swollen, and painful joint.

Arthroscopy↗

Case report 871. Synovial sarcoma, monophasic type.

A patient with a synovial sarcoma of the foot and several unusual radiographic findings has been reported. Radiographs demonstrated lamellated periosteal reaction in a metatarsal, a rare finding in cases of synovial sarcoma. Magnetic resonance scanning documented marrow invasion of multiple bones in the foot, when bony involvement has been reported as only erosive changes.

Adult↗

Diagnosis of systemic histoplasmosis in patients with AIDS.

To compare various laboratory methods for diagnosis of systemic histoplasmosis, we retrospectively reviewed the charts of 165 patients with AIDS (acquired immunodeficiency syndrome). In eight of those patients, systemic histoplasmosis was confirmed by laboratory techniques. The laboratory methods used were histomorphology and microbiology. Tissues and fluids used for fungal cultures and histochemical stains included blood, bone marrow, lung, skin, pleura, esophagus and colon biopsy specimens, sputum, cerebrospinal fluid, bronchial washing/brushing, and pleural and peritoneal fluids. Results were positive in 83% of blood cultures and 71% of bone marrow cultures, making these tissues the best sources of Histoplasma organisms for microbiologic study. Similarly, Histoplasma sp could be demonstrated by fungal stains in 75% of bone marrow biopsy specimens as the main source for morphologic documentation of systemic histoplasmosis. The other tissues and fluids were only occasionally positive either microbiologically or morphologically. There was cross-positivity between morphologic and microbiologic methods in 80% of confirmed cases, making both methods equally reliable. However, the results were obtained within 48 hours by histomorphology, allowing prompt initiation of antifungal therapy. Although more specific results were produced by microbiologic methods, it took 18 to 35 days to grow the organism.

AIDS-Related Opportunistic Infections↗