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PubMed1980

How to reduce medicolegal involvement in cases of trauma.

The lessons learned from 52 medicolegal cases related to trauma are discussed. The role of informed consent is usually indirect. Surprise complications result in anger, and anger may provoke a suit. The emergency situation may be responsible for an incomplete examination, absence of a plan of management, or need to work with inexperienced personnel. An emergency does not preclude the need for prolonged followup in some situations. The availability of numerous devices has complicated the medicolegal problems. Recent relevant court decisions are discussed.

Emergencies↗
PubMedDate not supplied

Intra-articular hemangioma of the knee as a cause of knee pain.

We report the case of a young patient with knee pain, limited range of motion, and swelling due to an intra-articular hemangioma. Clinically, the symptoms and findings were similar to those of a meniscal lesion. The diagnosis of an intra-articular tumor was made using magnetic resonance imaging. The tumor was excised, and the definitive diagnosis was made histologically. After tumor excision, the patient was pain free.

Adult↗
PubMed2003

Corneal iron ring associated with orthokeratology.

Two teenaged girls had orthokeratology to correct myopia. The postoperative development of corneal iron rings in both eyes was disclosed by a biomicroscopic examination at 3 months in 1 patient and 5 months in the other. The location of the corneal iron rings coincided with the fitting curve of the reverse-geometry rigid contact lens, suggesting that the rings might have developed from tear pooling.

Adolescent↗
PubMed1999

Pseudo-Fleischer ring after hyperopic laser in situ keratomileusis.

A 37-year-old woman had bilateral hyperopic laser in situ keratomileusis (LASIK). Six months postoperatively, an epithelial pigmentation ring pattern was identified on both corneas. The appearance of the ring pattern was similar to the iron deposits of the Fleischer ring of keratoconus. While corneal iron deposits in various patterns have been reported after other forms of ocular therapeutic and refractive surgery, this is the first report of the association between hyperopic LASIK and a corneal iron line, which we have called the "pseudo-Fleischer ring."

Adult↗
PubMed1999

Corneal iron ring after hyperopic photorefractive keratectomy.

PURPOSE: To report the incidence and course of corneal iron deposition after hyperopic photorefractive keratectomy (PRK). SETTING: Gazi University, Medical School, Department of Ophthalmology, Ankara, Turkey. METHODS: Between January 1995 and December 1997, 62 eyes had PRK to correct hyperopia. RESULTS: Nine eyes developed corneal iron ring 5 to 8 months (mean 6.25 months +/- 1.3 [SD]) after PRK for hyperopia. The rings persisted during the mean follow-up of 19 +/- 11.09 months. CONCLUSION: The ring-shaped iron deposition after PRK for hyperopia must be differentiated from the Fleischer ring. Our results suggest that the slitlamp findings of peripheral corneal iron deposition in hyperopic PRK patients correlate with achieved correction.

Adult↗
PubMed1985

Iron deficiency and iron overload.

An up to date review of our knowledge of human iron metabolism is given including problems of iron balance, internal transport, and intracellular mechanisms. Current knowledge of the iron proteins is summarized and this background is used in discussing the pathophysiology of iron deficiency and overload, together with the internal derangements such as sideroblastic anemia which form much of the clinical practice associated with disorders of iron metabolism. The therapeutic approach to these problems will be described.

Absorption↗
PubMed2002

MR imaging of iron depositional disease.

This article discusses the physiology of iron metabolism in humans. The pathophysiology and MR imaging findings of disorders that result in iron deposition in the liver are described. Emphasis is placed on genetic, clinical, and imaging findings of hemochromatosis. Radiologists should familiarize themselves with the patterns of iron deposition on MR images in order to suggest a potential etiology, which may not be known at the time of imaging.

Hemochromatosis↗
PubMed2002

Low-grade siderotic dysplastic nodules: determination of premalignant lesions on the basis of vasculature phenotype.

RATIONALE AND OBJECTIVES: The authors performed this study to determine whether, on the basis of the vascular profile, low-grade siderotic dysplastic nodules are premalignant lesions. MATERIALS AND METHODS: The authors used a monoclonal antibody specific for smooth muscle actin to stain 18 siderotic low-grade dysplastic nodules (mean size, 0.7 cm) from nine patients. Two pathologists counted the number of unpaired arteries per high-power field in siderotic dysplastic nodules and background siderotic regenerative nodules by using two techniques (conventional and hot spot). RESULTS: The number of unpaired arteries seen with the conventional counting technique in low-grade siderotic dysplastic nodules (range, 1-14; mean, 3.8) was significantly greater (P = .004) than that seen in background siderotic regenerative nodules (range, 0-3; mean, 1.2). Similarly, the number of unpaired arteries seen with the hot spot technique in low-grade siderotic dysplastic nodules (range, 0-14; mean, 5.2) was significantly greater (P = .005) than that seen in background siderotic regenerative nodules (range, 0-6; mean, 1.9). CONCLUSION: On the basis of the vascular profile, low-grade siderotic dysplastic nodules should be considered premalignant lesions. Further research is needed to help differentiate these lesions from siderotic regenerative nodules with magnetic resonance imaging.

Humans↗
PubMed2003

HFE C282Y heterozygosity in hepatocellular carcinoma: evidence for an increased prevalence.

BACKGROUND & AIMS: Iron overload is observed frequently in chronic liver disease, and some studies have suggested that chronic iron overload may contribute to the pathogenesis of hepatocellular carcinoma (HCC). Heterozygosity for hereditary hemochromatosis (HH) is associated with increased body iron stores. The discovery of the HH gene HFE has enabled identification of the heterozygote status. The aim of this study was to evaluate if heterozygosity for HH is a risk factor for HCC. METHODS: The C282Y and the H63D mutation of the HFE gene were analyzed in 137 patients with HCC and no history of HH, 107 patients with cirrhosis without HCC and 126 healthy controls. Hepatic iron content was measured by using a semiquantitative histologic score. RESULTS: Seventeen of 137 HCC patients (12.4%) were C282Y heterozygote, compared with only 4 of 107 (3.7%) cirrhotic patients without HCC and 6 of 126 (4.8%) healthy controls (P < 0.05). The frequency of the H63D mutation showed no significant differences. C282Y heterozygote HCC patients had significantly higher levels of serum ferritin and transferrin saturation than C282Y wild-type patients (793 +/- 122 vs. 355 +/- 23 ng/mL, and 42.3% +/- 7.3% vs. 29.2% +/- 1.7%, respectively), and significantly higher iron deposition in HCC as well as in nontumorous liver tissue. CONCLUSIONS: The C282Y heterozygous genotype is significantly more common in HCC patients and is associated with significantly increased intrahepatic iron deposition and systemic iron stores. These results suggest that C282Y heterozygosity plays a role in liver iron deposition and could contribute to hepatocarcinogenesis via the accumulation of potentially carcinogenic iron. These findings may have implications for HCC screening and prevention strategies.

Biomarkers, Tumor↗
PubMed2004

Hemochromatosis and the enigma of misplaced iron: implications for infectious disease and survival.

The mystery surrounding the apparent lack of iron within the macrophages of individuals with hereditary hemochromatosis, a condition of excessive uptake of dietary iron, has yet to be fully explained. We have suggested that iron deficiency of macrophages in people with hereditary hemochromatosis mutations is associated with increased resistance to infection by Yersinia and other intracellular pathogens, a selection pressure resulting in unusually high current population frequencies of hereditary hemochromatosis mutations. Such selection pressure has been called Epidemic Pathogenic Selection (EPS). In support of the theory of EPS, a considerable number of virulent species of bacteria multiply mainly in iron-rich macrophages of their mammalian hosts. Among these fastidious pathogens are strains of Chlamydia, Coxiella, Francisella, Legionella, Mycobacterium, Salmonella and Yersinia. Iron deficiency of macrophages of persons with hereditary hemochromatosis gene mutations may result in increased resistance to members of these bacterial pathogens. People with genes that result in hereditary hemochromatosis may be protected against coronary artery disease associated with Chlamydia and Coxiella infection in the absence of iron overload. In the clinical setting, when a patient appears to be iron deficient, the reason for this should be carefully evaluated. Iron supplementation may adversely affect the health of individuals who have mounted an acute phase response to infection, injury or stress, or who carry genes predisposing them to iron overload disorders.

Bacterial Infections↗
PubMed1977

Variation in the distribution of two human heart ferritin species. Isoferritin profile and subunit composition in normal and iron-overloaded subjects.

On polyacrylamide slab electrophoresis two ferritin species, termed fast and slow, were present in three control and four iron-loaded human hearts. The ratio of the fast to slow species varied between hearts and correlated with the distribution of isoferritins, which had pI values ranging from 4.8 to 5.6. The acidic isoferritins were prominent in all hearts, but one control and the four iron-loaded hearts contained, in addition, basic isoferritins. All ferritins were composed of two subunits, an acidic H type and a more basic HL type, which was the main subunit in normal liver. Hearts with the highest proportions of acidic isoferritin contained the highest proportion of the H subunit.

Adult↗
PubMed1987

A new form of ferritin heterogeneity explained. Isolation and identification of a nineteen-amino-acid-residue fragment from siderosomal ferritin of rat liver.

Ferritin present within siderosomes of iron-loaded rats has a faster anodal mobility than that of cytosolic ferritin from the same rats. A 19-amino-acid-residue peptide was isolated from this fast ferritin and shown to be derived from the C-terminal end of its L-subunit. A 17.3 kDa peptide seen on electrophoresis in denaturing gels of this ferritin accounts for the major portion of the original 182-residue subunit. The two peptides arise from cleavage within the 'insertion region' of the L-subunit sequence that occurs between the D and E helices and lies on the outside of the assembled molecule. This cleavage is present in about 80% of the L-subunits of siderosomal ferritin but nevertheless leaves the molecular structure otherwise intact. It gives rise to an apparent decrease in molecular size, accounting for the faster anodal mobility on native gels. Hence a new form of heterogeneity in ferritin preparations has been explained.

Amino Acid Sequence↗
PubMed1999

Interrelationships of alcohol and iron in liver disease with particular reference to the iron-binding proteins, ferritin and transferrin.

It is known that the regular consumption of alcohol is responsible for the disruption of normal iron metabolism in humans, resulting in the excess deposition of iron in the liver in approximately one-third of alcoholic subjects. The mechanisms involved are largely unknown; however, it is likely that the two major proteins of iron metabolism, ferritin and transferrin are intimately involved in the process. Tissue damage in alcoholic liver disease and the inherited iron-overload disease, haemochromatosis, are caused by excess alcohol and iron, respectively. The mechanisms of this damage are believed to be similar in both disease conditions and involve free radical-mediated toxicity. A high proportion of haemochromatosis sufferers consume excessive amounts of alcohol and synergistic hepatotoxic events may occur leading to the earlier development of liver cirrhosis. This review describes briefly the role of ferritin and transferrin in normal iron metabolism and in iron overload disease and explores the possible involvement of these proteins in the pathophysiology of excess iron deposition in alcoholic subjects.

Ferritins↗