overcome these disadvantages we have modified an existing commercial serum cortisol kit to achieve the sensitivity necessary to enable the direct radioimmunoassay of salivary cortisol at reasonable cost. SUMMARY The determination of cortisol levels in saliva offers a number of significant advantages as compared with plasma or serum measurements, and radioimmunoassay is the technique of choice because of the greater sensitivity required. To date, the assay of salivary cortisol has been limited to only a few centres employing 'in-house' reagents. We describe some simple modifications of a commercial kit, designed for the assay of cortisol in serum and urine, which allow direct and rapid determination of the steroid in saliva. These modifications enable any laboratory with access to a gamma counter to perform large numbers of salivary cortisol assays at relatively low cost.Radioimmunoassays and enzymoimmunoassays have recently been described for the determination of salivary levels of several steroids including cortisol.l " progesterone," 4 17cx-hydroxyprogesterone, 5 testosterone.s ? and dihydrotestosterone." There is increasing evidence that the use of saliva offers many Subjects and sample collection important advantages over plasma or serum samples, especial1y for cortisol assays used to assess the Ten healthy volunteers (seven men and three women) hypothalamic-pituitary-adrenocortical axis.provided paired samples of saliva and blood between From a clinical standpoint, salivary cortisol levels 0800 and 0930 and again between 2200 and 2330. reflect the biologically active 'free' fraction in plasma They then took 0·5 mg of dexamethasone by mouth, and, unlike serum total cortisol determinations, are and further paired samples were collected the next not affected by situations (such as pregnancy) morning. A further five normal subjects had paired associated with changes in circulating cortisol-salivary and blood samples col1ected at 0900 and binding globulin or by drugs (such as salicylates) again 30 and 60 minutes after a single injection of which compete with cortisol for its binding sites. 250 [Jog tetracosactrin (Synacthen). In addition, 150 Use of saliva also avoids the need for venepuncture adult volunteers (62 men and 88 women) aged and, thereby, the risk of stress-stimulating cortisol between 19 and 34, and 105 children aged 4 to 11, secretion," From a practical standpoint, collection of provided morning samples of saliva. Informed saliva is easier and much less expensive than taking a consent was given by al1 the adults and by the blood sample; with minimal instruction, a patient parents of the children in response to a letter from can collect salivary samples at home, thereby greatly their headmaster. facilitating, for example, circadian studies; and Saliva was collected into wide plastic tubes salivary samples greatly facilitate dynamic tests and (Universal containers, 90 x 24 mrn, Sterilin, studies in infants and children.Richmond, Surrey, UK) 15 minutes after rinsing the At present the only disadvantag...

Minimal PTC C4d+ staining but not isolated glomerular C4d+ staining is associated with AMR, circulating DSAs and immune-response-related gene activation.

No abstract

No abstract

Commonly reported complications of hepatic cysts are spontaneous hemorrhage, rupture into the peritoneal cavity, infection and compression of the biliary tree however cardiac complications are not commonly reported. We are presenting a case of a large liver cyst presenting with right atrial and ventricular inflow tract impingement resulting in cardiac symptoms. A 68 year-old Hispanic female presented with one month of fatigue and shortness of breath after household work and walking less than one block, right upper quadrant pain and weight loss. She had history of multiple hepatic cysts for more than 12 years, well-controlled diabetes and hypertension. Examination of the heart revealed tachycardia with regular heart sounds. There were no murmurs. She had tenderness in her right upper quadrant on palpation and an enlarged smooth liver. Rest of physical examination was unremarkable. CT scan of the abdomen showed multiple non-enhancing liver cysts in both lobes, with the largest measuring 12 x 15 x 17 cm which was significantly increased from her baseline of 7 x 8 x 10 cm in 2003. Echocardiogram showed normal left ventricular ejection fraction, grade 1 diastolic dysfunction and a hepatic cyst impinging RA and RV inflow tract. She had successful laparoscopic enucleation of liver cyst and subsequent relief from tachycardia, fatigue and shortness of breath. In conclusion, this case illustrates that hepatic cysts may become symptomatic after remaining quiescent for an extended period. They may present with unusual symptoms and clinicians should be mindful of rare complications, such as in this case.

No abstract

No abstract

No abstract