With data from the Women's Health Initiative indicating that estrogen plus progesterone are associated with an increased risk of cardiovascular events, many patients and practitioners are looking for alternative therapies to manage menopausal symptoms. One alternative is black cohosh, an herbal product used primarily to treat these symptoms. In recent years there have been several case reports associating this substance with hepatitis and fulminant hepatic failure. We present a case of a woman who developed hepatic failure requiring liver transplantation from the use of this herb. Liver Transpl 12:989-992, 2006.
Microarray studies of chronic hepatitis C infection have provided valuable
information regarding the host response to viral infection. However, recent
studies of the human transcriptome indicate pervasive transcription in
previously unannotated regions of the genome and that many RNA transcripts have
short or lack 3′ poly(A) ends. We hypothesized that using ENCODE tiling
arrays (1% of the genome) in combination with affinity purifying Pol II
RNAs by their unique 5′ m7GpppN cap would identify previously
undescribed annotated and unannotated genes that are differentially expressed in
liver during hepatitis C virus (HCV) infection. Both 5′-capped and
poly(A)+ populations of RNA were analyzed using ENCODE tiling arrays.
Sixty-four annotated genes were significantly increased in HCV cirrhotic as
compared to control liver; twenty-seven (42%) of these genes were
identified only by analyzing 5′ capped RNA. Thirty-one annotated genes
were significantly decreased; sixteen (50%) of these were identified only
by analyzing 5′ capped RNA. Bioinformatic analysis showed that capped RNA
produced more consistent results, provided a more extensive expression profile
of intronic regions and identified upregulated Pol II transcriptionally active
regions in unannotated areas of the genome in HCV cirrhotic liver. Two of these
regions were verified by PCR and RACE analysis. qPCR analysis of liver biopsy
specimens demonstrated that these unannotated transcripts, as well as IRF1,
TRIM22 and MET, were also upregulated in hepatitis C with mild inflammation and
no fibrosis. The analysis of 5′ capped RNA in combination with ENCODE
tiling arrays provides additional gene expression information and identifies
novel upregulated Pol II transcripts not previously described in HCV infected
liver. This approach, particularly when combined with new RNA sequencing
technologies, should also be useful in further defining Pol II transcripts
differentially regulated in specific disease states and in studying RNAs
regulated by changes in pre-mRNA splicing or 3′ polyadenylation
status.
Pancreatic heterotopia (PH) is a common, but typically small (<1 cm), incidental and asymptomatic finding; however, PH should be considered even for large and symptomatic upper gastrointestinal masses. A 27-year-old white woman presented with a 3-week history of burning epigastric pain, nausea, early satiety, and constipation. Physical examination revealed epigastric and right upper quadrant tenderness with normal laboratory workup, but imaging revealed a 5-cm, partly cystic mass arising from the gastric antrum with resulting pyloric stenosis and partial gastric outlet obstruction. Endoscopic ultrasound-guided fine needle aspiration revealed PH – an anomalous pancreatic tissue lying in a nonphysiological site. The patient ultimately underwent a resection and recovered uneventfully, with a complete pathologic examination revealing normal exocrine pancreatic tissue (PH type 2) without malignant transformation. We report a case of heterotopic pancreas manifesting as severe gastric outlet obstruction, in addition to a thorough diagnostic workup and surgical follow-up, in a young adult. Differential diagnoses and features that speak to benignity of a large, symptomatic mass lesion (PH in particular) are discussed.
Endoscopic ultrasound (EUS) combines the use of flexible fiberoptic endoscopes with high-resolution ultrasound technology. It is increasingly used for the evaluation, staging, and diagnosis of many luminal and extraluminal gastrointestinal (GI) cancers, as well as non-GI tract ailments, including the staging of lung cancer. In the past decade, EUS has become available on a wide scale, with an increasing number of indications. The technology has been shown to be comparable with and often more sensitive than computed tomography scan and magnetic resonance imaging in staging many malignancies. The use of fine-needle aspiration and ultrasound-guided injection also allows for accurate tissue diagnosis and therapy of GI ailments. Despite increasing availability and indications for EUS over the past decade, general internists may not be aware of EUS technology, when to order an EUS, and how to integrate the results of an EUS into their management decisions. This article will review the general indications for EUS referral, limitations, and role of EUS in the practice of general medicine.
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