Frykman VIII Fracture Secondary to Falling Onto an Outstretched Hand (FOOSH)

This is the case of a 41-year-old woman who presented with pain in the wrist after a fall from her bicycle, after which she tried to block her fall by outstretching her hand. She sustained a Frykman VIII fracture, with a fracture of the distal radius and ulnar styloid. Her labs were unremarkable, and she had no previous medical history. Her case was an example of a classic fracture due to FOOSH (falling onto an outstretched hand) which can easily be avoided by learning how to break falls properly. The patient's symptoms, diagnosis, treatment, and ways to avoid this injury are presented.

Stercoral Colitis Secondary to Opiate-Induced Constipation

The authors present the case of a 62-year-old woman who had stercoral colitis secondary to opiate use for rheumatoid arthritis leading to chronic constipation. Computed tomography imaging demonstrated stool along a significant length of the colon. Stercoral colitis is a seldom suspected cause of severe abdominal pain. Although constipation may seem benign, when it gets to the level of a stercoral colitis, mortality due to colonic perforation is a very real concern. The authors review the presentation, risk factors, and management of stercoral colitis.

Subungual Hematoma

The authors present the case of a 64-year-old male who presented to the emergency department due to foot trauma. He sustained a large subungual hematoma, which was drained. Following the procedure, the patient achieved complete resolution of his pain. He also reported no complications at two-week phone follow-up. The management of subungual hematoma, including the trephination procedure, is discussed. Potential complications, although rare, are reviewed.

Geographic Liver

The authors present the case of a man with a relatively benign clinical presentation who had a computed tomography scan that revealed a "geographic liver" pattern. The radiologic appearance of hepatic steatosis, its significance, and its association with metabolic syndrome highlight the importance of this radiologic finding.

Acute Cardioembolic Stroke in the Setting of Subtherapeutic Anticoagulation

Acute ischemic stroke is a sudden neurological deficit secondary to decreased or lack of blood flow (perfusion) due to a thrombus or an embolus. Embolic strokes are ischemic strokes that occur due to a distal clot that results in hypoperfusion upstream. Cardioembolic strokes are embolic strokes due to a cardiac origin. Almost a quarter of ischemic strokes are of cardioembolic etiology. Here, we present the case of an 83-year-old female presenting with right-side weakness and aphasia who arrived 45 minutes after symptom onset. Cardioembolic stroke symptoms, diagnosis, treatment, and risk factors are discussed.

Progesterone receptor-B enhances estrogen responsiveness of breast cancer cells via scaffolding PELP1- and estrogen receptor-containing transcription complexes

Progesterone and estrogen are important drivers of breast cancer proliferation. Herein, we probed ER-alpha and PR cross-talk in breast cancer models. Stable expression of PR-B in PR-low/ER+ MCF7 cells increased cellular sensitivity to estradiol and IGF1, as measured in growth assays performed in the absence of exogenous progestin; similar results were obtained in PR-null/ER+ T47D cells stably expressing PR-B. Genome-wide microarray analyses revealed that unliganded PR-B induced robust expression of a subset of estradiol-responsive ER-target genes, including CathepsinD (CTSD). Estradiol-treated MCF7 cells stably expressing PR-B exhibited enhanced ER Ser167 phosphorylation and recruitment of ER, PR, and the proline, glutamate and leucine rich protein 1 (PELP1) to an estrogen response element (ERE) in the CTSD distal promoter; this complex co-immunoprecipitated with IGF1R in whole cell lysates. Importantly, ER/PR/PELP1 complexes were also detected in human breast cancer samples. Inhibition of IGF1R or PI3K blocked PR-B-dependent CTSD mRNA upregulation in response to estradiol. Similarly, inhibition of IGF1R or PR significantly reduced ER recruitment to the CTSD promoter. Stable knockdown of endogenous PR or onapristone treatment of multiple unmodified breast cancer cell lines blocked estradiol-mediated CTSD induction, inhibited growth in soft agar, and partially restored tamoxifen-sensitivity of resistant cells. Further, combination treatment of breast cancer cells with both onapristone and IGF1R tyrosine kinase inhibitor AEW541 was more effective than either agent alone. In summary, unliganded PR-B enhanced proliferative responses to estradiol and IGF1 via scaffolding of ERalpha/PELP1/IGF1R-containing complexes. Our data provide a strong rationale for targeting PR in combination with ER and IGF1R in patients with luminal breast cancer.

Release of neurohypophysial hormones in vitro

1. The rate of release of neurohypophysial hormones in vitro, using isolated, halved neural lobes of the rat in an incubation medium containing excess K(+) and Ca(2+), was measured. The highest average rate of release was observed between 10 and 20 min after commencement of incubation.2. Incubation of isolated, halved rat neural lobes in the presence of acetylcholine, with or without eserine, did not stimulate hormone release. When complete isolated hypothalamo-neurohypophysial systems were incubated in a suspension medium containing 10(-7) mg/ml. acetylcholine a significant increase in the release of oxytocin occurred (P < 0.01); the increase in vasopressin release was less pronounced (P < 0.05).3. Uptake of O(2) by the isolated, halved neural lobes and the hypothalamo-neurohypophysial systems continued for 2-3 hr, i.e. in excess of the experimental incubation time.4. During the first 40 min of incubation the control halved neural lobes increased in weight; the neural lobes incubated in buffer containing high potassium and calcium showed no increase in weight.5. Neural lobes incubated in buffer containing excess K(+) and Ca(2+) contained about 3 times as much potassium as controls. The sodium content was not affected significantly.6. Factors involved in the process of neurohypophysial hormone release are discussed.

Effects of ether anaesthesia and haemorrhage on hormone storage and ultrastructure of the rat neurohypophysis

Effects of ether anaesthesia with or without haemorrhage were investigated in the rat neurohypophysis in vivo and in vitro. Simultaneous observations were made on hormone release from, and the ultrastructure of, the same neural lobes.

Variable decreases in hormone content were found in the neural lobes of both anaesthetized, and anaesthetized and bled animals. A significant depletion of vasopressin (P < 0·01) occurred in the latter group when related to pressor activity/mg. wet neurohypophysial tissue.

Incubation of neural lobes removed after stimulation showed that the proportions of diffusible (free) vasopressin and oxytocin had increased. Haemorrhage under ether anaesthesia caused a significant increase in the amount of free vasopressin (P < 0·01), but not of oxytocin (P > 0·05).

Examination of control and stimulated rat posterior pituitaries with the electron microscope showed a loss of the electron-dense material from the elementary granules of the neurohypophysial nerve fibres, their swellings and their terminals after the neurones had been subjected to hormone releasing stimuli. It is suggested that disappearance of the electron-dense content of the hormone-carrying granules is not related to hormone content in the gland.

An increased number of small vesicles (250–600 Å) was observed in the nerve fibre swellings of the stimulated posterior pituitary. The distribution, origin and function of these small vesicles is discussed.