Melatonin inhibits hypothalamic gonadotropin-releasing hormone release and reduces biliary hyperplasia and fibrosis in cholestatic rats.

Melatonin is a hormone produced by the pineal gland with increased circulating levels shown to inhibit biliary hyperplasia and fibrosis during cholestatic liver injury. Melatonin also has the capability to suppress the release of hypothalamic gonadotropin-releasing hormone (GnRH), a hormone that promotes cholangiocyte proliferation when serum levels are elevated. However, the interplay and contribution of neural melatonin and GnRH to cholangiocyte proliferation and fibrosis in bile duct-ligated (BDL) rats have not been investigated.

Effect of a Decision Aid on Decision Making for the Treatment of Pelvic Organ Prolapse.

Objectives: The aim of this study was to evaluate if the addition of a decision aid (DA) decreases decisional conflict in women presenting for the management and treatment of pelvic organ prolapse (POP).

Methods: Women scheduled for the evaluation and management of POP were randomized into either of 2 groups: standard counseling (SC) alone (n = 51) or SC plus a DA (n = 53). Upon completion of their initial visit, patients filled out a 16-item decisional conflict scale and short form general health survey.

Inhibition of mast cell-derived histamine secretion by cromolyn sodium treatment decreases biliary hyperplasia in cholestatic rodents.

Cholangiopathies are characterized by dysregulation of the balance between biliary growth and loss. We have shown that histamine (HA) stimulates biliary growth via autocrine mechanisms. To evaluate the paracrine effects of mast cell (MC) stabilization on biliary proliferation, sham or BDL rats were treated by IP-implanted osmotic pumps filled with saline or cromolyn sodium (24 mg/kg BW/day (inhibits MC histamine release)) for 1 week.

Knockout of histidine decarboxylase decreases bile duct ligation-induced biliary hyperplasia via downregulation of the histidine decarboxylase/VEGF axis through PKA-ERK1/2 signaling.

Histidine is converted to histamine by histidine decarboxylase (HDC). We have shown that cholangiocytes 1) express HDC, 2) secrete histamine, and 3) proliferate after histamine treatment via ERK1/2 signaling. In bile duct-ligated (BDL) rodents, there is enhanced biliary hyperplasia, HDC expression, and histamine secretion.

Barriers to breastfeeding in a resident clinic.

Despite the known health benefits for mother and infant, compliance with exclusive breastfeeding continues to challenge many healthcare providers. In an ongoing attempt to maintain the goals of the Healthy People 2010 initiative, our institution set out to identify patients with suboptimal breastfeeding rates in order to recognize potential barriers. Review of breastfeeding rates at the time of discharge noted significantly lower participation by clinic patients.

Inhibition of histidine decarboxylase ablates the autocrine tumorigenic effects of histamine in human cholangiocarcinoma.

Background: In several tumours the endogenous activity of histidine decarboxylase (HDC), the enzyme stimulating histamine synthesis, sustains the autocrine trophic effect of histamine on cancer progression. Cholangiocarcinoma is a biliary cancer with limited treatment options. Histamine interacts with four G-protein coupled receptors, H1-H4 histamine receptors (HRs).

Progression from atypical/dysplastic intraepidermal proliferations and carcinoma in situ to invasive tumors: a pathway based on current knowledge.

Oncology research efforts in recent years have begun to elucidate the role of the peritumoral stroma in the development of dysplasia and subsequent invasive malignancy. In the skin, the stroma surrounding keratinocytic and melanocytic tumors reacts to the dysplastic epidermis in a similar fashion to the wound healing response. Once epidermal genetic mutations and aberrant molecular signaling have occurred, the stroma responds through a 3-phase process-extracellular matrix degradation is produced by matrix metalloproteinases; angiogenesis is induced by vascular endothelial growth factor and mast cell mediators; and the inflammatory response is elicited by cytokines and cyclin D1 overexpression balanced by the immunosuppression of mast cell mediators such as tumor necrosis factor alpha, histamine, and transforming growth factor beta.

Successful surgical treatment of advanced erythema elevatum diutinum.

Erythema elevatum diutinum is a rare, chronic cutaneous vasculitis that presents with plaques or nodules on the extensor surfaces of extremities. Although the exact pathogenesis is unknown, patients usually have an underlying systemic medical problem such as malignancy, autoimmune disease or HIV. Management of the cutaneous manifestations is aimed at controlling the underlying disease process, in addition to medical therapy directed at suppressing the lesions.

SERPINE 1 Links Obesity and Diabetes: A Pilot Study.

In the past decade there has been a dramatic increase in the number of Americans considered obese. Over this same period, the number of individuals diagnosed with diabetes has increased by over 40%. Interestingly, in a great number of cases individuals considered obese develop diabetes later on.

Nodular mucinosis of the breast: expanding our understanding with an unusual case.

Nodular mucinosis of the breast is an extraordinarily rare lesion that occurs in patients who do not have Carney syndrome. Typically, the affected patients are young women with no medical history and a nodule under 1 nipple. Histopathologic examination has, until now, shown a multinodular myxoid lesion containing scattered capillaries and histiocytes but void of epithelial components.

Glatiramer acetate-associated, CD30+, primary, cutaneous, anaplastic large-cell lymphoma.

Objective: To report the association of the development of a primary, cutaneous, anaplastic large-cell lymphoma after initiation of glatiramer acetate treatment of a patient with relapsing-remitting multiple sclerosis.

Design: Case report.

Setting: Dermatology outpatient clinic.

Prevalence of the human papillomavirus in an inner-city indigent population with previously normal Pap tests.

Objective: To determine the prevalence of human papillomavirus (HPV) in our inner-city indigent population (clinic population) of women with previously normal Pap tests and to identify any associated risk factors.

Materials And Methods: A prospective cohort of 187 women between the ages of 15 and 49 years, with previously normal Pap tests, was recruited from a university affiliated outpatient clinic. A demographic questionnaire of social and sexual history was elicited, and ThinPrep cytology (Cytyc, Marlborough, MA) and HPV Digene Hybrid Capture II results (Digine, Gaithersburg, MD) were obtained.

Quantification of gadolinium in nephrogenic systemic fibrosis: re-examination of a reported cohort with analysis of clinical factors.

Background: Nephrogenic systemic fibrosis (NSF) has been associated with exposure to gadolinium-based contrast agent (GdCA) used in medical imaging.

Objective: We sought to quantify levels of gadolinium in affected skin of patients with NSF and correlate the levels to clinical and laboratory parameters.

Methods: Skin biopsy specimens were analyzed using inductively coupled plasma mass spectroscopy (ICP-MS) and the micrograms of gadolinium per gram (microg/g) of dry tissue were determined.

Successful pregnancy in a hemodialysis patient and marked resolution of her nephrogenic systemic fibrosis.

Nephrogenic systemic fibrosis (NSF) is a recently recognized clinicopathologic entity. It is believed to be related to exposure to gadolinium-containing magnetic resonance imaging agents with gadolinium deposition in the tissues, including skin and other organs. It mainly affects patients on dialysis therapy.

Nephrogenic systemic fibrosis: a review of 6 cases temporally related to gadodiamide injection (omniscan).

Objectives: Nephrogenic systemic fibrosis (NSF) is a rare acquired disorder that was first recognized in 1997. Presented is a retrospective review of 6 cases of NSF diagnosed by skin biopsy in our institution during the past 4 years and their relationship to gadodiamide exposure.

Methods And Results: Patient age ranged from 23 to 71 years.

Case reports: malignant transformation of aneurysmal bone cysts.

An aneurysmal bone cyst is an uncommon benign primary bone tumor. Careful intralesional curettage through a wide cortical window in addition to cauterization with or without adjuvant therapy (phenol or hydrogen peroxide) and bone grafting or cementation is the preferred surgical treatment. Adjuvant or primary radiation of an aneurysmal bone cyst rarely is used because of its association with malignant transformation of the lesion.

Lack of adherence to practice guidelines for women with atypical glandular cells on cervical cytology.

Objective: We sought to estimate the rates and types of evaluation in women with atypical glandular cells of undetermined significance (AGC-US) on cervical cytology and to assess these findings on the basis of published management guidelines.

Methods: The rates of histologic sampling, comprehensive initial evaluations, and secondary evaluations were assessed in 477 women with an AGC-US Pap test from 1998 to 2001. A comprehensive evaluation was defined as a colposcopy and an endocervical curettage with or without a cervical biopsy.

Dysplasia associated with atypical glandular cells on cervical cytology.

Objectives: To estimate the rates of and identify risk factors for disease in women with atypical glandular cells of undetermined significance (AGUS).

Methods: From 1998-2001, 477 Pap tests at Hartford Hospital were classified as AGUS and met the inclusion criteria of this study. Findings were evaluated for 2 years from the initial test.

Transitional cell carcinoma presenting as clitoral priapism.

Background: Clitoral priapism is an uncommon cause of clitoromegaly. It should be suspected in the absence of hirsuitism and the presence of clitoral engorgement, pain, and local irritation.

Case: A 48-year-old female had a straight catheterization of her bladder for a history of frequent urinary tract infections.

Lung cancer metastatic to a cervical polyp.

Background: We describe an unusual finding of a lung cancer metastatic to a cervical polyp.

Case: A 69-year-old female with metastatic lung cancer was referred for evaluation of an asymptomatic cervical polyp. The polyp was removed and pathologic examination revealed a focus of invasive adenocarcinoma with signet ring features within a polypoid fragment of squamous mucosa.

Building an award-winning women's health ambulatory service and beyond.

Many barriers exist for the provision of high-quality health care to inner-city minority women. The barriers include access to care, compliance problems, financial concerns, system navigation issues, as well as language barriers. This article describes the transition of the Women's Ambulatory Health Services at Hartford Hospital from a traditional clinic model to a culturally sensitive private practice model.