Red Marks Research Articles

Isolated Splenic Vein Thrombosis in a Patient with Polycythemia Vera

Purpose: Polycythemia vera (PCV) is a known cause of hypercoagulable states, however, isolated splenic vein thrombosis associated with PCV is only rarely reported. We report a case of the insidious onset of a splenic vein thrombosis presenting as an upper gastrointestinal bleed in a patient with PCV. Case: A 46 year old white female presented to the emergency room with complaints of melena for four days. She denied vomiting and abdominal pain associated with the melena. Her history was significant for polycythemia vera for which she had not seen a physician in years. She reported intermittent phlebotomy in the past. She denied non-steroidal anti-inflammatory use. Hemodynamics were significant for orthostasis, and presenting labs revealed a hemoglobin of 6.9 gm/dL. Abdominal examination was normal. After volume resuscitation, an esophagogastroduodenoscopy was performed. This revealed a normal esophagus and duodenum but multiple large, gastric varices with red marking signs in the gastric fundus. The finding of isolated gastric varices prompted an evaluation for a splenic vein thrombosis. An ultrasound Doppler exam revealed patent portal veins and a patent splenic vein at the level of the splenic hilum. As this did not exclude the possibility of a more central splenic vein occlusion, a CT venogram was ordered for confirmation. This revealed non-visualization of the splenic vein, suggesting a chronic splenic vein thrombosis. Extensive collateral formation was noted around the stomach and spleen. The patient underwent splenectomy with gastric devascularization and ligation of gastric and retroperitoneal varices as definitive treatment. The patient had a full recovery. This case highlights the importance of maintaining a high level of suspicion for the consequences of thrombosis in unusual locations in patients with hypercoagulable states. This case also demonstrates the relative lack of sensitivity of extracorporeal ultrasound for the diagnosis of splenic vein thrombosis.

Angiolymphoid hyperplasia with eosinophilia affecting the penis

Conflicts of interest: none declared. Sir, Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign entity that usually affects middle‐aged women. Patients present with painful small, superficial papules or nodules. There is a predilection for the periauricular area. Few cases involving the penis have been reported.1 2–3 Management of penile ALHE is problematic. We describe the first penile case with paucifocal lesions to be successfully treated medically. A 47‐year‐old man presented to a urologist with an 8‐month history of light red marks on the glans penis. They became increasingly painful as they expanded into nodules and ulcerated. There was dyspareunia but the pain did not correlate with erections and there was no difficulty in micturition. A biopsy was taken but interpretation presented diagnostic difficulties. He was circumcised but within 3 months a bulky lesion reappeared in the scar and the pain worsened considerably requiring treatment with oxycodone and gabapentin. Systemically he was completely well. There was no other past medical history or drug history of note. Screening for sexually transmitted diseases was negative. He was referred to a dermatologist.

Primary prophylaxis of esophageal variceal bleeding in cirrhosis

Variceal bleeding is a common and severe complication of liver cirrhosis. The risk of bleeding increases with the size of varices, red wheal marks and disease severity. Noninvasive tests are not accurate enough for the diagnosis of varices, so all patients with cirrhosis should be screened by endoscopy. Nonselective beta-blockers (propranolol, nadolol) are indicated for primary prophylaxis in patients with medium/large varices, and for those with small varices and red signs or advanced liver failure (Child C). In such patients, beta-blockers have been shown to reduce the risk of bleeding from 25 to 15%. There is no evidence to support using beta-blockers with nitrates or spironolactone. In patients with contraindication or intolerance to beta-blockers, endoscopic band ligations are indicated.

Reply to Dr. Tominaga et al.

We strongly believe that cat scratch colon is due to barotrauma; however, we have not been able to provide any evidence. We have on several occasions noted the sudden onset of bright red linear marks (”cat scratch”) upon insufflating a Hartmann’s pouch, but this cannot be extrapolated to the colon.

Emergence of “cat scratch colon” during a colonoscopy

We read with interest the article ”Cat scratch colon” by McDonnell et al. [1]. Red linear marks or parallel corkscrew lesions have been observed in the cecum and ascending colon [2] [3]. McDonnell et al. term these endoscopic findings ”cat scratch colon”, describing them as superficial breaks in the mucosa possibly secondary to barotrauma [1]. We report a case of colonoscopic barotrauma that emerged during a colonoscopy with reference to the article by McDonnell et al. [1].

Cat scratch colon

Bright red linear marks in the right colon are occasionally seen but have never been described in the medical literature. We have termed this finding "cat scratch" colon. This was a prospective examination of 8277 colonoscopies at a single endoscopy center in a private practice setting. All cases of cat scratch colon were biopsied, and the results read by two pathologists. A total of 21 cases of cat scratch colon were identified, all in the ascending colon and cecum, with a prevalence of 0.25%. The majority of cases were in women. Although the colon was histologically normal in most cases, there was a significantly higher proportion of collagenous colitis in patients with cat scratch colon compared with the total cohort (14% vs. 0.15%). The prevalence of bright red linear markings (cat scratch colon) in the cecum and ascending colon is 0.25%. These markings appear to be superficial breaks in the mucosa possibly secondary to barotrauma. Patients tend to be older women with higher proportion of collagenous colitis.

Sound Off!: Stepping Up Your Game

The faces of students in my high school precalculus class looked somber as I returned their chapter 2 tests. The exam itself had not been especially difficult, though many students had performed worse than they had hoped they would. Students saw the red marks on their papers and seemed to take them personally. For some, the return of the exam was demoralizing.

The Effect of Endoscopic Band Ligation for Symptomatic Internal Hemorrhoids

Background: Recently, endoscopic band ligation is increasingly used for the treatment of symptomatic internal hemorrhoids such as bleeding or rectal prolapse. The purpose of this study was to assess the safety and efficacy of endoscopic band ligation for symptomatic internal hemorrhoids. Methods: Endoscopic band ligation was performed in 16 patients (Goligher classification of internal hemorrhoid, 7, stage I; 7, stage II; 2, stage III) who had anal bleeding or rectal prolapse. The band ligation was performed with retroflexed endoscopic view (n = 12) or forward view (n = 4). Symptoms were graded by association with defecation (0, none; 1, sometimes at defecation; 2, at each defecation; 3, irrespective of defecation). Range and form of hemorrhoids was evaluated in accordance with the endoscopic classification of esophageal varices. Range, the circumferential distribution of hemorrhoids, was classified into 5 scores (0, none; 1, <1/4 of circumference; 2, 1/2 of circumference; 3, <3/4 of circumference; 4, the entire circumference). Form, the size of the largest hemorrhoid, was classified into 3 scores (0, none; 1, <12 mm; 2, >12 mm). The diameter of the colonoscope, 12 mm, was used as a reference. The red color sign was defined as a change in the color of the surface of the rectal column, including telagiectasia, red wale marking, and hematocystic spots. Prophylactic antibiotics were used for 3 days after procedure to prevent procedure associated infection. Results: After endoscopic band ligation, symptoms improved in 15 among 16 patients (93.7%). During the mean follow up of 2.7 ± 2.1 months, the mean score for bleeding was decreased after therapy from 1.63 to 0.44 and the mean scores for prolapse, from 1.78 to 0.22. The endoscopic finding of internal hemorrhoids also was improved (mean score for the range; from 3.25 to 1.81, for the form; from 1.81 to 0.81). RCS disappeared after therapy in 10 among 12 patients. Three patients were treated in a single session, 4 in two sessions, 8 in three sessions. A mean of 2.9 bands were placed in each session. No major complication, such as massive bleeding or pelvic sepsis was noted. 3 patients suffered from anal pain for several days and one patient from transient fever for 2 days, but subsided consevatively. Conclusion: Endoscopic band ligation is one of the effective and safe methods for the treatment of symptomatic internal hemorrhoids, and may provide an alternative to surgical treatment. Further study with a larger number of patients and a longer follow up is warranted.

A new snake of the genus Atractus Wagler, 1828 (Reptilia: Squamata: Colubridae) from Kaieteur National Park, Guyana, northeastern South America

A new colubrid snake of the genus Atractus Wagler 1828 is described from Kaieteur National Park, west-central Guyana. The new species differs from all other congeners by the combination of two postoculars, 15 dorsal scale rows, eight supralabials, seven to eight infralabials, loreal much longer than high, six maxillary teeth, and a color pattern consisting of irregular red or pale red markings, sometimes forming an incomplete broken dorsolateral stripe, on a medium brown to brownish black ground color, and heavy brownish black mottling on a yellowish cream venter. A key to the species of the genus Atractus from Guyana is provided.

Evaluation of Paintball, Mark–Resight Surveys for Estimating Mountain Goat Abundance

We evaluated mark-resight estimates of mountain goat (Oreamnos americanus) abundance using paintball marks at Seven Devils and Black Mountain, Idaho, USA. We marked mountain goats with recreational paintball equipment fired from a helicopter. Blue-violet dye marks were difficult to distinguish from dark, soiled areas on goats, while orange, yellow, and red oil-based paint marks were easily recognized, highly visible, and persisted for at least 71 days. Marking rates varied with equipment function and pilot effectiveness and ranged between 6.3 and 14.6 goats marked/hour of flight time. Precision of abundance estimates was reasonable with mark samples ≥51% of N. We analyzed a 3-occasion survey at Black Mountain using Program MARK to determine the likelihood and magnitude of potential sources of bias. Model Mb, which allows a behavioral response to capture, was best supported by the data, while model Mt, which allows time-varying capture probabilities, had reasonable support. The pattern of time-varying capture probabilities likely was a by-product of trap-shy behavior. Model Mb was 3 times more likely than model Mt to be the best approximating model, given the data. Behavioral response to marking and time-varying capture probabilities can be accommodated with >2 survey occasions. However, the strong evidence for a behavioral response implies that Lincoln-Petersen estimates of abundance are inappropriate. The set of candidate models did not include a model that would accommodate heterogeneity of individual sighting probabilities, which remains a concern with the mark-resight approach.

Incorporating a Module for the Practice of Space-Anatomic Positioning Ability, to the Otolaryngology Simulator WESST-OT

With the development of this project, a great aide is presented to the user of the prototype «Análisis, diseño e implementación del prototipo de un entorno de práctica de habilidades quirúrgicas en Otorrinolaringología». This aide will help the user to acquire the space-anatomic positioning ability, which allows the user to associate what he sees on 2D radiological slices with what he sees through the virtual endoscope of the simulation environment. To achieve the cited ability, the user is presented with radiological images (tomography slices) with red marks that represent the current position of the endoscope he is using in the simulation environment. There are no new types of users added with this extension, but multiple modifications were made to the user interface, to the functionality and evaluation system. The Object Oriented methodology is used and the language used for this extension is the same that the one used in the original simulation environment -JAVA. Also, there is more data sent into the database system. To achieve the 3D - 2D association needed to place the endoscope positions, questions and information on the radiological images, an auxiliary software was developed in C language; this software gave us the capability to match tridimensional morphological structures with their radiological, 2D partners.

De Novo Biosynthetic Profiling of High Abundance Proteins in Cystic Fibrosis Lung Epithelial Cells

In previous studies with cystic fibrosis (CF) IB3-1 lung epithelial cells in culture, we identified 194 unique high abundance proteins by conventional two-dimensional gel electrophoresis and mass spectrometry (Pollard, H. B., Ji, X.-D., Jozwik, C. J., and Jacobowitz, D. M. (2005) High abundance protein profiling of cystic fibrosis lung epithelial cells. Proteomics 5, 2210-2226). In the present work we compared the IB3-1 cells with IB3-1/S9 daughter cells repaired by gene transfer with AAV-(wild type)CFTR. We report that gene transfer resulted in significant changes in silver stain intensity of only 20 of the 194 proteins. However, simultaneous measurement of de novo biosynthetic rates with [(35)S]methionine of all 194 proteins in both cell types resulted in the identification of an additional 31 CF-specific proteins. Of the 51 proteins identified by this hybrid approach, only six proteins changed similarly in both the mass and kinetics categories. This kinetic portion of the high abundance CF proteome, hidden from direct analysis of abundance, included proteins from transcription and signaling pathways such as NFkappaB, chaperones such as HSC70, cytoskeletal proteins, and others. Connectivity analysis indicated that approximately 30% of the 51-member hybrid high abundance CF proteome interacts with the NFkappaB signaling pathway. In conclusion, measurement of biosynthetic rates on a global scale can be used to identify disease-specific differences within the high abundance cystic fibrosis proteome. Most of these kinetically defined proteins are unaffected in expression level when using conventional silver stain analysis. We anticipate that this novel hybrid approach to discovery of the high abundance CF proteome will find general application to other proteomic problems in biology and medicine.

Visible Implant Elastomer Color Determination, Tag Visibility, and Tag Loss: Potential Sources of Error for Mark–Recapture Studies

AbstractErrors in visible implant elastomer (VIE) color determination may exert stronger influences on mark–recapture data quality than poor tag visibility and tag loss. I applied individual VIE tags to 567 wild long‐snouted seahorses Hippocampus guttulatus using four fluorescent colors (red, orange, green, and yellow). Given VIE tag data were compared with tag data recorded by observers as they released recently tagged individuals back to initial capture locations. During releases, 13.3% of VIE tags were incorrectly read, primarily because of confusions between orange and red markings and between green and yellow markings. Tags were partially invisible in 5% of released individuals; yellow and green markings were the least visible. Whole or partial tag loss was 2.3% within 14 months of tagging. The ability to correctly determine VIE tag colors or detect markings varied among observers and according to the VIE tag color employed, skin color, and shade of the skin color (e.g., light versus dark green). Observer experience did not influence ability to correctly determine VIE colors or detect tags. Pilot studies should precede mark–recapture studies employing multiple VIE colors to identify strategies for reducing confusion among colors in addition to evaluating tag visibility, tag loss, and tag effects on life history rates.

Portal Hypertensive Gastropathy in Chronic Hepatitis C Patients with Bridging Fibrosis and Compensated Cirrhosis: Results from the HALT-C Trial

The clinical significance of portal hypertensive gastropathy (PHG) in patients with compensated liver disease is not well established. The aim of this study was to determine the prevalence and correlates of PHG in a large cohort of patients with chronic hepatitis C virus (HCV) infection and bridging fibrosis/compensated cirrhosis entering the randomized phase of the Hepatitis C Antiviral Long-term Treatment against Cirrhosis trial (HALT-C). The presence and severity of PHG in 1,016 HCV patients with no prior history of gastrointestinal bleeding was determined at surveillance endoscopy using the New Italian Endoscopy Club criteria. Overall, 37% of HALT-C patients had PHG with 34% having mild and 3% with severe changes. The mucosal mosaic pattern was identified in 33%, red marks in 15%, and gastric antral vascular ectasia (GAVE) features in only 3%. Independent correlates of PHG included biochemical markers of liver disease severity (lower serum albumin, higher bilirubin), portal hypertension (lower platelet count), insulin resistance (higher glucose), and non-African American race. Independent correlates of GAVE included a history of smoking, nonsteroidal anti-inflammatory drugs (NSAIDs) use within the past year, and higher serum bilirubin and glucose levels. There was a strong positive association between the presence of PHG and esophageal varices (p < 0.0001). PHG is associated with the histological and biochemical severity of liver disease in patients with HCV and advanced fibrosis but is mild in most patients. The clinical relevance of these findings will be further explored during the randomized phase of the HALT-C study.

Supporting children when there is a new baby in the family

Jodie brought three-year-old Jake into nursery and was quite distressed. She had discovered Jake leaning over his new baby sister, saying ‘I hate you, I hate you’ and pinching her arm, leaving clear red marks.

Endemic species of Impatiens spp. (Balsaminaceae) in Sumatra and its possibility as an ornamental plants

Inventory study of Impatiens has been done in Sumatra. Twenty five species of Impatiens were colleted from several research sites. Based on the morphological flower and their color, 9 species among them, such as I. tujuhensis Utami &amp; T. Shimizu, I. elephanticeps Grey-Wilson, I. sorikensis N. Utami, I. pilosivitata Grey-Wilson, I. steenisii Grey-Wilson, I. sidikalangensis Grey-Wilson, I. pseudoperezii Grey-Wilson, I. rubriflora Grey-Wilson, and I. batanggadisensis N. Utami have potential as ornamental plants. I. tujuhensis Utami et T. Shimizu is closely related to I. elephanticeps Grey-Wilson. The two taxa are characterized by lower sepal like an elephant’s trunk, but I. tujuhensis differs from I. elephanticeps in having leaf lamina pubescent above with crenulated margins, petioles with several stipulated glands, the smaller tepals densely pubescent outside, but with lateral united petals which are bent backward along the midrib, the upper portions of the lateral united petals with a brown-purple patch and the dorsal petal with dense brown-purple reticulation inside. I. sorikensis N. Utami finds its closest ally in I. pilosivitata Grey-Wilson. They differ in a number of important aspects: the shape of the lateral petals, the color of the flowers, and the shape of the leaves. I. steenisii Grey-Wilson has a broader navicular lower sepal with a short incurved spur; flowers when viewed from the front have a curious bilateral asymmetry caused by a twist in the lateral united petals. I. sidikalangensis Grey-Wilson is characterized by rather flat or shallowly cupped, white or pale pink flowers, the dorsal petal and the base of the two lateral petals stained with reddish or lilac-purple. I. pseudoperezii Grey-Wilson has large pink or purple, with long curved spurs. I. rubriflora Grey-Wilson is the only species with red flowers, with its stout inflorescence and narrow bucciniform lower sepal. I. batanggadisensis N. Utami is characterized by yellow flowers with red markings on the bases of the two lateral petals, emarginated lower petals, and glabrous leaves. © 2006 Jurusan Biologi FMIPA UNS SurakartaKey words: Impatiens, Balsaminaceae, wild plant, endemic, ornamental plants

Prophylaxis with beta blockers as a performance measure of quality health care in cirrhosis

Prophylaxis with beta blockers as a performance measure of quality health care in cirrhosis

Dr Taylor and the Transylvanian Peel

Dr Taylor and the Transylvanian Peel

Bruce Stovel 1941-2007

Bruce Stovel 1941-2007 Patricia Demers Generosity is the word that first comes to mind when I think of Bruce Stovel. I realize that outgoing engagement is an easy tag for people whose equanimity, intuitive understanding, and largeness of spirit amaze and confound us. Bruce put all these qualities into action. He never sought or hogged the spotlight. But if he undertook to do something, his commitment was wholehearted. When he observed junior colleagues' classes, he wrote full and perceptive comments. He wouldn't stint on details in letters of reference for undergraduate and graduate students, who invariably won the scholarships. As an Associate Chair his decisions were not expedient; he considered each case, listened to each petition with sympathetic insight. As an Associate Editor for esc Bruce was a meticulous and, yes, humbling perfectionist. In the days before online editing, copy-editing was in every sense hands-on, attentive labour. I remember passing to Bruce texts that had been through a few editorial filters and that I thought were ready to go only to find them in my box the next day festooned with his precise red and blue markings. The difference between the dash and the hyphen was an article of faith for Bruce. He made silent corrections and innumerable improvements. A genial host who concocted a sinful chocolate mousse, an academic who connected with several communities, a blues man who didn't whine, Bruce was a rare colleague. Patricia Demers Associate Editor, English Studies in Canada, 1986-1989 Copyright © 2005 Association of Canadian College and University Teachers

Causes of portal venous thrombosis in cirrhotic patients: the role of genetic and acquired factors

We compared frequencies of three common prothrombotic mutations (factor V Leiden, the G20210A mutation of the prothrombin gene, and homozygosity for C677T methylenetetrahydrofolate reductase) in 219 cirrhotic patients, 43 with and 176 without portal vein thrombosis (PVT). The following variables were related to PVT: prothrombin levels, platelet count, Child-Pugh classification, previous abdominal surgery, number of decompensation events, size of varices, red markers on varices, and sclerotherapy. All patients were followed up for a mean period of 18 months (range 10-30). Prothrombotic mutations were detected in 64 of the 219 cirrhotic patients (29.2%), at equal frequency in patients with or without PVT. At univariate analysis, PVT was associated with Child-Pugh classes B and C, signs of liver decompensation, large varices with red markings, sclerotherapy, and abdominal surgery. At multivariate analysis, PVT was associated with sclerotherapy [odds ratio (OR) 4.9, 95% confidence interval (CI) 2.2-11] and previous surgery (OR 2.8, 95% CI 1.2-6.3). The combination of the two acquired factors increased the risk of PVT, whereas the combination of local with genetic defects did not. Only a single patient with genetic thrombophilia and without PVT at inclusion developed the complication during follow-up, concomitantly with the development of hepatocellular carcinoma. In cirrhotic patients prothrombotic mutations by themselves are not causative of PVT. Sclerotherapy and previous abdominal surgery favour the development of two-thirds of cases of PVT; in the remaining cases the pathogenesis remains elusive.