Embolization of a ruptured aneurysm in classic polyarteritis nodosa presenting as perirenal hematoma

A 26-year-old man was admitted with abdominal pain, anemia, and hypertension. Ultrasonography and computed tomography revealed a perirenal hematoma. Soon after admission, the patient went into shock, and emergency angiography was performed. Two active bleeding sites were found in the left kidney and were successfully embolized. Also, multiple aneurysms, consistent with the diagnosis of classic polyarteritis nodosa, were seen. After treatment was initiated, the patient recovered fully. When a spontaneous perirenal hematoma is a presenting symptom of classic polyarteritis nodosa, a delay in making the right diagnosis is likely to occur. Angiography not only may provide a quick diagnosis, but it can also be used to perform therapeutic embolization. In patients with classic polyarteritis nodosa and hemorrhage from a ruptured aneurysm, angiography may be a therapeutic alternative to surgery.     

Redox potentials for yeast, Escherichia coli and human glutathione reductase relative to the NAD+/NADH redox couple: enzyme forms active in catalysis

The flavoenzyme glutathione reductase catalyzes the NADPH-dependent reduction of glutathione disulfide, yielding two molecules of glutathione. The oxidation-reduction potentials, Eox/EH2 (two-electron reduced enzyme), for yeast, Escherichia coli, and human glutathione reductase have been determined between pH 6.0 and 9.8 relative to the nonphysiological substrate couple NAD+/NADH and were found to be -237, -243, and -227 mV (+/-5 mV) at pH 7.0 and 20 degreesC, respectively. The potential as a function of pH demonstrated slopes of -51, -45, and -42 mV/pH unit, respectively, at low pH and -37, -31, and -34 mV/pH unit, respectively, at high pH. The change in slope indicated pKa values of 7.4, 8.5, and 7.6, respectively. The slopes indicate that two protons are associated with the two-electron reduction of Eox at low pH and that only one proton is involved with the two-electron reduction of Eox at high pH, provided that the effects of nearby titratable residues are considered in the data analysis. The influence of four such groups, Cys50, Cys45, His456', and either Tyr107 or the flavin-(N3), has been included (residue numbering refers to the yeast sequence). The enzyme loses activity upon deprotonation of the acid-base catalyst at high pH. Since the pKa ascribed to the EH2-to-EH- ionization is lower than the pKa of the acid-base catalyst, both the EH2 and EH- forms of glutathione reductase must be catalytically active, in contrast to the closely related enzyme lipoamide dehydrogenase, for which only EH2 is active.     

Book reviews

Landscape and Power in Vienna

Robert Rotenberg

Baltimore and London, The John Hopkins University Press, 1995, ISBN 0-8018-4961-6, 416 pp, £33.00, ($39.95), hb

The Avebury Cycle

Michael Dames

London, Thames & Hudson Ltd, 2nd edition (revised), ISBN 0-500-27886-5, 240 pp, 201 illus., £10.95 ($16.95), pb

Landscapes of Settlement: prehistory to the present

Brian K. Roberts

London and New York, Routledge, 1996, ISBN 0-415-11968-5, x +181 pp, £47.50 hb, £16.99 pb

The Body Language of Trees: a handbook of failure analysis

Claus Mattheck & Helge Breloer (translator: Robert Strouts)

London, HMSO, 1996, ISBN 0 11 753067 0, 239 pp, £17.50     

Posttraumatic stress disorder symptoms after bone marrow transplantation for breast cancer

Hormonal treatments which have an androgenic effect have the potential to cause vocal changes. The changes in vocal fold structure and voice quality are considered to be irreversible. To date, studies have documented subjective vocal changes or documented single cases without detailed, baseline voice assessments. The impact on laryngeal function of women taking these androgenic treatments requires further detailed, objective assessment. The need for increased awareness of the actions of androgenic hormones on womens' voices, and the benefits of a thorough voice assessment are discussed.     

Late postirradiation occlusive vasculopathy in childhood medulloblastoma. Report of two cases

The kinetics of the interaction of Rab7 with REP-1 have been investigated using the fluorescence of GDP and GTP analogs at the active site of Rab7. The results show that REP-1 has higher affinity for the GDP bound form of Rab7 (Kd=1 nM) than for the GTP bound form (Kd=20 nM). Both affinities should still be sufficient for the formation of stable complexes in the cell. The association reaction proceeds in two steps for the GDP bound form. The initial step is fast (k+1 = ca. 10[7] M[-1] s[-1]) and concentration dependent while the second represents a slow equilibration (k+2 + k-2 = 3.5 s[-1]) which has little effect on the overall equilibrium. The difference in affinity of the two nucleotide bound forms arises from a difference in dissociation rates (0.012 s[-1] for Rab7 x GDP and 0.2 s[-1] for Rab7 x GTP).