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Many small oligopeptides are rapidly excreted unchanged into bile, which requires vectorial transport across the hepatocyte. To characterize the involved carrier system(s) at the canalicular membrane, studies were undertaken with vesicle preparations from the rat and the model pseudohexapeptide ditekiren. The initial uptake rate into inside-out-oriented vesicles was found to be ATP- and temperature-dependent and saturable. Kinetic analysis indicated the involvement of three processes: (1) an ATP-dependent carrier-mediated process (Km = 19.1 +/- 4.26 microM; mean +/- S.E.M.), Vmax = 140 +/- 29.4 pmol/mg of protein/15 sec), (2) an ATP-independent carrier-mediated transporter (Km = 17.2 +/- 9.58 microM, Vmax = 62.9 +/- 24.5 pmol/mg of protein/15 sec) and (3) a nonsaturable component. ATP-dependent uptake was inhibited by several other oligopeptides, which in the case of EMD 51921 was competitive. Cis-inhibition studies with known substrates for the canalicular bile salt (taurocholate), multispecific organic anion (glutathione disulfide) and P-glycoprotein (daunomycin, nicardipine, cyclosporin A) transporters indicated a major role for the latter carrier system. Inhibition of the initial uptake rate of ditekiren by daunomycin was found to be competitive in nature (Ki = 16 microM). These findings indicate that the biliary excretion of ditekiren and possibly other hydrophobic oligopeptides is mediated, in part, by P-glycoprotein and suggest a possible physiological role for this hepatic transporter.

Ovarian remnant syndrome results from residual ovarian tissue after bilateral oophorectomy. The syndrome is associated with chronic pelvic pain and is suspected when premenopausal levels of FSH and LH are present in a patient with documented bilateral oophorectomy. Histologic demonstration of ovarian tissue at operation confirms the diagnosis. We treated a patient with ovarian remnant syndrome with a 10-day course of clomiphene citrate, 100 mg daily, to stimulate the residual ovarian tissue and facilitate localization. Preoperative ultrasound revealed a 5.0 x 3.5 x 6.2-cm cystic mass in the right adnexal region. Exploratory laparotomy easily localized the mass, and it was removed intact. Histologic slides demonstrated normal ovarian tissue with multiple follicles in various stages of development and a corpus luteum cyst. Clomiphene citrate is capable of stimulating an ovarian remnant, producing an enlarged, cystic structure easily localized by ultrasound. The increased size and preoperative knowledge of the location facilitated surgical removal.

Abstract:This study examined the vocational education programs at residential schools for the deaf to find out what adjustments they have made to help high school students prepare for future employment, as well as to assess the status and some of the trends affecting the programs from 1980 through 1987. This study also attempted to determine what schools plan for the next five years (1988 through 1992). Additionally, the study looked at residential schools' student populations to assess the extent of mainstreaming of deaf residential school students into public schools and the reverse mainstreaming of hearing students into residential schools. Finally, the study attempted to identify what actions, if any, residential schools are undertaking in their vocational programs to meet changing enrollment patterns and other education trends in employment and technology.

Objective. We present a case of an adrenal hemangioma, an uncommon cause of an adrenal mass, and review the clinical presentation, work-up, and management of adrenal incidentalomas. Background. A 64-year-old male was found to have a right adrenal incidentaloma during work-up for elevated liver transaminase levels, later found to be from hepatitis C. The mass was suspicious for adrenocortical carcinoma on CT imaging. Biochemical evaluation revealed no evidence of function. He underwent an open right adrenalectomy. The mass was found to be an adrenal hemangioma on histopathologic analysis. Methods. This is a case report with pertinent review of the diagnosis and management of adrenal incidentalomas. Results. Adrenal hemangiomas are rare, benign, nonfunctional tumors typically found during imaging for other reasons. As illustrated by this case, they appear similar to adrenocortical carcinoma on CT imaging. The diagnosis is usually not made prior to surgical resection. Conclusion. Adrenal hemangioma is a rare nonfunctional adrenal incidentaloma that displays atypical features on CT imaging. The suspicion for adrenocortical carcinoma usually prompts adrenalectomy.