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A 45-year-old woman presented 22 months after cadaveric kidney transplant with 2 days of bloody diarrhea. The initial hematocrit was 28.7% (baseline 38.9%, normal 40%50%). Medications included prednisone, tacrolimus, and mycophenolate mofetil (MMF) (CellCept; Roche Pharmaceuticals, Hoffman–LaRoche Inc, Nutley, NJ). Colonoscopy revealed a patchy colitis characterized by erythema, granularity, and superficial ulceration, most prominent in the cecum and extending to the descending colon (A, B).

Patients with ulcerative colitis in Hong Kong are diagnosed at an older age and have a more extensive disease at diagnosis than patients in Melbourne. The high proportion of patients with extensive disease has implications for disease control, type of medications required, cancer risk, and surveillance requirements. Drug treatment in Hong Kong was less intense; in particular immunosuppressive treatment was often not used prior to colectomy. Phenotypic and management differences between East and West should serve to highlight areas of clinical and resource needs.

Conclusions: This case report represents the only documented case of a pyogenic granuloma arising from the epiglottis. This is a rare but potentially lifethreatening situation as bleeding from this site is difficult to control and may lead to airway compromise. Assessment of the airway and surgical excision are necessary for prevention of recurrent episodes of supraglottic bleeding. PG are most commonly found on the skin and very rarely in the gastrointestinal tract, with the exception of the oral cavity. Oral PG predominantly develop on gingival tissue (61%)6, particularly on the anterior maxilla. Based on a review of the literature, our case represents the first reported case of a pyogenic granuloma arising on the epiglottis. Another interesting aspect of this case is the lack of an identifiable trigger leading to the development of this PG. The patient underwent surgery for cardiac stent placement approximately one year prior to presentation. PGs typically develop over the course of weeks to a few months and are most likely to bleed while in the early stages of development, when they are most vascular. This makes it unlikely that intraoperative trauma (e.g. during intubation) would lead to development of a pyogenic granuloma this long after the inciting event.

A man from Barbados was admitted to the hospital for evaluation of progressive lethargy and confusion. His medical history was remarkable for diabetes mellitus, hypertension, alcohol abuse, and cirrhosis of the liver. He had not received any medical care for many years and was brought to the United States by his family 2 months before admission. At presentation, he was jaundiced and obtunded. Physical examination documented grade III hepatic encephalopathy, ascites, hepatomegaly, and a bruit in the right upper quadrant. Laboratory evaluation was consistent with advanced liver failure; tests revealed an international normalized ratio (INR) of 3 (reference range, #1); serum albumin, 16 g/L (reference range, 35– 50 g/L); and total bilirubin, 121.41 mmol/L (7.1 mg/ dL) (reference range, 5–21 mmol/L [0.1–1.0 mg/dL]). Abdominal ultrasound revealed massive ascites and a mass in the right lobe of the liver. The patient’s serum a-fetoprotein level was 320 000 mg/L (reference range, 0–10 mg/L). The patient was treated with oral lactulose with minimal clinical improvement and died in the hospital 48 hours later. At autopsy, the liver revealed a large, multinodular, and focally necrotic yellow mass replacing 90% of the right lobe and 40% of the left lobe. The tumor was extending and eroding into the lumen of the inferior vena cava (Figure 1). There was invasion and thrombosis of the portal and hepatic veins by the mass (Figure 2). Microscopic examination confirmed hepatocellular carcinoma (HCC) arising in a background of micronodular cirrhosis (Figure 3). The tumor cells were arranged in trabecular and solid patterns with nuclear pleomorphism, prominent nucleoli, and scant basophilic cytoplasm. There was extensive invasion of intrahepatic vascular channels (Figure 4). Multiple metastatic nodules were identified within the lung parenchyma.

Native human haptoglobin isolated from normal human plasma by affinity chromatography on chicken hemoglobin -Sepharose was used as standard antigen. A direct sandwich ELISA for haptoglobin was developed, with human hemoglobin as a capturing agent. The peroxidase activity of the complex was measured as a means of detecting functional haptoglobin. The reactivities of monoclonal antibody vs. polyclonal antisera on the haptoglobin-hemoglobin complex were compared. Adopting a monoclonal antibody, clone 21.7, which is directed to the α chain of haptoglobin, a specific method to quantitate the native haptoglobin which can complex with hemoglobin has been developed.

Background Primary amenorrhea usually result from a genetic or anatomic abnormality. We present the first reported patient with the absence of endometrium and lumen in a small bicornuate uterus in a patient with primary amenorrhea. Case presentation A 41-year-old woman presented for evaluation of primary amenorrhea and infertility. She did develop normal secondary sexual characteristics but never had menses. Physical examination, hormone analyses, and karyotype analysis were normal. Transvaginal ultrasonography revealed a small uterus with absent endometrial stripe. Ovaries were normal in size. Pathology from hysterectomy for abnormal Pap smears revealed a hypoplastic bicornuate uterus with absence of lumen and absent endometrium. DNA analyses for mutations in the coding sequences of three members of HOXA gene family was performed, but no variants in the coding sequence of these genes were found. These findings support the hypothesis that mutations in the coding sequence of HOXA10, HOXA11, and HOXA13 are not responsible for congenital endometrial absence with bicornuate hypoplastic uterus. Conclusions Congenital absence of the endometrium is an uncommon etiology for primary amenorrhea, and nonvisualization of the endometrial stripe on ultrasound imaging in association with primary amenorrhea should raise suspicion of this rare disorder in this case.