Clinicopathologic Appearance of Advanced Ketoacidosis With Basal Vacuolation in Renal Tubules

Context.— Basal vacuolization (BV) in renal tubules is a histopathologic hallmark of advanced ketoacidosis that enables us to retrospectively diagnose these cases. Objective.— To clarify the pathologic background and serologic findings of ketoacidosis with BV, and to reveal the pathologic findings by each pathologic background. Design.— We examined 664 serial autopsy cases. A systemic histopathologic examination and measurement of serum β-hydroxybutyrate concentration were performed for the cases with BV. The extent of steatosis and fibrosis in the organs and the degree of coronary artery stenosis were semiquantitatively investigated. Immunohistochemistry for adipophilin was also performed to analyze its usefulness for the pathologic diagnosis. Results.— Basal vacuolization was found in 16 cases, all of which showed a pathologic serum β-hydroxybutyrate concentration. The main background of ketoacidosis was considered as alcohol abuse in 6 cases, diabetes in 5, malnutrition in 3, and hypothermia and infection in 1 case each. Severe hepatic fibrosis was observed only in the alcohol-abuser group. Moreover, cardiac steatosis was more severe in patients with possible alcohol abuse than in those with other causes. Immunohistochemistry for adipophilin showed immunoreactivity consistent with BV in 13 of 16 cases. There was no correlation between β-hydroxybutyrate concentration and either the postmortem or storage interval. Conclusions.— Basal vacuolization may be a useful finding for detecting ketoacidosis cases in a postmortem investigation. Serum β-hydroxybutyrate was a stable and reliable compound for the definitive diagnosis of ketoacidosis in such cases. The present study showed that pathologic changes in some organs may vary by each pathologic background of ketoacidosis with BV.

Märta Tikkanen’s gender and alcohol saga

Märta Tikkanen’s poetry collection Århundradets kärlekssaga ( The love story of the century, 1978) is a confessional book on life in a family where the husband and father is an alcohol abuser. It is also a love story about a married couple who love one another despite the terrible challenges posed to the relationship by alcoholism. The poetry collection became one of the most influential books in contemporary Nordic fiction, its themes on gender roles and alcohol abuse setting the trend in the Nordic discussion of women’s liberation. Märta Tikkanen’s courage to tell her own private story inspired other women to confess their gender equality problems to the public. The alcohol abuse of Märta Tikkanen’s husband Henrik Tikkanen was seen as an allegory for the more general problems in the relation between men and women. My essay introduces Märta Tikkanen’s poetry collection and discusses how the poems develop the theme of gender and alcohol. I will also compare her description of their marriage with Henrik Tikkanen’s self-portrait in his autobiographical novella Mariegatan 26, Kronohagen (1977). The analysis refers to contemporary research on gender and alcohol abuse and discusses how the poems contribute to a public recognition of the relationship between gender and alcohol abuse. The essay discusses the reception of Märta Tikkanen’s influential poems and explores her treatment of alcohol and gender in relation to other Nordic confessional or fictional books on alcohol abuse.

Cystic dystrophy of the duodenal wall in ectopic pancreas

Introduction. Cystic dystrophy of the duodenal wall is a rare complication of the ectopic pancreas that is characterized by cyst/s formation within thickened duodenal wall. Case Outline. A 61?year?old male with recurrent abdominal pain, weight loss (about 25 kg) who had been moderate alcohol abuser and heavy smoker was presented. On ultrasonography, very thickened duodenal wall (2.5 cm), an enlarged head of the pancreas with cyst of 3 cm in diameter as well as dilated pancreatic duct (<6 mm) were seen. Barium meal showed stenosis of the first and second part of the duodenum. CT and endoscopic ultrasound confirmed the ultrasonographic finding. The patient underwent surgery. The pathologic finding was established only on first two portions of the duodenum and limited part of the head of the pancreas along duodenum while the rest of the pancreas was normal. Due to poor general condition, gastrojejunostomy was performed. Although some improvement was evident, the patient did not become asymptomatic, and, therefore, four months later a cephalic duodenopancreatectomy was carried out which made him fully asymptomatic. A year later, the patient was symptom?free and in good health. Histologic examination showed a cystic dystrophy of the duodenal wall in the ectopic pancreas. Conclusion. Unless there are strong contraindications, cephalic duodenopancreatectomy is best treatment of the disease.