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One Case (one + case)
Kinds of One Case Terms modified by One Case Selected AbstractsCongenital polymicrogyria including the perisylvian region in early childhoodCONGENITAL ANOMALIES, Issue 1 2010Tomoyuki Takano ABSTRACT Six pediatric cases including four infants with congenital polymicrogyria including the perisylvian region are presented herein. Their clinical features were analyzed and compared with patients suffering from congenital bilateral perisylvian syndrome (CBPS). Two specific abnormalities were diagnosed as accompanying disorders in two cases, namely Kabuki syndrome and Peters' anomaly. In the other four cases, the pathogenetic etiology was not elucidated. Subtle symptoms, such as choking and drooling became detectable in one case each, and expressive language development was delayed in two patients. A developmental delay became apparent in five cases during the follow-up period, and epilepsy was observed in one patient with onset at 12 years of age. Our results indicate that the presence of perisylvian polymicrogyria may not always result in the development of oropharyngoglossal dysfunction or dysarthria, although most patients tend to gradually show the onset of developmental disorders. To support cognitive and psychosocial development, an early integrated approach, including not only conventional speech and language therapy, but also various communication methods is essential for patients with congenital polymicrogyria including the perisylvian region. [source] Incorporation of Recreational Fishing Effort into Design of Marine Protected AreasCONSERVATION BIOLOGY, Issue 5 2006TIM P. LYNCH consulta pública; modelos de reservas marinas; pesca con caña; suposiciones de poza dinámica Abstract:,Theoretical models of marine protected areas (MPAs) that explore benefits to fisheries or biodiversity conservation often assume a dynamic pool of fishing effort. For instance, effort is homogenously distributed over areas from which subsets of reserves are chosen. I tested this and other model assumptions with a case study of the multiple-use Jervis Bay Marine Park. Prior to zoning of the park I conducted 166 surveys of the park's recreational fisheries, plotting the location of 16,009 anglers. I converted these plots into diagrams of fishing effort and analyzed correlates between fishing and habitat and the effect of two reserve designs,the draft and final zoning plans of the park,on the 15 fisheries observed. Fisheries were strongly correlated with particular habitats and had negatively skewed and often bimodal spatial distribution. The second mode of intensely fished habitat could be 6 SD greater than the fishery's mean allocation of effort by area. In the draft-zoning plan, sanctuary zone (no-take) area and potential subduction of fishing effort were similar. In the final plan, which was altered in response to public comment, the area of sanctuary zone increased, and the impact on fishing effort decreased. In only one case was a fishery's most intensely targeted location closed to fishing. Because of the discriminating manner with which fishers target habitats, if simple percentage targets are used for planning, sanctuary location can be adjusted to avoid existing fishing effort. According to modeled outcomes, the implication of this may be diminished reserve effectiveness. To address this, reserve area should be implicitly linked to subducted fishing effort when promoting or modeling MPAs. Resumen:,Los modelos teóricos de áreas marinas protegidas (AMPs) que exploran los beneficios para las pesquerías o la conservación de la biodiversidad a menudo asumen que hay una poza dinámica en el esfuerzo de pesca. Por ejemplo, el esfuerzo es distribuido homogéneamente en áreas en las que se seleccionan subconjuntos de reservas. Probé esta y otras suposiciones del modelo con un estudio de caso del Parque Marino Jarvis Bay. Antes de la zonificación del parque, realicé 166 muestreos de las pesquerías recreativas del parque, dibujando la localización de 16,009 pescadores con caña. Convertí estos dibujos en diagramas de esfuerzo de pesca y analicé las correlaciones entre la pesca, el hábitat y el efecto de dos diseños de reserva,el anteproyecto y los planes finales de zonificación del parque,sobre las 15 pesquerías observadas. Las pesquerías se correlacionaron fuertemente con los hábitats particulares y tenían una distribución espacial sesgada negativamente y a menudo bimodal. El segundo tipo de hábitat pescado intensivamente podría ser 6 DS mayor que la asignación promedio de esfuerzo de pesquería por unidad de área. En el anteproyecto de plan de zonificación, el área santuario (sin pesca) y la subducción potencial del esfuerzo de pesca eran similares. En el plan final, que fue alterado en respuesta a comentarios del público, el área del santuario fue incrementada, y el impacto del esfuerzo de pesca disminuyó. En solo un caso fue cerrado a la pesca la localidad de pesca más intensiva. Debido a la forma discriminada en que los pescadores eligen los hábitats, si se utilizan objetivos porcentuales simples para la planificación, la localización del santuario puede ser ajustada para evitar el esfuerzo de pesca existente. De acuerdo con los resultados del modelo, la implicación puede ser la disminución de la efectividad de la reserva. Para abordar esto, el área de la reserva debiera estar implícitamente relacionada con la reducción del esfuerzo de pesca cuando se promueven o modelan AMPs. [source] Fine needle aspiration cytology of follicular variant of papillary carcinoma of thyroidCYTOPATHOLOGY, Issue 4 2003M. Powari In this retrospective study, we tried to ascertain the fine needle aspiration cytology (FNAC) features of six histopathologically proven cases of the follicular variant of papillary carcinoma of thyroid (FVPCT). These proven cases were diagnosed from 1998,2000. May,Grunwald,Giemsa and haematoxylin & eosin stained FNAC smears were studied independently by two observers (MP and PD) for detailed cytological features. A comparison of the cytological features was undertaken with those reported in the literature. There were six cases of which only one case was diagnosed as FVPCT while the other five cases were diagnosed as follicular neoplasm (four cases) and neoplasm unclassifiable (one case) on FNAC smears. All these cases showed abundant cellularity with a prominent follicular pattern. No papillae were identified in any of the cases. Syncytial clusters (five cases), nuclear grooves (six cases), nuclear inclusions (one case) and chewing gum colloid (three cases) were noted in variable proportions. We suggest that a differential diagnosis of FVPCT should be considered if the cytology smears show abundant cellularity, syncytial clusters and follicular arrangement along with thick colloid. [source] Outcomes of Childhood Hemangiomas Treated with the Pulsed-Dye Laser with Dynamic Cooling: A Retrospective Chart AnalysisDERMATOLOGIC SURGERY, Issue 12 2009CARINA RIZZO MD BACKGROUND Laser treatment of childhood hemangiomas remains controversial. Previous studies have used outdated technology, resulting in a potential overrepresentation of adverse outcomes. OBJECTIVE To evaluate outcomes of hemangiomas treated with the most current laser technology. METHODS A retrospective chart analysis of 90 patients with a median age of 3.0 months and a total of 105 hemangiomas were enrolled over a 2.5-year period. All were treated with the 595-nm long-pulse pulsed-dye laser (LP-PDL) with dynamic epidermal cooling at 2- to 8-week intervals depending on the stage of growth. Exclusion criteria were previous laser, surgical, or corticosteroid treatment. Three reviewers assessed outcomes. RESULTS Near-complete or complete clearance in color were achieved for 85 (81%) and in thickness for 67 (64%) hemangiomas. There was no scarring or atrophy. Ulceration occurred in one case and resolved during treatment. Hyperpigmentation and hypopigmentation occurred in 4% and 14% of hemangiomas, respectively. CONCLUSION Early treatment of childhood hemangiomas with the 595-nm LP-PDL with dynamic cooling may reduce the proliferative phase and result in excellent rates of clearing and few adverse events. [source] Phenol-Castor Oil: Modified Peel for Dermal MelasmaDERMATOLOGIC SURGERY, Issue 5 2006THADA PIAMPHONGSANT MD BACKGROUND Deep type of melasma is difficult to treat. Various compositions for peeling have been formulated to accomplish this. OBJECTIVE Our purpose was to determine the safe use of the new formula, which was composed of phenol and castor oil. METHODS Different concentrations of phenol and castor oil were mixed in five formulations, and the solutions were tested on the forearms of 10 volunteers. The application time was 1 minute, different from that of the original phenol-croton oil. Formula 4 was found to cause a high effect of peeling with least side effects and was used to treat deep facial melasma in 30 patients. RESULTS Higher concentrations of castor oil produced more inflammation when mixed with phenol. Formula 4 was used to clear two cases of melasma in 1 week despite no effect from prior use of a modified antimelasma cream, while some degree of fading was noted in other cases. The total number of different melasma indices was reduced from 206.4 to 91.2 in 30 patients. Hyperpigmentation was noted in five cases and hypopigmentation in one case. Neither scar formation nor cardiac arrhythmia was observed. CONCLUSION A phenol-castor oil peel with an application time of 1 minute reduces pigments in the deep type of melasma with least side effects and a high efficiency when combined with an antimelasma cream. The safe formula and the technique of application are introduced. [source] p75NGFR Immunostaining for the Detection of Perineural Invasion by Cutaneous Squamous Cell CarcinomaDERMATOLOGIC SURGERY, Issue 2 2006REBECCA LEWIS KELSO MD BACKGROUND Perineural invasion (PNI) in cutaneous squamous cell carcinoma (CSCC) may portend a poor prognosis for patients. p75NGFR (nerve growth factor receptor) is part of a membrane receptor complex that binds nerve growth factor. Its use for detecting PNI in CSCC in comparison to S-100 immunohistochemical staining has not been explored. OBJECTIVE To determine whether detection of PNI may be improved by staining with p75NGFR as compared with hematoxylin and eosin (H&E) and S-100. METHODS Thirty-four cases of CSCC were retrospectively evaluated for the presence of PNI using standard H&E as well as S-100 and p75NGFR immunohistochemical stains. Staining intensity was correlated to the presence or absence of PNI and tumor differentiation. RESULTS Results showed a positive correlation between staining intensity and the presence of PNI detected by p75NGFR (p=.04). Using p75NGFR allowed for the detection of seven cases of PNI not detected by H&E alone. Five of these cases were detected by S-100, with two cases seen by p75NGFR only. Six cases of PNI were detected using S-100 not seen on H&E, with one case also not seen using p75NGFR. CONCLUSION p75NGFR immunostaining increased detection of PNI compared with H&E. p75NGFR could serve as an alternative to S-100 in the detection of PNI, or as part of an immunostaining panel for PNI detection. [source] Cryosurgery in the Treatment of Earlobe Keloids: Report of Seven CasesDERMATOLOGIC SURGERY, Issue 12 2005Tomas Fikrle MD Background. Keloids are benign cutaneous lesions that result from excessive collagen synthesis and deposition. Earlobe keloids in particular are seen as a complication of plastic surgery or piercing. Many different treatment modalities have been used, often with unsatisfactory results. Methods. We have made a retrospective analysis of seven young patients (ages 9 to 22 years) with earlobe keloids. Scarring followed plastic surgery in six cases and piercing in one case. All patients were treated with cryosurgery as the monotherapy. The freeze time and the number of sessions varied depending on the clinical findings, the effect of the treatment, and the patients' tolerance. Cryotherapy was started 6 to 24 months after keloid development. Results. Scar volume was reduced in all cases. Complete flattening in five patients and a pronounced reduction to a maximum of 25% of the previous thickness in one other patient were achieved. One patient discontinued the therapy because of soreness after only partial improvement. The procedure was painful for all patients; no further side effects were noticed. No recurrence was observed within 1 to 4.5 years of follow-up. Conclusion. We present an excellent effect of cryosurgery as the monotherapy for the treatment of earlobe keloid scars of young patients. TOMAS FIKRLE, MD, AND KAREL PIZINGER, MD, PHD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] An Effective Treatment of Dark Lip by Frequency-Doubled Q-Switched Nd:YAG LaserDERMATOLOGIC SURGERY, Issue 1 2001Somyos Kunachak MD Background. Dark lip is a common cosmetic problem in Southeast Asia. There is no known effective treatment. Objective. To propose an effective method for treating dark lips of varying causes with frequency-doubled Q-switched Nd:YAG laser. Methods. Seventy patients with dark lip, of which 22 were congenital, 24 acquired, and 24 of uncertain cause, were treated by frequency-doubled Q-switched Nd:YAG laser at a fluence of 2,3.5 J/cm2 (mode 2.5 J/cm2) after application of topical anesthesia. The endpoint of treatment was complete clearance of the pigment. Follow-up time was 24,36 months (mean 29 months). Results. All patients attained complete clearance of the lesion after an average of 2.5 treatments in the congenital group, 2.2 treatments in the acquired group, and 1.8 treatments in the group with uncertain etiology. The mean (±SD) number of treatments required by the whole group was 2.1 ± 1.4. Recurrence was observed in one case of congenital origin 3 months after the last treatment. In the remaining cases, results persisted up to the time of follow-up. Herpes simplex reactivation was noted in one case 3 days after treatment. There was no dyschromia, scar formation, or change of skin texture. Conclusion. Dark lip can be effectively treated by frequency-doubled Q-switched Nd:YAG laser without major adverse effects. [source] Lycanthropy alive in Babylon: the existence of archetypeACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009A. A. Younis Objective:, Lycanthropy is the belief in the capacity of human metamorphosis into animal form. It has been recorded in many cultures. Apart from historic description of lycanthropy, there has been several case reports described in the medical literature over the past 30 years. Method:, We identified eight cases of lycanthropy in 20 years, mainly in the area of Babylon, Iraq. Results:, The most commonly reported diagnosis was severe depressive disorder with psychotic symptoms. The type of animal that the patients changed into were mainly dogs (seven cases) and only one case changed into a cow for the first time to report. Conclusion:, Lycanthropy delusion is a rare delusion but appears to have survived into modern times with possible archetypal existence. [source] Entities and frequency of neonatal diabetes: data from the diabetes documentation and quality management system (DPV)DIABETIC MEDICINE, Issue 6 2010J. Grulich-Henn Diabet. Med. 27, 709,712 (2010) Abstract Aims, The aim of this study was to elucidate the entities and the frequency of neonatal diabetes mellitus (NDM) in a large representative database for paediatric diabetes patients in Germany and Austria. Methods, Based on the continuous diabetes data acquisition system for prospective surveillance (DPV), which includes 51 587 patients with onset of diabetes before the age of 18 years from 299 centres in Germany and Austria, we searched for patients with onset of diabetes mellitus in the first 6 months of life. Results, Ninety patients were identified, comprising 0.17% of all paediatric cases in the DPV registry. This represented an incidence of approximately one case in 89 000 live births in Germany. A monogenic basis for NDM was established in 30 subjects (seven UPD6, 10 KCNJ11, seven ABCC8, two FOXP3, two PDX1, one INS, one EIF2AK3). Pancreatic hypoplasia or agenesis was reported in 10 patients and seven subjects were classified as having Type 1 diabetes by their centres. Transient neonatal diabetes (TNDM) accounted for approximately 10% of all cases with NDM. No aetiology was defined in 41 subjects, which may reflect incomplete genetic testing or novel genetic aetiologies. Conclusion, Based on a large database, we identified a higher rate of NDM in Germany than has been reported previously. Full molecular genetic testing should be performed in all patients diagnosed before 6 months of age. [source] Characterizing blood pressure control in individuals with Type 2 diabetes: the relationship between clinic and self-monitored blood pressureDIABETIC MEDICINE, Issue 9 2003R. S. Mazze Abstract Aims To determine the relationship between blood pressure (BP) measurement in the clinic and self-monitored blood pressure (SMBP); and to evaluate the accuracy of self-reported data in patients with Type 2 diabetes treated intensively for hypertension. Methods Seventy subjects had baseline and 1-week follow-up clinic BP measured using an Omron 907® automated device. During a contemporaneous 14-day period these subjects measured their BP at least four times each day using an Omron IC® semiautomatic portable monitor which, unknown to them, contained an onboard memory capable of storing BP with corresponding time and date. Results There was no significant difference between mean clinic and mean self-monitored BP. Correlations between clinic BP and SMBP were r = 0.61 (P < 0.0001) for systolic BP and r = 0.69 (P < 0.0001) for diastolic BP. Clinic BP classified 56 subjects as uncontrolled hypertension (BP , 130/80 mmHg, adjusted for diabetes) and 14 subjects as controlled hypertension. Using World Health Organization-International Society of Hypertension criteria for SMBP (, 125/75 mmHg), 55 cases of clinic classified uncontrolled hypertension were confirmed, resulting in 98% sensitivity. Clinic and SMBP agreed in one case of controlled hypertension, resulting in 7% specificity. For all subjects, the median percent of values exceeding SMBP criteria for controlled hypertension was systolic 92% and diastolic 70%. Self-reporting precision averaged 89 ± 10% (range 45,100%); under-reporting was 25 ± 16% (ranging from 0 to 56%) and over-reporting was 12 ± 15% (ranging from 0 to 46%). The overall logbook mean was not significantly different from the downloaded data from the Omron IC® monitors. Conclusions SMBP was able to identify 13 patients with uncontrolled hypertension who, by clinic BP measurement, had been classified as controlled. [source] Fine needle aspiration biopsy of epithelioid hemangioendothelioma of the oral cavity: Report of one case and review of literatureDIAGNOSTIC CYTOPATHOLOGY, Issue 3 2006Guo-Xia Tong M.D., Ph.D. Abstract Epithelioid hemangioendothelioma (EHE) is an uncommon vascular tumor with biological behavior intermediate between hemangioma and angiosarcoma. It rarely occurs in the oral cavity. We report a case of an 81-yr-old woman with a 2-mo history of a 2 × 2 cm2 submucosal buccal mass. Fine needle aspiration (FNA) smears were paucicellular and showed mainly single atypical large epithelioid cells in a bloody background. The atypical cells had abundant dense cytoplasm, some with fine vacuoles. Occasionally, cells with large cytoplasmic lumina were seen. Cytology preparations from fresh tissue received for frozen section revealed numerous neoplastic cells with large intracytoplasmic lumina, some of which contained red blood cells. In addition, cells with distinct intranuclear inclusions were present. Histologic sections and immunohistochemical stains confirmed the diagnosis of EHE. Although the histologic features of EHE are well recognized, reports of FNA cytology findings are sparsely existent in the literature as several case reports. The characteristic cytological features of EHE are reviewed in this report. We believe that the diagnosis of this rare tumor can be suggested when an adequate FNA specimen is obtained. Diagn. Cytopathol. 2006;34:218,223. © 2006 Wiley-Liss, Inc. [source] Fine-needle aspiration cytology and immunocytochemistry of orbital massesDIAGNOSTIC CYTOPATHOLOGY, Issue 1 2006Edneia Tani M.D., Ph.D. Abstract A series of 85 fine-needle aspiration (FNA) biopsies from orbital space occupying lesions of 82 patients are reviewed. A total of 32 benign lesions and 49 malignant lesions were conclusively diagnosed. In two cases the aspirates were insufficient for diagnosis. Of two cases, which were cytologically suspicious for lymphoma, a repeat FNA resulted in a conclusive diagnosis of lymphoma in one case, while the second case proved to be a pseudotumor on an open biopsy material. Of the 32 benign lesions seven were fibrosis, six pseudotumors, four epidermal cysts, four meningiomas, and three pleomorphic adenomas. The remaining cases included two hematomas, one granuloma, three inflammations, and one malformation. In 43 of 49 malignant tumors cytomorphology was corroborated with immunocytochemistry. Thirty five of these were low- or high-grade lymphomas, nine metastases, two sarcomas, two plasmacytomas, and one chloroma. All lymphomas were of B phenotype with monoclonal light chain expression. The rate of cell proliferation as measured by Ki-67 immunostaining varied between 4,25% and 30,80% for low- and high-grade lymphomas, respectively. These results confirm previous reports on the usefulness of FNA biopsy in diagnosing orbital masses and emphasize the value of immunocytochemistry in tumor characterization. Diagn. Cytopathol. 2006; 34:1,5. © 2005 Wiley-Liss, Inc. [source] Exfoliative sputum cytology of cancers metastatic to the lung,DIAGNOSTIC CYTOPATHOLOGY, Issue 3 2005Tehmina Z. Ali M.D. Abstract Although largely replaced by fine-needle aspiration (FNA) and bronchoscopy, cytological examination of sputum for exfoliated malignant cells still is considered a valuable initial diagnostic test in patients presenting with a lung mass. Thirty-five cases of secondary/metastatic tumors involving the lung and diagnosed on sputum were retrospectively reviewed from our cytopathology files for a period of 22 yr (1980,2001). Clinical history and the relevant histopathological material were examined and correlated with the cytological findings. In all cases, a history of malignancy was known. Cytological diagnoses included colonic adenocarcinoma (7 cases); non-Hodgkin's lymphoma (NHL; 5 cases); malignant melanoma (MM; 5 cases); breast carcinoma (5 cases); Hodgkin's lymphoma (HL; 3 cases); pancreatic adenocarcinoma (2 cases); prostatic adenocarcinoma (2 cases); and 1 case each of urothelial carcinoma, endometrial carcinoma, renal cell carcinoma, hepatic small-cell carcinoma, squamous-cell carcinoma (cervix), and leiomyosarcoma (LMS). Cellular preservation was optimal in all cases. The smear background was relatively clean in 25 (71%) cases and predominantly inflamed and/or necrotic in 10 (29%) cases. In non-lymphoid tumors (27 cases), isolated single malignant cells were seen in 7 (26%) cases (all cases of MM and prostatic adenocarcinoma), whereas 20 (74%) cases displayed fragments with intact tumor architecture. Overall, only 10/35 (29%) cases showed noticeable tumor-cell necrosis. In one case (LMS), cell block sections were used for immunoperoxidase (IPOX) studies with positive staining for desmin and actin. Exfoliation of cancer cells in sputum from secondary tumors in the lung is a rare phenomenon in current-day practice, with metastatic colonic adenocarcinoma seen most commonly. Intact tumor architecture was observed in exfoliated cells in 75% of the cases. Diagn. Cytopathol. 2005;33:147,151. © 2005 Wiley-Liss, Inc. [source] Detection of a subset of CD30+ anaplastic large cell lymphoma by interphase fluorescence in situ hybridizationDIAGNOSTIC CYTOPATHOLOGY, Issue 2 2003Hyung Ju C. Shin M.D. Abstract T/null-cell anaplastic large cell lymphoma (ALCL) is a morphologically and clinically heterogeneous group of non-Hodgkin's lymphoma; to date several morphologic variants have been described on histologic specimens. However, the cytologic features of these variants in the fine-needle aspiration (FNA) specimens have not been well evaluated. The t(2;5)(p23;q35) has been identified in a subset of T/null-ALCL and is known to be associated with a favorable prognosis. We reviewed the cytomorphologic characteristics in 24 FNA specimens of ALCL. In all cases, the diagnosis was confirmed on histologic specimens, and immunohistochemical studies for anaplastic lymphoma kinase (ALK) protein expression were performed on the aspirates. The presence of ALK breakpoints were evaluated in nine cases, using a DNA break-apart probe on chromosome 2 covering the ALK gene by fluorescence in situ hybridization (FISH) techniques. Two hundred cells per case were examined. The results were expressed as the percentage of cells containing more than two signals of chromosome 2 to the total number of cells counted. FNA sites included lymph nodes (20), lung (2), breast (1), and soft tissue (1). The median age of the patients was 56 yr (range, 17,75 yr). Twenty cases had systemic involvement; in four cases, skin was the primary site with secondary involvement of the lymph nodes. All cases were CD30+ by immunohistochemistry; 20 were of T-cell phenotype and 4 were null cell type. The cytologic evaluation revealed typical anaplastic morphology (common type) with many "hallmark cells" in 16 (67%) cases. Other morphologic variants identified were small cell pattern in five cases, monomorphic pattern in two cases, and lymphohistiocytic pattern in one case. FISH studies showed that six (66.7%) of nine cases had at least two signals of chromosome 2, consistent with ALK breakpoints. With careful cytomorphologic evaluation in conjunction with appropriate immunohistochemical studies, a diagnosis of ALCL can be confidently made in the FNA specimens in the cellular aspirates and its morphologic variants also can be recognized. Furthermore, the FNA specimen is suitable in detecting ALK breakpoints by FISH study, permitting rapid identification of a subset of patients with ALCL, who may have a favorable prognosis. Using a commercially available probe, detection of ALK breakpoints in the FNA specimens is simple and can be a useful diagnostic adjunct in cases where distinction from other lymphomas or lymphoid lesions is morphologically difficult. Diagn. Cytopathol. 2003;29:61,66. © 2003 Wiley-Liss, Inc. [source] Cytologic spectrum of 227 fine-needle aspiration cases of chest-wall lesionsDIAGNOSTIC CYTOPATHOLOGY, Issue 6 2001Amit Goel M.D., D.N.B. Abstract This study was carried out with the objective of studying the cytomorphology of the wide variety of chest-wall lesions. Two hundred twenty-seven chest-wall lesions were studied over a period of 4 yr. Routine May-Grünwald-Giemsa (MGG) and hematoxylin-eosin (H&E) slides were studied along with special stains, whenever required. The malignant lesions comprised 36.13% of all cases (81/227). Of the 126 benign lesions, the majority were inflammatory in nature (68/126), the next commonest lesion being lipoma (38/126). Rare cases of tuberculosis involving the sternum, epithelioid leiomyosarcoma, and neuroendocrine tumors involving ribs, malignant nerve sheath tumors involving the chest wall, metastatic carcinoma of the stomach and prostate, and papillary carcinoma thyroid are reported in this series. Histopathology was available in 24 cases, and hematological correlation in one case. A 100% cytohistological and cytohematological correlation was found, with no false positives or false negatives. In conclusion, fine-needle aspiration cytology is a rapid, diagnostic tool, eliciting many interesting lesions in the chest wall. It is useful not only in detecting primary and metastatic lesions, but also in follow-up of tumor recurrence. Diagn. Cytopathol. 24:384,388, 2001. © 2001 Wiley-Liss, Inc. [source] LONG-TERM OUTCOME OF ENDOSCOPIC PAPILLOTOMY FOR CHOLEDOCHOLITHIASIS WITH CHOLECYSTOLITHIASISDIGESTIVE ENDOSCOPY, Issue 2 2010Tatsuya Fujimoto Aim:, To assess long-term outcome of endoscopic papillotomy alone without subsequent cholecystectomy in patients with choledocholithiasis and cholecystolithiasis. Methods:, Retrospective review of clinical records of patients treated for choledocholithiasis and cholecystolithiasis from 1976 to 2006. Of 564 patients subjected to endoscopic papillotomy and endoscopic stone extraction, 522 patients (279 men, 243 women; mean age 66.2 years) were followed up and predisposing risk factors for late complications were analyzed. Results:, The mean duration of follow up was 5.6 years. Cholecystitis and recurrent choledocholithiasis occurred in 39 (7.5%) and 60 (11.5%) patients, respectively. Cholecystitis, including one severe case, resolved with conservative treatment. Recurrent choledocholithiasis was successfully treated endoscopically except in one case. Pneumobilia was found to be a significant risk factor for cholecystitis (P = 0.019) and recurrent choledocholithiasis (P = 0.013). Biliary tract cancer occurred in 16 patients; gallbladder cancer in 13 and bile duct cancer in three. Gallbladder cancer developed within 2 years after endoscopic papillotomy in seven of the 13 patients (53.8%). Conclusion:, Pneumobilia was the only significant risk factor for cholecystitis and recurrent choledocholithiasis in our study population. As for the long-term outcome, it was unclear whether endoscopic papillotomy contributed to the occurrence of biliary tract cancer. [source] Conservative management of duodenal perforation following endoscopic sphincterotomyDIGESTIVE ENDOSCOPY, Issue 2 2005Chee Fook Choong Overall endoscopic retrograde cholangiopancreatography (ERCP) complication rates of 4,10% and mortality rates of 1.5% have been reported. For those patients who fail conservative therapy, a mortality rate of almost 50% has been reported. This has led some authors to recommended early operation in all duodenal perforations. We report two cases of duodenal perforations following endoscopic sphincterotomy. Perforation was suspected immediately post-ERCP in one case and, in the second case, perforation was evident during ERCP and a biliary stent was inserted. Both of the patients were managed conservatively with bowel rest, nasogastric suction, analgesia and intravenous antibiotics. Although abdominal XR and CT showed extensive intraperitoneal and retroperitoneal gas, both of the patients made an uneventful recovery without surgical management. Based on our experience and literature review, routine surgery is not required in patients with duodenal perforations following endoscopic sphincterotomy. Surgery should be considered in any patients with clinical signs of sepsis, abscess or fluid collection in the retroperitoneum or peritoneum, documented ERCP perforation with cholelithiasis, choledocholithiasis or retained hardware. There are currently no strong data to support the benefits of early routine surgery and management should be tailored individually according to the patient's clinical condition and response to therapy. [source] A case of gastric cancer with high pepsinogen II levels in both serum and ascitesDIGESTIVE ENDOSCOPY, Issue 1 2000Manabu Muto The first case of gastric cancer in which pepsinogen (PG) II levels were found to be extremely high not only in the serum but also in the ascites, with values of 603 ng/mL and 1910 ng/mL, respectively, is reported. Pepsinogen I and PG II are normally secreted into the gastric lumen and only 1% of the amount secreted enters the circulation. Although gastric cancer cells are found to produce PG II more often than PG I, elevated PG values in serum are extremely rare, and only one case has ever been reported. That patient had extremely high serum levels of PG I and PG II at the time of gastric cancer relapse. Pepsinogen has never been reported in the ascites, and thus nothing is known about the mechanism of entry into the ascites. In this case report, we postulate two mechanisms to explain the increased PG II in the ascites: (i) a high level of serum PG II infiltrated the ascites and caused elevation of PG II in the ascites; or (ii) disseminated cancer cells directly produced PG II and it elevated PG II levels in the ascites. [source] Thoracoscopic enucleation of esophageal leiomyoma: a retrospective study on 40 casesDISEASES OF THE ESOPHAGUS, Issue 3 2009G. Jiang SUMMARY Esophageal leiomyoma is the most common benign esophageal tumor. Thoracoscopic enucleation is currently a preferred approach to most of these lesions. We present our experiences of enucleation of these tumors using thoracoscopic approach. A retrospective review of 40 patients who underwent enucleation of esophageal leiomyoma from 1997 to 2007 in our institute was conducted. Presenting symptoms, operative approach, tumor size, tumor shape, outcomes, and indication for this approach were analyzed. Forty patients were identified. Postoperative histopathology confirmed the leiomyoma in all patients. The thoracoscopic enucleation was completed in 34 cases, and the operation was converted to open procedure in six cases. Reasons for conversion included too small tumors to be visualized in two cases, thoracic cavity adhesion in one case, and the too large tumors in three cases. The median operating time was 70 min (50 to 210 min). Mean tumor size was 3.7 cm (0.5,10 cm). There were no major postoperative complications. Symptoms especially dysphasia were relieved postoperatively. Short- and long-term follow-up was satisfactory with none of the patients having tumor recurrences or other problems. Thoracoscopic enucleation of esophageal leiomyoma is technically safe and effective. It is currently the best choice for management of esophageal leiomyoma 1 to 5 cm in diameter. It can also be tried on a tumor larger than 5 cm, although the possibility of conversion to thoracotomy increases along with tumor growing and surrounding the esophagus. [source] Outcome of floppy Nissen fundoplication with intraoperative manometry to treat sliding hiatal herniaDISEASES OF THE ESOPHAGUS, Issue 4 2008Y. Lei SUMMARY., The aim of this study was to evaluate the effectiveness of floppy Nissen fundoplication with intraoperative esophageal manometry. Between February 1992 and July 2004, there were 102 patients with sliding hiatal hernia undergoing transabdominal Nissen fundoplication. They were divided into three groups: 27 patients were in the Nissen group (CNF), 44 in the floppy Nissen group (FNF, including 5 with laparoscopic Nissen fundoplication), and 31 in the intraoperative-esophageal-manometry group (INF, 13 with laparoscopic Nissen fundoplication). There were no operation-related deaths. Operation-related complications occurred in five patients within 1 month after operation: In CNF, two patients suffered from dysphagia and one from regurgitation; in FNF, one patient had slight dysphagia and two had regurgitation; in INF, there was no one who complained about dysphagia or regurgitation, but pneumothorax occurred in one case. After more than 2 years of follow-up, two patients, in CNF, suffered from severe dysphagia, one recurred and two with abnormal 24 h pH monitoring. In FNF, one patient had dysphagia, one recurred and three had abnormal 24 h pH monitoring; in INF, two patients had acid reflux on 24 h pH monitoring. The postoperative lower esophageal sphincter pressure was in the normal range in 30 of 31 patients (96.5%). The normal rate of postoperative tests in CNF, FNF and INF were 81.5%, 86.4% and 93.5%, respectively. Both the Nissen fundoplication and the floppy Nissen fundoplication are effective approaches to treat patients with sliding hiatal hernia. Intraoperative manometry is useful in standardizing the tightness of the wrap in floppy Nissen fundoplication and may contribute to reducing or avoiding the occurence of postoperative complications. [source] Why are ferns regularly over-represented on state and provincial rare plant lists?DIVERSITY AND DISTRIBUTIONS, Issue 6 2006Matthew Wild ABSTRACT Several recent studies have suggested that rare species are not randomly distributed throughout plant taxa. This would appear to apply to North American ferns, which are frequently over-represented on local lists of rare plant species. However, such lists often paint a skewed portrait of the true situation because of our tendency to recognize the rarity of well-known and charismatic species while ignoring that of lesser-known or less-appreciated species. In order to verify if this over-representation of ferns is a real and consistent trend throughout local floras in North America, we used data from what we consider to be the most complete and objective available database: NatureServe Explorer (http://www.natureserve.org/explorer/). We compiled data on total vascular plant species, total fern species, as well as rare vascular plant species and rare fern species for each North American subnational (Canadian province or US state) flora. Rare species were defined as those belonging to one of NatureServe's ,at risk' categories. The null hypothesis that the contribution of rare ferns to total rare species did not differ from their contribution to the total vascular flora was assessed using ,2. Out of 64 subnational floras, we obtained significantly higher values than expected in 28 cases, and significantly lower in only one case. Similar trends hold true for individual fern families. These tendencies could be related to several factors of anthropogenic, biological, climatological, evolutionary, and geographical origin. However, we believe that the main reason is related to scale, namely the geopolitical units at which rarity is often studied. Our results illustrate one of the problems of a parochial approach to conservation, where the perceived rarity of an entire taxon is exaggerated because of the scale at which rarity is addressed. [source] Incremental Value of Live/Real Time Three-Dimensional Transthoracic Echocardiography in the Assessment of Right Ventricular MassesECHOCARDIOGRAPHY, Issue 5 2009Venkataramana K. Reddy M.D. This case series demonstrates the incremental value of three-dimensional transthoracic echocardiography (3D TTE) over two-dimensional transthoracic echocardiography (2D TTE) in the assessment of 11 patients with right ventricular (RV) masses or mass-like lesions (three cases of RV thrombus, one myxoma, one fibroma, one lipoma, one chordoma, and one sarcoma and three cases of RV noncompaction, which are considered to be mass-like in nature). 3D TTE was of incremental value in the assessment of these masses in that 3D TTE has the capacity to section the mass and view it from multiple angles, giving the examiner a more comprehensive assessment of the mass. This was particularly helpful in the cases of thrombi, as the presence of echolucencies indicated clot lysis. In addition, certainty in the number of thrombi present was an advantage of 3D TTE. Also, sectioning of cardiac tumors allowed more confidence in narrowing the differential diagnosis of the etiology of the mass. In addition, 3D TTE allowed us to identify precise location of the attachments of the masses as well as to determine whether there were mobile components to the mass. Another noteworthy advantage of 3D TTE was that the volumes of the masses could be calculated. Additionally, the findings by 3D TTE correlated well with pathologic examination of RV tumors, and some of the masses measured larger by 3D TTE than by 2D TTE, which was also validated in one case by surgery. As in the case of RV fibroma, another advantage was that 3D TTE actually identified more masses than 2D TTE. RV noncompaction was also well studied, and the assessment with 3D TTE helped to give a more definitive diagnosis in these patients. [source] Role of Contrast Echocardiography in the Assessment of Myocardial RuptureECHOCARDIOGRAPHY, Issue 1 2003Sumit Mittle M.D. Left ventricular free wall rupture is known to complicate acute myocardial infarction and is the second most common cause of inhospital mortality in this patient population. Contrary to widely held medical belief, this does not always result in immediate fatal pericardial tamponade with hemodynamic collapse. Up to 40% of such occurrences are subacute and may evolve over hours or even days. A high index of suspicion and accurate diagnostic tests are required to identify and treat these patients with emergent surgery. Echocardiography has emerged as an important diagnostic modality to identify this catastrophic condition. Although the literature has scattered reports on the role of transesophageal and transthoracic echocardiography in diagnosing free wall rupture, to date, only one report in the literature used ultrasound contrast agents to better delineate echocardiographic findings. We will present two cases in which echocardiography with use of intravenous ultrasound contrast agents was instrumental in helping to exclude rupture in one case and help identify rupture in another. (ECHOCARDIOGRAPHY, Volume 20, January 2003) [source] Testing the assumptions of chronosequences in successionECOLOGY LETTERS, Issue 5 2008Edward A. Johnson Abstract Many introductory ecology textbooks illustrate succession, at least in part, by using certain classic studies (e.g. sand dunes, ponds/bogs, glacial till, and old fields) that substituted space for time (chronosequence) in determining the sequences of the succession. Despite past criticisms of this method, there is continued, often uncritical, use of chronosequences in current research on topics besides succession, including temporal changes in biodiversity, productivity, nutrient cycling, etc. To show the problem with chronosequence-based studies in general, we review evidence from studies that used non-chronosequence methods (such as long-term study of permanent plots, palynology, and stand reconstruction) to test the space-for-time substitution in four classic succession studies. In several cases, the tests have used the same locations and, in one case, the same plots as those in the original studies. We show that empirical evidence invalidates the chronosequence-based sequences inferred in these classic studies. [source] Do family members interfere in the delivery of care when present during invasive paediatric procedures in the emergency department?EMERGENCY MEDICINE AUSTRALASIA, Issue 3 2007Glenn Ryan Abstract Objective:, To determine whether family members interfere with patient care when present during invasive procedures performed on their children in the ED. Methods:, A prospective observational study of consecutive cases of procedural sedation of children aged between 12 months and 16 years was conducted between March 2002 and March 2006 in the ED of a secondary-level regional hospital in south-east Queensland. Procedures performed included laceration repair, fracture reduction, foreign body removal and abscess incision and drainage. Parents/primary caregivers were encouraged to stay with their child. A stepwise explanation of the procedure and sedation to be used was undertaken, informed consent obtained and telephone follow up attempted 5,14 days post procedure. Results:, Six hundred and fifty-two patient encounters with parents or primary caregivers present for the procedure were included for a total of 656 procedures: 234 laceration repairs, 250 fracture reductions, 85 foreign body removals, 33 abscess incision and drainages, 14 dislocation reductions and 40 other procedures. Telephone follow up was successful in 65% (424) of cases. The mean age was 6.5 years. Family member interference occurred in one case (0.15%, 95% confidence interval 0,0.73%). In 17 cases (2.68%, 95% confidence interval 2.1,5.9%) family members present expressed concerns about the procedure during the telephone follow up but had not interfered at the time of the procedure. There were no significant differences between the concerned parents at follow up and the study group across key patient variables such as child's age (P = 0.369), weight (P = 0.379), respiratory rate (P = 0.477), sex (P = 0.308), procedure indication (P = 0.308) and airway manoeuvres (P = 0.153). Conclusion:, When family members are encouraged to stay for invasive procedures performed on their child, and careful explanation of the procedure, sedation, possible complications, choice of medication for sedation and possible side-effects is undertaken, family member interference is extremely rare. [source] An international survey of training programs for treating tobacco dependenceADDICTION, Issue 2 2009Nancy A. Rigotti ABSTRACT Aims The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) requires countries to implement tobacco dependence treatment programs. To provide treatment effectively, a country needs trained individuals to deliver these services. We report on the global status of programs that train individuals to provide tobacco dependence treatment. Design Cross-sectional web-based survey of tobacco treatment training programs in a stratified convenience sample of countries chosen to vary by WHO geographic region and World Bank income level. Participants Key informants in 48 countries; 70% of 69 countries who were sent surveys responded. Measurements Program prevalence, frequency, duration and size; background of trainees; content (adherence to pre-defined core competencies); funding sources; challenges. Findings We identified 61 current tobacco treatment training programs in 37 (77%) of 48 countries responding to the survey. Three-quarters of them began in 2000 or later, and 40% began after 2003, when the FCTC was adopted. Programs estimated training 14 194 individuals in 2007. Training was offered to a variety of professionals and paraprofessionals, but most often to physicians and nurses. Median program duration was 16 hours, but programs' duration, intensity and size varied widely. Most programs used evidence-based guidelines and reported adherence to core tobacco treatment competencies. Training programs were less frequent in low-income countries and in Africa. Securing funding was the major challenge for most programs; current funding sources were government (58%), non-government organizations (23%), pharmaceutical companies (17%) and, in one case, the tobacco industry. Conclusion Training programs for tobacco treatment providers are diverse and growing. Most upper- and middle-income countries have programs, and most programs appear to be evidence-based. However, funding is a major challenge. In particular, more programs are needed for non-physicians and for low-income countries. [source] Circumferential mural bands in the small intestine causing simple obstructive colic: a case seriesEQUINE VETERINARY JOURNAL, Issue 4 2006J. F. PEREZ OLMOS Summary Reasons for performing study: Circumferential mural band (CMB) in the small intestine is an emerging condition in Ireland. The clinical presentation is a simple obstruction of the small intestine of unknown aetiology. Hypothesis: Horses affected with CMB in the small intestine have a good prognosis following surgical decompression into the caecum. Methods: A retrospective study was carried out and 28 cases identified from 559 colic surgeries performed over a 5.5 year period. An exploratory celiotomy was performed in every case. A simple obstruction at the mid or distal jejunum was identified caused by a CMB, which was multiple in some cases. All of the horses except 2 had undergone a regular anthelmintic programme. Results: Manual decompression of the small intestine into the caecum resulted in resolution of the simple jejunal obstruction. A constricted segment of small intestine was resected in one case, as the degree of constriction was severe. A full thickness biopsy was taken from another case. Histopathology was performed on both samples. All horses recovered from surgery and were discharged from the hospital 7,32 days post operatively. Short-term complications were observed. Survival rate was 100% at long-term follow-up. Histopathology showed inflammatory infiltration in the submucosa, muscularis and serosa with eosinophils predominating. Parasites were not detected. Conclusion and potential relevance: Small intestine circumferential mural bands have a good prognosis after surgical decompression of the small intestine into the caecum. [source] Standing oral extraction of cheek teeth in 100 horses (1998-2003)EQUINE VETERINARY JOURNAL, Issue 2 2005P. M. DIXON Summary Reasons for performing study: Extraction of cheek teeth (CT) by the conventional repulsion technique requires general anaesthesia and carries a high rate of post operative complications. Consequently, an alternative method of extraction, i.e. orally in standing horses, was evaluated. Hypothesis: The need for and risks of general anaesthesia could be avoided and post extraction sequelae reduced by performing extractions orally in standing horses. Methods: One hundred mainly younger horses (median age 8, range 2-18 years) with firmly attached CT that required extraction because of apical infections, displacements, diastemata, idiopathic fractures and the presence of supernumerary CT had the affected teeth (n = 111) extracted orally under standing sedation. Follow-up information was obtained for all cases, a median of 16 months later. Results: Oral extraction was successful in 89 horses and unsuccessful in 11 due to damage to the CT clinical crown (n = 9) during extraction, for behavioural reasons (n = 1) and because the apex of a partly extracted CT fell back into the alveolus following sectioning (n = 1). Predispositions to extraction-related CT fractures were present in 5 of the 9 cases, i.e. advanced dental caries (n = 2) and pre-existing ,idiopathic' fractures (n = 3). The iatrogenically fractured CT were later repulsed under standing sedation (n = 3) and under general anaesthesia (n = 6). Eighty-one of the remaining 89 horses had successful oral CT extraction with no or minimal intra- or post operative complications occurring. Post operative complications in the other 8 cases included post extraction alveolar sequestration (n = 3), alveolar sequestration and localised osteomyelitis (n = 1), localised osteomyelitis (n = 1), incorporation of alveolar packing material into alveolar granulation tissue (n = 1), and nasal discharge due to continued intranasal presence of purulent food material (n = 1) and to ongoing sinusitis (n = 1). The above sequelae were treated successfully in all cases, with general anaesthesia required in just one case. Following oral extraction, significantly (P<0.001) fewer post operative problems developed in 54 horses with apically infected CT in comparison with 71 previous cases that had repulsion of apically infected CT at our clinic. Conclusions and potential relevance: Oral extraction of cheek teeth is a successful technique in the majority of younger horses with firmly attached CT and greatly reduces the post operative sequelae, compared with CT repulsion. Additionally, the costs and risks of general anaesthesia are avoided. Further experience and refinement in the described protocol could potentially increase the success of this procedure and also reduce the incidence of post operative sequelae. [source] Analysis of clinical outcomes and prognostic factors of neoadjuvant chemoradiotherapy combined with surgery: intraperitoneal versus extraperitoneal rectal cancerEUROPEAN JOURNAL OF CANCER CARE, Issue 3 2006E. BENZONI md Neoadjuvant chemoradiotherapy (CRT) is a widely purposed and performed treatment for rectal cancer. Downstaging effects possibly enhance the rate of curative surgery and may enable sphincter preservation in low-lying tumours. The current study examines the clinical outcomes in patients enrolled in a neoadjuvant CRT-surgery protocol for rectal cancer, distinguishing between intraperitoneal and extraperitoneal cancer. From 1994 to 2003, 58 patients with a primary diagnosis of rectal cancer were enrolled in a single-centre, not randomized study based on 5-week sessions of radiotherapy associated with a 30-day protracted venous 5-FU infusion followed by surgical resection. The study population was divided into two groups according to the localization of the tumour: 18 intraperitoneal and 40 extraperitoneal (EPt). Fifty-eight patients were treated with neoadjuvant CRT and surgery. Overall mortality rate was 25.9%, no deaths were recorded during hospitalization; 10 patients (all EPt) died because of recurrence. Significant differences in disease-free survival and overall survival rates were found between intraperitoneal vs. extraperitoneal tumours (P = 0.006), both intraperitoneal vs. extraperitoneal tumours N0 (P = 0.04 and P < 0.05) and intraperitoneal vs. extraperitoneal tumours N+ (P < 0.05). We diagnosed all local recurrence and liver metastasis in extraperitoneal tumours (t = 0.02 and t = 0.04), and only one case of lung metastasis arose from intraperitoneal cancer. Extraperitoneal tumours could be more aggressive than intraperitoneal ones, spreading more precociously, and/or less responsive to the neoadjuvant CRT because of their localization rather than biological differences. Aside from lymph node status, the location of the tumour with respect to the peritoneum border, is also a prognostic factor of survival in rectal cancer treated by neoadjuvant CRT and surgery. [source] | |||||||||||||||||||||||||||||||||||||||||||