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Selected AbstractsFine 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] 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] 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] 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] 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] THE PHYLOGENETIC PATTERN OF SPECIATION AND WING PATTERN CHANGE IN NEOTROPICAL ITHOMIA BUTTERFLIES (LEPIDOPTERA: NYMPHALIDAE)EVOLUTION, Issue 7 2006Chris D. Jiggins Abstract Species level phylogenetic hypotheses can be used to explore patterns of divergence and speciation. In the tropics, speciation is commonly attributed to either vicariance, perhaps within climate-induced forest refugia, or ecological speciation caused by niche adaptation. Mimetic butterflies have been used to identify forest refugia as well as in studies of ecological speciation, so they are ideal for discriminating between these two models. The genus Ithomia contains 24 species of warningly colored mimetic butterflies found in South and Central America, and here we use a phylogenetic hypothesis based on seven genes for 23 species to investigate speciation in this group. The history of wing color pattern evolution in the genus was reconstructed using both parsimony and likelihood. The ancestral pattern for the group was almost certainly a transparent butterfly, and there is strong evidence for convergent evolution due to mimicry. A punctuationist model of pattern evolution was a significantly better fit to the data than a gradualist model, demonstrating that pattern changes above the species level were associated with cladogenesis and supporting a model of ecological speciation driven by mimicry adaptation. However, there was only one case of sister species unambiguously differing in pattern, suggesting that some recent speciation events have occurred without pattern shifts. The pattern of geographic overlap between clades over time shows that closely related species are mostly sympatric or, in one case, parapatric. This is consistent with modes of speciation with ongoing gene flow, although rapid range changes following allopatric speciation could give a similar pattern. Patterns of lineage accumulation through time differed significantly from that expected at random, and show that most of the extant species were present by the beginning of the Pleistocene at the latest. Hence Pleistocene refugia are unlikely to have played a major role in Ithomia diversification. [source] The gene for polycomb group protein enhancer of zeste homolog 2 (EZH2) is amplified in late-stage prostate cancerGENES, CHROMOSOMES AND CANCER, Issue 7 2006Outi R. Saramäki Overexpression of the polycomb group protein enhancer of zeste homologue 2 (EZH2) has been found in several malignancies, including prostate cancer, with an aggressive phenotype. Amplification of the gene has previously been demonstrated in several malignancies, but not in prostate cancer. Our goal was to evaluate the gene copy number and expression alterations of EZH2 in prostate cancer. The copy number of EZH2 in cell lines (LNCaP, DU145, PC-3, 22Rv1), xenografts (n = 10), and clinical tumors (n = 191) was studied with fluorescence in situ hybridization. All cell lines had a gain of EZH2. Eight of the ten xenografts showed an increased copy number of the gene, including one case of high-level amplification (,5 copies of the gene and EZH2/centromere ratio ,2). 34/125 (27%) of untreated prostate carcinomas showed increased copy number, but only one case of low-level amplification (,5 copies of the gene and EZH2/centromere ratio <2), whereas half (25/46) of the hormone-refractory carcinomas showed increased copy number, including seven cases of low-level amplification and three cases of high-level amplification (P < 0.0001). Expression of EZH2 was significantly (P = 0.0009) higher in hormone-refractory prostate cancer compared with that in benign prostatic hyperplasia or untreated cancer, according to quantitative real-time RT-PCR assay. Also, the expression of EZH2 protein was found to be higher in hormone-refractory tumors than in hormone-naïve tumors by immunohistochemistry. The EZH2 gene amplification was significantly (P < 0.05) associated with increased EZH2 protein expression. The data show that amplification of the EZH2 gene is rare in early prostate cancer, whereas a fraction of late-stage tumors contains the gene amplification leading to the overexpression of the gene, thus indicating the importance of EZH2 in the progression of prostate cancer. © 2006 Wiley-Liss, Inc. [source] Semi-presidentialism, Cohabitation and the Collapse of Electoral Democracies, 1990,2008GOVERNMENT AND OPPOSITION, Issue 1 2010Robert Elgie Semi-presidentialism is the situation where a constitution makes provision for both a directly elected fixed-term president and a prime minister and cabinet who are responsible to the legislature. A common argument against the adoption of a semi-presidential constitution by a new democracy is the problem of cohabitation , where a president from one party holds power at the same time as a prime minister from an opposing party and where the president's party is not represented in the cabinet. The concern is that cohabitation creates competing power centres within the executive that are dangerous for young democracies. This article shows that cohabitation has been directly associated with the collapse of a young democracy in only one case. Moreover, by specifying the conditions under which cohabitation can occur, we also show that the threat of cohabitation has been associated with collapse in only one further case. We suggest that this is so because cohabitation refers to a very specific situation that can only occur under a certain combination of circumstances that can often be avoided. Overall, we show that there is little evidence to support one of the most well-known and long-standing arguments against semi-presidentialism. Thus, while semi-presidentialism may indeed be perilous for new democracies, we conclude that it is perilous for reasons other than the problem of cohabitation. [source] Down-regulation of ATBF1 is a major inactivating mechanism in hepatocellular carcinomaHISTOPATHOLOGY, Issue 5 2008C J Kim Aims:, ,-Fetoprotein (AFP) is frequently detected in hepatocellular carcinomas (HCCs) and AT motif binding factor 1 (ATBF1) down-regulates AFP gene expression in hepatic cells. The ATBF1 gene also inhibits cell growth and differentiation, and altered gene expression is associated with malignant transformation. The aim was to investigate the potential role of the ATBF1 gene in HCCs. Methods and results:, Somatic mutations, allelic loss and hypermethylation of the ATBF1 gene were analysed in 76 sporadic HCCs. The level of ATBF-1 mRNA expression was analysed using quantitative real-time reverse transcriptase-polymerase chain reaction. Genetic studies of the ATBF1 gene revealed absence of somatic mutation in the hotspot region and 15 (25%) of 60 informative cases showed allelic loss at the ATBF1 locus. Hypermethylation in the intron 1 region of the ATBF1 gene was detected in only one case. Interestingly, ATBF1 mRNA expression in HCCs was significantly reduced in 55 (72.4%) samples compared with the corresponding surrounding liver tissues. Reduced expression was not statistically associated with clinicopathological parameters including stage, histological grade, infective virus type, and serum ,-fetoprotein level. Conclusions:, The ATBF1 gene may contribute to the development of HCCs via transcriptional down-regulation of mRNA expression, but not by genetic or epigenetic alterations. [source] Suspected white-tail spider bite and necrotic ulcersINTERNAL MEDICINE JOURNAL, Issue 1-2 2004G. K. Isbister Abstract Aim: To describe the clinical features, investigation, diagnosis and treatment of ulcers attributed to white-tail (WT) spider bites or necrotic arachnidism. Methods: The study was a prospective case series of patients referred to the Hunter Area Toxicology Service (a tertiary referral toxicology unit servicing a population of 500 000) with an ulcer or skin lesion that had been attributed to either a suspected WT spider bite or necrotic arachnidism. Eleven patients with skin lesions or necrotic ulcers were referred between January 2000 and June 2002. Results: In two patients that were inpatients in other hospitals, investigation and follow up was not possible. In both cases there was no history of spider bite and Staphylococcus aureus was cultured. In nine patients, a diagnosis other than spider bite was made following appropriate investigation and follow up, including: (i) two cases of dermatophytoses, (ii) three staphylococcal infections, (iii) one case of pyoderma gangrenosum, (iv) one case of cutaneous polyarteritis nodosa, (v) one case of Nocardia braziliensis and (vi) one infected diabetic ulcer. There was only one case where the person recalled seeing a spider bite them, but the patient did not collect the spider for identification. The median time to diagnosis was 3 weeks (interquartile range: 3,9 weeks) and 3.5 years in one case. Appropriate treatment was initiated once the correct diagnosis was made and all cases resolved. Conclusions:, In this series, all cases initially referred as WT spider bites or necrotic arachnidism were found to have alternative diagnoses with appropriate investigations. This demonstrates that spider bites are an unlikely cause of necrotic ulcers and that all ulcers should be properly investigated with bacterial, fungal and mycobacterial cultures and skin biopsy for histopathology. (Intern Med J 2004; 34: 38,44) [source] Granuloma annulare , a manifestation of infection with Borrelia?JOURNAL OF CUTANEOUS PATHOLOGY, Issue 11 2008Mirjana Ziemer Background:, Among the theories of origin of granuloma annulare (GA) are those of infection. Reports gave raise to the assumption that there is evidence for Borrelia as the causing agent. Methods:, To assess the evidence for infection with Borrelia in GA, tissue sections were stained with a polyclonal Borrelia antibody. With focus-floating microscopy (FFM), slides were scanned at a 200- to 400-fold magnification. Part of the material was also investigated with a Borrelia-specific polymerase chain reaction (PCR). Results:, A total of 157 biopsies of GA have been investigated. Using FFM, Borrelia were detected in 127 cases of GA (80.9%). Borrelia were more prominent in localized (85.2%) than in diffuse GA (62.1%). In 27 cases of GA analysed by PCR, Borrelia-specific DNA could be detected in only one case (3.7%), but was positive in 21 cases by FFM (77.8%). About 93.3% of 15 control cases of borreliosis were positive with FFM and 46.7% with PCR, while all controls other than borreliosis remained negative for spirochetes. Conclusion:, FFM is a reliable method to show Borrelia in tissue sections of GA, which is more sensitive than PCR. This underlines the possibility that Borrelia are involved specifically in the aetiology and pathogenesis of GA. [source] Possible involvement in oncogenesis of a single base mutation in an internal ribosome entry site of Epstein,Barr nuclear antigen 1 mRNAJOURNAL OF MEDICAL VIROLOGY, Issue 4 2004Rika Endo Abstract It has been reported recently that the U leader exon located within the 5, untranslated region of Epstein,Barr nuclear antigen 1 (EBNA1) gene contains an internal ribosome entry site (IRES) element. Sequence analysis of the U leader exon was undertaken in samples from 19 patients with infectious mononucleosis and 19 patients with lethal lymphoproliferative diseases and in 15 spontaneously established lymphoblastoid cell lines. The sequence was conserved except for a single base substitution (T-C) at position 67,585. Although the mutation was detected in only one case of infectious mononucleosis, it was found in more than half of the lethal lymphoproliferative diseases and all lymphoblastoid cell lines. The results suggest that a mutation in the IRES element affects EBNA1 gene expression at the translational level and provides Epstein,Barr virus (EBV)-infected cells with a growth advantage, leading to immortalization of cells in vitro and to the development of lethal lymphoproliferative diseases in vivo. J. Med. Virol. 72:630,634, 2004. © 2004 Wiley-Liss, Inc. [source] Treatment of lumbar and lumbosacral spinal tuberculosis with minimally invasive surgeryORTHOPAEDIC SURGERY, Issue 1 2010Xi-feng Zhang MD Objective:, To evaluate the outcome of computed tomography (CT)-guided percutaneous puncture and local chemotherapy for tuberculosis (TB) of the lumbar or lumbosacral spine. Methods:, From January 2002 to August 2006, 49 patients with lumbar or lumbosacral spinal TB in whom conservative treatment had failed were treated by minimally invasive surgery. There were 21 female and 28 male patients. The mean age of the patients was 47 ± 18 years (range from 12 to 78 years). There were 40 cases with lumbar TB, and 9 with lumbosacral TB. From L1 to S1, the involved vertebral numbers were 8, 26, 19, 19, 21 and 10, respectively. In 3 patients the spinal TB involved a single vertebra, in 39 patients two, in 6 patients three and in only one case four vertebrae. According to the Frankel scale, three patients had grade E incomplete paralysis preoperatively. The outcome, after treatment by CT-guided percutaneous puncture and local chemotherapy, was retrospectively analyzed according to the preoperative and postoperative kyphotic angles and the Oswestry disability index (ODI). Results:, Forty-nine patients were followed up for from one year to 5 years and 8 months (average 35 months). All cases recovered, and there was no recurrence. Preoperatively, the kyphotic angle was 16.47°± 8.74°, and it had decreased to 13.35°± 8.02° by the final follow-up (t= 5.79, P < 0.001). The average ODI score had improved from 70.12 ± 22.24 to 12.72 ± 8.62 (t= 21.42, P < 0.001). Conclusion:, The majority of cases of lumbar and lumbosacral spinal TB can achieve satisfactory results with minimally invasive surgery. Its clinical application is therefore strongly recommended. [source] Maternal vaginal colonisation by Staphylococcus aureus and newborn acquisition at deliveryPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2010Nadège Bourgeois-Nicolaos Summary Bourgeois-Nicolaos N, Lucet J-C, Daubié C, Benchaba F, Rajguru M, Ruimy R, Andremont A, Armand-Lefèvre L. Maternal vaginal colonisation by Staphylococcus aureus and newborn acquisition at delivery. Paediatric and Perinatal Epidemiology 2010. We studied 1139 mother,infant pairs where the mother had had at least one vaginal swab in the month before delivery and their babies had had gastric and ear swabs taken immediately after delivery. The prevalence of vaginal carriage of Staphylococcus aureus was 5.9% among 1139 pregnant women within 1 month of delivery. The colonisation rate of S. aureus in newborns was tenfold higher when the mother was a vaginal carrier than when she was not (31.3% vs. 2.7%; relative risk 11.6 [95% CI 7.0, 19.2]; P < 0.05). Among carriers, delivery by caesarean section compared with the vaginal route, significantly decreased the likelihood of S. aureus colonisation in the newborns (15.4% vs. 41.5%; relative risk 0.35 [95% CI 0.14, 0.98]; P < 0.03). No S. aureus colonisation was detected in the mothers of 58% of the colonised newborns suggesting extra-delivery colonisation routes. Consequences for newborns were unclear as only one case of S. aureus neonatal sepsis was observed. [source] HHV-8 infection status of AIDS-unrelated and AIDS-associated multicentric Castleman's diseasePATHOLOGY INTERNATIONAL, Issue 9 2001Tetsuji Suda Multicentric Castleman's disease (MCD) is a clinicopathologically defined entity characterized by systemic lymphadenopathy with unique pathomorphology such as angiosclerosis, blood vessel proliferation in and around follicles, and plasmacytosis. While its pathogenesis has remained unclarified for many years, identification of the human herpesvirus 8 (HHV-8) in at least some MCD cases has opened new perspectives in this field. Because previous reports have described many inconsistencies regarding HHV-8 positivity in MCD, we intended to clarify this issue by the introduction of more convincing methodologies. For this investigation, we introduced two antibodies produced in our laboratories that recognize a latent gene product ORF73 and a lytic gene product ORF59, together with two well-recognized methods, in situ hybridization for the detection of lytic phase transcript T1.1/nut -1, and genomic polymerase chain reaction (PCR). Eighty-two cases of MCD were collected from Japan (n= 75) and France (n= 7). In three cases, the patients were suffering from acquired immunodeficiency syndrome (AIDS). Immunohistochemistry and in situ hybridization showed identical results: only three out of 82 cases were positively stained, and all the positive cases were found to be the patients with AIDS. Genomic PCR was done in 43 cases, and only one case produced positive results: the only AIDS case among the 43 cases studied by genomic PCR. Histopathologically, the HHV-8-positive cases showed the highest intensity of angiosclerosis and germinal center / perifollicular vascular proliferation, while plasmacytosis was not severe in the HHV-8-positive cases. Some of the HHV-8-negative MCD cases displayed similar histopathology, but at a far less intense level, except for the plasmacytosis. These results suggest that: (i) all three of the HHV-8-positive MCD patients in the present group are the patients with AIDS; and (ii) HHV-8-positive MCD patients develop typical but marked angiosclerosis and vascular proliferation that might be differentiated from HHV-8-negative MCD patients, who showed far less intense changes. [source] Goal attainment for spasticity management using botulinum toxinPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 1 2006Stephen Ashford Abstract Background and Purpose. To determine whether goal attainment scaling (GAS) can demonstrate functional gains following injection of botulinum toxin (BTX) for spasticity in severely disabled patients. Method. Subjects were categorized as ,responder' (positive clinical outcome) and ,non-responder' (non-significant clinical outcome) on the basis of their overall clinical response. GAS scores for functional goals were calculated retrospectively and compared with standard outcome assessments undertaken at the time of intervention. Integrated care pathway (ICP) proformas were interrogated for 18 patients with acquired brain injuries. Mean age was 44.4 (SD 13.4) years. Results. Baseline GAS and Barthel scores were similar for the responder and non-responder groups. The outcome GAS score was significantly greater in the responder than in the non-responder group (Mann,Whitney U = 11.0; p = 0.011) as was the change in GAS score (Mann,Whitney U = 8.0; p = 0.004). GAS scores reflected change recorded in focal outcome measures. However, the Barthel Index measured change in only one case. Conclusions. This exploratory retrospective study provides preliminary support for the hypothesis that GAS provides a useful measure of functional gains in response to treatment with BTX, and is more sensitive than global measures such as the Barthel Index. Copyright © 2006 John Wiley & Sons, Ltd. [source] Response to Galvanic Vestibular Stimulation in Patients with Unilateral Vestibular LossTHE LARYNGOSCOPE, Issue 1 2006Hyun Jik Kim MD Abstract Objectives: This study sought to characterize various responses to galvanic vestibular stimulation (GVS) by comparing GVS-induced eye movements in healthy subjects and patients with vestibular function loss. The study also aimed to estimate the clinical significance of GVS tests. Finally, an effort was made to localize the primary excitation site of stimulation in the vestibular system. Materials and Methods: Three parameters of response to GVS, spontaneous nystagmus, galvanic stimulating nystagmus (GSN), and postgalvanic stimulating nystagmus (PGSN), were evaluated in 20 normal subjects and 14 patients with complete unilateral vestibular function loss resulting from labyrinthectomy or vestibular neurectomy using a three-dimensional video-electronystagmography technique. Results: In normal subjects, GSN was detected in all subjects and was directed toward the negative electrode. PGSN was also detected but was directed toward the opposite electrode. When the negative electrode was attached to the intact side in unilateral vestibular loss subjects, GSN was always directed toward the negative electrode and PGSN was never observed. When the negative electrode was attached to the lesion side, however, GSN was detected in only one case, and PGSN was observed and directed to the intact side in 13 patients. Conclusions: The response to GVS in vestibular loss patients differed from that in normal subjects, which suggests that GVS could be useful for estimating the extent of vestibular function loss. The fact that the patterns of GVS response differed so significantly suggests that the primary site of excitation is not central but is instead the peripheral vestibular organ. [source] Hospitalized Nephrolithiasis after Renal Transplantation in the United StatesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2003Kevin C. Abbott The national incidence of and risk factors for hospitalized nephrolithiasis (NEP) in renal transplant (RT) recipients has not been reported. We conducted a historical cohort study of 42 096 RT recipients in the United States Renal Data System between 1 July 1994 and 30 June 1998. The 1-year incidence of NEP (ICD-9 codes 592.x) after RT in 1997 was compared to the rate of NEP in the general population using the National Hospital Discharge Survey. Associations with time to hospitalizations for a primary diagnosis of nephrolithiasis were assessed by Cox Regression. NEP was uncommon after RT (104 cases per 100 000 person years in 1997). However, females, but not males, had a statistically significant increased risk of NEP compared to the general population (rate ratio for females, 2.84, 95% confidence interval, 2.35,3.58). Kidney stones were more common than ureteral stones, and percutaneous procedures were more common than ureteroscopy or extracorporeal shock wave lithotripsy (ESWL). The only risk factor identified for NEP was renal failure due to stone disease (only one case). NEP was uncommon after RT, but was still more common than in the general population. We identified differences in the presentation and management of NEP after RT in comparison to the general population. [source] Kidneys from patients with small renal tumours: a novel source of kidneys for transplantationBJU INTERNATIONAL, Issue 2 2008David L. Nicol OBJECTIVE To report the use of a novel donor source as a further option to increase the number of patients who might be able to receive a renal transplant. PATIENTS AND METHODS Between May 1996 and July 2007, 43 kidneys were transplanted using kidneys obtained from patients with small (<3 cm diameter) incidentally detected tumours. After bench surgery to excise the tumour, they were all successfully transplanted into patients who were elderly or had significant comorbidities. RESULTS Apart from four patients who died from unrelated illnesses, all grafts continued to function with a median and mean follow-up of 25 and 32 months. The follow-up, which included 3-monthly renal ultrasonography and chest X-rays, showed only one case of tumour recurrence, which occurred 9 years after transplantation; the patient remains stable under observation after 18 months. CONCLUSIONS From our experience we consider that where nephrectomy is used for small, localized, incidentally detected renal tumours, the kidney should be considered for transplantation into carefully selected patients. Such patients with numerous medical comorbidities might benefit from renal transplantation, but not survive the waiting period if they are dependent on a deceased donor graft. Paradoxically the use of these marginal kidneys has the potential to increase the quality and length of life of these patients, despite the apparent contradiction of an intuitive principle of organ transplantation and immunosuppression. [source] Magnetic resonance renal angiography and venography: an analysis of 111 consecutive scans before donor nephrectomyBJU INTERNATIONAL, Issue 3 2006DOMINIC J. HODGSON OBJECTIVE To determine the accuracy of magnetic resonance imaging (MRI) renal angiography in predicting vascular anatomy before donor nephrectomy, to determine the significance of missed vessels and to ascertain whether vessels are missed because of technical limitations or errors in interpretation. PATIENTS AND METHODS In all, 111 consecutive living donations were assessed; the anatomy on MRI before donation was compared with that at nephrectomy. The significance of additional arteries and veins was recorded at the time of donation, with extra vessels either anastomosed or sacrificed. Finally, the scans in which extra vessels had not been identified were re-examined to establish whether these could be identified retrospectively. RESULTS In all, 93 kidneys had a single renal artery and 18 had two. All lower pole arteries were anastomosed and all upper pole arteries were sacrificed. Nine arteries were identified before surgery (five were to the lower pole), and nine were missed (four to the lower pole). There were 13 kidneys with more than one vein. Four of these were seen on MRI. However, an extra vein was anastomosed in only one case. On review of the imaging, three arteries were missed because of human error and six due to technical limitations. Of the nine missed veins, only three were easily identified retrospectively. Overall, using MRI as a preoperative investigation for the 111 consecutive cases, the surgeon encountered a previously unidentified accessory artery in nine (8%), and this required anastomosis in four (4%). CONCLUSION MR angiography has the advantage over computed tomography (CT) of having virtually no side-effects, and if the small possibility is accepted of missing extra vessels because of technical limitation or interpretation, it is a good investigation. However, in light of the failure to visualize all arteries transplanted, we have started to use multi-slice (16-channel) CT to see if its improved spatial resolution alters the results. [source] Molecular characterization of six unrelated Italian patients affected by pyrimidine 5,-nucleotidase deficiencyBRITISH JOURNAL OF HAEMATOLOGY, Issue 5 2003Paola Bianchi Summary. Pyrimidine 5,-nucleotidase deficiency is a rare autosomal recessive disorder characterized by haemolytic anaemia, marked basophilic stippling and accumulation of pyrimidine nucleotides within the erythrocytes. The gene encoding for this enzyme (P5,N-1) has been cloned recently, and seven mutations have so far been identified in 11 unrelated families. We describe the haematological and molecular characteristics of six unrelated Italian patients affected by pyrimidine 5,-nucleotidase deficiency (one from northern and five from southern Italy). The sequence of the complete P5,N-1 gene showed the presence of four different new mutations: a missense mutation AAT,AGT at codon 190 (Asn,Ser), one splicing mutation (IVS9-1 g-c) and two frameshift mutations, DelG576 and InsGG743. Although the molecular defect was homozygous in all patients but one, parents' consanguinity could be confirmed in only one case. InsGG743 was detected in two cases, and DelG576 was found in three patients originating from southern Italy, suggesting a possible geographical distribution of the genetic defect. Haematological data showed the presence of peripheral spherocytosis in all cases, although only one had a concomitant membrane defect. An increase in serum ferritin levels was observed in the splenectomized patients, suggesting that the iron status of these subjects should be monitored and that they should be investigated for potential additional risk factors for iron accumulation. [source] | |||||||||||||||||||||||||