DISEASES OF THE ESOPHAGUS, Issue 2 2008
A. D. Savoy
SUMMARY., Barrett's esophagus (BE) with high-grade dysplasia (HGD) or early carcinoma treated with surgery or photodynamic therapy (PDT) is at risk of recurrence. The efficacy of endoscopic ultrasound (EUS) for surveillance after PDT is unknown. Our objective was to determine if EUS is superior to esophagogastroduodenoscopy (EGD) and/or CT scan for surveillance of BE neoplasia after PDT. The study was designed as a retrospective review with the setting as a tertiary referral center. Consecutive patients with BE with HGD or carcinoma in situ treated with PDT were followed with EUS, CT scan and EGD with jumbo biopsies every 1 cm at 3, 4, or 6-month intervals. Exclusion criteria was < 6 months of follow up and/or < 2 EUS procedures. Main outcome measurements were residual or recurrent disease discovered by any method. Results showed that 67/97 patients met the inclusion criteria (56 men and 11 women). Median follow-up was 16 months. Recurrent or residual adenocarcinoma (ACA) was detected in four patients during follow-up. EGD with random biopsies or targeted nodule biopsies detected three patients. EUS with endoscopic mucosal resection of the nodule confirmed T1 recurrence in one of these three. In the fourth patient, CT scan revealed perigastric lymphadenopathy and EUS-FNA (fine needle aspiration) confirmed adenocarcinoma. There were two deaths, one related to disease progression and one unrelated. The rate of recurrent/persistent ACA after PDT was 4/67 = 6%. EUS did not detect disease when EGD and CT were normal. Limitations of this study include non-blinding of results and preferential status of non-invasive imaging (CT) over EUS. Our experience suggests that EUS has little role in the surveillance of these patients, unless discrete abnormalities are found on EGD or cross-sectional imaging. [source]

Systematic review: the prevalence of idiopathic bile acid malabsorption as diagnosed by SeHCAT scanning in patients with diarrhoea-predominant irritable bowel syndrome

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009
L. WEDLAKE
Summary Background, Recurrent, watery diarrhoea affects one-third of patients diagnosed with irritable bowel syndrome (,IBS-D'). Idiopathic bile acid malabsorption (,I-BAM') may be the cause. Aim, To determine the prevalence of I-BAM in patients suffering from IBS-D. Methods, A systematic search was performed of publications reporting patients presenting with IBS-D type symptoms, who were subsequently confirmed as having I-BAM by SeHCAT scanning. Results, Eighteen relevant studies, 15 prospective, comprising 1223 patients were identified. Five studies (429 patients) indicated that 10% (CI: 7,13) patients had severe bile acid malabsorption (SeHCAT 7 day retention <5% of baseline value). 17 studies (1073 patients) indicated that 32% (CI: 29,35) patients had moderate bile acid malabsorption (SeHCAT <10%). 7 studies (618 patients) indicated that 26% (CI: 23,30) patients had mild (SeHCAT <15%) bile acid malabsorption. Pooled data from 15 studies showed a dose-response relationship according to severity of malabsorption to treatment with a bile acid binder: response to colestyramine occurred in 96% of patients with <5% retention, 80% at <10% retention and 70% at <15% retention. Conclusions, Idiopathic adult-onset bile acid malabsorption is not rare. International guidelines for the management of irritable bowel syndrome need to be revised so that clinicians become more aware of this possibility. [source]

Oral pathology in untreated coelic disease

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11-12 2007
G. CAMPISI
Summary Background Many coeliac disease patients with atypical symptoms remain undiagnosed. Aim To examine the frequency of oral lesions in coeliac disease patients and to assess their usefulness in making coeliac disease diagnosis. Patients and methods One hundred and ninety-seven coeliac disease patients and 413 controls were recruited and the oral examination was performed. Results Forty-six out of 197 coeliac disease patients (23%) were found to have enamel defects vs. 9% in controls (P < 0.0001). Clinical delayed eruption was observed in 26% of the pediatric coeliac disease patients vs. 7% of the controls (P < 0.0001). The prevalence of oral soft tissues lesions was 42% in the coeliac disease patients and 2% in controls (P < 0.0001). Recurrent aphthous stomatitis disappeared in 89% of the patients after 1 year of gluten-free diet. Multi-logistic analysis selected the following variables as the most meaningful in coeliac disease patients: dental enamel defects (OR = 2.652 CI = 1.427,4.926) and soft tissue lesions (OR = 41.667, CI = 18.868,90.909). Artificial Neural Networks methodology showed that oral soft tissue lesions have sensitivity = 42%, specificity = 98% and test accuracy = 83% in coeliac disease diagnosis. Conclusions The overall prevalence of oral soft tissue lesions was higher in coeliac disease patients (42%) than in controls. However, the positive-predictive value of these lesions for coeliac disease diagnosis was low. [source]

When yellow jackets attack: Recurrent and severe anaphylactic reactions to insect bites and stings,,

AMERICAN JOURNAL OF HEMATOLOGY, Issue 12 2009
Daniel A. Pollyea
First page of article [source]

Carcinoma of the Tongue Base Treated by Transoral Laser Microsurgery, Part Two: Persistent, Recurrent and Second Primary Tumors

THE LARYNGOSCOPE, Issue 12 2006
David G. Grant MD
Abstract Objectives: To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the treatment of persistent, recurrent, and second primary squamous cell carcinoma of the tongue base. Study Design: A two-center prospective case series analysis. Methods: Twenty-five patients with persistent, recurrent, or second primary squamous cell carcinoma of the tongue base were treated with TLM between 1997 and 2005. Four (16%) patients with persistent disease at the primary site were considered TX. Eleven (44%) patients with recurrent disease were pathologically staged rT1 3/11, rT2 2/11, rT3 4/11, T4 1/11, and TX 1/11. Ten (40%) patients with second primary tumors were staged pT1, 4/10; pT2, 3/10; pT3, 2/10; and pT4, 1/10. Eight (32%) patients underwent neck dissection. Three (12%) patients received adjuvant radiotherapy. Pre- and post-treatment organ function was assessed using a clinical Functional Outcome Swallowing Scale (FOSS) and Communication Scale. Results: The mean follow-up period was 26 months. The 2-year Kaplan-Meier local control and locoregional control estimate was 69%. For those patients presenting with persistent/recurrent or second primary disease, the 2 year local control estimates were 75% and 68%, respectively. For all patients, the respective 2 and 5 year overall survival estimates were 54% and 26%. Two (8%) patients suffered postoperative hemorrhage. The average duration of hospitalization was 3.6 days. The median pretreatment and posttreatment FOSS stage was stage 2 and stage 3, respectively. Conclusions: Transoral laser surgery is a rational and effective treatment in appropriately selected patients with persistent, recurrent, or second primary tongue base cancer. The low morbidity and mortality and shortened duration of hospitalization associated with TLM make it an attractive therapeutic alternative. [source]

Semiparametric Transformation Models with Random Effects for Joint Analysis of Recurrent and Terminal Events

BIOMETRICS, Issue 3 2009
Donglin Zeng
Summary We propose a broad class of semiparametric transformation models with random effects for the joint analysis of recurrent events and a terminal event. The transformation models include proportional hazards/intensity and proportional odds models. We estimate the model parameters by the nonparametric maximum likelihood approach. The estimators are shown to be consistent, asymptotically normal, and asymptotically efficient. Simple and stable numerical algorithms are provided to calculate the parameter estimators and to estimate their variances. Extensive simulation studies demonstrate that the proposed inference procedures perform well in realistic settings. Applications to two HIV/AIDS studies are presented. [source]

Recurrent ,sterile' verrucous cyst abscesses and epidermodysplasia verruciformis-like eruption associated with idiopathic CD4 lymphopenia

BRITISH JOURNAL OF DERMATOLOGY, Issue 3 2003
E. Tobin
Summary Rupture of follicular (epidermoid) cysts is believed to be the consequence of bacterial infection. We report a 24-year-old man with idiopathic CD4 lymphopenia and chronic Mycobacterium avium intracellulare infection who developed multiple, recurring painful abscesses over the distal extremities that increased in number and severity when systemic steroid and interferon-, treatment was instituted for interstitial lung disease. Cultures were consistently negative for microorganisms, but pathological examination revealed ruptured epidermoid cyst walls with human papillomavirus (HPV) viropathic changes (keratinocytes with perinuclear halos and abundant basophilic keratohyaline granules). Cutaneous examination showed numerous, widespread flat-topped papules and achromic macules over the extremities, head and neck. Nested polymerase chain reaction analysis for HPV DNA revealed that the abscess-related cyst walls harboured epidermodysplasia verruciformis (EV)-associated HPV types 20, 24, alb-7 (AY013872) and 80. His cutaneous lesions harboured HPV types 3, 8 and 80. Similar to past reports, our patient developed an EV-like eruption in the setting of immunodeficiency. In this instance, EV-associated HPV infection of the follicular infundibular epithelium or pre-existing cysts in the setting of immunodeficiency may have led to cystic growth, rupture and subsequent painful inflammation. [source]

Prevalence and clinical correlates of JAK2 mutations in Down syndrome acute lymphoblastic leukaemia

BRITISH JOURNAL OF HAEMATOLOGY, Issue 6 2009
Amos Gaikwad
Summary Recurrent, prognostically significant chromosomal abnormalities occur in approximately 75% of paediatric acute lymphoblastic leukaemia (ALL), but only infrequently in children with Down syndrome (DS) and ALL. Recently, novel somatic activating mutations in the gene Janus kinase 2 (JAK2) were reported in 18% of DS ALL. Here we report identification and clinical correlates of JAK2 mutations in an independent cohort. JAK2 activating mutations occurred in 10/53 DS ALL cases (18·9%). Mutations were overrepresented in males (P < 0·03), occurred once in association with high hyperdiploidy and were not significantly correlated with age, initial white blood count, or event-free survival. Our results confirm the significance of JAK,STAT pathway activation in DS ALL. [source]

Recurrent bloody nipple discharge in a 3-year-old boy

ACTA PAEDIATRICA, Issue 12 2009
P Triantafyllou
No abstract is available for this article. [source]

Clinical Immunology Review Series: An approach to the patient with recurrent infections in childhood

CLINICAL & EXPERIMENTAL IMMUNOLOGY, Issue 3 2008
M. A. Slatter
Summary Recurrent or persistent infection is the major manifestation of primary immunodeficiency, which also results in atypical infection with opportunistic organisms. Young children are also vulnerable to infection and recurrent infection is common. While most children with recurrent infection have a normal immunity, it is important to recognize the child with an underlying primary immunodeficiency and investigate and treat appropriately and yet not over investigate normal children. Prompt, accurate diagnosis directs the most appropriate treatment, and early and judicious use of prophylactic antibiotics and replacement immunoglobulin can prevent significant end organ damage and improve long-term outlook and quality of life. This paper describes important presenting features of primary immunodeficiency and indicates when further investigation is warranted. [source]

Carcinoma of the Tongue Base Treated by Transoral Laser Microsurgery, Part Two: Persistent, Recurrent and Second Primary Tumors

Monitoring cytomegalovirus IE-1 and pp65-specific CD4+ and CD8+ T-cell responses after allogeneic stem cell transplantation may identify patients at risk for recurrent CMV reactivations ,

CYTOMETRY, Issue 4 2008
Jan W. Gratama
Abstract We studied the recovery of CMV-specific CD4+ and CD8+ T-cell immunity in 52 recipients of allogeneic stem cell transplantation (SCT). The proportions of IFN-,-producing CD4+ and CD8+ T cells upon in vitro activation using peptide pools representing the CMV pp65 and IE-1 proteins were assessed at multiple time points post SCT, and correlated with the occurrence of CMV reactivation. In a retrospective analysis, recurrent CMV reactivations occurred in 9 patients and were associated with low pp65-specific CD4+ T-cell and low IE-1-specific CD8+ T-cell reactivities, whereas patients without detectable CMV reactivation (n = 30) or a single reactivation (n = 13) showed a better recovery of these immune responses. CD4+ T-cell responses to IE-1 were infrequent in most patients, whereas CD8+ T-cell responses to pp65 occurred frequently, but did not correlate with protection against (recurrent) reactivation. Prospectively, CMV-specific T-cell responses could be studied prior to 14 reactivation episodes in 8 patients. CD4+ T-cell responses to IE-1 and pp65 were positive in only 1 and 2 episodes, respectively. CD8+ T-cell responses against IE-1 were positive in 4, but against pp65 in 12 episodes, again showing that CD8+ T-cell reactivity against pp65 did not prevent CMV reactivation. Thus, monitoring of particular CMV-specific CD4+ and CD8+ T-cell responses after allogeneic SCT may identify patients at risk for recurrent CMV reactivations. © 2008 Clinical Cytometry Society [source]

Review of the long-term effectiveness of cognitive behavioral therapy compared to medications in panic disorder

DEPRESSION AND ANXIETY, Issue 2 2003
Deepa N. Nadiga M.D.
Abstract Panic disorder is a recurrent and disabling illness. It is believed that Cognitive Behavioral Therapy (CBT) has a long-term protective effect for this disorder. This would offer CBT considerable advantage over medication management of panic disorder, as patients often relapse when they are tapered off their medications. This is a review of the literature about the long-term effectiveness of CBT. We searched for follow-up studies of panic disorder using CBT. Of the 78 citations produced in the initial search, most had major methodological flaws, including ignoring losses to follow-up, not accounting for interval treatment, and unclear reporting. Three papers met strict methodological criteria, and two of these demonstrated a modest protective effect of CBT in panic disorder patients. We make recommendations for well-designed studies involving comparisons of medications and cognitive behavior therapy. Depression and Anxiety 17:58,64, 2003. © 2003 Wiley-Liss, Inc. [source]

Diameter of Involved Nerves Predicts Outcomes in Cutaneous Squamous Cell Carcinoma with Perineural Invasion: An Investigator-Blinded Retrospective Cohort Study

DERMATOLOGIC SURGERY, Issue 12 2009
AMY S. ROSS MD
BACKGROUND Perineural invasion (PNI) has been associated with poor prognosis in cutaneous squamous cell carcinoma (CSCC), but it is unclear how different degrees of nerve involvement affect prognosis. OBJECTIVE To determine whether the diameter of nerves invaded by CSCC affects outcomes of recurrence, metastasis, and disease-specific and overall survival. METHODS A retrospective cohort study was conducted of patients with CSCC with PNI. Dermatopathologists blinded to subject outcomes determined the diameter of the largest involved nerve. RESULTS Data were obtainable for 48 patients. Small-caliber nerve invasion (SCNI) of nerves less than 0.1 mm in diameter was associated with significantly lower risks of all outcomes of interest. Disease-specific death was 0% in subjects with SCNI, versus 32% in those with large-caliber nerve invasion (LCNI) (p=.003). Other factors associated with significantly worse survival were recurrent or poorly differentiated tumors or tumor diameter of 2 cm or greater or depth of 1 cm or greater. On multivariate analysis, only tumor diameter and age predicted survival. CONCLUSIONS The individual prognostic significance of factors associated with poor survival remains uncertain. Small-caliber nerve invasion may not adversely affect outcomes. Defining PNI as tumor cells within the nerve sheath and routine recording of diameter of involved nerves, tumor depth, and histologic differentiation on pathology reports will facilitate further study. [source]

Longitudinal Diminution of Tumor Size for Basal Cell Carcinoma Suggests Shifting Referral Patterns for Mohs Surgery

DERMATOLOGIC SURGERY, Issue 1 2008
ANDREW L. KAPLAN MD
BACKGROUND The Mohs technique for removal of cutaneous malignancies offers tissue-sparing benefits compared with other treatment methods. With wider acceptance and availability of Mohs surgery, referral patterns may be shifting toward the treatment of smaller, lower-risk tumors. OBJECTIVE The objective was to examine whether referral patterns for basal cell carcinoma (BCC) at an academic Mohs surgery practice have shifted over recent years toward referral for smaller, lower risk tumors. METHODS A retrospective longitudinal comparison of tumor characteristics was performed for BCCs treated at our institution from a recent year (2004) and a past year (1996). Statistical analyses were used to identify differences in tumor size, distribution by anatomic site, and primary versus recurrent status. RESULTS Complete data were available for 603 BCCs treated in 1996 and 1,514 BCCs treated in 2004. A 24% decrease in preoperative tumor surface area was observed from 1996 (1.25 cm2) to 2004 (0.95 cm2). Tumors were twice as likely to be recurrent in 1996 (15.1%) than in 2004 (7.4%). There were no significant differences in the anatomic distribution of lesions in the years compared. CONCLUSIONS Findings at our institution suggest that in recent years, referral patterns have shifted toward a preference for Mohs surgery for the treatment of smaller, primary BCCs. This may be a result of increased awareness by the dermatologic and medical community of the numerous advantages of Mohs surgery and a greater appreciation of its tissue-sparing properties, which may result in less complex and more successful aesthetic reconstructions. [source]

Molecular mechanisms and diagnosis of chromosome 22q11.2 rearrangements

DEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 1 2008
Beverly S. Emanuel
Abstract Several recurrent, constitutional genomic disorders are present on chromosome 22q. These include the translocations and deletions associated with DiGeorge and velocardiofacial syndrome and the translocations that give rise to the recurrent t(11;22) supernumerary der(22) syndrome (Emanuel syndrome). The rearrangement breakpoints on 22q cluster around the chromosome-specific segmental duplications of proximal 22q11, which are involved in the etiology of these disorders. While the deletions are the result of nonallelic homologous recombination (NAHR) between low copy repeats or segmental duplications within 22q11, the t(11;22) is the result of rearrangement between palindromic AT-rich repeats on 11q and 22q. Here we describe the mechanisms responsible for these recurrent rearrangements, discuss the recurrent deletion endpoints that are the result of NAHR between chromosome 22q specific low copy repeats as well as present current diagnostic approaches to deletion detection. © 2008 Wiley-Liss, Inc. Dev Disabil Res Rev 2008;14:11,18. [source]

Orthopaedic issues in the musculoskeletal care of adults with cerebral palsy

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2009
HELEN M HORSTMANN MD
Aims, Orthopaedic care of adults with cerebral palsy (CP) has not been well documented in orthopaedic literature. This paper focuses on some of the common problems which present themselves when adults with CP seek orthopaedic intervention. In particular, we review the most common orthopaedic issues which present to the Penn Neuro-Orthopaedics Program. Method, A formal review of consecutive surgeries performed by the senior author on adults with CP was previously conducted. This paper focuses on the health delivery care for the adult with orthopaedic problems related to cerebral palsy. Ninety-two percent of these patients required lower extremity surgery. Forty percent had procedures performed on the upper extremities. Results, The majority of problems seen in the Penn Neuro-Orthopaedics Program are associated with the residuals of childhood issues, particularly deformities associated with contractures. Patients are also referred for treatment of acquired musculoskeletal problems such as degenerative arthritis of the hip or knee. A combination of problems contribute most frequently to foot deformities and pain with weight-bearing, shoewear or both, most often due to equinovarus. The surgical correction of this is most often facilitated through a split anterior tibial tendon transfer. Posterior tibial transfers are rarely indicated. Residual equinus deformities contribute to a pes planus deformity. The split anterior tibial tendon transfer is usually combined with gastrocnemius-soleus recession and plantar release. Transfer of the flexor digitorum longus to the os calcis is done to augment the plantar flexor power. Rigid pes planus deformity is treated with a triple arthrodesis. Resolution of deformity allows for a good base for standing, improved ability to tolerate shoewear, and/or braces. Other recurrent or unresolved issues involve hip and knee contractures. Issues of lever arm dysfunction create problems with mechanical inefficiency. Upper extremity intervention is principally to correct contractures. Internal rotation and adductor tightness at the shoulder makes for difficult underarm hygiene and predispose a patient to a spiral fracture of the humerus. A tight flexor, pronation pattern is frequently noted through the elbow and forearm with further flexion contractures through the wrist and fingers. Lengthenings are more frequently performed than tendon transfers in the upper extremity. Arthrodesis of the wrist or on rare occasions of the metacarpal-phalangeal joints supplement the lengthenings when needed. Conclusions, The Penn Neuro-Orthopaedics Program has successfully treated adults with both residual and acquired musculoskeletal deformities. These deformities become more critical when combined with degenerative changes, a relative increase in body mass, fatigue, and weakness associated with the aging process. [source]

Melanoma with cartilaginous differentiation: Diagnostic challenge on fine-needle aspiration with emphasis on differential diagnosis

DIAGNOSTIC CYTOPATHOLOGY, Issue 1 2009
Krisztina Z. Hanley M.D.
Abstract Fine-needle aspiration (FNA) is a minimally invasive, fast, and accurate diagnostic method for the evaluation of patients with locally recurrent or distant metastases of malignant melanoma. In the vast majority of cases, the diagnosis is straightforward with the characteristic cytologic features well documented in the literature. Divergent differentiation (chondroid, neural, myofibroblastic, and osteocartilagenous) in a melanoma is rare and can potentially create diagnostic challenges if the evaluator is unaware of the same. We report a case of a 46-year-old female with a history of primary anal melanoma who presented with a groin mass. The FNA of the groin mass showed a neoplasm rich in chondroid matrix and raised the possibility of a second primary mesenchymal neoplasm rather than metastasis from the patient's known primary anal melanoma. A review of the histologic features of the anal melanoma showed divergent chondroid differentiation in the anal melanoma with the metastatic deposit in the groin exhibiting extensive chondroid differentiation. The differential diagnostic considerations are discussed. Diagn. Cytopathol. 2009. © 2008 Wiley-Liss, Inc. [source]

Cyto-histological correlations inprimary, recurrent, and metastatic bone and soft tissue osteosarcoma.

DIAGNOSTIC CYTOPATHOLOGY, Issue 5 2007
Institut Curie's experience
Abstract To determine diagnostic cytomorphologic features of osteosarcoma on fine-needle aspiration materials, we reviewed the cytologic material and corresponding histologic slides of 126 tumors in 107 patients. Fifty-five (43.6%) tumors were primary, 31 (24.6%) were recurrent, and 40 (31.8%) were metastatic. Review of original cytology reports revealed that 120 (95.3%) tumors were diagnosed as malignant. Six (4.7%) cases were reported as suspicious, false-negative, or unsatisfactory samples. Our findings showed that osteoblastic roundish cells, spindle-shaped cells, reactive giant cells, and osteoid were the most consistent features representative of osteosarcoma. Periosteal reactions, fractures with callous formation, giant cells of osteoclastic type in various conditions, chondrosarcoma with enchondral ossification are entities to consider in the differential diagnosis. Diagn. Cytopathol. 2007;35:270,275. © 2007 Wiley-Liss, Inc. [source]

Fine-needle aspiration diagnosis of Hodgkin lymphoma using current WHO classification,Re-evaluation of cases from 1999,2004 with new proposals

DIAGNOSTIC CYTOPATHOLOGY, Issue 6 2006
Jue-Rong Zhang M.D., Ph.D.
Abstract With the advent of modern therapy, the differences in prognoses and treatment regimens among different subtypes of Hodgkin lymphoma (HL) have largely vanished. Stage and the presence of systemic symptoms are much more important than histologic subtypes as predictive factors. The current (2001) WHO classification markedly de-emphasizes spatial relationships as critical to the diagnosis of lymphoma and emphasizes cell morphology, immunophenotype, genetic features, and clinical information to define the disease states. This classification, thus, greatly enhances the capability of fine-needle aspiration (FNA) to accurately diagnose HL. We searched all the FNA cases in our institute in years 1999 through 2004 and found 42 cases, for which 13 were primarily diagnosed (31.0%), 2 were recurrent (4.8%), 5 were highly suspicious (11.9%), and 22 were suspicious (52.3%) for HL. On follow-up tissue biopsy, all the primarily diagnosed, recurrent, and highly suspicious cases were confirmed to be HL (100% agreement). For the 22 suspicious cases, 13 were HL (59.1%), 5 were other lymphomas (22.8%), 1 was lymphoma unclassifiable (4.5%), and 3 were reactive processes (13.6%). The effect of immunostains on the diagnosis of HL was examined, and its importance was emphasized. Analysis of demographic data and the distribution of HL subtypes demonstrate that the study sample is representative of the general HL patient population. On the basis of these results, we propose: (1) If the FNA diagnosis of HL is confirmed both by morphology and immunostains, no further tissue confirmation, subclassification and grading is necessary, and appropriate treatment regimens should follow. (2) The nodular lymphocyte predominant HL and classical HL can be differentiated by adequate immunostaining. (3) If a definitive diagnosis cannot be achieved by FNA, a second FNA or a tissue biopsy should be recommended. Diagn. Cytopathol. 2006;34:397,402. © 2006 Wiley-Liss, Inc. [source]

Cytologic comparison of a primary parathyroid cancer and its metastatic lesions: A case report

DIAGNOSTIC CYTOPATHOLOGY, Issue 1 2006
I.A.C., Katsuhide Ikeda C.T.
Abstract We describe the fine-needle aspiration cytology features of a primary parathyroid cancer and of the local recurrent and distant metastatic lesions. The presence of prognostic factors Ki-67 and proliferating cell nuclear antigen (PCNA) was compared immunohistochemically between primary parathyroid carcinoma and related metastatic and recurrent foci. Flow cytometric DNA analysis was also performed to investigate any chromosomal abnormality of the parathyroid carcinoma. Cytologic examination of the endocrine tumor showed that it comprised a loose cohesive cluster and tumor cells with granular cytoplasm and mild nuclear atypia, but for purposes of cytodiagnosis, it is difficult to determine whether such a neoplasm is malignant on the basis of morphology alone. Immunohistochemical analysis showed that Ki-67 and PCNA labeling indices were higher in the recurrent and metastasized carcinomas than in the primary cancer, suggesting that neoplastic cells become more malignant in the recurrent and metastasized foci. To our knowledge, this is the first report describing not only cytopathologic but also immunocytologic differences between primary parathyroid cancer and the metastatic lesion. Diagn. Cytopathol. 2006;34:50-55. © 2005 Wiley-Liss, Inc. [source]

Subgrouping and grading of soft-tissue sarcomas by fine-needle aspiration cytology: A histopathologic correlation study

DIAGNOSTIC CYTOPATHOLOGY, Issue 5 2001
Hal E. Palmer M.D.
Abstract To evaluate the accuracy and reproducibility of subgrouping and grading soft-tissue sarcomas by fine-needle aspiration biopsy (FNAB), a blind review was conducted of 84 FNAB specimens from 77 malignant and 7 benign soft-tissue lesions. Cytomorphologic subgroups included 31 spindle-cell, 24 pleomorphic, 11 myxoid, 7 epithelioid/polygonal, 3 small round cell, and 8 nondiagnostic cases. Malignancies included one lymphoma and 41 primary, 15 recurrent, and 20 metastatic soft-tissue sarcomas. Adequacy was defined as a majority of slides with at least 5 clusters of 10 unobscured cells. Five originally false-negative cases were considered nondiagnostic on review. Sarcoma was recognized in 59 of 64 adequate cases (92%) with available histology; however, the specific histopathologic subtype was identified in only 9 cases (14%). Benign myxoid and spindle-cell lesions were difficult to separate from low-grade sarcomas in 4 cases, and a B-cell lymphoma with sclerosis mimicked a low-grade myxoid sarcoma. The assigned cytologic grade accurately reflected the histologic grade in 90% of sarcomas when segregated into high and low grades. Pleomorphic, small round cell, and epithelioid/polygonal subgroups corresponded to high-grade sarcomas in all cases with only minor noncorrelations. Major grading noncorrelations occurred in 50% of myxoid and 9% of spindle-cell sarcomas. Therefore, attention should be given to specimen adequacy, and caution should be exercised when attempting to grade myxoid and spindle-cell sarcomas by FNAB. Diagn. Cytopathol. 24:307,316, 2001. © 2001 Wiley-Liss, Inc. [source]

First record of the brachiopod Lingulella waptaensis with pedicle from the Middle Cambrian Burgess Shale

ACTA ZOOLOGICA, Issue 2 2010
Sandra Pettersson Stolk
Abstract Pettersson Stolk, S., Holmer, L. E. and Caron, J -B. 2010. First record of the brachiopod Lingulella waptaensis with pedicle from the Middle Cambrian Burgess Shale. ,Acta Zoologica (Stockholm) 91: 150,162 The organophosphatic shells of linguloid brachiopods are a common component of normal Cambrian,Ordovician shelly assemblages. Preservation of linguloid soft-part anatomy, however, is extremely rare, and restricted to a few species in Lower Cambrian Konservat Lagerstätten. Such remarkable occurrences provide unique insights into the biology and ecology of early linguloids that are not available from the study of shells alone. Based on its shells, Lingulella waptaensis Walcott, was originally described in 1924 from the Middle Cambrian Burgess Shale but despite the widespread occurrence of soft-part preservation associated with fossils from the same levels, no preserved soft parts have been reported. Lingulella waptaensis is restudied herein based on 396 specimens collected by Royal Ontario Museum field parties from the Greater Phyllopod Bed (Walcott Quarry Shale Member, British Columbia). The new specimens, including three with exceptional preservation of the pedicle, were collected in situ in discrete obrution beds. Census counts show that L. waptaensis is rare but recurrent in the Greater Phyllopod Bed, suggesting that this species might have been generalist. The wrinkled pedicle protruded posteriorly between the valves, was composed of a central coelomic space, and was slender and flexible enough to be tightly folded, suggesting a thin chitinous cuticle and underlying muscular layers. The nearly circular shell and the long, slender and highly flexible pedicle suggest that L. waptaensis lived epifaunally, probably attached to the substrate. Vertical cross-sections of the shells show that L. waptaensis possessed a virgose secondary layer, which has previously only been known from Devonian to Recent members of the Family Lingulidae. [source]

Salvage esophagectomy after definitive chemoradiotherapy for synchronous double cancers of the esophagus and head-and-neck

DISEASES OF THE ESOPHAGUS, Issue 1 2010
R. Yoshida
SUMMARY Head-and-neck cancer is frequently associated with esophageal cancer. Because the operative procedures for these synchronous double cancers are too invasive, definitive chemoradiotherapy tends to be applied as an initial treatment. A salvage esophagectomy for either recurrent or residual disease after definitive chemoradiotherapy in patients with such double cancer has never been reported. We reviewed 21 patients with esophageal cancer who underwent a salvage esophagectomy after definitive chemoradiotherapy. Among them, the treatment course of five patients who underwent a salvage esophagectomy for patients with synchronous double cancers of the esophagus and head-and-neck region was analyzed. Because head-and-neck cancer was well controlled after chemoradiotherapy in all five patients, a salvage esophagectomy was indicated for either recurrent or residual esophageal cancer after definitive chemoradiotherapy. Anastomotic leakage developed in four patients; however, no other complications including pulmonary complications were recognized. All of them were discharged to home and three of them are still alive without any recurrence for 20,43 months. A salvage esophagectomy should be considered as a treatment option for either recurrent or residual esophageal cancer with well-controlled head-and-neck cancer after definitive chemoradiotherapy when complete resection of the esophagus is expected. [source]

Persistent, recurrent, and acquired infection of the root canal system post-treatment

ENDODONTIC TOPICS, Issue 1 2003
Markus Haapasalo
Apical periodontitis is an inflammatory process in the periradicular tissues caused by microorganisms in the necrotic root canal. Accordingly, to achieve healing of apical periodontitis, the main goal of the treatment must be elimination of the infection and prevention of re-infection. As shown by recent epidemiological studies in several countries around the world, post-treatment endodontic disease is a far too common finding. To understand the reasons for survival of resistant bacteria in the filled root canal, it is important to know in detail the interaction between treatment procedures and the root canal flora in primary apical periodontitis. Therefore, in the first half of this review, the focus is placed on control of infection in primary apical periodontitis. This is followed by a detailed description of the resistant root canal microflora and a discussion about the present and future strategies to eliminate even the most resistant microbes in post-treatment disease. [source]

El Niño, climate change, and Southern African climate

ENVIRONMETRICS, Issue 4 2001
Simon J. Mason
Abstract The El Niño phenomenon involves a large-scale warming of the equatorial eastern and central Pacific Ocean. Recent developments in the El Niño,Southern Oscillation (ENSO) phenomenon have raised concerns about climate change. In this review paper, these recent developments are critically assessed and forecasts of possible future changes are reviewed. Since the late-1970s, El Niño episodes have been unusually recurrent, while the frequency of strong La Niña events has been low. Prolonged/recurrent warm event conditions of the first half of the 1990s were the result of the persistence of an anomalously warm pool near the date line, which, in turn, may be part of an abrupt warming trend in tropical sea-surface temperatures that occurred in the late-1970s. The abrupt warming of tropical sea-surface temperatures has been attributed to the enhanced-greenhouse effect, but may be indicative of inter-decadal variability: earlier changes in the frequency of ENSO events and earlier persistent El Niño and La Niña sequences have occurred. Most forecasts of ENSO variability in a doubled-CO2 climate suggest that the recent changes in the tropical Pacific are anomalous. Of potential concern, however, is a possible reduction in the predictability of ENSO events given a warmer background climate. El Niño events usually are associated with below-normal rainfall over much of southern Africa. Mechanisms for this influence on southern African climate are discussed, and the implications of possible changes in ENSO variability on the climate of the region are assessed. Recent observed changes in southern African climate and their possible relationships with trends in ENSO variability are investigated. The El Niño influence on rainfall over southern Africa occurs largely because of a weakening of tropical convection over the subcontinent. A warming of the Indian Ocean during El Niño events appears to be important in providing a teleconnection from the equatorial Pacific Ocean. The abrupt warming of the tropical Pacific and Indian oceans in the late-1970s is probably partly responsible for increasing air temperatures over southern Africa, and may have contributed to a prolongation of predominantly dry conditions. A return to a wet phase appears to have occurred, despite the persistence of anomalously high sea-surface temperatures associated with the late-1970s warming, and a record-breaking El Niño in 1997/98. Copyright © 2001 John Wiley & Sons, Ltd. [source]

Monoamine variability in the chronic model of atypical absence seizures

EPILEPSIA, Issue 4 2009
Eduard Bercovici
Summary Purpose:, We studied the variability of the slow-spike-and-wave discharges (SSWDs) derived from AY-9944 (AY) treatment during brain development of Long-Evans hooded (LEh) rats. Methods:, Although all LEh rats received the standard dose of AY (7.5 mg/kg), we have observed an intersubject variability of the total SSWD duration at postnatal day (P) 55. Therefore, we set out to investigate the underlying brain levels of norepinephrine (NE), dopamine (DA), and serotonin (5-HT) and its metabolite (5-HIAA), as determined by high-performance liquid chromatography (HPLC) analyses from four different brain regions: thalamus (Th), frontoparietal cortex (Cx), hippocampus (Hp), and brainstem (Bs). Results:, All brains were obtained after two baseline electrocorticographic (ECoG) recordings with characteristic chronic, recurrent, bilaterally synchronous 4,6 Hz SSWD, at P 55 (336.25 ± 97.23 s/h) and P60 (494.50 ± 150.36 s) (r = 0.951, r2 = 0.904, p < 0.005, Pearson product). The thalamic NE levels and the brainstem NE, DA, and 5HT levels were all significantly correlated with baseline SSWD duration at P55 and P60 (p < 0.01, Pearson product). Conclusion:, Our data indicate that brain monoamine levels may determine the intersubject variability of SSWD duration in AY rats with chronic atypical absence seizures. [source]

Mechanisms and consequences of bladder cell invasion by uropathogenic Escherichia coli

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2008
B. K. Dhakal
ABSTRACT Strains of uropathogenic Escherichia coli (UPEC) are the major cause of urinary tract infections worldwide. Multiple studies over the past decade have called into question the dogmatic view that UPEC strains act as strictly extracellular pathogens. Rather, bacterial expression of filamentous adhesive organelles known as type 1 pili and Afa/Dr fibrils enable UPEC to invade host epithelial cells within the urinary tract. Entry into bladder epithelial cells provides UPEC with a protected niche where the bacteria can persist quiescently for long periods, unperturbed by host defences and protected from many antibiotic treatments. Alternately, internalized UPEC can rapidly multiply, forming large intracellular inclusions that can contain several thousand bacteria. Initial work aimed at defining the host and bacterial factors that modulate the entry, intracellular trafficking, and eventual resurgence of UPEC suggests a high degree of host-pathogen crosstalk. Targeted disruption of these processes may provide a novel means to prevent and treat recurrent, relapsing and chronic infections within the urinary tract. [source]

Recurrent palmar,plantar erythrodysaesthesia following high-dose cytarabine treatment for acute lymphoblastic leukemia

EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5-6 2002
Julie H. Crawford
Abstract: Palmar,plantar erythrodysaesthesia (PPE) is an uncommon cutaneous complication of cytotoxic chemotherapy which generally presents as a painful erythema involving the palms and soles. It has been suggested that PPE caused by cytarabine does not recur with subsequent cytarabine re-challenge. We report a patient with recurrent, increasingly severe episodes of PPE, ultimately complicated by a severe bullous eruption, following successive cycles of high-dose cytarabine for the treatment of acute lymphoblastic leukaemia. Contrary to previous recommendations, our experience cautions against the further use of high-dose cytarabine in patients who develop PPE, and is a timely reminder of the potential toxicity of this agent, which is now increasingly being used as first-line treatment in the management of haematologic malignancies. [source]

Definitive molecular cytogenetic characterization of 15 colorectal cancer cell lines,

GENES, CHROMOSOMES AND CANCER, Issue 3 2010
Turid Knutsen
In defining the genetic profiles in cancer, cytogenetically aberrant cell lines derived from primary tumors are important tools for the study of carcinogenesis. Here, we present the results of a comprehensive investigation of 15 established colorectal cancer cell lines using spectral karyotyping (SKY), fluorescence in situ hybridization, and comparative genomic hybridization (CGH). Detailed karyotypic analysis by SKY on five of the lines (P53HCT116, T84, NCI-H508, NCI-H716, and SK-CO-1) is described here for the first time. The five lines with karyotypes in the diploid range and that are characterized by defects in DNA mismatch repair had a mean of 4.8 chromosomal abnormalities per line, whereas the 10 aneuploid lines exhibited complex karyotypes and a mean of 30 chromosomal abnormalities. Of the 150 clonal translocations, only eight were balanced and none were recurrent among the lines. We also reviewed the karyotypes of 345 cases of adenocarcinoma of the large intestine listed in the Mitelman Database of Chromosome Aberrations in Cancer. The types of abnormalities observed in the cell lines reflected those seen in primary tumors: there were no recurrent translocations in either tumors or cell lines; isochromosomes were the most common recurrent abnormalities; and breakpoints occurred most frequently at the centromeric/pericentromeric and telomere regions. Of the genomic imbalances detected by array CGH, 87% correlated with chromosome aberrations observed in the SKY studies. The fact that chromosome abnormalities predominantly result in copy number changes rather than specific chromosome or gene fusions suggests that this may be the major mechanism leading to carcinogenesis in colorectal cancer. Published 2009 Wiley-Liss, Inc. [source]