CONGESTIVE HEART FAILURE, Issue 2 2009
Satoru Osaki MD
Predictors of myocardial recovery after ventricular assist device (VAD) implantation are not well defined. The authors report their current VAD weaning protocol. Between 2003 and 2006, 38 patients received VAD implants. The authors performed 5 tests in 4 patients in whom echocardiography findings suggested myocardial recovery after implant. The protocol consists of assessing symptoms, electrocardiographic findings, hemodynamics, and cardiac function at baseline and as VAD support is weaned. As a result, 3 patients passed the weaning protocol and were explanted. There has been no recurrence of heart failure 667, 752, and 1007 days after explant, respectively. One patient failed the protocol after 151 days of support because of low cardiac index during the protocol. This patient was transplanted. This current experience of VAD weaning protocol is a novel tool to identify candidates for successful VAD explantation. [source]

Invasive and Noninvasive Correlations of B-Type Natriuretic Peptide in Patients With Heart Failure Due to Chagas Cardiomyopathy

CONGESTIVE HEART FAILURE, Issue 3 2008
Fábio Vilas-Boas MD
Heart failure due to Chagas cardiomyopathy (HFCC) differs from failure with other etiologies because of the occurrence of intense inflammatory infiltrate and right ventricle compromise. This article investigates correlations of B-type natriuretic peptide (BNP) levels with parameters of severity in HFCC. Twenty-eight patients and 8 normal controls underwent heart catheterization and clinical and laboratory analyses. BNP levels were higher in patients with HFCC (P<.0001) and correlated with New York Heart Association (NYHA) class; right atrial pressure; wedge pressure; cardiac output; levels of serum sodium, hemoglobin, urea, and tumor necrosis factor-,; and ejection fraction. Interferon-, and transforming growth factor-, did not correlate with BNP level. The authors conclude that BNP levels are elevated in patients experiencing HFCC, irrespective of NYHA class, and that the occurrence of HFCC correlates with severity of disease. [source]

Invasive and quarantine pests in forests in Slovakia1

EPPO BULLETIN, Issue 2 2006
Milan Zúbrik
Biological invasions of insects, plants, and fungal pest species often cause substantial disturbance to forest ecosystems and as well as severe socioeconomic impacts. Central Europe acts as a ,bridge' between Western and Eastern Europe both ecologically and as an important transit corridor for people. Human activity, including the movement of material goods, increases the risk of invasions. Some species introduced in the past have been established, becoming common and causing serious problems (such as Dreyfusia nordmannianae or Hyphantria cunea). The status, importance and spatial distribution in Slovakia of seven different forest pests recently introduced into Slovak forest ecosystems (Cameraria ohridella, Coleotechnites piceaella, Cryphonectria parasitica, Dothistroma septospora, Ips duplicatus, Parectopa robiniella, Phyllonorycter robiniellus) as well as two others not yet recorded in Slovakia (Anoplophora glabripennis, Phytophthora spp.) is discussed. [source]

An initial assessment of native and invasive tunicates in shellfish aquaculture of the North American east coast

JOURNAL OF APPLIED ICHTHYOLOGY, Issue 2010
M. R. Carman
Summary The objective of the study was to assess the distribution of native and invasive tunicates in the fouling community of shellfish aquaculture gear along the U.S. east coast of the Atlantic. Since the 1980s, several species of invasive tunicates have spread throughout the coastal waters of the North American east coast and have become dominant fouling organisms on docks, boat hulls, mooring lines, and in shellfish aquaculture. Invasive and native tunicates negatively impact shellfish aquaculture through increased maintenance costs and reduced shellfish growth. While the presence of alien tunicates has been well documented at piers, harbors, and marinas, there are few published reports of invasive tunicate impacts to aquaculture. We surveyed shellfish aquaculture operations at Martha's Vineyard, Massachusetts and shellfish aquaculturists in other areas along the North American east coast and report high levels of fouling caused by seven invasive, three native, and two cryptogenic species of tunicates. All study sites were fouled by one or more tunicate species. Biofouling control treatments varied among aquaculture sites and were effective in removing tunicates. Invasive and native tunicates should be considered when assessing the economic impacts of fouling organisms to the aquaculture industry. [source]

Fellowship in Minimally Invasive and Robotic Surgery in Gynaecology 2011

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2010
Article first published online: 7 FEB 2010
No abstract is available for this article. [source]

Interactions between surface proteins of Streptococcus pyogenes and coagulation factors modulate clotting of human plasma

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2 2003
H. Herwald
Summary., Invasive and toxic infections caused by Streptococcus pyogenes are connected with high morbidity and mortality. Typical symptoms of these infections are hypotension, edema formation, tissue necrosis, and bleeding disorders. Here we report that components of the coagulation system including fibrinogen, factors V, XI, and XII, and H-kininogen, are assembled at the surface of S. pyogenes through specific interactions with bacterial surface proteins. In plasma environment, absorption of fibrinogen by S. pyogenes causes a hypocoagulatory state resulting in prolonged clotting times and impaired fibrin network formation. Moreover, the binding of coagulation factors and the subsequent activation of the coagulation system at the bacterial surface lead to the formation of a fibrin network covering S. pyogenes bacteria adhering to epithelial cells. The results suggest that interactions between S. pyogenes and components of the coagulation system contribute to some of the symptoms seen in severe infections caused by this important human pathogen. [source]

Competitive Interactions among First-Year and Second-Year Plants of the Invasive, Biennial Garlic Mustard (Alliaria petiolata) and Native Ground Layer Vegetation

RESTORATION ECOLOGY, Issue 5 2010
Jonathan T. Bauer
We studied the effects of hand weeding of second-year plants of the biennial garlic mustard (Alliaria petiolata) on first-year plants (seedlings) and native ground layer vegetation. Garlic mustard is a Eurasian species that has invaded deciduous forest ground layers in eastern North America. Treatments consisted of a control and an early or late weeding of second-year garlic mustard. The early treatment (early March) was applied before garlic mustard seeds had germinated and when most native species were dormant. The late treatment (mid-May) occurred after plants had bolted, flowering was occurring, and most native species and new garlic mustard seedlings were actively growing. Pre-treatment data were obtained in 2004 and treated and control plots were sampled in 2005, 2006, and 2007. No significant treatment effects were observed in 2004 or 2005. In 2006, mean cover of first-year plants was higher in the early weeding treatment than in the late weeding treatment and control. In 2007, mean cover of first-year garlic mustard was higher in the control than in either of the two weeding treatments. There were no significant treatment effects in any year on native vegetation cover, bare ground, or the five most abundant native species. Our data indicate that (1) late weeding of garlic mustard provided more effective control than early weeding because late weeding allows second-year plants to compete with garlic mustard seedlings for a longer period of time and (2) competition between first- and second-year plants is responsible for alternating dominance of first-year and second-year garlic mustard plants. [source]

Visual Support for Interactive Post-Interventional Assessment of Radiofrequency Ablation Therapy

COMPUTER GRAPHICS FORUM, Issue 3 2010
Christian Rieder
Abstract Percutaneous radiofrequency (RF) ablation is a minimally invasive, image-guided therapy for the treatment of liver tumors. The assessment of the ablation area (coagulation) is performed to verify the treatment success as an essential part of the therapy. Traditionally, pre- and post-interventional CT images are used to visually compare the shape, size, and position of tumor and coagulation. In this work, we present a novel visualization as well as a navigation tool, the so-called tumor map. The tumor map is a pseudo-cylindrical mapping of the tumor surface onto a 2D image. It is used for a combined visualization of all ablation zones of the tumor to allow a reliable therapy assessment. Additionally, the tumor map serves as an interactive tool for intuitive navigation within the 3D volume rendering of the tumor vicinity as well as with familiar 2D viewers. [source]

Epidemiology of invasive and other pneumococcal disease in children in England and Wales 1996,1998

ACTA PAEDIATRICA, Issue 2000
E Miller
The results of enhanced national surveillance of pneumococcal disease in children <15y of age in England and Wales are reported for the period 1996,1998. Of the 1985 cases of laboratory-confirmed invasive disease (annual incidence 6.6 per 100000 overall and 39.7 per 100000 in infants <1 y of age), 485 (24%) were meningitis (annual incidence of 1.6 per 100000 overall and 15.7 per 100000 in infants <1 y of age). Fifty-nine deaths in children with invasive disease were identified-3% of the total reports. Thirty-one different serogroups/types were identified, with organisms in the 7-valent conjugate vaccine responsible for 69% of the infections in children <5 y of age; this rose to 77% and 82%, respectively, for the 9-and 11-valent vaccines. Resistance to penicillin varied from 2.3% to 6.2% in different years, but erythromycin resistance remained constant at 17%. The vast majority of resistant isolates were in vaccine serotype/groups. Computerized hospital admission records for all children <15 y of age with a discharge diagnosis code indicating probable pneumococcal disease were also analysed for 1997. The annual incidence for cases with a code specifically mentioning S. pneumoniae was 9.9 per 100000 compared with 71.2 per 100000 for lobar pneumonia; the mean duration of stay for both was < 1 wk. The incidence of admission for pneumococcal meningitis (1.9 overall and 19.6 for infants < 1 y of age) was similar to that derived from laboratory reports and resulted in an average duration of stay of 2 wk. Conclusion: This surveillance has confirmed the substantial burden of morbidity attributable to pneumococcal disease in British children and the potential public health benefits that could be achieved by the use of pneumococcal conjugate vaccines. [source]

Anomalous Left Anterior Descending Coronary Artery from the Pulmonary Artery, Unroofed Coronary Sinus, Patent Foramen Ovale, and a Persistent Left-sided SVC in a Single Patient: A Harmonious Quartet of Defects

CONGENITAL HEART DISEASE, Issue 2 2009
Andrew J. Klein MD
ABSTRACT Unroofing of the coronary sinus without complex structural heart defects is a rare congenital defect often seen in conjunction with a persistent left-sided superior vena cava. Anomalous origin of the left anterior descending artery from the pulmonary artery with normal origin of the left circumflex coronary artery is an even rarer congenital cardiac defect. We report a case of a 54-year-old woman presenting with mild dyspnea on exertion who was found on invasive and noninvasive evaluations to have a unique combination of defects,unroofed coronary sinus, persistent left-sided superior vena cava, patent foramen ovale, and anomalous origin of the left anterior descending artery from the pulmonary artery without evidence of previous coronary ischemia. [source]

Implications of Climatic Warming for Conservation of Native Trees and Shrubs in Florida

CONSERVATION BIOLOGY, Issue 4 2001
David W. Crumpacker
Climatic-envelope models are useful for simultaneous investigation of many plant species whose range-limiting mechanisms are poorly known. They are most effectively applied in regions with strong temperature and moisture gradients and low relief. Their required databases are often relatively easy to obtain. We provide an example involving the effect of six annual warming scenarios, ranging from +1° C to +2° C and from +10% to ,20% annual precipitation (some have greater warming in winter than in summer), on 117 native woody species in Florida (U.S.A.). Tree species at their southern range boundaries in several parts of Florida are likely to be negatively affected by as little as 1° C warming if it is greater in winter than in summer or is accompanied by a 20% decrease in annual precipitation. Potential species responses to an identical type of 1° C warming may be different for some conservation areas in the same region of Florida. Potentially extensive disruption of some major woody ecosystems is predicted under certain types of 1° C annual warming and under all types of 2° C annual warming that were investigated. Additional consideration of nonclimatic factors suggests that many potential effects on species and ecosystems are not underestimates of actual effects over a 100-year period of warming. We recommend monitoring for decreased fertility and viability of ecologically important, temperate woody species near their southern range limits in Florida. Early detection of such changes in fitness might then provide time for mitigations designed to alleviate more serious subsequent effects on biodiversity. Control of invasive, non-native plant species and prevention of their additional introduction, human-assisted translocation of native subtropical plant species into previously temperate parts of Florida, and restoration of more natural hydrological regimes are examples of potentially useful mitigations if climatic warming continues. Resumen: Los modelos de procesos ecológicos y los modelos empíricos han sido usados para relacionar predicciones de cambio climático con los efectos en especies de plantas y vegetación. Los modelos climáticos son útiles para la investigación simultánea de muchas especies de plantas cuyos mecanismos limitantes de rango son poco conocidos. Estos modelos son más eficientemente aplicados en regiones con gradientes de temperatura y humedad fuertes y con relieve bajo. Las bases de datos requeridas son a menudo relativamente fáciles de adquirir. Proveemos un ejemplo que involucra el efecto de seis escenarios anuales de calentamiento con un rango de +1° C a +2° C y de +10% a ,20% de precipitación anual (algunos con rangos de calentamiento mayores en el invierno que en el verano), en 117 especies leñosas nativas de Florida ( E.U.A.). Las especies de árboles en sus límites de rango al sur en diversas partes de Florida son más factibles de ser negativamente afectadas por tan poco como 1° C de calentamiento, si este es mayor en el invierno que en el verano o si es acompañado por una disminución de un 20% de precipitación anual. Las respuestas potenciales de las especies a un tipo idéntico de calentamiento de 1° C puede ser diferente para algunas áreas de conservación en la misma región de Florida. Se predicen perturbaciones potencialmente extensivas en algunos ecosistemas leñosos principales investigados bajo ciertos tipos de calentamiento anual de 1° C y bajo todos los tipos de calentamiento anual de 2° C. Las consideraciones adicionales de factores no climáticos sugieren que muchos efectos potenciales sobre las especies y ecosistemas no son subestimaciones de los efectos actuales sobre un período de calentamiento de 100 años. Se recomienda el monitoreo de la disminución de la fertilidad y viabilidad de especies leñosas templadas ecológicamente importantes cerca de los límites sureños de sus rangos en la Florida. La detección temprana de estos cambios en adaptabilidad pueden proveer tiempo para mitigaciones diseñadas para aliviar efectos posteriores más serios en la biodiversidad. Algunos ejemplos de mitigaciones potencialmente útiles en caso de que el calentamiento global continúe incluyen el control de especies de plantas invasoras no nativas y la prevención de su introducción adicional, la translocación asistida por humanos de plantas nativas subtropicales en partes previamente templadas de Florida y la restauración de regimenes hidrológicos más naturales. [source]

Imaging of the lymphatic system: new horizons,

CONTRAST MEDIA & MOLECULAR IMAGING, Issue 6 2006
Tristan Barrett
Abstract The lymphatic system is a complex network of lymph vessels, lymphatic organs and lymph nodes. Traditionally, imaging of the lymphatic system has been based on conventional imaging methods like computed tomography (CT) and magnetic resonance imaging (MRI), whereby enlargement of lymph nodes is considered the primary diagnostic criterion for disease. This is particularly true in oncology, where nodal enlargement can be indicative of nodal metastases or lymphoma. CT and MRI on their own are, however, anatomical imaging methods. Newer imaging methods such as positron emission tomography (PET), dynamic contrast-enhanced MRI (DCE-MRI) and color Doppler ultrasound (CDUS) provide a functional assessment of node status. None of these techniques is capable of detecting flow within the lymphatics and, thus, several intra-lymphatic imaging methods have been developed. Direct lymphangiography is an all-but-extinct method of visualizing the lymphatic drainage from an extremity using oil-based iodine contrast agents. More recently, interstitially injected intra-lymphatic imaging, such as lymphoscintigraphy, has been used for lymphedema assessment and sentinel node detection. Nevertheless, radionuclide-based imaging has the disadvantage of poor resolution. This has lead to the development of novel systemic and interstitial imaging techniques which are minimally invasive and have the potential to provide both structural and functional information; this is a particular advantage for cancer imaging, where anatomical depiction alone often provides insufficient information. At present the respective role each modality plays remains to be determined. Indeed, multi-modal imaging may be more appropriate for certain lymphatic disorders. The field of lymphatic imaging is ever evolving, and technological advances, combined with the development of new contrast agents, continue to improve diagnostic accuracy. Published in 2006 by John Wiley & Sons, Ltd. [source]

How predictive is a cervical smear suggesting invasive squamous cell carcinoma?

CYTOPATHOLOGY, Issue 3 2001
S. J. Johnson
How predictive is a cervical smear suggesting invasive squamous cell carcinoma? Features have been described in severely dyskaryotic cervical smears that suggest frankly invasive or microinvasive squamous cell carcinoma. These are reported in three separate categories in our department. The aim of the current study was to assess the positive predictive value of these categories for invasive disease on histology. All smears reported in these categories over a five year period were correlated with the histology results. 527 smears were assessed. The positive predictive value of a smear suggesting frank invasion was 55.7% for all invasive squamous carcinomas and 40% for stage IB or above. Smears suspicious of invasion or microinvasion predicted invasive disease in 22.3% and 17.2%, respectively, most carcinomas being stage IA. Invasive squamous cell carcinoma may be predicted to a limited degree by cervical cytology especially when the smear suggests frank invasion. [source]

Cervical screening in England and Wales: its effect has been underestimated

CYTOPATHOLOGY, Issue 6 2000
A. Herbert
Opinions about cervical screening in the UK tend to follow one of two negative lines of thought. The first is that cervical cancer is a rare disease, and too much time and effort are spent on screening. The second is that it has been relatively ineffective, since incidence of invasive carcinoma did not fall until the NHS Cervical Screening Programme (NHSCSP) was introduced in 1988, although it fell by 40% since then. This paper presents publicly available data to demonstrate that neither of these views is true. Registrations of invasive carcinoma of the uterine cervix and carcinoma in situ in England and Wales between 1971 and 1996 show that a substantially increased risk of disease in women born since 1940 has been reversed, almost certainly by greatly improved screening. Cervical carcinoma is now a rare disease because most cases are prevented before they become invasive, mostly by screening young women, aged 20,40, before the decade of life when symptomatic cervical carcinoma most frequently presents. [source]

Reduction in the Incidence of Squamous Cell Carcinoma in Solid Organ Transplant Recipients Treated with Cyclic Photodynamic Therapy

DERMATOLOGIC SURGERY, Issue 5 2010
ANDREA WILLEY MD
BACKGROUND AND OBJECTIVES Squamous cell carcinomas (SCCs) produce significant morbidity in solid organ transplant recipients (SOTRs), particularly in patients who develop multiple tumors. Topical photodynamic therapy (PDT) has been shown to decrease the number of keratotic lesions in SOTRs, but the duration of the beneficial effect is limited. The aim of this study was to evaluate the potential benefit of cyclic PDT in the prevention of new SCCs in SOTRs. METHODS Twelve high-risk SOTRs received cyclic PDT treatments at 4- to 8-week intervals for 2 years. The development of new SCCs (invasive and in situ) performed 12 and 24 months after the start of cyclic PDT were compared with the number of SCCs developed during the year before initiation of cyclic PDT. RESULTS The median reduction in the 12- and 24-month post-treatment counts from the 1-month pretreatment counts was 79.0% (73.3,81.8%) and 95.0% (87.5,100.0%), respectively. Treatments were well tolerated. CONCLUSION Cyclic PDT with 5-aminolevulinic acid may reduce the incidence of SCC in SOTRs. Additional studies with larger numbers of patients and optimized protocols are necessary to further explore the potential benefits of cyclic PDT in the prevention of skin cancer in this high-risk patient population. Dr. Lee is member of the Medical Advisory Board of Dusa Pharmaceuticals, Inc. [source]

How to identify patients with vulnerable plaques

DIABETES OBESITY & METABOLISM, Issue 10 2008
Salim S. Virani
Multiple strategies are available for clinicians to identify patients at high risk for cardiovascular events. Two commonly discussed strategies are the identification of vulnerable plaques and the identification of vulnerable patients. The strategy of identifying vulnerable patients is less invasive, easy to implement and not restricted primarily to one vascular bed (e.g. coronary or cerebral). This review discusses the utility as well as the limitations of global risk assessment tools to identify such patients. The utility of biomarkers [C-reactive protein, lipoprotein-associated phospholipase A2 and lipoprotein(a)] and non-invasive measures of atherosclerosis burden (coronary artery calcium scores, carotid intima,media thickness and ankle,brachial index) in identifying patients at high risk for cardiovascular events are also discussed. [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]

Cell blocks of breast FNAs frequently allow diagnosis of invasion or histological classification of proliferative changes

DIAGNOSTIC CYTOPATHOLOGY, Issue 5 2007
Smiljana Istvanic M.D.
Abstract Two major limitations of breast fine needle aspiration (FNA) compared with core needle biopsies (CNB) are the inability to determine whether a cancer is invasive and to classify proliferative lesions. We studied 40 consecutive "rapid cell blocks" from breast FNAs with surgical pathology follow-up to test whether cell blocks can overcome these limitations. Of 25 carcinomas, invasion could be identified in the cell block sections in 11 (44%). One cystosarcoma phyllodes was suspected based on the cell block sections. Cell blocks from 12 of 14 benign breast FNAs showed sufficient cells to assign a histologic diagnosis of no hyperplasia (1 case, confirmed on follow-up) and usual hyperplasia (11 cases; confirmed in eight of 11 on follow-up). Specific histologic diagnoses included intraductal papilloma (2 cases), and in situ lobular neoplasia (2 cases). Cell blocks complement smears and monolayers and appear to overcome major limitations of breast FNA. Diagn. Cytopathol. 2007;35:263,269. © 2007 Wiley-Liss, Inc. [source]

Role of Pap Test terminology and age in the detection of carcinoma invasive and carcinoma in situ in medically underserved California women

DIAGNOSTIC CYTOPATHOLOGY, Issue 4 2004
Lydia P. Howell M.D.
Abstract Our goals were to evaluate Pap Test findings classified by the Bethesda system, and follow up biopsies from participants in the California Breast and Cervical Cancer Control Program (Ca-BCCCP) for: 1) correlation in the detection of carcinoma in situ (CIS) and carcinoma invasive (CI), and 2) age-related trends, with discussion in the context of the 2001 ASCCP Management Guidelines. Women (n = 52,339) who had their initial screening Pap Tests with Ca-BCCCP between January 1995,December 1999 were followed for diagnostic services through December 2000. Descriptive and analytical methods were used in the analysis. Of the Pap results, 81.9% were negative, 10.6% showed infection, 4.7% showed an epithelial abnormality as defined by the Bethesda system (atypical squamous cells of undertermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL)), 0.1% showed squamous-cell cancer (SCC), and 2.7% showed other or unsatisfactory. Subsequent to the initial Pap Test, follow-up results of carcinoma in situ (CIS) and carcinoma invasive (CI) accounted for 0.36% and 0.05% of the population, respectively. Among HSIL Pap Tests (n = 285), 40.7% had follow-up showing CIS. Among SCC Pap Tests, 17.9% had follow-up results of CIS and 28.6% CI. Of the 191 patients with CIS as a follow-up finding, the initial Pap smear showed: HSIL 60.7%, SCC 2.6%, LSIL 10.5%, ASCUS 13.6%, and negative or infection 9.9%. Of the 27 patients with CI, the initial Pap Test showed: HSIL 40.7%, SCC 29.6%, LSIL 7.4%, ASCUS 7.4%, and negative or infection 11.1%. Pap diagnoses of other or unsatisfactory accounted for 2.6% of the Pap results from patients with CIS and 3.7% of Pap results from patients with CI. Except for LSIL, there was an increasing age trend in the number of cases in each of Pap results, with the exception of age 65+ yr. However, the ratio of LSIL and ASCUS to negative cases decreased with age. (P < 0.0001 and 0.0293, respectively). HSIL Pap results indicate a reasonably high probability of CIS and CI. However, approximately 1/3 of patients with CIS and 1/4 of patients with CI presented with Pap diagnoses of less severity than HSIL. When a negative Pap Test result is chosen as reference group, there is a negative age trend for LSIL and ASCUS, and no age trend for other results. These findings all have important implications in the design of follow-up strategies, and support the 2001 ASCCP Consensus Guidelines for the Management of Women with Cervical Abnormalities. Diagn. Cytopathol. 2004;30:227,234. © 2004 Wiley-Liss, Inc. [source]

MANAGEMENT OF OBSCURE GASTROINTESTINAL BLEEDING BASED ON THE CLASSIFICATION OF CAPSULE ENDOSCOPIC BLEEDING FINDINGS

DIGESTIVE ENDOSCOPY, Issue 3 2010
Mitsunori Maeda
Background:, Double-balloon endoscopy (DBE) and capsule endoscopy (CE) have been useful in managing obscure gastrointestinal bleeding (OGIB). However, DBE is invasive, complex and time-consuming, therefore indications should probably be selective. The aim of this study was to evaluate the usefulness of the classification of the CE bleeding findings for determining the indications and timing of DBE in patients with OGIB. Methods:, From February 2003 to January 2009, 123 patients with OGIB who underwent CE were included in this study. These CE findings were classified based on the bleeding source. Type CE-I, II, III, IV and 0 indicate active bleeding, previous bleeding, lesions without active bleeding, a lesion outside of the small bowel, and no findings, respectively. We compared diagnostic yield and outcome between the classification and the findings of DBE or enteroclysis. Results:, Comparisons of the positive findings rate with DBE or enteroclysis, the treatment rate and the rebleeding rate with the classification showed: CE-Ia, 100% (6/6), 50% (3/6), 33.3% (2/6); Ib, 66.7% (4/6), 0% (0/6), 16.7% (1/6); IIa, 33.3% (1/3), 33.3% (1/3), 33.3% (1/3); IIb, 53.8% (7/13),15.4% (2/13), 30.8% (4/13); III, 100% (84/84), 9.5% (8/84), 8.3% (7/84); IV, 100% (2/2), 50% (1/2), 0% (0/2); and 0, 0% (0/9), 0% (0/9), 0% (0/9), respectively. Conclusions:, The proportion of patients requiring treatment, the positive findings rate with DBE or enteroclysis and the rebleeding rates tended to be higher in the higher ranked classification types (CE-I > II > III > IV > 0). These findings suggest that the classification can provide useful information on determining the indications and timing of DBE. [source]

ENDOSCOPIC MANAGEMENT OF BILIARY STRICTURES

DIGESTIVE ENDOSCOPY, Issue 2004
Yoshitsugu Kubota
ABSTRACT Endoscopic stenting, due to being less invasive, is feasible for most patients with biliary strictures; however, presumed efficacy should be balanced against the procedure-related morbidities for an individual patient. Self-expandable metallic stents have a longer patency, but are not retrievable. Therefore, the use of self-expandable metallic stents should be limited to those with unequivocal findings of unresectable malignancy. Plastic stents are indicated for strictures due to benign etiologies and equivocal malignancy. Endoscopic stenting for hilar biliary stricture is challenging. Bilateral hepatic drainage seems ideal but is often demanding to achieve with endoscopic technique, and contrast injection into undrained segments may pose a substantial risk for cholangitis and aggravate prognosis. Therefore, the extent of drainage should be balanced against the procedure-related complications. Preoperative magnetic resonance cholangiopancreatography may help determine feasibility of bilateral drainage or an ,intended and selective drainage' with a single stent and might obviate the possible morbidities. [source]

RECENT PROGRESS IN ENDOSCOPY-BASED DIAGNOSIS OF HELICOBACTER PYLORI INFECTION

DIGESTIVE ENDOSCOPY, Issue 1 2001
Tadashi Sato
Numerous invasive and non-invasive tests are available in the detection of Helicobacter pylori. Endoscopy-based tests that include rapid urease test, histological examination and culture are important generally in the assessment of H. pylori status before eradication therapy. Recently, several new endoscopy-based diagnostic methods have been developed aiming at rapid and accurate detection of the organisms. It would be possible to diagnose H. pylori infection in treated patients by using these new highly sensitive tests. Although the diagnosis of H. pylori infection itself is possible by using non-invasive diagnostic tests, endoscopy-based tests provide not only the diagnosis of the organisms, but also the exclusive information such as treatment indications and the susceptibility for the antimicrobial drugs. Recently, new triple therapy including clarithromycin has been widely performed in Japan. Along with an increase in the prevalence of the antibiotic-resistant strains, culture may become a more important diagnostic method in the future. The inappropriate application of the tests may increase the potential risk of the misdiagnosis and the treatment failures. The diagnostic method should be selected by taking into account the circumstances in which a diagnosis is to be performed. [source]

Combined Use of Uncovered Duodenal and Covered Biliary Metallic Stent for Carcinoma of the Papilla of Vater

DIGESTIVE ENDOSCOPY, Issue 4 2000
Hitoshi Sano
We have reported successful implantation of self-expandable metallic stents for palliative treatment in a case of an 87-year-old female patient with carcinoma of the papilla of Vater. She suffered from both duodenal and biliary stenoses, but refused surgical treatment. For the duodenal stenting, a self-expandable knitted nitinol metallic stent, for esophageal use, was inserted endoscopically. For the biliary stenting, a self-expandable metallic stent, partially polyurethane-covered on the proximal part to prevent tumor ingrowth and overgrowth, was inserted via the percutaneous transhepatic biliary drainage route. No major complications occured during these procedures. After the two stents were inserted in an end-to-side fashion, she was able to eat a normal diet adequately and suffered from no abdominal symptoms and jaundice during the follow-up period of 13 months. These stenting procedures might be less invasive and more useful than surgical treatment and provide long patency of biliary stenting and a good quality of life. [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]

Experimental esophageal carcinogenesis: technical standardization and results

DISEASES OF THE ESOPHAGUS, Issue 4 2002
J. A. Sallet
SUMMARY., The aim of this research was to determine the occurrence of epidermoid carcinoma of the esophagus induced by diethylnitrosamine (DEN) in Wistar rats. DEN was administered (250,300 g) in drinking water (10 mg/kg body weight) to four groups of rats for 72 h/week, for a duration of 90, 120, 150, or 200 days (groups T90, T120, T150, and T200). Ten animals whose drinking water did not contain DEN constituted the control group. All rats were sacrificed and their esophaguses studied macro- and microscopically. The control group did not exhibit either carcinomas or preneoplasic lesions. The T120 and T200 groups presented, respectively, 47 and 58 in situ carcinomas; 1 and 20 submucosal carcinomas (P < 0.05); 4 and 17 microinvasive carcinomas (P < 0.05); 4 and 11 advanced carcinomas (P < 0.05); and 1 and 1 cases of benign hyperplasia. Pulmonary and liver carcinomas were also found in the T200 group. The majority of advanced macroscopic lesions in the T200 group were polypoid, exophytic, and not microscopically invasive in the esophageal wall. This research confirms the effectiveness of the DEN in bringing about carcinogenesis in the Wistar rat esophagus and also shows that the lesions are dosage dependent. [source]

BIODIVERSITY RESEARCH: Genetic diversity in two introduced biofouling amphipods (Ampithoe valida & Jassa marmorata) along the Pacific North American coast: investigation into molecular identification and cryptic diversity

DIVERSITY AND DISTRIBUTIONS, Issue 5 2010
Erik M. Pilgrim
Abstract Aim, We investigated patterns of genetic diversity among invasive populations of Ampithoe valida and Jassa marmorata from the Pacific North American coast to assess the accuracy of morphological identification and determine whether or not cryptic diversity and multiple introductions contribute to the contemporary distribution of these species in the region. Location, Native range: Atlantic North American coast; Invaded range: Pacific North American coast. Methods, We assessed indices of genetic diversity based on DNA sequence data from the mitochondrial cytochrome c oxidase subunit I (COI) gene, determined the distribution of COI haplotypes among populations in both the invasive and putative native ranges of A. valida and J. marmorata and reconstructed phylogenetic relationships among COI haplotypes using both maximum parsimony and Bayesian approaches. Results, Phylogenetic inference indicates that inaccurate species-level identifications by morphological criteria are common among Jassa specimens. In addition, our data reveal the presence of three well supported but previously unrecognized clades of A. valida among specimens in the north-eastern Pacific. Different species of Jassa and different genetic lineages of Ampithoe exhibit striking disparity in geographic distribution across the region as well as substantial differences in genetic diversity indices. Main conclusions, Molecular genetic methods greatly improve the accuracy and resolution of identifications for invasive benthic marine amphipods at the species level and below. Our data suggest that multiple cryptic introductions of Ampithoe have occurred in the north-eastern Pacific and highlight uncertainty regarding the origin and invasion histories of both Jassa and Ampithoe species. Additional morphological and genetic analyses are necessary to clarify the taxonomy and native biogeography of both amphipod genera. [source]

Satellite sleuthing: does remotely sensed land-cover change signal ecological degradation in a protected area?

DIVERSITY AND DISTRIBUTIONS, Issue 2 2009
T. A. Waite
ABSTRACT Aim, We evaluate whether remotely sensed land-cover change within a newly protected area signalled human-driven ecological degradation. Vegetation density changed in a quarter of pixels during the first 13 years (1986,1999) following the sanctuary's formal enclosure, with many patches showing a decrease in density. We use on-the-ground data collected in 2006 in 132 random plots to explore whether these changes in vegetation density reliably signalled latent shifts in local diversity of woody plants and whether they could be attributed to illicit activities including fuel wood collection and livestock grazing. Location, Kumbhalgarh Wildlife Sanctuary, Rajasthan, India. Results, Species richness, species sharing, species assemblages, and incidence of invasive and useful species were statistically similar among plots in which vegetation density had decreased, increased or remained similar. Likewise, intensity of disturbance associated with human activities was similar across these plot types. Main conclusions, Our data provide no clear evidence that local changes in vegetation density signalled latent shifts in local diversity of woody plants. They also fail to reveal any clear association between local changes in vegetation density and human-related activities. Finding no evidence that land-cover change led to biotic erosion, we reflect on the utility of resource-use bans in protected areas, particularly those embedded within historically coupled human-nature systems. [source]

From introduction to the establishment of alien species: bioclimatic differences between presence and reproduction localities in the slider turtle

DIVERSITY AND DISTRIBUTIONS, Issue 1 2009
Gentile Francesco Ficetola
ABSTRACT Aim, Understanding the factors determining the transition from introduction of aliens to the establishment of invasive populations is a critical issue of the study of biological invasions, and has key implications for management. Differences in fitness among areas of introduction can define the zones where aliens become invasive. The American slider turtle Trachemys scripta has been introduced worldwide, and has negative effects on freshwater communities, but only a subset of introduced populations breed successfully. We used species distribution models to assess the factors influencing the slider distribution in Italy, by analysing bioclimatic features that can cause the transition from presence of feral adults to breeding populations. We also evaluated whether climate change might increase the future suitability for reproduction. Location,, Central and Northern Italy. Methods,, The distribution of slider turtle was obtained from the literature, unpublished reports and field surveys. We used Maxent to build bioclimatic models. Results,, Reproductive populations are associated to a clear bioclimatic envelope with warmer climate, more solar radiation and higher precipitations than populations where reproduction is not observed. Several Mediterranean areas currently have climatic features suitable for sliders. Scenarios of climate change predict the expansion of these areas. In the near future (2020), the proportion of populations in areas suitable for reproduction will dramatically increase. Main conclusion,, Our study shows that bioclimatic differences can determine the areas where aliens become invaders. Management should be focused to these source areas. However, climate change can increase fitness in the future, and therefore the interactions between climate change and fitness can boost the invasiveness of this alien species. [source]

Tolerance to herbivory, and not resistance, may explain differential success of invasive, naturalized, and native North American temperate vines

DIVERSITY AND DISTRIBUTIONS, Issue 2 2008
Isabel W. Ashton
ABSTRACT Numerous hypotheses suggest that natural enemies can influence the dynamics of biological invasions. Here, we use a group of 12 related native, invasive, and naturalized vines to test the relative importance of resistance and tolerance to herbivory in promoting biological invasions. In a field experiment in Long Island, New York, we excluded mammal and insect herbivores and examined plant growth and foliar damage over two growing seasons. This novel approach allowed us to compare the relative damage from mammal and insect herbivores and whether damage rates were related to invasion. In a greenhouse experiment, we simulated herbivory through clipping and measured growth response. After two seasons of excluding herbivores, there was no difference in relative growth rates among invasive, naturalized, and native woody vines, and all vines were susceptible to damage from mammal and insect herbivores. Thus, differential attack by herbivores and plant resistance to herbivory did not explain invasion success of these species. In the field, where damage rates were high, none of the vines were able to fully compensate for damage from mammals. However, in the greenhouse, we found that invasive vines were more tolerant of simulated herbivory than native and naturalized relatives. Our results indicate that invasive vines are not escaping herbivory in the novel range, rather they are persisting despite high rates of herbivore damage in the field. While most studies of invasive plants and natural enemies have focused on resistance, this work suggests that tolerance may also play a large role in facilitating invasions. [source]

Prediction and validation of the potential global distribution of a problematic alien invasive species , the American bullfrog

DIVERSITY AND DISTRIBUTIONS, Issue 4 2007
Gentile Francesco Ficetola
ABSTRACT Predicting the probability of successful establishment and invasion of alien species at global scale, by matching climatic and land use data, is a priority for the risk assessment. Both large- and local-scale factors contribute to the outcome of invasions, and should be integrated to improve the predictions. At global scale, we used climatic and land use layers to evaluate the habitat suitability for the American bullfrog Rana catesbeiana, a major invasive species that is among the causes of amphibian decline. Environmental models were built by using Maxent, a machine learning method. Then, we integrated global data with information on richness of native communities and hunting pressure collected at the local scale. Global-scale data allowed us to delineate the areas with the highest suitability for this species. Predicted suitability was significantly related to the invasiveness observed for bullfrog populations historically introduced in Europe, but did not explain a large portion of variability in invasion success. The integration of data at the global and local scales greatly improved the performance of models, and explained > 57% of the variance in introduction success: bullfrogs were more invasive in areas with high suitability and low hunting pressure over frogs. Our study identified the climatic factors entailing the risk of invasion by bullfrogs, and stresses the importance of the integration of biotic and abiotic data collected at different spatial scales, to evaluate the areas where monitoring and management efforts need to be focused. [source]