Ocular-adnexal lymphoid tumors: a clinicopathologic and molecular genetic study of 77 patients.

PURPOSE: To determine whether molecular genetic analysis of ocular-adnexal lymphoid tumors, combined with histopathology and tumor location, is helpful in predicting which patients will develop systemic lymphoma. METHODS: A combined retrospective and prospective study of 77 patients with ocular-adnexal lymphoid tumors was performed. The tumors were subdivided into conjunctival, orbital, and eyelid lesions, and all were studied using both routine histopathology and molecular genetic analysis. RESULTS: Most lesions (70%) were small cell lymphomas of the mucosa-associated lymphoid tissue type, and the majority of tumors (90%) contained monoclonal or oligoclonal populations of lymphocytes discovered on molecular genetic analysis. Additionally, 72% of tumors exhibiting clonality had more than one gene rearrangement. Fifty-three percent of patients developed extraocular lymphoma sometime during the course of their disease. Patients with gene rearrangements on Southern blot hybridization had a 52% incidence of nonocular disease, compared with 63% of those without rearrangements. Patients with conjunctival tumors had a 37.5% incidence of nonocular disease, those with orbital tumors had a 54% incidence, and those with eyelid tumors had a 100% incidence of nonocular lymphoma. Only two patients died as result of systemic lymphoma. CONCLUSIONS: Most ocular-adnexal lymphoid tumors are lymphomas of the mucosa-associated lymphoid tissue type. The majority of tumors exhibit gene rearrangements on molecular genetic analysis, and this technique was not helpful in predicting which patients would develop nonocular lymphoma. Tumor location did have predictive value: Conjunctival lesions had the lowest incidence of nonocular lymphoma, and lid lesions had the highest incidence. Even with disseminated disease, most patients have a favorable prognosis with treatment.     

Staging papillary carcinoma of the thyroid: magnetic resonance imaging vs ultrasound of the neck

AIM: To evaluate the role of magnetic resonance imaging (MRI) for staging local disease and lymph node metastases in papillary carcinoma of the thyroid by comparing MRI with ultrasound (US) of the neck. MATERIALS AND METHODS: Fourteen patients with papillary carcinoma underwent MRI and US. The images were prospectively reviewed for (1) identification of the primary lesion; (2) presence of multifocal thyroid disease; (3) extracapsular extension; (4) invasion into the trachea, oesophagus and major vessels; and (5) presence of lymph node metastases. Correlation was made with the surgical findings. RESULTS: The site of the primary lesion was correctly identified by US in 14 of 14 (100%) and by MRI in 13 of 14 (93%) of patients. Multifocal thyroid tumour was correctly identified by US in two of two patients (100%) and by MRI in zero of two (0%). Extracapsular extension (n = 9), oesophageal invasion (n = 1) and tracheal invasion (n = 2) were identified by MRI in seven, zero, and one, and by US in six, zero and zero patients, respectively. Invasion of the major vessels was not seen. Metastatic cervical nodes were present in 19 nodal groups in 10 patients involving the internal jugular chain (n = 10), posterior triangle (n = 4) supraclavicular fossa (n = 1) and central group (n = 4). Both MRI and US failed to identify metastatic nodes in the central group but correctly identified 14 of the 15 nodal groups outside the central group. CONCLUSION: Ultrasound should be used as the first line of investigation for detecting the primary lesion, multifocal disease and cervical lymphadenopathy. In cases where the primary tumour is not surrounded by normal thyroid tissue MR imaging should be added to assess extracapsular spread, especially into the trachea.     

The environment and falls prevention: Do environmental modifications make a difference?

Background and Aims:  Environmental modification is a strategy widely recommended in many falls prevention programs. However the effectiveness of such a strategy has not been well established. This study aimed to evaluate published research related to falls prevention and environmental modification for older people.
Method:  A review of research conducted between 1993 and 2004 was undertaken. Ageline, Cinahl and OvidMedline databases were searched using falls prevention, home modifications, environmental modifications and occupational therapy as key words.
Results:  Eighteen articles were found relating to community and institutional dwellings and the relevance of environmental modifications.
Conclusion:  There is some evidence to support the use of environmental modification as a strategy in falls prevention for older people particularly in association with multidisciplinary/multifactorial programs targeted to those people with a history of falls.     

Cellular expression of ionotropic glutamate receptor subunits in subpopulations of neurons in the rat substantia nigra pars reticulata

In order to characterize the expression of ionotropic glutamate receptor immunoreactivity in subpopulations of neurons in the rat substantia nigra pars reticulata (SNr), double labeling experiments were performed. Neurons in the reticulata were found to display GluR1, GluR2, GluR2/3, GluR4, N-methyl-D-aspartate receptor 1 (NMDAR1) and NMDAR2B immunoreactivity. Some of the reticulata neurons were shown to display GluR1 and GluR2 immunoreactivity or GluR2 and GluR4 immunoreactivity at the single cell level. In addition, subpopulations of reticulata neurons were characterized on the basis of the strong expression of parvalbumin (PV) and GABA transaminase immunoreactivity. All of the reticulata neurons that displayed strong immunoreactivity for PV or GABA transaminase also displayed immunoreactivity for GluR1, GluR2/3, GluR4, NMDAR1 and NMDAR2B. A tiny portion (around 15%) of reticulata neurons that display NMDAR1 immunoreactivity was found to be PV- or GABA-transaminase-negative. The present results indicate that native alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionate (AMPA)-type receptors and NMDA-type receptors in the rat substantia nigra are composed of heteromeric receptor subunits. The present findings further demonstrate that most of the AMPA-type and NMDA-type glutamate receptor subunits are primarily expressed by subpopulations of neurons in the rat SNr.     

The Value of Ultrasound in Detecting Extra‐Axillary Regional Node Involvement in Patients With Advanced Breast Cancer

Assessment of the regional lymphatics is important for accurate staging and treatment of breast cancer patients. We sought to determine the role of regional ultrasound in providing clinically relevant information. We retrospectively analyzed data from patients who were treated curatively in 1996–2006 at The University of Texas MD Anderson Cancer Center for clinical stage III breast cancer. We compared differences in regional lymph node staging based on ultrasound versus mammography and physical examination in the 865 of 1,200 patients who had external-beam radiation as part of their treatment and regional ultrasound studies as part of their initial evaluation. Ultrasound uniquely identified additional lymph node involvement beyond the level I or II axilla in 37% of the patients (325 of 865), leading to a change in clinical nodal stage. Ninety-one percent of these abnormalities that could be biopsied (266 or 293) were confirmed to contain disease. The sites of additional regional nodal disease were: infraclavicular disease, 32% (275 of 865); supraclavicular disease, 16% (140 of 865); and internal mammary disease, 11% (98 of 865). All patients with involvement in the extra-axillary regional nodal basins received a radiation boost to the involved areas ≥10 Gy. Thus, over one third of patients with advanced breast cancer had their radiation plan altered by the ultrasound findings. Regional ultrasound evaluation in patients with advanced breast cancer commonly revealed abnormalities within and beyond the axilla, which changed the clinical stage of disease and the radiation treatment strategy. Therefore, regional ultrasound is beneficial in the initial staging evaluation for such patients.     

The pharmacological mechanisms of omalizumab in patients with very high IgE levels—Clues from studies on atopic dermatitis

Seventeen case series investigating the effects of omalizumab on patients with atopic dermatitis included patients whose pretreatment serum IgE was above 700 IU/ml, the upper inclusion limit specified in the product label. In all, 107 patients received omalizumab at doses of ≤375 mg every 2 weeks, which is recommended for patients with IgE <700 IU/ml. Among them, 87 improved in clinical symptoms and some did so after the first dose. Among these 87 patients, 35 and 12 had pretreatment serum IgE in the range 700–7000 IU/ml and 7000–121,000 IU/ml, respectively. These results not only suggest the pathogenic roles of IgE and the potential utility of omalizumab in atopic dermatitis, but also raise questions concerning the pharmacological mechanisms of omalizumab in patients with very high IgE levels. If omalizumab at regular doses is proven to treat patients with ultra high IgE (e.g. above 7000 IU/ml) effectively, it probably achieves this without neutralizing most of the IgE produced in the patients and downregulating the high-affinity IgE-Fc receptors on basophils and mast cells. Herein, we propose that a potential main pharmacological mechanism of omalizumab in patients with ultra high IgE is the ability of the rapidly accumulated IgE:omalizumab complexes to trap allergens.