Calcified pseudotumor of the pleura: description of a case

We describe a calcifying fibrous pseudotumour of pleura in a 46-year-old female, smoker. The patient presented with a well-delimited pleural mass, 3-cm across, located at the base of the right lung and attached to the lung with a short pedicle. Seven years after surgical excision of the mass, the patient is alive and well. Microscopically, the lesion was mostly composed of dense collagenous tissue, with sparse benign spindle cells, a rich inflammatory infiltrate and scattered calcifications, sometimes laminated. Immunohistochemically, spindle cells were positive for vimentin and negative for smooth muscle actin, desmin, S100 protein, CD34, CD99 and Bcl2. Calcifying fibrous pseudotumour is rare in the pleura. Pertinent data from the literature and problems in differential diagnosis are briefly discussed.     

Determination of ErbB2 protein in breast cancer tissues by different methods. Relationships with other biological parameters

Summary Four different methods to measure in parallel the erbB2 protein expression (p185^neu) were evaluated in order to: a) compare two enzyme immunoassays with the immunohistochemical assays (IHC) and western blotting (WB) and b) extrapolate eventual relationships between erbB2 and biological parameters.Tissue samples from 248 patients with primary breast cancer were consecutively assayed. We used two different cut-off levels for WB, ELISA, and EIA, defined as follows: 1) the highest level of expression of non malignant tissue was chosen as the discriminant threshold between low and elevated samples: 2) the elevated group was further subdivided into two subgroups: intermediate and high, according to their median value. According to the first cut-off, the results were considered elevated in about 52% of cases with the three biochemical methods, while using the second cut-off the percentage lowered to about 26%. Considering this cut-off, the concordance rates between the paired biochemical methods ranged between: 78.4% (WB vs EIA), 93% (ELISA vs EIA), and 82.6% (ELISA vs WB). The comparison between biochemical and immunohistochemical methods gave these concordance rates: 82% (WB vs IHC), 90.5% (ELISA vs IHC), and 85.5% (EIA vs. IHC). According to the first cut off level, 27.5% of tumor samples showed IHC detectable p185 levels, in agreement with other immunohistochemical studies. The relationship between high erbB2 and estrogen and progesterone receptors showed an inverse association. No relationship was found between erbB2 and axillary lymph node positivity or tumor size. In short, the results of the four methods seem generally well correlated; nevertheless, it appears that different methodological approaches of measuring p185^neu are not completely equivalent, and there is a need for an authoritative standardization and quality control for clinical applications.     

Lysozyme localization in normal and diseased human gastric and colonic mucosa. A correlative histochemical, immunohistochemical and immunoelectron microscopic investigation.

The distribution of lysozyme in normal and pathological human gastric and colonic mucosa was studied by light and electron microscopic immunocytochemical techniques and compared with histological and histochemical features. Lysozyme was localized in pyloric glandular epithelial cells, mucous neck cells of fundic glands, Paneth cells and some crypt cells of the mature colonic mucosa. In addition, lysozyme was detected in a large spectrum of "immature" or "regenerative" epithelium: neck cells of the gastric regenerative zone, undifferentiated columnar cells of surface and hyperplastic interfoveolar crests of the stomach, regenerative cells in a healed gastric ulcer, some goblet cells in incomplete intestinal metaplasia, cells of the regenerative zone at the bottom of colonic crypts and, finally, fetal intestinal epithelium. Electron microscopically, we localized lysozyme in the central core of mucous granules in the pyloric gastric glandular epithelium and in the dense mucous granules in gastric mucous neck cells. Lysozyme was also detected in some immature mucin-producing cells of the gastric regenerative zone and in the rough endoplasmic reticulum of surface hyperplastic columnar gastric cells. At the electron microscopic level, a peculiar correlation between the immunopattern of lysozyme and the morphology of mucous granules has been postulated. All our data support and extend the view that the presence of lysozyme may be related to cell immaturity as well as to a regenerative state of the cell. Finally, the lysozyme distribution and its relation to mucosubstances in gastric and colonic carcinoma suggest that lysozyme should not be considered an exclusive marker of cells of gastric derivation.     

Infections After Simultaneous Pancreas and Kidney Transplantation: A Single-Center Experience

Simultaneous pancreas-kidney transplantation (SPKT) is now an accepted therapy for patients with insulin-dependent diabetes mellitus. However, SPKT has an high rate of morbidity and mortality, mainly for infection. From October 1986 to June 2008, in our center 54 patients (18 female; 36 male) affected by diabetes and end-stage renal disease underwent SPKT. The mean duration of diabetes mellitus was 25 ± 4 years. Only 4 patients had not been treated by dialysis before SPKT. Three operative techniques were used: duct injection (n = 5), bladder diversion (n = 14), and enteric diversion (n = 39). The kidneys were always placed into the left retroperitoneal space. The pancreas was placed extraperitoneally in 5 patients. Thirty-four recipients are alive, including 30 with function of both grafts. Six patients died during the first year after transplantation. Infectious complications were the main cause of death in 3 subjects whereas 98 infections were diagnosed in 51 patients. All patients were treated with immunosuppressive agents: steroids associated with calcineurin inhibitors and mycophenolic acid, or azathioprine. Antibody induction was used in 41 patients with anti-interleukin-2 monoclonal antibody or antithymocyte globulin. We detected 41 episodes of cytomegalovirus infection: systemic (n = 38), bladder (n = 2), and duodenal (n = 1). The 51 bacterial infections were systemic: (n = 10); urinary tract: (n = 22); pulmonary (n = 11); wound (n = 5); intestinal (n = 3). The 5 fungal infections were gastrointestinal tract (n = 3); and arteritis (n = 2). Some patients experienced more than 1 type of infection. The predominant etiology of the systemic infections was bacterial. In conclusion, infectious complications were the main causes of morbidity after SPKT. An early diagnosis of infection, particularly fungal complications, is essential. We recommend administration of broad-spectrum prophylactic antibiotics, antifungals, and antiviral agents.     

Stellenwert der Multislice-CT bei der Diagnostik der Lungenembolie

Multislice computed tomography (MSCT) of the pulmonary arteries has overcome the limitations of single-slice CT and is accepted as the sole reference standard for imaging pulmonary embolism (PE) in many institutions. This technique provides the opportunity of efficient risk stratification to enable adequate differential therapy. With a low or intermediate pretest probability and a negative CT angiography (CTA), relevant PE can be ruled out safely. In >30% further diagnoses other than pulmonary embolism, e.g., pneumonia or aortic aneurysm, can be established on the basis of thoracic CTA.This article discusses the present role of MSCT in diagnostic imaging of PE and provides optimized acquisition protocols as well as practical aspects for secondary image reconstruction. Examples of typical imaging features of PE are shown. Diagnostic algorithms for daily emergency practice are discussed with respect to artifacts and pitfalls in image interpretation.     

Correlation between Surface Roughness and Microhardness of Experimental Composites with Varying Filler Concentration

Aim: The purpose of this study was to investigate the influence of the surface roughness on the surface microhardness of experimental composites with varying filler concentration. Materials and methods: Experimental resin composites were formulated by mixing Bis-GMA and TEGDMA in a 50/50% weight ratio and CQ/EDAB were added to make the material photosensitive. Silanized glass particles were incorporated in the resin blend in two concentrations: C50 with 50% and C75 with 75% in weight ratio. The surface roughness and the surface microhardness measurements were determined after every three finishing procedures with #280-, #600- and #1200-grit wet sandpapers, respectively. The data were analyzed statistically by Two Way ANOVA and Tukey's test, and comparisons were conducted using the Spearman's correlation test (p > 0.05). Results: The surface roughness and surface microhardness were negatively associated (r = - 0.68) and the finishing procedures of both composites resulted in harder and smoother surfaces than the initial ones. Additionally, in a smooth circumstance, the higher content of fillers has not resulted in a composite with better microhardness and smoothness. Conclusion: Finishing procedures decreased the surface roughness and consequently improved the surface microhardness of the composites evaluated. Clinical significance: Finishing and polishing procedures are effectives in reducing the surface roughness amplitude of composite materials and in improving their surface microhardness. Thus a microhardness test and any hardness evaluation must be conducted only after a properly finished and polished surface is achieved. Keywords: Laboratory research, Composite resins, Surface properties, Hardness, Roughness, Nanoparticles. How to cite this article: Munchow EA, Correa MB, Ogliari FA, Piva E, Zanchi CH. Correlation between Surface Roughness and Microhardness of Experimental Composites with Varying Filler Concentration. J Contemp Dent Pract 2012;13(3):299-304. Source of support: Nil Conflict of interest: None declared.     

Sentinel Lymph Node Status is a Main Prognostic Parameter Needful for the Correct Staging of Patients with Melanoma Thicker than 4 mm: Single-Institution Experience and Literature Meta-Analysis

Purpose of the study: The usefulness of sentinel lymph node biopsy in thick melanomas is debated. The aim of this study was to evaluate the possible prognostic significance of sentinel lymph node biopsy in T4 melanoma patients and to verify whether this was a homogeneous group of patients with similar poor behavior.

Materials and Methods: A retrospective observational study was performed. Data were extracted from the Tuscan Regional Referral Center database. The outcome of sentinel lymph node-negative and sentinel lymph node-positive T4 melanomas were compared. A systematic review of published series on this issue and a meta-analysis were performed.

Results: Among 125 T4 melanoma patients, 53 patients (42.4%) were sentinel lymph node-positive and 72 (57.6%) patients were sentinel lymph node-negative. The 5-year and the 10-year melanoma specific survival were 81.9% and 72.3% for sentinel lymph node-negative patients and 42.4% and 17.9% (P < 0.001) for sentinel lymph node-positive patients. A positive sentinel lymph node showed an HR of 3.08. The meta-analysis confirmed that there was a significantly greater risk of death for patients with thick melanoma and positive sentinel lymph node (RR 1.75).

Conclusions: The results of the study point out that the sentinel lymph node biopsy is required for the correct staging of patients with melanoma thicker than 4 mm and that the status of sentinel lymph node is a significant predictor of melanoma specific survival. This knowledge allows early surgical and adjuvant treatment as well as appropriate trial enrollment and tailored follow-up.     

Influence of water concentration in an experimental self-etching primer on the bond strength to dentin

PURPOSE: To investigate the influence of different water concentrations in the solvents of self-etching primers on microtensile bond strength (LTBS) of an experimental adhesive system. MATERIALS AND METHODS: Five experimental self-etching primers with 0, 5, 10, 20 and 40 (wt%) water as solvent were formulated. An experimental adhesive resin (AD-50) was also synthesized to create one experimental self-etching adhesive system. Clearfil SE Bond (CSEB) was used as the commercial reference. Sixty bovine incisors were randomly separated into 6 groups. Buccal enamel was removed to expose the superficial coronal dentin; this surface was polished wet to create a standardized smear layer. After rinsing, water was removed, leaving the surface visibly dried. The dentin surfaces were etched with primer and air dried, adhesive resin was applied and photoactivated, then the composite resin restoration was placed. After storage for 24 h, the specimens were sectioned with a cooled diamond saw at low speed. Microtensile bond strength was measured and data were analyzed with one-way ANOVA/Tukey's test (alpha = 0.05). RESULTS: ANOVA showed that primer composition was a significant factor for bond strength. There was no significant difference in bond strengths between the primers with a water concentration of 40% (53.9 +/- 12.7 MPa), 20% (51.1 +/- 11.5 MPa, and 10% (47.5 +/- 11.4 MPa), and CSEB (50.7 +/- 9.8 MPa). The groups with 5% (38.6 +/- 12.9 MPa) and 0% (31.5 +/- 7.5 MPa) water presented similar bond strengths amongst themselves but were statistically significantly lower than that of the other groups. CONCLUSION: The water concentration in the primer solvent exercises a significant influence on the bond strength of this experimental self-etching adhesive system.