Prognostic factors and the role of nephrectomy in metastatic renal cell carcinoma

The objective of this study is to evaluate the prognostic factors and the role of nephrectomy in metastatic renal cell carcinoma. We reviewed 62 cases of metastatic renal cell carcinoma to document the factors influencing survival and to evaluate the role of nephrectomy. Sex and age of patients, size of primary tumor, site and number of metastases, nephrectomy, cell type and grade of tumor and medical treatment were analyzed as prognostic factors. Age and sex, cell type and type of medical treatment cannot be considered reliable predicting factors. However, improved survival was correlated with tumor size < or = 7 cm in diameter, low grade histology, metastasis limited to single organ and removal of the primary tumor. When these parameters were analyzed in a multivariate model, the presence of nephrectomy was the sole significant parameter. We therefore suggest that nephrectomy should be considered in all patients with metastatic renal cell carcinoma, as long as the morbidity of the operation is acceptable.     

The effect of prostaglandins, branched-chain amino acids and other drugs on the outcome of experimental acute porcine hepatic failure

Prostaglandins, N-acetyl-cysteine, cholestyramine and essential phospholipids have all been shown to protect experimental animals from severe hepatic damage in various models when used prophylactically. Silibinin has been used in the treatment of Amanita phalloides poisoning. Branched-chain amino acids have been recommended in acute hepatic failure. We have used all these forms of therapy at the time of initiation of hepatic failure in a reliable pig model. Of the above, only prostaglandins have been shown to reverse the effects of the hepatic insult in terms of prolonged survival and histological changes. Although conventional liver function tests and plasma amino acids in prostaglandin-treated animals are not improved, cerebrospinal fluid amino acids remain normal, in contrast to the other groups of untreated and treated hepatic failure animals.     

Fatigability as a function of physical activity energy expenditure in older adults

Increased fatigue is a predictor of morbidity and mortality in older adults. Fatigability defines a change in performance or self-reported fatigue in response to physical activity (PA). However, the relationship of fatigability to PA-related energy expenditure (PAEE) is unknown. Changes in performance, fatigue, and energy expenditure were measured simultaneously in 17 adults (11 females, 74–94 years old) performing eight standardized PA tasks with various energy expenditure requirements in a whole-room indirect calorimeter. Change in performance was objectively measured using a PA movement monitor and change in fatigue was self-reported on a seven-point scale for each task. Performance and perceived fatigability severity scores were calculated as a ratio of change in performance and fatigue, respectively, and PAEE. We found that change in both objective performance and self-reported fatigue were associated with energy expenditure (Spearman rho = −0.72 and −0.68, respectively, p < 0.001) on a task requiring relatively high level of energy expenditure. The performance and perceived fatigability severity scores were significantly correlated (rho = 0.77, p < 0.001) on this task. In summary, results of this proof of concept pilot study show that both perceived and performance fatigability severity scores are related to PAEE-induced fatigue on a task requiring relatively high level of energy expenditure. We conclude that fatigability severity is a valid measure of PAEE-induced fatigue in older adults.     

Free-Floating Tumor Thrombus in the Left Atrium Associated with Non-Small Cell Lung Cancer

Abstract   A free-floating tumor thrombus in the left atrium is an unusual metastasis of non-small cell lung cancer. Surgical resection of free-floating tumor thrombus prior to adjuvant therapy relieves cardiac symptoms such as exertional dyspnea, and prevents life-threatening complications including systemic embolization, mitral obstruction, or sudden death.     

Atypical endometrial stromal cells related with a polypoid leiomyoma with bizarre nuclei: a case report.

We presented a polypoid leiomyoma with bizarre nuclei having atypical endometrial stromal cells adjacent to the leiomyoma. Although atypical stromal cells of the female genital tract have been described, to our knowledge, no lesion identical to ours has been reported thus far. These atypical cells may be mistaken for malignant cells on histologic examination, especially in small endometrial samples. To differentiate these kinds of atypical-featured lesions from sarcoma is important, especially in curettage materials. The etiology and precise nature of multinucleated giant cells and atypical stromal cells in the endometrium are unclear. To prevent radical surgery, pathologists must be familiar with these atypical cells in the female genital tract.     

Use of fluorescence resonance energy transfer for rapid detection of isoniazid resistance in Mycobacterium tuberculosis clinical isolates.

SETTING: Rapid detection of drug resistance in Mycobacterium tuberculosis is important to select effective treatment and prevent transmission of resistant isolates. OBJECTIVE: To evaluate the use of fluorescence resonance energy transfer (FRET) for rapid detection of isoniazid (INH) resistance in M. tuberculosis clinical isolates. DESIGN: One hundred INH-resistant and 50 INH-susceptible isolates of M. tuberculosis were included in the study. The drug susceptibility of all isolates was determined by the standard agar proportion method, and all isolates were then tested by FRET. Three genes associated with INH resistance, katG, inhA and ahpC, were analysed. All isolates were amplified with three pairs of primers. Three pairs of fluorescently labelled DNA probes specific to codon 315 of katG, nucleotide 209 in the regulatory region of inhA and a frequent mutation site in the intergenic region of oxyR-ahpC, were used for mutation detection. RESULTS: The results obtained using FRET were compared with those from the proportion method. The sensitivity and specificity of FRET were respectively 76% and 100%. The frequencies of mutations were 48% in katG, 17% in inhA, 8% in ahpC, 2% in inhA-ahpC and 1% in inhA-katG. CONCLUSION: FRET is a rapid, specific method that can be useful to detect INH resistance in M. tuberculosis clinical isolates.     

A predictable pathophysiological model of porcine hepatic failure

A technique is described in which acute hepatic failure may be uniformly induced in pigs using a combination of oral phenobarbitone pretreatment and 2-hour interruption of hepatic arterial blood supply followed by intragastric carbon tetrachloride. This results in deep hepatic coma over a narrowly predictable time span and death within 12-52 h. Amino acid levels in plasma and cerebrospinal fluid obtained 24 h after the induction of hepatic failure were similar to those reported in human and experimental encephalopathy.     

Migraine and stroke in young women

In this paper we review the evidence that migraine is associated with ischaemic stroke in young women, emphasizing potential biases, factors that may influence the association, potential mechanisms, and potential public health impact. Consistency of case-control findings from several countries and supporting evidence from prospective data suggest that the association is not an artifact of study design or execution, although, due to methodological limitations, none of the studies mentioned can be considered definite proof of the association. However, it is less clear whether migraine without aura is associated with stroke or whether the association is restricted to migraine with aura. Similarly, there are few data examining the magnitude of the association among nonusers of oral contraceptives compared with those who use low oestrogen oral contraceptives. As a consequence, there is a lack of data concurrently stratifying both by the presence vs. the absence of aura and by the use of low oestrogen oral contraceptives vs. non-use of oral contraceptives. Moreover, there is still no convincing evidence on the mechanisms that would be implied and on the groups of migraineurs really at risk of ischaemic stroke. Despite the considerable advances in our understanding of the relationship between migraine and stroke, there are many gaps in the data needed for public health recommendations.