Restaging of recurrent cervical carcinoma with dual-phase [18F]fluoro-2-deoxy-D-glucose positron emission tomography

BACKGROUND: The clinical value of positron emission tomography (PET) with [18F]fluoro-2-deoxy-D-glucose (FDG) for primary staging in cervical carcinoma appears to be promising. The authors sought to evaluate the diagnostic efficacy and benefit of PET in restaging cervical carcinoma at the time of first recurrence. METHODS: Forty patients with cervical carcinoma who experienced confirmed treatment failure but who were feasible candidates for curative salvage therapy were enrolled prospectively in the current study. Restaging was performed with PET and with computed tomography and/or magnetic resonance imaging (CT/MRI). Dual-phase PET was performed by adding 3-hour-delayed images to the 40-minute scans. The results of the PET and CT/MRI scans were compared. Lesion status was determined by pathologic findings or by clinical follow-up. The receiver operating characteristic curve method with calculation of area under the curve (AUC) was used to evaluate diagnostic efficacy. The primary endpoint was percent improvement in restaging (with improvement indicated by treatment modification) after PET. The secondary endpoint was 2-year overall survival among study participants compared with comparable previously treated patients who did not undergo disease restaging with PET. RESULTS: Twenty-two patients (55%) had their treatment modified due to PET findings. PET was significantly superior to CT/MRI (sensitivity: 92% vs. 60%; AUC: 0.962 vs. 0.771; P<0.0001) in identifying metastatic lesions. For individuals receiving primary surgery, a significantly better 2-year overall survival rate was observed among study participants compared with patients who underwent disease restaging without PET (HR, 0.21 [95% confidence interval, 0.05-0.83]; P=0.020). CONCLUSIONS: Dual-phase FDG-PET is superior to CT/MRI in the restaging of recurrent cervical carcinoma. Restaging with PET provides benefit by allowing the physician to offer optimal management of recurrent cervical carcinoma.     

Mesenteric and omental cysts: An ultrasonographic and clinical study of 15 patients

The clinical and ultrasonographic (US) features of 15 cases of mesenteric or omental cyst are herein described. This series included seven male and eight female patients, whose age ranged from 2–89 years. Correct clinical diagnosis was made in two children only, but preoperative US examination accurately demonstrated the lesion in 11 of 13 patients (85%). These cystic lesions usually had a thin wall, internal septations, and fluid content with sedimentation. Enteric duplication cysts had a relatively thick wall merging with the muscle layer of bowel loop, and multiloculation was noted mainly with cystic lymphangiomas or pseudocysts. The diagnostic and surgical management of these lesions are briefly reviewed and their US appearance is illustrated.     

Senescence-initiated reversal of drug resistance: specific role of cathepsin L

The present study was undertaken to verify whether induction of senescence could be sufficient to reverse drug resistance and, if so, to determine the underlying mechanism(s). Our findings indicated that cotreatment of drug-resistant neuroblastoma cells with doxorubicin, at sublethal concentrations, in combination with the pan-caspase inhibitor, Q-VD-OPH, elicited a strong reduction of cell viability that occurred in a caspase-independent manner. This was accompanied by the appearance of a senescence phenotype, as evidenced by increased p21/WAF1 expression and senescence-associated beta-galactosidase activity. Experiments using specific inhibitors of major cellular proteases other than caspases have shown that inhibition of cathepsin L, but not proteasome or cathepsin B, was responsible for the senescence-initiated reversal of drug resistance. This phenomenon appeared to be general because it was valid for other drugs and drug-resistant cell lines. A nonchemical approach, through cell transfection with cathepsin L small interfering RNA, also strongly reversed drug resistance. Further investigation of the underlying mechanism revealed that cathepsin L inhibition resulted in the alteration of intracellular drug distribution. In addition, in vitro experiments have demonstrated that p21/WAF1 is a substrate for cathepsin L, suggesting that inhibition of this enzyme may result in p21/WAF1 stabilization and its increased accumulation. All together, these findings suggest that cathepsin L inhibition in drug-resistant cells facilitates induction of senescence and reversal of drug resistance. This may represent the basis for a novel function of cathepsin L as a cell survival molecule responsible for initiation of resistance to chemotherapy.     

Extrarenal Wilms tumor occurring in the inguinal canal

We report an unusual case of extrarenal Wilms tumor discovered incidentally during routine inguinal orchiopexy. The world literature and embryological implications of Wilms tumor in the inguinal canal are reviewed.     

Monomorphous histiocytoma in a child. Report of a case with ultrastructural features suggestive of dendritic cell differentiation

The authors describe a rapidly growing soft tissue tumor of predominantly histiocytic composition in an 8-year-old child. The tumor cells were identified as elements of the mononuclear phagocyte system by histologic, histochemical, immunologic, and electron microscopic study. Despite the presence of a minor fibroblastic component, the tumor did not conform to established criteria for a diagnosis of malignant fibrous histiocytoma. Formation of frequent desmosome-like intercellular junctions raised the possibility of dendritic reticulum cell differentiation, since the latter cells seem to be the only elements of the mononuclear phagocyte system that display such specialized cell junctions. The results of immunostaining were discrepant with those reported for normal dendritic reticulum cells, but the currently available information makes it doubtful that the entire neoplastic spectrum of dendritic cell differentiation can currently be diagnosed in surgical pathology.     

Stimulation of cells derived from nifedipine-induced gingival overgrowth with Porphyromonas gingivalis, lipopolysaccharide, and interleukin-1beta

The purpose of this study was to clarify the main contributory factor of nifedipine-induced gingival overgrowth either by Porphyromonas gingivalis lipopolysaccharide (Pg-LPS) or interleukin-1beta (IL-1beta). Human gingival fibroblasts from healthy tissues and nifedipine-induced gingival overgrowth tissues were stimulated with nifedipine, IL-1beta, Escherichia coli lipopolysaccharide (Ec-LPS), and Pg-LPS, and the gene expressions were analyzed by RT-PCR. Analysis of the data showed no strong evidence of a synergistic effect of nifedipine and Pg-LPS on IL-6, connective tissue growth factor (CTGF), and type 1 collagen gene expression of either healthy cells or nifedipine-induced gingival overgrowth cells. Among the three stimulants--IL-1beta, Pg-LPS, and Ec-LPS--androgen receptor and IL-6 gene expressions in both the healthy and nifedipine-induced gingival overgrowth groups were strongly up-regulated by the presence of IL-1beta only. Furthermore, the responses to IL-1beta in the nifedipine-induced gingival overgrowth group were stronger than those of the healthy group. It can be concluded that IL-1beta is an important mediator responsible for the higher IL-6 and androgen receptor expression of nifedipine-induced gingival overgrowth cells.     

Sleep problems among Taiwanese children with autism, their siblings and typically developing children

The current study compared the sleep schedules, sleep problems among children with autism, their siblings and typically developing children, and to explore other associated factors with sleep problems. We conducted a case-control study consisting 110 children with autistic disorder, 125 unaffected siblings, and 110 age-, sex-, and parental education-matched typically developing children, aged 4-13 years old. We conducted psychiatric interviews to obtain DSM-IV diagnosis of autistic disorder and confirmed by the Chinese Version of the Autism Diagnostic Interview-Revised. The mothers were asked to report on the self-administered questionnaires regarding sleep schedules and problems of their children and parenting styles. Our results showed that children with autism had more sleep problems, including early insomnia, middle insomnia, sleep-wake schedule disorders and daytime napping. Their unaffected siblings also had more risk of early insomnia, sleep-talking and nightmares, compared to the typically developing children in non-autistic family. We also found an association between bring-up experience and nightmare, and between maternal overprotection and middle insomnia and sleep-wake schedule disorder. The findings of increased risks for sleep problems in both children with autism and their unaffected sibling suggest that parenting counseling should be included in intervention of sleep problems in children with autism and their siblings.