Localized giant pseudo polyposis of the colon. Apropos of a case

A giant pseudo-polyposis lesion was diagnosed clinically and radiologically as cancer of right side of colon. The etiopathology of this lesion can probably be explained by the hemorrhagic rectocolitis that developed three years after its excision.     

Long-term results of harris total hip replacement

The long-term clinical and radiographic results of 38 Harris total hip replacements performed on 31 patients (average age, 50.7 years), with an average follow-up period of 11.5 years, were reviewed. According to a modified d'Aubigne-Postel hip rating system, 14 hips were rated excellent, 19 good, 4 fair, and 1 poor. Only one patient had revision surgery for symptomatic acetabular and femoral loosening. Eight acetabular components migrated, usually after 10 years; this did not correlate with an unsatisfactory clinical result, except in one hip. There was subsidence or loosening of the femoral component in five hips, usually associated with a technical error or severe calcar resorption; this occurred early and did correlate with an unsatisfactory clinical result. Clinical results were satisfactory in 86% of the hips with long-term follow-up study. However, radiographic failure occurred in 34% of the hips, with a predominance of late acetabular migration.     

Antibodies to cardiolipin in stroke: association with mortality and functional recovery in patients without systemic lupus erythematosus

Antibodies to cardiolipin were measured in 100 consecutive patients with first ever stroke, on admission and at three and six months after the acute event. One hundred healthy, age- and sex-matched, British elderly individuals were also screened for antibodies to cardiolipin as a control group. Elevated levels of anticardiolipin antibody (i.e. 5 SD above the laboratory control mean) were present in none of the control group, but in 21 per cent of the patients with stroke. Thirteen of these 21 patients (62 per cent) died within three months, compared to 17 (21.5 per cent) of the seventy-nine patients without elevated levels of anticardiolipin antibodies (p less than 0.001). Six of the eight survivors with persistently elevated anticardiolipin antibodies had significant residual disability following stroke (Barthel score 0-9) compared to 11 of the 62 without (p less than 0.001). Two patients with initially raised anticardiolipin antibodies who became independent at six months showed a progressive decline in the level of these antibodies to normal. The presence of high levels of anticardiolipin antibody did not correlate with other recognized prognostic indices of stroke, except for incontinence. No correlation was noted between levels of antibody to cardiolipin, antinuclear factor, antibody to double-stranded DNA and C-reactive protein, either in the stroke patients or in the elderly control population. Hypertension was significantly more common in the patients with high anticardiolipin antibodies than in the rest of the patients in the stroke population (p = 0.33). There was no correlation between levels of anticardiolipin antibody and age. Anticardiolipin antibody may be considered as an independent prognostic marker for both mortality and clinical outcome after acute stroke.     

Orbitopalpebral repair after 835 excisions of malignant tumours.

Repair of any defect in the eyelid depends on its size and position and the state of the surrounding tissues. Basal cell carcinoma (BCC) is the most common malignant tumour of the eyelids, and squamous cell carcinoma (SCC), mixed carcinomas or basosquamous cell carcinomas (BSC), and cutaneous melanomas (CM), also invade the eyelids and periocular zones. Reconstruction of the eyelids and associated orbital structures after resection requires a complete understanding of the anatomy. The adequacy of the reconstruction is judged by the quality of functional restoration and the aesthetic appearance. The purpose of this study was to document various, simple or complex reconstructive procedures that may be used after excision of malignant tumours of the eyelids and to assess the outcome of surgical treatment.     

Prediction of drug residence times in regions of the human respiratory tract following aerosol inhalation

A mathematical model was developed for predicting drug residence kinetics in various regions of the human respiratory tract (RT). The model allows for regional deposition of different dose fractions (following mouth inhalation of various particle sizes according to four popular breathing regimes). Predicted alveolar deposition was dependent on the mode of inhalation and breath-holding. Deposition in the ciliated airways, however, was largely unaffected by breath-holding and was at a maximum for aerodynamic diameters between 5-9 micron (slow inhalation) and 3-6 microns (fast inhalation). Selected mucociliary and absorption rate constants determined the durations (T) taken to deplete the initial deposition in a chosen lung region to a selected minimum dose fraction (MDF). Values of T for an MDF of 0.01 in the ciliated airways were dependent on aerosol size, mode of inhalation, and rate of dissolution. In the case of rapidly dissolving solutes, the maximum duration was short (1-2 h) and occurred at particle sizes and modes of inhalation which maximized deposition in the conducting airways. For less soluble particles, however, T in the same airways could approach 12 h due to a prolonged supply of particles from the alveolar regions. The optimal size distribution and the mode of inhalation for maximum duration differed substantially in each case. The model enables formulation of testable hypotheses relating to the extension of local drug residence in the RT following inhalation of therapeutic aerosols.     

The ossified hyoid apparatus--morphology, interpretation, clinical and functional significance. Presentation of a rare case and highlights of the literature

A rare and unique case of completely ossified hyoid apparatus, found in an 80 years old female cadaver, is presented. The ossified apparatus consists of 4 bones bilaterally--the stylohyal, the main and the accessory keratohyal and the hypohyal--of which the 2 first, on the left and the second and third, on the right, were almost fused. In addition a very long lesser cornu, exceeding 35 mm, was noted bilaterally. Highlights of the literature are given with respect to anatomy, comparative anatomy, embryology as well as to clinical and functional implications.     

Apical Membrane Alterations in Non-intestinal Organs in Microvillus Inclusion Disease

Objectives

Microvillus inclusion disease (MVID) is a severe form of neonatal diarrhea, caused mainly by mutations in MYO5B. Inactivating mutations in MYO5B causes depolarization of enterocytes in the small intestine, which gives rise to chronic, unremitting secretory diarrhea. While the pathology of the small intestine in MVID patients is well described, little is known about extraintestinal effects of MYO5B mutation.

Methods

We examined stomach, liver, pancreas, colon, and kidney in Navajo MVID patients, who share a single homozygous MYO5B-P660L (1979C>T p.Pro660Leu, exon 16). Sections were stained for markers of the apical membrane to assess polarized trafficking.

Results

Navajo MVID patients showed notable changes in H/K-ATPase-containing tubulovesicle structure in the stomach parietal cells. Colonic mucosa was morphologically normal, but did show losses in apical ezrin and Syntaxin 3. Hepatocytes in the MVID patients displayed aberrant canalicular expression of the essential transporters MRP2 and BSEP. The pancreas showed small fragmented islets and a decrease in apical ezrin in pancreatic ducts. Kidney showed normal primary cilia.

Conclusions

These findings indicate that the effects of the P660L mutation in MYO5B in Navajo MVID patients are not limited to the small intestine, but that certain tissues may be able to compensate functionally for alterations in apical trafficking.

     

Gemcitabine Combined with the mTOR Inhibitor Temsirolimus in Patients with Locally Advanced or Metastatic Pancreatic Cancer. A Hellenic Cooperative Oncology Group Phase I/II Study

Background

The prognosis of patients with advanced pancreatic cancer is dismal, and there is a need for novel and effective treatments.

Objectives

Tο determine the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of a novel gemcitabine (G) and temsirolimus (T) combination (phase I) and estimate the 6-month progression-free survival (PFS) in patients treated with the T?+?G combination (phase II).

Patients and Methods

Eligible patients with histologically confirmed inoperable or metastatic pancreatic carcinoma (MPC) were entered into the trial. G was given bi-weekly and T weekly in a 4-week cycle. The first dose level was set at G 800 mg/m² and T 10 mg. G was escalated in increments of 200 mg/m² and T in increments of 5 mg until DLT was reached, and the recommended dose was used for the phase II part.

Results

Thirty patients were enrolled in the phase I component at the pre-planned six dose levels; one bilirubin DLT of grade III occurred at the first dose level. The MTD was established as the approved doses of both drugs. Fifty-five patients were entered into the phase II component. Median relative dose intensities administered in the first cycle were 0.75 for T and 0.99 for G. Grade 3-4 hematological toxicities were recorded in 87.3% of patients. The most common non-hematological adverse events were metabolic disorders (81.8%) followed by gastrointestinal disorders (63.6%). Median PFS was 2.69 months (95% CI 1.74-4.95) and median OS was 4.95 months (95% CI 3.54-6.85), while the 6-month PFS rate was 30.9%.

Conclusions

Combination of G and T is feasible in patients with locally advanced or MPC with manageable side effects, but lacks clinical efficacy.The study was registered in the Australian New Zealand Clinical Trials Registry (ACTRN12611000643976).