Basal cell carcinoma of the eyelid associated with Gorlin-Goltz syndrome

PURPOSE: To describe the ophthalmic and systemic features in a series of patients initially seen with eyelid basal cell carcinoma associated with Gorlin-Goltz syndrome. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Of 105 consecutive patients with eyelid basal cell carcinoma managed at an Ocular Oncology Center between January 1973 and December 1999, four patients with Gorlin-Goltz syndrome were identified. METHODS: The ophthalmic and systemic features, management, and outcome of patients with eyelid basal cell carcinoma associated with Gorlin-Goltz syndrome were analyzed. The published literature on Gorlin-Goltz syndrome, specifically related to genetics, systemic features, ophthalmic associations, and prophylactic management strategies, was reviewed. MAIN OUTCOME MEASURES: Response of the eyelid basal cell carcinoma to treatment and the final systemic condition were the main outcome measures. RESULTS: All four patients had a family history of Gorlin-Goltz syndrome. The systemic manifestations included multiple basal cell carcinomas in all the patients, frontal bossing or increased occipitofrontal circumference in three patients, palmar pits in two patients, odontogenic keratocyst in one patient, ectopic calcification in one patient, and bifid rib in one patient. The mean age at the detection of the first basal cell carcinoma was 30 years (range, 16-38 years). All four patients had multiple basal cell carcinomas on the face and elsewhere. The eyelid basal cell carcinoma was advanced with orbital infiltration in three patients, one of whom opted for palliative radiotherapy, whereas the other two underwent orbital exenteration. The fourth patient, who had localized recurrent basal cell carcinoma in the upper eyelid, was treated with excision and eyelid reconstruction. At the final follow-up (mean, 41 months), eyelid basal cell carcinoma was cured in three patients and stable in one patient. No patient had life-threatening sequelae of Gorlin-Goltz syndrome. CONCLUSIONS: Gorlin-Goltz syndrome is a rare autosomal dominant cancer predisposition syndrome that may be associated with eyelid basal cell carcinoma. The associated systemic findings may be a clue to the diagnosis of this condition. It is important to recognize Gorlin-Goltz syndrome when a patient has multiple basal cell carcinomas or when a young patient with eyelid basal cell carcinoma is seen by an ophthalmologist, because lifelong monitoring is essential for patient management.     

Validation in a community hospital setting of a clinical rule to predict preserved left ventricular ejection fraction in patients after myocardial infarction

BACKGROUND: A previous study showed that patients with previous myocardial infarction (MI) who meet 4 simple clinical and/or electrocardiographic criteria have a left ventricular ejection fraction (LVEF) of 40% or greater, with a positive predictive value of 98%. The objective of this study was to validate this clinical rule in the community hospital setting. METHODS: Retrospective chart review in a 330-bed community hospital. Two hundred thirteen consecutive patients with MI were identified between June 1, 1993, and March 31, 1995. Left ventricular ejection fraction was predicted in a blinded fashion by means of the clinical rule before the actual LVEF test was reviewed. RESULTS: We identified 213 patients admitted with the primary discharge diagnosis of acute MI. All patients met standard clinical and enzymatic definitions for acute MI and had at least 1 measure of LVEF, such as echocardiography, ventricular angiography, or gated blood pool scan. The clinical rule predicted that 83 patients (39.0%) would have an LVEF of 40% or greater. Of these 83 patients, 71 had an ejection fraction of 40% or greater, for a positive predictive value of 86%. Of the 12 patients who were incorrectly predicted to have a preserved LVEF, 6 (50%) had an index non-Q-wave anterior MI (P<.001). Reanalyzing the patient population with a fifth variable (anterior non-Q-wave MI) added to the original 4 variables increased the positive predictive value to 91%. CONCLUSION: This simple clinical prediction rule has a positive predictive value of 86% when applied in the community hospital setting. Patients with anterior non-Q-wave MI may be 1 group in whom the rule is inaccurate, and expanding the clinical rule to 5 variables may increase the positive predictive value. When a technology-based assessment of left ventricular function is considered in patients after an MI, this prediction rule may allow for a more cost-effective patient selection, and as many as 40% of patients who have had acute MIs may require no testing at all.     

老年胃癌患者围手术期并发症及其处理

目的 研究老年胃癌患者的临床特点,总结老年胃癌患者的年龄、术前各种合并症等对术后并发症发生的影响.方法 总结自2005年1月至2007年1月接受手术的181例胃癌患者的临床资料,其中老年患者(年龄大于65岁者)65例,回顾性分析老年胃癌患者的年龄、术前各种合并症与术后并发症发生的关系.结果 老年胃癌组术前合并症总发生率为83%,非老年胃癌组为59%;老年胃癌组中有52%存在2种或2种以上合并症,发生率最高的合并症为高血压,达40%;老年胃癌患者的根治率为86%,非老年胃癌组的根治率为93%;老年胃癌组术后并发症的发生率为37%,术前合并高血压、糖尿病、肺部疾病、低蛋白血症、贫血者术后并发症发生率较高.结论 老年胃癌患者手术治疗后的总并发症发生率和病死率与非老年胃癌患者相比无差异.     

STUDIES IN THE SEROLOGY OF SYPHILIS : I. THE MECHANISM OF THE FLOCCULATION REACTIONS

A. The lipoid antigen used in the serum diagnosis of syphilis, when colloidally dispersed in water, forms a relatively stable amphoteric suspension with predominantly hydrophilic properties. Although the colloidal particles flocculate at their isoelectric point (pH 1.9), in more alkaline reaction the negative surface potential prevents their cohesion and must be depressed to 1 to 5 millivolts before visible flocculation is obtained, indicating a very slight affinity between the colloidal particles. The amount of electrolyte necessary to depress this surface charge below its critical value decreases somewhat with increasing concentration of the sol, but is uniformly large: in a suspension containing 0.04 per cent lipoid, 1 M univalent and 1/40 M bivalent cation are the coagulation values. B. In normal serum, hydrophilic protein is adsorbed, forming a protective film around the individual lipoid particles, with a corresponding change in the cataphoretic potential and the isoelectric point towards those of serum protein, the degree of shift depending upon the extent of the adsorbed film. The critical potential, however, is not affected, and the lipoid remains as stable away from its isoelectric point as in the absence of serum. The water-soluble film of unchanged protein is readily removed by washing, and does not prevent the subsequent combination of the underlying lipoid with the specific component of syphilitic serum. C. When the lipoid antigen is added to syphilitic serum, in addition to this loose adsorption of normal protein it combines more or less irreversibly with a specifically altered fraction of the serum globulin (reagin), demonstrable in the washed precipitate both chemically and by sensitization experiments. Like adsorbed normal serum, it depresses the surface potential and causes a shift in the isoelectric point; but there the similarity ends. The reagin-globulin is rendered water-insoluble by its firm combination with the lipoid, exactly as any antibody is denatured upon combination with its specific antigen (bacteria, red cells, or dissolved protein). The hydrophobic films of reagin have five times as great an affinity for each other as the original lipoid surfaces; accordingly, the critical potential is raised from its original value of 1 to 5 millivolts to 10 to 15 millivolts, that of particles of denatured globulin or of any antigen-antibody complex, and relatively small quantities of electrolytes (at serum pH, cations) suffice to depress the stabilizing potential below this critical level, with resultant aggregation and flocculation. In brief, a specific globulin combines with the colloidal particles of the antigen, conferring upon them the unstable properties of a suspension of denatured protein. Like the antibody film on bacteria, or red cells, and unlike normal adsorbed protein, the reagin globulin on the lipoid particle can adsorb ("fix") complement. When this protein film is destroyed by heat-coagulation, the complement-fixing property is lost; concomitantly, the specific groups of the lipoid having been freed from the closely adherent reagin, the antigen becomes again active, able to react with more syphilitic serum. These changes in the properties of reagin globulin upon its combination with the lipoid antigen (denaturation) are in every sense analogous to those effected in any antibody by its specific antigen, and are probably due to the same, as yet unknown, factors. It has been suggested for bacterial and red cell "agglutinins" and protein "precipitins," that the groups of the antibody determining its specificity are also those which endow it with its hydrophilic properties; when these combine with antigen, residual free hydrophobic groups determine the surface properties of the complex. The same tentative hypothesis may be offered for the denaturation of reagin globulin by the lipoid antigen. The complete analogy between the flocculation reactions for syphilis and the so-called specific reactions (bacterial and red cell agglutination; protein precipitation) suggests that like agglutinins, precipitins, etc., reagin globulin represents an antibody response to products of infection.     

The University of Michigan Honest Broker: A Web-based Service for Clinical and Translational Research and Practice

For the success of clinical and translational science, a seamless interoperation is required between clinical and research information technology. Addressing this need, the Michigan Clinical Research Collaboratory (MCRC) was created. The MCRC employed a standards-driven Web Services architecture to create the U-M Honest Broker, which enabled sharing of clinical and research data among medical disciplines and separate institutions. Design objectives were to facilitate sharing of data, maintain a master patient index (MPI), deidentification of data, and routing data to preauthorized destination systems for use in clinical care, research, or both. This article describes the architecture and design of the U-M HB system and the successful demonstration project. Seventy percent of eligible patients were recruited for a prospective study examining the correlation between interventional cardiac catheterizations and depression. The U-M Honest Broker delivered on the promise of using structured clinical knowledge shared among providers to help clinical and translational research.     

Does the visual system exploit projective geometry to help solve the motion correspondence problem?

Projective geometry determines how the retinal image of an object deforms as it moves through three-dimensional space. Does the visual system use constraints derived from this information, such as rigidity, to aid the tracking of moving objects? A novel psychophysical technique is introduced for assessing which of two competing motion transformations is 'preferred' by the visual system, in a two-frame sequence. In the first experiment, relative preference strengths for translations parallel and perpendicular to the major axis of a wire-frame object were measured by pitting the two against each other. It was found that parallel translations were preferred to perpendicular ones. On the basis of these data a proximity measure for normalising different transformations, independent of any effects of figural similarity, was developed. In the second experiment, two wire-frame planar structures were used to pit one of five transformations (rotation, expansion, vertical expansion, shear and random jitter) against a translation. Preference strength was measured as the translation distance at which the transformation and the translation were perceived with equal frequency. The PSEs were found to collapse on to a single line when plotted against the proximity magnitude, with the exception of a residual preference for pure translation over all other transformations. In general, these results suggest that preference strength for moving wire-frame figures is determined primarily by the proximity of local features on the displacing contour, with little regard for the projective shape transformation.