Surface triggering receptor expressed on myeloid cells 1 expression patterns in septic shock

Objective To analyze the pattern of cell-surface expression of the triggering receptor expressed on myeloid cells (TREM) 1 during septic shock.Design and setting Prospective clinical study in an adult 16-bed medical ICU.Patients and methods 25 septic shock patients, 15 patients with shock of noninfectious origin and 7 healthy volunteers. Arterial blood was drawn within 12 h of admission and subjected to flow cytometry analysis after staining with anti-TREM-1 and anti-CD14 antibodies. Repeated sampling was performed on days 2, 3, 5, 7, and 14 in septic shock patients.Results Monocytic TREM-1 expression was significantly higher in septic shock patients (mean fluorescence intensity 2.3±0.2) than in nonseptic patients (1.0±0.1), and healthy volunteers (1.0±0.1). There was no difference in monocytic TREM-1 expression between nonseptic patients and healthy volunteers or between any of the three groups with respect to TREM-1 expression on neutrophils. The time course of TREM-1 expression on monocytes diverged significantly by day 3 between survivors and ns.Conclusions The specificity of TREM-1 regulation by infection is highlighted. Moreover, surface TREM-1 expression on monocytes may prove useful in allowing the follow-up of septic patients during the course of the diseaseElectronic Supplementary Material Electronic supplementary material to this paper can be obtained by using the Springer Link server located at .     

Prader-Willi syndrome: is there a recognizable fetal phenotype?

OBJECTIVES: To determine fetal features, which could lead to the diagnosis of Prader-Willi syndrome (PWS) during pregnancy. METHODS: We analyze the ultrasound features, genetic studies and pathologic findings in two cases of PWS diagnosed during pregnancy. RESULTS: In the first case, diminished fetal movement, polyhydramnios and oddly positioned hands and feet suggested PWS. Methylation studies confirmed diagnosis and a deletion was detected in the 15q11-q13 region. In the second case, similar ultrasound findings led to prenatal diagnosis of PWS with an abnormal methylation pattern compatible with uniparental disomy. Both fetuses had a characteristic appearance at 28 and 30 weeks' gestation, which included a peculiar position of hands with flexed wrists and dorsi-extended feet with flexed toes. CONCLUSIONS: The peculiar position of the extremities combined with diminished fetal movement and polyhydramnios seems to be characteristic and should suggest PWS. Copyright (c) 2008 John Wiley & Sons, Ltd.     

Surgical Management of Benign and Borderline Phyllodes Tumors of the Breast

Phyllodes tumors (PT) are uncommon fibroepithelial breast neoplasms and there is currently no clear consensual treatment for these tumors. The aim of our study was to evaluate the surgical management and outcome of benign and borderline PT. We retrospectively assessed 76 cases of benign or borderline PT managed at the Leon Berard comprehensive cancer center in Lyon, France between July 2003 and December 2013. The mean age at diagnosis was 37.9 years and the median follow‐up was 58 months. Seventy‐five patients (99%), with a mean tumor size of 27 mm, underwent a breast‐conserving procedure. The tumor margins were considered positive (when the tumor was present at the inked surgical section) in seven of 76 cases (9%) and negative in 65 out of 76 cases (86%). We observed the presence of small negative surgical margins <10 mm in 89% and <1 mm in 71% of the patients. Although no re‐excision was performed to increase these margins, we did not see any increase in the local recurrence rate (4%) when compared to recurrence rates reported in the literature. We thus suggest that systematic revision surgery for close or positive surgical margins for benign PT should not be systematically performed. However, as recurrences occur within 2 years of initial excision, we recommend a regular clinical and imaging follow‐up especially during this period for which patient's compliance is essential.     

Papular Epidermal Nevus with “Skyline” Basal Cell Layer (PENS) Following a Blaschko Linear Pattern

Papular epidermal nevus with “skyline” basal cell layer (PENS), a variant of epidermal nevi, has recently been described as a small, round or polygonal papule, visible at birth or shortly thereafter, with characteristic histopathologic features. It has been considered a separate entity from keratinocytic nevi because no lesion observed thus far has followed any of the known archetypical mosaic patterns. Here we describe for the first time a PENS lesion following a linear distribution pattern along Blaschko's lines.     

Motion correction and myocardial perfusion SPECT using manufacturer provided software. Does it affect image interpretation?

Purpose  

Myocardial perfusion SPECT is an excellent tool for the assessment of coronary artery disease (CAD); however, it is affected by several artifacts, such as patient motion during acquisition, which increases false-positive rates. Therefore, the purpose of this work is to analyze changes in perfusion scores after motion-correction software application.