Impact of gynecological screening in Lynch syndrome carriers with an MSH2 mutation

Lifetime risk of developing endometrial cancer in Lynch syndrome carriers is very high and females are also at an increased risk of developing ovarian cancer. The aim of the study was to determine the impact of gynecological screening in MSH2 mutation carriers. Gynecological cancer incidence and overall survival was compared in female mutation carriers who received gynecological screening (cases) and in matched controls. Controls were randomly selected from non‐screened mutation carriers who were alive and disease‐free at the age the case entered the screening program. Median age to diagnosis of gynecological cancer was 54 years in the screened group compared to 56 years in controls (p = 0.50). Stage I or II cancer was diagnosed in 92% of screened patients compared to 71% in the control group (p = 0.17). Two of three deaths in the screened group were the result of ovarian cancer. Mean survival in the screened group was 79 years compared to 69 years in the control group (p = 0.11), likely associated with concomitant colonoscopy screening. Gynecological screening did not result in earlier gynecologic cancer detection and despite screening two young women died from ovarian cancer suggesting that prophylactic hysterectomy with bilateral salpingo‐oophorectomy be considered in female mutation carriers who have completed childbearing.     

Ultrastructurally "Invasive" Microvilli in an Aggressively Metastasizing Biphasic Malignant Mesothelioma

The presence of long, slender, often branching microvilli on cell surfaces is a characteristic feature of malignant and benign mesothelial cells. However, these typical microvilli are seen only in better-differentiated lumens within epithelial areas of malignant mesotheliomas. Presented here are the clinical and ultrastructural findings in a biphasic malignant mesothelioma that lacked lumens, but possessed very long microvilli. These invaginated deeply into the cytoplasm of neighboring tumor cells, as well as into the surrounding stromal matrix. The tumor cells had well-formed intercellular desmosomal junctions. The primary tumor was localized to the pleura and invaded the chest wall, but only minimally the lung. Lobectomy demonstrated the presence of metastatic tumor in 2 peribronchial lymph nodes. The disease progressed rapidly and, within 6 months, killed the patient. An autopsy revealed widespread metastases in multiple systemic organs. The authors speculate that the unique ultrastructural features of this case may be a clue to the unusually aggressive course of the neoplasm.     

Diagnosis of type I cryoglobulinaemia made through identifying crystals in the blood smear

We report a case of type I cryoglobulinaemia in a 52-year-old man who presented with widespread cutaneous necrosis. The diagnosis could not be established early on, as repeated testing for cryoglobulin was negative despite a careful collection method. The diagnosis was made 1 year later, on an incidental full blood smear that revealed crystals, which is an uncommon way to diagnose this condition. We discuss the difficulties we faced in establishing the diagnosis and emphasise the need for repeat cryoglobulin testing in this clinical setting. In such cases, examination of a blood smear should be considered.     

Is repeat prostate biopsy for high-grade prostatic intraepithelial neoplasia necessary after routine 12-core sampling?

Objectives. To determine whether repeat biopsy is necessary when the diagnosis of high-grade prostatic intraepithelial neoplasia (HGPIN) is made with a 12-core biopsy. Repeated biopsy has been recommended for individuals with HGPIN noted on sextant prostate biopsy because of the high likelihood of cancer detection. Recently, we have recommended the routine use of 12 cores, rather than 6, to improve cancer detection.Methods. The charts of all patients undergoing prostate biopsy during a 2-year period at the Manhattan Veterans Administration Medical Center were reviewed. Patients diagnosed with HGPIN on a 12-core biopsy were identified, and those undergoing a repeat 12-core biopsy within 1 year of the initial biopsy were evaluated to determine the rate of cancer detection.Results. A total of 619 men underwent biopsy during the study period. Of 103 men diagnosed with HGPIN, 43 underwent a repeat biopsy within 1 year at the discretion of the managing urologist. The mean age and median prostate-specific antigen level of those undergoing a repeat biopsy was 65.5 years and 5.37 ng/mL, respectively. At the time of the repeat biopsy, 1 patient was found to have cancer (2.3%), 20 had HGPIN (46.5%), 20 had benign pathologic findings (46.5%), and 1 patient (2.3%) had atypical small acinar proliferation.Conclusions. A repeat biopsy after the diagnosis of HGPIN on 12-core prostate biopsy rarely results in cancer detection. In the absence of other factors increasing the suspicion of cancer, immediate repeat biopsy for HGPIN diagnosed on a 12-core biopsy is unnecessary.     

Failure of resin-modified glass-ionomers subjected to shear loading.

The mechanism of bond failure of resin-modified glass-ionomers is unknown. This study examined the failure on shear loading at the dentine interface of these materials. Twenty-five teeth (embedded in acrylic blocks) were sectioned longitudinally to expose a flat dentine surface. Cylinders of materials were made by injecting into a tube placed on the dentine of each section surface. The materials used were Fuji Cap II and Fuji II LC (GC Corp., Japan), Vitremer (3M Dental Products, USA), Photac-Fil (original) and Photac-Fil* (new) (ESPE Dental-AG, Germany). After a week, a fluorescent dye was placed in the pulp chamber of each tooth and left for 3 h. The specimens were sectioned through the cylinders before both halves were tested in shear. The failure was observed using a confocal microscope, with video rate images (stored) digitally. The shear load at failure and locus of failure were recorded. All specimens had intact interfaces before testing, except the original Photac-Fil specimens which dislodged from their tooth surfaces even before testing, while being mounted on the device. An amorphous zone or absorption layer was noted at the dentine interface of 60% of Fuji II LC, 22% of Vitremer and all of the Photac-Fil* (new) specimens, but not in Fuji Cap II. Failure was cohesive in Fuji II LC, adhesive in Vitremer, cohesive/adhesive in Photac-Fil* (new) and cohesive in Fuji Cap II. In specimens with the absorption layer present, the failure was at the material/absorption layer interface, leaving it behind on the dentine surface. The mean stresses at failure (MPa) and standard deviations were 5.60, 2.46 (Fuji II LC); 4.82, 0.99 (Vitremer); 4.97, 2.10 MPa (Photac-Fil*); and 3.48, 1.06 (Fuji Cap II). All data were normally distributed as tested by the Shapiro-Francia test. One-way analysis of variance using exact inferential statistics indicated no significant difference between the mean failure stress for all the systems, p = 0.08. The mechanism of failure of resin-modified glass-ionomer materials to shear loading at the dentine interface varies between products. In materials in which the absorption layer is present, it appears to play an important role in mediating the bond of the glass-ionomer to dentine.     

Estimates of aging and secular changes using total arm length

Stature, total arm length, and subischial length were studied in a cross-sectional sample of 387 working (career women) and 460 nonworking women (housewives), 20–75 years of age, from one endogamous group, the Khatris. Statural decrease due to aging was separated from secular effects by using total arm length, which was least affected by aging. The rate of loss in stature due to aging was 0.142 cm/year in the working women and 0.140 cm/year in the nonworking women. Both estimates are significantly different from zero. After adjusting stature for estimated aging effects, the resulting secular estimates were 0.004 cm/year in working women and 0.01 cm/year for nonworking women, both of which do not significantly differ from zero. © 1995 Wiley-Liss, Inc.     

Effect of dentin age on effectiveness of dentin bonding agents.

The purpose of this research effort was to investigate the effect of age changes in dentin on the effectiveness of two dentin adhesives in minimizing microleakage at the tooth-restoration interface. Cavities were prepared in permanent teeth extracted from patients below 20 years or over 55 years of age. Wedge-shaped cervical preparations were made with the gingival cavosurface margin on dentin. Treatment groups were randomly restored with one of two composite restorative materials, together with the appropriate dentin adhesives. The control group specimens were restored with the respective composite restorative materials without the adhesives. All specimens were thermocycled, then placed in 0.5% basic fuchsin dye solution for 24 hours and subsequently sectioned longitudinally. Microleakage at the tooth-restoration interface was assessed by dye penetration. The results showed that the use of adhesives significantly reduced microleakage along the tooth-restoration interface. The adhesive formulated with glycidyl methacrylate was significantly more effective in reducing microleakage in dentin of the over-55 age group.