Endometrial cancer patients have a significant risk of harboring isolated tumor cells in histologically negative lymph nodes

In this study, we examine the prevalence of finding isolated tumor cells (ITCs) in negative lymph nodes of endometrial cancer patients using immunohistochemistry. Seventy-six endometrial cancer patients with lymph nodes histologically negative for metastatic disease were examined. Nodal tissue sections were stained with anticytokeratin antibodies AE-1 and CAM 5.2. Nodes with single or groups of cells (two to four cells) < or =0.2 mm and showing cytokeratin reactivity were positive for ITCs. Findings were compared to features of the primary tumor and patient outcome. ITCs were present in 31 of 1712 lymph nodes. Fifteen (19.7%) patients had ITC-positive nodes. ITCs involved only pelvic nodes in nine cases, only para-aortic nodes in five cases, and pelvic and para-aortic in one case. Tumor in adnexa was the only pathologic feature associated with nodal ITCs (P= 0.0485). All 15 patients with nodal ITCs were alive at follow-up. One (6.7%) patient suffered recurrent disease but was alive at last encounter. Disease recurred in 5 (8.8%) of 57 patients without nodal ITCs. Two are alive without disease, two alive with disease, and one died from her cancer. In summary, a significant proportion of endometrial cancer patients have ITCs detected by immunohistochemistry in histologically negative regional lymph nodes.     

Left pulmonary artery evaluation through transesophageal echocardiography.

INTRODUCTION: Transesophageal echocardiography (TEE) has become increasingly useful in the study of patients with suspected pulmonary thromboembolism. OBJECTIVE: The aim of this study was to prospectively evaluate the usefulness of TEE in the study of the distal part of the left pulmonary artery (LPA) as well as the influence of this procedure on total echocardiographic exam duration. METHODOLOGY: A prospective study in two groups of consecutive patients referred for TEE with a one- year interval between evaluation of Group A: 33 patients, 17 male, mean age 54 +/- 24 years, and Group B: 42 patients, 20 male, mean age 48 +/- 27 years (p = NS). The procedure was considered long when it took more than 3 min to evaluate the distal part of the LPA. RESULTS: In group A we were able to visualize the distal part of the LPA in 24 patients (73%) without significant prolongation of total exam duration in 16 patients (48% of group A). In one of the patients with suspected pulmonary thromboembolism thrombi were only observed in the distal part of the LPA. In group B we were able to visualize the distal part of the LPA in 36 patients (86%) without significant prolongation of total exam duration in 26 patients (61% of group B). CONCLUSIONS: 1. Visualization of the distal part of the LPA was possible in more patients, and with TEE time prolongation in less patients, in group B. These differences can be accounted for by the training of the operator in this technique. 2. The importance of visualization of this part of the LPA in guiding treatment in the subset of patients with pulmonary thromboembolism confirms the usefulness of this specific procedure.     

Evaluation of an enzyme immunoassay kit for estrogen receptor measurement--report II

We present evidence to show that monoclonal antibodies to estrogen receptors (ER) in solid phase recognize the secondary estrogen binding sites with moderate to low affinity for estradiol (E2). An excellent quantitative agreement was found in five cytosols between the ER values obtained by the enzyme immunoassay (ER-EIA) and the amount of secondary estrogen binding sites measured by the assay involving dextran-coated charcoal (Clin Chem 1986;32:1496). The immunoreactive protein recognized by the antibody-coated beads, when allowed to react with ER(+) cytosols, is shown to bind [3H]estradiol only when the ligand concentration exceeds 8 nmol/L. Further biochemical and functional characterization of the immunoreactive protein is required to establish similarities/dissimilarities between this protein, high-affinity Type I ER sites, and the secondary sites such as Type II sites.     

Die klassifikatorische und pr?diktive Qualit?t des Merkmals “suicide intent” bei Parasuiziden Eine clusteranalytische Untersuchung Eine clusteranalytische Untersuchung

In einer clusteranalytischen Untersuchung mit 137 Patienten, die einen Parasuizid verübt hatten, wurden 6 Subgruppen unter Berücksichtigung der Klassifikationsvariable “suicide intent” isoliert. Es wurde die Hypothese geprüft, dass sich sowohl die Motivstrukturen als auch die Raten an wiederholten Parasuiziden in Abh?ngigkeit der Clusterl?sung bedeutsam voneinander unterscheiden. Die Ergebnisse unterstützen die Annahme einer zunehmenden Ausdifferenzierung der interpersonell orientierten Motivstrukturen mit sinkendem bzw. einer Einengung der Motivstruktur auf den Todeswunsch mit steigendem “suicide intent”. Es wurden folgende Subgruppen differenziert: eine Suizid-Hochrisikogruppe mit ausschlie?licher Todesintention und -motivation, 2 moderate Suizid-Risikogruppen mit hoher Todesintention und leichten Tendenzen zu interpersoneller Motivation, eine Subgruppe, gekennzeichnet durch eine manipulativ/strategisch orientierte Motivstruktur und auff?llig h?ufigen Parasuizidwiederholungen, eine Subgruppe mit vorrangig appellativ orientierten Motiven, Kontrollverlust und vergleichsweise seltenen Parasuizidwiederholungen und eine Subgruppe mit ambivalenter Motivstruktur (interpersonell und todesorientiert).     

Delayed presentation of traumatic popliteal artery pseudoaneurysms: a review of seven cases.

OBJECTIVES: to examine the management and outcome of patients with traumatic popliteal artery pseudoaneurysms with delayed presentation. MATERIALS: over a 2-year period 7 patients with traumatic popliteal pseudoaneurysms presenting to a tertiary referral unit after a delay of 1 month were reviewed. METHODS: a retrospective review of clinical records. RESULTS: the median interval between injury and presentation was 1.5 months (range 1-24 months). Penetrating trauma from gunshot wounds was the cause of the initial vascular injury in 6 patients and a stab wound in one. All patients had large pseudoaneurysms of more than 8 cm filling the popliteal fossa with variable degrees of fixed flexion deformity (FFD) of the knee. Severe FFD of more than 40 degrees was noted in 2 patients and 3 others had mild flexion deformities of 10 to 20 degrees. Six patients underwent repair of the pseudoaneurysm. One patient required an above knee amputation due to an infected false aneurysm. There were no deaths or graft related complications. Despite aggressive post-operative physiotherapy only 2 patients were able to completely straighten the leg at the time of discharge. CONCLUSIONS: in patients with neglected popliteal artery pseudoaneurysms, morbidity is associated with the pre-operative degree of fixed flexion deformity of the knee.     

The effect of bracing on proprioception of knees with anterior cruciate ligament injury.

This paper is a comprehensive review on the effect of bandaging, bracing, and neoprene sleeves on knee proprioception following anterior cruciate ligament (ACL) injury and reconstruction with a focus on studies that have measured joint position sense and threshold to detection of passive knee motion. Disruption of the ACL does not appear to alter joint position sense soon after injury, although there is evidence that in some subjects deterioration may occur over time. An ACL tear creates a deficit in the threshold to detection of passive knee motion soon after injury and in those with chronic tears. The magnitude of worsening is less then 1.0 degree of movement in flexion-extension and of questionable concern from a clinical and functional perspective. Application of a functional brace or neoprene sleeve to the ACL-deficient limb does not improve the threshold to detection of passive knee motion; however, application of an elastic bandage to a knee with an ACL tear improves joint position sense. Reconstruction of a torn ACL is associated with a deficit in the threshold to detection of passive knee motion, and during the first year of healing the use of a neoprene sleeve provides improvement. Two years following ACL reconstruction there is no deficit in the threshold to detection of passive knee motion and the use of a brace has no effect on this outcome.