A genetic dichotomy between pure sclerosing epithelioid fibrosarcoma (SEF) and hybrid SEF/low‐grade fibromyxoid sarcoma: A pathologic and molecular study of 18 cases

Sclerosing epithelioid fibrosarcoma (SEF) is a rare soft tissue tumor exhibiting considerable morphologic overlap with low‐grade fibromyxoid sarcoma (LGFMS). Moreover, both SEF and LGFMS show MUC4 expression by immunohistochemistry. While the majority of LGFMS cases are characterized by a FUS‐CREB3L1 fusion, both FUS‐CREB3L2 and EWSR1‐CREB3L1 fusions were recently demonstrated in a small number of LGFMS and SEF/LGFMS hybrid tumors. In contrast, recent studies pointed out that SEF harbor frequent EWSR1 rearrangements, with only a minority of cases showing FUS‐CREB3L2 fusions. In an effort to further characterize the molecular characteristics of pure SEF and hybrid SEF/LGFMS lesions, we undertook a clinicopathologic, immunohistochemical and genetic analysis of a series of 10 SEF and 8 hybrid SEF/LGFMS tumors. The mortality rate was similar between the two groups, 44% within the pure SEF group and 37% in the hybrid SEF/LGFMS with a mean overall follow‐up of 66 months. All but one pure SEF and all hybrid SEF/LGFMS‐tested cases showed MUC4 immunoreactivity. The majority (90%) of pure SEF cases showed EWSR1 gene rearrangements by fluorescence in situ hybridization with only one case exhibiting FUS rearrangement. Of the nine EWSR1 positive cases, six cases harbored CREB3L1 break‐apart, two had CREB3L2 rearrangement (a previously unreported finding) and one lacked evidence of CREB3L1/2 abnormalities. In contrast, all hybrid SEF/LGFMS tumors exhibited FUS and CREB3L2 rearrangements. These results further demarcate a relative cytogenetic dichotomy between pure SEF, often characterized by EWSR1 rearrangements, and hybrid SEF/LGFMS, harboring FUS‐CREB3L2 fusion; the latter group recapitulating the genotype of LGFMS. © 2014 Wiley Periodicals, Inc.     

Review: Resin Composite Filling

The leading cause of oral pain and tooth loss is from caries and their treatment include restoration using amalgam, resin, porcelain and gold, endodontic therapy and extraction. Resin composite restorations have grown popular over the last half a century because it can take shades more similar to enamel. Here, we discuss the history and use of resin, comparison between amalgam and resin, clinical procedures involved and finishing and polishing techniques for resin restoration. Although resin composite has aesthetic advantages over amalgam, one of the major disadvantage include polymerization shrinkage and future research is needed on reaction kinetics and viscoelastic behaviour to minimize shrinkage stress.     

Feasibility of a Novel Approach to Inguinal Lymphadenectomy: Minimally Invasive Groin Dissection for Melanoma

Introduction

Inguinal lymphadenectomy for metastatic melanoma is reported to have a complication rate as high as 50%. Wound dehiscence has been reported to occur in more than half of these patients, and as a result many surgeons routinely use sartorius muscle transposition to protect against the potential for exposed vessels. We report feasibility of minimally invasive inguinal lymphadenectomy intended to minimize wound complications inherent to this procedure.

Methods

Five patients with histologically confirmed inguinal metastases from melanoma underwent minimally invasive inguinal lymphadenectomy. Procedures were performed via three ports: one at the apex of the femoral triangle, a second two fingerbreadths medial to the adductors, and the third two fingerbreadths lateral to the sartorius. No inguinal incision was utilized for the purpose of surgery. A standard melanoma dissection was performed through these ports: contents of the femoral triangle and 5 cm up onto the external oblique aponeurosis were removed. To validate this technique, sentinel node biopsy scars were excised to permit visual confirmation of adequate anatomic dissection.

Results

Five patients underwent minimally invasive inguinal lymphadenectomy for metastatic melanoma. Median operative time was 180 (range, 142–223) min, median hospital stay was 1 day, and two patients developed cutaneous erythema but neither suffered wound dehiscence. Median nodal yield was 10 (range, 4–13). Blood loss was <100 ml for all procedures. Median duration of drain usage was 8 (range 7–19) days.

Conclusions

Minimally invasive inguinal lymphadenectomy is feasible for patients with melanoma as demonstrated by nodal yield and visual inspection. This technique may reduce complication rates and wound dehiscence, and the risk of exposed vessels is minimized by eliminating the inguinal incision. This obviates the need for routine sartorius muscle transposition. A prospective, randomized trial comparing the open versus the videoscopic approach is currently in progress.     

Delivery room management of very low birth weight infants in Germany,Austria and Switzerland - a comparison of protocols

Background

Surveys from the USA, Australia and Spain have shown significant inter-institutional variation in delivery room (DR) management of very low birth weight infants (VLBWI, < 1500 g) at birth, despite regularly updated international guidelines.

Objective

To investigate protocols for DR management of VLBWI in Germany, Austria and Switzerland and to compare these with the 2005 ILCOR guidelines.

Methods

DR management protocols were surveyed in a prospective, questionnaire-based survey in 2008. Results were compared between countries and between academic and non-academic units. Protocols were compared to the 2005 ILCOR guidelines.

Results

In total, 190/249 units (76%) replied. Protocols for DR management existed in 94% of units. Statistically significant differences between countries were found regarding provision of 24 hr in house neonatal service; presence of a designated resuscitation area; devices for respiratory support; use of pressure-controlled manual ventilation devices; volume control by respirator; and dosage of Surfactant. There were no statistically significant differences regarding application and monitoring of supplementary oxygen, or targeted saturation levels, or for the use of sustained inflations. Comparison of academic and non-academic hospitals showed no significant differences, apart from the targeted saturation levels (SpO₂) at 10 min. of life. Comparison with ILCOR guidelines showed good adherence to the 2005 recommendations.

Summary

Delivery room management in German, Austrian and Swiss neonatal units was commonly based on written protocols. Only minor differences were found regarding the DR setup, devices used and the targeted ranges for SpO₂ and FiO₂. DR management was in good accordance with 2005 ILCOR guidelines, some units already incorporated evidence beyond the ILCOR statement into their routine practice.     

Sequential comparisons of postoperative urodynamic changes between retropubic and transobturator midurethral tape procedures

Objectives  To sequentially compare the postoperative urodynamic changes in patients with urodynamic stress incontinence (USI) who underwent tension-free vaginal tape (TVT) or transobturator tape (Monarc TOT) procedure. Methods  Between January 2001 and December 2005, 50 consecutive patients with USI who underwent TVT (n = 24) or TOT (n = 26) procedures were studied, and postoperative urodynamic changes were sequentially compared by one-way ANOVA test with Bonferroni’s correction. Results  There were no significant between-group postoperative changes in urodynamic parameters of uroflowmetry, filling and voiding cystometry. However, the TVT group had a higher objective cure rate (100% vs. 69.2%, P = 0.004) by pad test, urethral closure pressure area [40.4 cm² H₂O, 95% confidence interval (CI) = 22.3–58.5 cm² H₂O vs. 3.9 cm² H₂O, 95% CI = −10.9 to 18.7 cm² H₂O, P = 0.036], and continence area (34.4 cm² H₂O, 95% CI = 16.1–52.7 cm² H₂O vs. −3.5 cm² H₂O, 95% CI = −16.7 to 9.8 cm² H₂O, P = 0.001) at 12 months than those of the TOT group. Conclusions  This study demonstrated that tension-free vaginal tape and transobturator tape procedures had no significant difference of impact on bladder voiding and storage functions. However, this study demonstrated that TVT procedure resulted in a higher cure rate with a significantly increased urethral closure pressure area and continence area than did TOT procedure 12 months postoperatively. Thus, TVT procedure might be a better therapeutic choice to achieve continence than TOT.