The pretreatment DNA labelling index of the blast cells of patients with acute lymphoblastic leukaemia as a prognostic factor in the outcome of treatment: the concept of ‘G-0 acute leukaemia’

Summary A group of 15 patients with acute lymphoblastic leukaemia was studied prospectively to analyse the impact of the pretreatment DNA labelling indices of the blast cells. Patients with labelling indices < 5% did significantly worse than those with labelling indices > 5%: the 60-week disease-free survival of patients with acute lymphoblastic leukaemia and labelling indices > 5% was 80%, whereas that for patients with labelling indices < 5% was 24%, P < 0.05. In addition, three patients with acute leukaemia and DNA labelling indices of 0%, so-called G-0 acute leukaemias, are described: all of them had refractory forms of acute lymphoblastic leukaemia with a very poor outcome to treatment.     

Unilateral and segmental cystic disease of the kidney

Unilateral and segmental cystic disease is a rare cystic disease of the kidney. Except for its unilaterality, it resembles autosomal dominant polycystic kidney disease on gross and histological examination. It also lacks genetic background and progressive deterioration of renal function. Only a small number of unilateral and segmental cystic disease of the kidney cases have been reported to date. The present case is a report of a 69-year-old man who had a large multicystic mass involving the lower and middle part of the right kidney with normal residual renal parenchyma at the upper pole. The left kidney was entirely normal. All the laboratory tests were within normal limits. Right nephrectomy was performed because of a strong suspicion of malignancy.     

Restoring the function of a proximally stenosed or occluded sequential aortocoronary venous graft by PTCA of a bypassed native vessel: the 'back-door technique'

If a sequential saphenous vein graft occludes proximally butits distal part remains open, it may act as a large intercoronarycollateral. In such situations percutaneous transluminal coronaryangioplasty (PTCA) of a stenosis is one of the recipient nativevessels may restore the function of the graft. In 250 of ourpatients who underwent PTCA after previous coronary artery bypasssurgery, this technique could be used 20 times in 18 patients.PTCA was performed 3–101 months (mean 24.7 months) afterbypass surgery. Complete revascularization could be achievedin all but three patients. Two patients had a small myocardialinfarction during PTCA. The primary success rate was 95%. Twopatients had a clinical and angiographic recurrence and underwentsuccessful redilatation. Fourteen patients have remained symptomfree during follow-up, which ranged from 4 to 44 months (mean19.5 months). We conclude that this ‘back-door technique’provides a new approach to symptomatic relief in patients withrecurrent symptoms after previous sequential venous bypass grafting.     

Monitoring Persistent Platelet Reactivity in Patients with Unprotected Left Main Stenting

Objective

This study sought to determine the rate and potential clinical impact of persistent platelet reactivity (PPR) in unprotected left main (ULMD) stenting.

Background

PPR under aspirin or thienopyridines is associated with acute events after angioplasty.

Methods

We prospectively included 125 patients referred for ULMD stenting. For the first 64 patients (ALMA‐1), angioplasty was performed under aspirin and clopidogrel without platelet reactivity assessment. For the last 61 patients (ALMA‐2), platelet reactivity was assessed before angioplasty: in patients with aspirin‐related PPR, aspirin twice daily was given and in those with clopidogrel‐related PPR, clopidogrel double dose or prasugrel was used.

Results

Overall, patients' mean age was 69 ± 13 years, 37% were diabetic, and 37% had non‐ST segment elevation myocardial infarction (NSTEMI). Patients' characteristics were similar in both studies with isolated left main in 14% and associated with 1‐, 2‐, or 3‐vessel disease in 23%, 36%, and 27%, respectively. Mean SYNTAX score was 23 ± 9. Procedural characteristics were similar using provisional T stenting in 69%, T stenting in 27%, and other techniques in 4%. In ALMA‐2, 28% patients had PPR for aspirin, 29% for clopidogrel, and 8% for both. Aspirin twice daily was given in 28% of patients, clopidogrel double dose in 26%, and prasugrel in 31%. The rate of 1‐year major adverse cardiovascular and cerebrovascular events (MACCE) was lower in ALMA‐2 versus ALMA‐1 (8.2% vs. 20.8%; P = 0.04) as a composite end‐point of cardiovascular death or stent thrombosis (0.0% vs. 8.3%; P = 0.02).

Conclusion

PPR under aspirin and thienopyridines is frequent in ULMD stenting and could be related to subsequent major events.

     

Perception of benefits to smoking cigarettes in adolescents unexposed to smoker in their social environment

The objective of the study was to describe a group of adolescentswho have no smokers in their social environment and to examinetheir beliefs regarding the benefits of smoking. The designwas a telephone survey. A population-based survey was conductedin California in 1990. There were 7,767 adolescent respondentsbetween 12 and 17 years of age, 373 (5%) of whom were unexposedto smokers in their social environment. A positive responseto any 1 of 5 questions concerning a belief in the benefitsof smoking was the main outcome measure. In teenagers unexposedto smokers in their social environment 70% were 12 or 13 yearsof age compared to only 35% of teenagers exposed to smokers.Unexposed teenagers were more often female and more often whiterather than Hispanic, African-American or Asian. After adjustingfor demographic factors, unexposed teenagers were only one-quarteras likely as exposed teenagers to harbour a belief in the benefitsof smoking. However, 40% of unexposed teenagers held such abelief with 28% believing that smoking helps people feel morecomfortable in social situations, 19% believing that smokinghelps people relax and 13% believing that smoking helps peoplekeep their weight down. It is unlikely that the group of teenagersunexposed to smokers in their social environment acquired theirbeliefs about the benefits of smoking through contact with smokers.Cigarette advertising might be a likely source of these perceptions.     

Efficacy and Safety of Short-Pulse Erbium:YAG Laser in the Treatment of Acquired Melanocytic Nevi

BACKGROUND: Various laser systems have been used in the treatment of acquired melanocytic nevi. However, CO2 lasers may cause scarring, and some nevi cannot be removed with pigment-specific lasers completely. To date, no study has evaluated the efficacy and safety of an erbium:yttrium-aluminum-garnet (YAG) laser, with its small penetration depth and fewer adverse effects, in the treatment of acquired melanocytic nevi. OBJECTIVE: To investigate the efficacy and safety of the short-pulse erbium:YAG laser in the treatment of acquired melanocytic nevi. METHODS: The study included 28 nevi in 14 patients. The lesions were pigmented, flat, or just palpable nevi. Nevi were irradiated with single-pulse laser energy of 1,000 mJ and a pulse duration of 300 microseconds. Fluences between 5.2 and 14.4 J/cm2 were used. Four months following laser treatment, the entire lesion was excised. Each specimen was histopathologically and immunohistochemically examined for the presence of nevus cells. RESULTS: Clinically, all of the nevi and, histopathologically, 27 of 28 nevi (96%) were completely removed without scarring. Post-inflammatory hyperpigmentation was seen in two patients and hypopigmentation in three patients. CONCLUSIONS: Short-pulse erbium:YAG laser treatment is an effective and safe method for removing acquired melanocytic nevi.     

Granulomatous prostatitis – an infrequent diagnosis

BACKGROUND: Granulomatous prostatitis is an unusual benign inflammatory process of the prostate. Clinically, it mimics prostatic carcinoma, thus requiring pathological examination for diagnosis. MATERIALS AND METHODS: Histopathological records of 1353 prostate specimens received in the Department of Pathology, Government Medical College, Chandigarh, India, over a period of 8 years (1995-2002) were reviewed and 20 cases of granulomatous prostatitis were retrieved. RESULTS: Out of 20 cases of granulomatous prostatitis, we encountered 12 cases of non-specific granulomatous prostatitis, two cases of xanthogranulomatous prostatitis, two cases of tuberculous prostatitis, two cases of malakoplakia prostate and one case each of granulomatous prostatitis associated with adenocarcinoma prostate and post-surgical palisading granuloma. The diagnosis was made by histopathological examination of Trucut biopsy, transuretheral resection of prostate chips or retropubic prostatectomy specimen. In all the cases, granulomatous prostatitis was an incidental finding. CONCLUSIONS: Non-specific granulomatous prostatitis is the most common type of granulomatous prostatitis. Despite tuberculosis being very common in India, granulomatous prostatitis associated with tuberculosis is not common. Distinction between non-specific and infectious granulomatous prostatitis is important for therapeutic reasons.     

Which device is more accurate to determine the stability/mobility of dental implants? A human cadaver study

Summary Non‐invasive devices including resonance frequency (RF) analysis and mobility measuring (MM) damping capacity assessment are used to measure implant stability/mobility. The aims of the study were to compare the primary stability of implant inserted into extraction sockets by using RF with cable, RF wireless and new wireless MM device, to clarify the relation between these devices and to understand the correlations between peri‐implant bone levels and implant stability. A total of 30 screw‐type implants (3·75 × 11 and 4·2 × 11 mm) were inserted into extraction sockets of eight mandibular pre‐molar regions of human cadavers. The primary stability of implants was measured by three devices after insertion. Peri‐implant vertical defects were created in millimetre increments ranging between 0 and 5 mm, and stability/mobility of implants were analysed. At placement, the mean implant stability quotient of RF with cable, RF wireless and MM device values was 46 ± 1, 57·8 ± 9 and ?5·4 ± 1, respectively. Statistical correlations were demonstrated between these devices (P = 0·001). Statistically significant differences were presented for all peri‐implant detects ranging between 0 and 5 mm for RF with cable and RF wireless at all increments. However, only a significant decrease was found between 0 and 1 mm defects, and 4 and 5 mm defects in MM device. Although RF with cable and RF wireless seem to be suitable to detect peri‐implant bone loss around implants in 1 mm increments, the new MM device may not be suitable to detect the 1 mm peri‐implant bone changes in human dried cadaver mandibles.     

Congenital Hemangioma: A Report of Evolution from Rapidly Involuting to Noninvoluting Congenital Hemangioma with Aberrant Mongolian Spots

Abstract:   Congenital hemangiomas are unusual vascular tumors that are fully developed at the time of delivery. We report a case of an infant with an exophytic congenital hemangioma with features of a rapidly involuting hemangioma on the arm which over 3 years decreased in volume but continued to persist with features of a noninvoluting congenital hemangioma. He also had aberrant, persistent Mongolian spots on both legs. To our knowledge, this association has not been reported to date.