Almost all infiltrating colloid carcinomas of the pancreas and periampullary region arise from in situ papillary neoplasms: a study of 39 cases.

Colloid carcinomas of organs such as the breast, colon, and prostate have been well characterized. However, up until now there have been only a few studies of colloid carcinomas of the pancreas and periampullary region, and the number of colloid carcinomas in these studies has been limited. A search of our files revealed 39 resections for pancreatic and periampullary carcinomas with colloid differentiation. All neoplasms were extensively sampled. "Carcinomas with colloid differentiation" were defined as tumors associated with abundant extracellular mucin containing free-floating mucinous epithelial cells. Cases with >50% colloid differentiation were classified as "colloid carcinomas," whereas those with less were termed "carcinomas with focal colloid features." Cases with no colloid differentiation at all were designated "carcinomas without colloid differentiation." Of the 39 carcinomas, 31 were colloid carcinomas, and eight were carcinomas with focal colloid features. Twenty-seven were centered in the pancreas, seven were in the duodenum, and five were in the ampulla of Vater. Remarkably, 38 of the 39 carcinomas (97%) arose in association with an intraductal papillary mucinous neoplasm or a tubular/tubulovillous adenoma. Of the patients with colloid carcinomas, the 2-and 5-year actuarial survival rates were 69% and 29%, respectively. There was no significant difference in survival rates between patients with colloid carcinomas and patients with adenocarcinomas without colloid differentiation, whether or not the latter arose in association with intraductal papillary mucinous neoplasms or tubular/tubulovillous adenomas. In a multivariate model colloid differentiation was not an independent predictor of patient survival, while other factors such as tumor location, perineural invasion, vascular invasion, and margin status after resection independently influenced patient survival. Most colloid carcinomas of the pancreas and periampullary region arise in association with a well-defined in situ papillary neoplasm. The diagnosis of a pancreatic or periampullary colloid carcinoma should encourage the pathologist to search for an associated low-grade in situ component. In addition, colloid carcinomas of the pancreas and periampullary region do not necessarily have a better prognosis than carcinomas without colloid differentiation. Instead, other factors such as tumor location, perineural invasion, vascular invasion, and margin status after resection are far more important.     

Measurement of the humeral head retroversion angle. A new radiographic method

BACKGROUND: In this study, a simple and reliable radiographic method is described to determine the torsional profile of the humeral head. METHODS: First, by using a specially developed frame, the humeral head retroversion angles (HRAs) of 20 dry humeri were measured by an anatomist and an orthopedist. Then the HRA of these humeri were measured by two orthopedists on radiographs taken in semi-axial view when the humeri were in 20 degrees abduction. RESULTS: The results were assessed with the SPSS 9.05 program, and the repeatability coefficient of both methods was 98%. The average difference in angle determination between the two methods was 0.9 degrees; the maximum difference was 3 degrees. After that, posteroanterior semi-axial radiographs of both humerus bones of 40 healthy volunteers were taken by positioning their arms in 20 degrees abduction to the X-ray axis. The mean HRA difference between the right and left sides was 0.4 degrees (maximum difference 3 degrees ) and is of no clinical significance. It was determined that left and right HRAs can be taken as a reference to each other. For measurement of the HRA in the planning of proximal humeral rotation osteotomy and prosthesis replacement arthroplasty, the presented radiographic method can be used with a high rate of accuracy.     

Intrinsic and extrinsic regulation of the proliferation and differentiation of cells in the rodent rostral migratory stream

An overriding principle of development is that neurons become permanently postmitotic once they initiate differentiation. Work in our laboratory, however, has provided evidence for a population of progenitor cells in mammalian forebrain that express properties of differentiated neurons, even though they continue to divide. These neuronal progenitor cells are situated in the rostral migratory stream (RMS), which extends from a specialized portion of the subventricular zone surrounding the anterior tip of the lateral ventricle, referred to as the SVZa, to the middle of the olfactory bulb. As SVZa-derived cells migrate to the olfactory bulb, they undergo cell division, and they never deviate from the RMS. Once they reach their final destinations, they become terminally postmitotic interneurons. This Mini-Review concerns findings from our recent experiments designed to reveal the intrinsic and extrinsic mechanisms governing the proliferation and differentiation of the unique SVZa neuronal progenitor cells. We have investigated the role(s) of cell cycle regulatory proteins, in particular, the cell cycle inhibitor p19(INK4d), in the control of SVZa cell proliferation. Several studies have indicated that cells withdraw from the cell cycle once they express p19(INK4d). To begin to investigate whether p19(INK4d)(+) SVZa-derived cells are postmitotic, we analyzed the pattern of p19(INK4d) expression by the cells of the RMS. A pronounced gradient of p19(INK4d) expression was demonstrated; progressively more cells are p19(INK4d) immunoreactive as the olfactory bulb is approached. In addition, the capacity of p19(INK4d)(+) cells to incorporate bromodeoxyuridine was investigated. From the results of these studies, we conclude that SVZa cells in the RMS can successively down-regulate their expression of p19(INK4d) as they migrate and that they repeatedly exit and reenter the cell cycle while en route to the olfactory bulb. These studies led us to investigate whether bone morphogenetic proteins (BMPs) are involved in the regulation of SVZa cell proliferation and p19(INK4d) expression, because, elsewhere in the CNS, BMPs modulate cell proliferation and influence cell fate decisions. To determine the effects of BMP signaling on SVZa cell proliferation and differentiation, we altered the expression of the BMP receptor Ia (BMPR-Ia) using retrovirally mediated gene transfer. The cells in the SVZa encoding the wild-type BMPR-Ia exit the cell cycle and do not appear to migrate through the RMS. Conversely, both within the SVZa and along the RMS, the majority of SVZa-derived cells encoding a dominant-negative BMPR-Ia gene do not express p19(INK4d). These findings indicate that p19(INK4d) expression is suppressed when BMP signaling is inhibited. Furthermore, SVZa-derived cells with both augmented and inhibited BMP signaling retain their neuronal commitment. Collectively, these studies have revealed that SVZa cell proliferation and differentiation is under the control of several interacting intrinsic and extrinsic factors.     

Pars plana vitrectomy for ocular complications of Beh?et's disease.

BACKGROUND AND OBJECTIVES: To evaluate the outcomes of vitreoretinal surgery for the ocular complications of Behcet's disease. PATIENTS AND METHODS: This retrospective study included 20 eyes of 15 patients with Beh?et's disease (9 men, 6 women; mean age at surgery, 31.0 +/- 1.8 years; range, 21-44 years) who had undergone vitreoretinal surgery for Behcet's disease at Ondokuz Mayis University, Faculty of Medicine, Department of Ophthalmology, Samsun, Turkey, between January 2000 and September 2003. Postoperative visual acuity outcome, course of uveitis, and complications were evaluated in all patients. RESULTS: Indications for surgery were vitreous opacities in 10 eyes (50%), cystoid macular edema in 5 eyes (25%), epiretinal membrane in 3 eyes (15%), and vitreous hemorrhage in 2 eyes (10%). At the last postoperative follow-up, visual acuity had increased 2 Snellen lines or more in 10 (50%) of 20 eyes. Cystoid macular edema completely improved in 3 (60%) of 5 eyes after vitrectomy. Uveitis attacks significantly decreased during follow-up (P = .015). Immunosuppressive treatment was stopped in 11 (73%) of 15 patients. Retinal detachment and phthisis were not observed in any eye. CONCLUSION: Vitreoretinal surgery may be useful in the treatment of posterior segment complications of Behcet's disease.     

A comparative study of genotoxic effects in the treatment of trichomonas vaginalis infection: metronidazole or nalidixic acid

We performed a prospective randomized study to compare the potential genotoxic effects of metronidazole and nalidixic acid which they are used in the treatment of Trichomonas vaginalis infection. 20 patients with Trichomonas vaginalis infections participated in this study. 14 patients with vaginal trichomoniasis were treated with therapeutic doses of metronidazole 250 mg 3 times/d and six patients were treated with nalidixic acid 400 mg twice a day for 10 d. The genotoxic potential of a variety of mutagenic and carcinogenic agents can be evaluated by sister-chromatid exchange (SCE) test as a rapid cytogenetic test. An increased number of exchanges in lymphocytes reflects the influence of mutagens. No significant difference was observed in the SCE frequency of metronidazole treated patient however, a statistically significant increase (P<0.05) after nalidixic acid treatment could be described. We conclude that in spite of wide use of nalidixic acid for Trichomonas vaginalis infection, because of its potential genotoxic effect its usage must be individualized especially for pregnant women and small babies.     

A Phase II study of celecoxib,gemcitabine, and cisplatin in advanced pancreatic cancer

Summary Background. Pancreatic cancer is amongst the most chemoresistant malignancies. Expression of the cyclooxygenase-2 (COX-2) enzyme plays a major role in tumor progression and resistance to therapy. A Phase II study was undertaken to determine the effect of gemcitabine by fixed-dose rate infusion (FDR), cisplatin and the COX-2 inhibitor, celecoxib, on the 6-month survival rate in patients with metastatic pancreatic cancer. Methods. The eligibility criteria included a pathologically or cytologically confirmed diagnosis of adenocarcinoma of the pancreas. No prior gemcitabine therapy was allowed. Patients received a combination of gemcitabine 1000 mg/m² over 100 minutes, cisplatin 35 mg/m² I.V. on days 1 and 8, and celecoxib continuously at a daily dose of 800 mg. Cycles were repeated every 21 days. Results. Twenty-two patients with metastatic pancreas cancer were enrolled (median age, 59.5 years; M:F, 13:9). The median number of cycles was 2 per patient. The median survival time was 5.8 months (90% CI, 3.6–7.6 months). The probability of survival at 6 months was 46% (90% CI, 27–62%). The major toxicity was neutropenia with grade 3 or 4 toxicities seen in 65% of patients. Conclusions. The addition of celecoxib to gemcitabine (by FDR) and cisplatin did not appear to increase activity of the chemotherapy doublet in patients with advanced pancreatic cancer. Celecoxib alone may not be sufficient to sensitize pancreatic cancer to the effects of conventional cytotoxic therapy.     

Can E-selectin be a reliable marker of inflammation in lumbar disc disease?

The cause of sciatica and low back pain associating with lumbar disc herniation has not been clearly identified until now. Inflammation has been shown to occur via immunohistochemical and biochemical methods in herniated disc tissues. The important prognostic role of E-selectin has recently been substantiated by other studies in early rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA). The important role of adhesion molecules in the initiation and progression of the inflammatory response is well known for infectious diseases and autoimmune disorders. In our study, we aimed to show the role of E-selectin as an inflammatory marker and the correlation of inflammation with straight-leg raise (SLR) test findings and subtype of disc herniation. We found that the cases with positive SLR test had higher rates of immunostaining with E-selectin. This led us to think that E-selectin might play an important role in the activity status of the disease, meaning patients with more limited movement capacity might benefit from E-selectin antagonist therapy. Among the many studies performed to identify the relationship between the inflammation markers and activity of lumbar disc herniation, this is the first investigation held with E-selectin.     

Topographic localization of the motor branch of the median nerve

PURPOSE: To redefine the localization of the thenar branch (TB) of the median nerve in relation to the surface landmarks that are in routine use. METHODS: The study was performed in 37 hands of 34 patients who had carpal tunnel release. All of the patients were women and the mean age was 50 years (range, 35-67 y). A radiologic marking technique was used to determine the localization of the TB, the middle finger radial side line, and Kaplan's cardinal line. The TB was marked by circumscribing with a soft radiopaque yarn and the surface landmark lines were shown by taping a K-wire to the hand for each line. An image-intensifier-printed image was obtained for each case and the distances between the markers of the TB and the wires were measured. RESULTS: The TB had a mean ulnar offset of 12.6 mm (range, 4.0-19.7 mm) from the middle finger radial side line and was located 4.4 mm (range, 0-9.5 mm) proximal to the cardinal line. CONCLUSIONS: During carpal tunnel release surgery the surgeon must pay more attention to the localization of the TB of the median nerve because it was found to be 12.6 mm more ulnar than the location described in the literature.