Tricuspid valve papillary fibroelastoma: a rare tumor with a diagnostic dilemma

Papillary fibroelastoma is a rare primary tumor of the heart valves. This lesion can occur on any of the valves or endothelial surface of the heart and has been detected by echocardiography, by cardiac catheterization, during open heart operations for other conditions, and at autopsy. Because of the potential for comorbidities, this tumor should be removed. We present the case of an elderly man with a diagnosis of severe mitral valve regurgitation and moderate tricuspid valve regurgitation who was suspected to have a tricuspid valve vegetation. Mitral valve replacement, tricuspid valve repair, and excision of the lesion were performed successfully. A histologic examination of the vegetation confirmed it to be a papillary fibroelastoma. We present this case to emphasize the rarity of this tumor and the importance of a correct diagnosis to avoid delaying its prompt and definitive management.     

Cadherin 11 Promotes Immunosuppression and Extracellular Matrix Deposition to Support Growth of Pancreatic Tumors and Resistance to Gemcitabine in Mice

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Cementoblastic lineage formation in the cross-talk between stem cells of human exfoliated deciduous teeth and epithelial rests of Malassez cells

Objectives

The purpose of this study was to evaluate the synergistic effect of epithelial rests of Malassez cells (ERM) and transforming growth factor-β₁ (TGF-β₁) on proliferation, cementogenic and osteogenic differentiation of stem cells derived from human exfoliated deciduous teeth (SHED).

Materials and methods

SHED were co-cultured with ERM with/without TGF-β₁. Then, SHED proliferation, morphological appearance, alkaline phosphatase (ALP) activity, mineralization behaviour and gene/protein expression of cemento/osteoblastic phenotype were evaluated.

Results

TGF-β₁ enhanced SHED proliferation when either cultured alone or co-cultured with ERM. ERM induced the cementoblastic differentiation of SHED which was significantly accelerated when treated with TGF-β₁. This activity was demonstrated by high ALP activity, strong mineral deposition and upregulation of cementum/bone-related gene and protein expressions (i.e. ALP, collagen type I, bone sialoprotein, osteocalcin and cementum attachment protein).

Conclusions

ERM were able to induce SHED differentiation along the cemento/osteoblastic lineage that was triggered in the presence of TGF-β₁.

Clinical relevance

The cemento/osteoblastic differentiation capability of SHED possesses a therapeutic potential in endodontic and periodontal tissue engineering.

     

Interrater and Intrarater Reliability of the Active Knee Extension (AKE) Test among Healthy Adults

[Purpose] The purpose of this study was to determine the reliability of the active knee extension (AKE) test among healthy adults. [Subjects] Fourteen healthy participants (10 men and 4 women) volunteered and gave informed consent. [Methods] Two raters conducted AKE tests independently with the aid of a simple and inexpensive stabilizing apparatus. Each knee was measured twice, and the AKE test was repeated one week later. [Results] The interrater reliability intraclass correlation coefficients (ICC_2,1) were 0.87 for the dominant knee and 0.81 for the nondominant knee. In addition, the intrarater (test-retest) reliability ICC_3,1 values range between 0.78–0.97 and 0.75–0.84 for raters 1 and 2 respectively. The percentages of agreement within 10° for AKE measurements were 93% for the dominant knee and 79% for the nondominant knee. [Conclusion] The finding suggests the current AKE test showed excellent interrater and intrarater reliability for assessing hamstring flexibility in healthy adults.Key words: Hamstring, Flexibility, Range of movement     

Population 70 million: a consideration of health aspects

A 70 million population for Malaysia by the year 2010 has been officially targeted for in the mid-term review of the Fourth Malaysia Plan, 1981-1985. In response to this, a preliminary investigation was undertaken into the health aspects of population growth; infant mortality rates are used as the health indicators. In recognition of the relevance of the medical, economic, and education factors to health, trends in Malaysia's population ratio, per capita gross national product (GNP), and rates of school enrollment are also drawn. The characteristics associated with low mortality and high life expectancy are identified as low population growth, high literacy, and high per capita GNP. Whatever the ideology--Malthusian or Marxist--there is no doubt that population is closely linked to development variables, of which health is a part. Linear regressions on West Malaysian trends show a very high correlation between percent school enrollment and number of medical doctors. Selected cross-country comparisons show that the real issue is not the size of the population but its pace of growth and the social and economic climate at the time. The most dramatic reduction in mortalities from 1957-1980 has been for infant mortality rates (IMR), which have fallen from 76 to 25/1000 live births. Significant control over IMRs has been achieved by effective treatment of malaria, smallpox, tuberculosis, whooping cough, and diarrheal diseases. Attempting a prediction on health outcome at population 70 million, various health statistics from selected countries near that population size were compiled. It is apparent that certain relevant features are associated with low infant mortalities and high life expectancy at birth: 1) low population growth rates, crude birth rates, and fertility; 2) high literacy rates; and 3) high per capita GNP. Overall, health improved for the nation as a whole, and this is highly correlated with school enrollment and health service ratios.     

DISSEMINATED PRIMARY CUTANEOUS HISTOPLASMOSIS

Two patients with primary disseminated mucocutaneous histoplasmosis are reported. As there was no focus of infection, active or healed, in the lung or other internal organs, it is assumed that a primary cutaneous site was the source for dissemination to the skin and mucous membrane. The organism could be cultured from the skin and mucous membrane only. No immune suppression was detected. Infection cleared with amphotericin B.