Intranodal Myofibroblastoma: Report of a Case

Palisaded myofibroblastoma (hemorrhagic spindle cell tumor) is a recent addition to the group of benign primary spindle cell lesions of lymph nodes. These tumors are characterized histologically by hemorrhage, palisading, and foci of collagen called amianthoid fibers. We report a further typical example with the aim of discussing its differentiation. Tumor cells were positive for smooth-muscle actin and vimentin. The cytoplasm contained moderate numbers of rough endoplasmic reticulum cisternae and some smooth-muscle type myofilaments. Sub-plasmalemmal densities and plasmalemmal caveolae, as well as material interpreted as external lamina, were identified at the cell surface, whereas the fibronexus junctions typical of myofibroblasts were not seen. Immunostaining for type IV collagen was positive. Intranodal myofibroblastomas have largely been considered as myofibroblastic, but the observations presented here raise the alternative possibility of simple smooth-muscle differentiation. The foci of collagen widely referred to as amianthoid fibers contained fibrils mostly of conventional diameter, 50-83 nm. The giant collagen fibrils typical of true amianthoid change were absent. It is suggested that the term amianthoid be used only after ultrastructural confirmation of the presence of giant collagen fibrils.     

Examining the uptake of predictive BRCA testing in the UK; findings and implications

Predictive BRCA testing is offered to asymptomatic individuals to predict future risk where a variant has been identified in a relative. It is uncertain whether all eligible relatives access testing, and whether this is related to health care inequalities. Our aim was to analyse trends and inequalities in uptake of testing, and identify predictors of testing and time-to-receipt of testing. A database from April 2010 to March 2017 was collated. Multivariate analysis explored individual associations with testing. Predictor variables included gender, BRCA test type, cancer history, Index of Multiple Deprivation (IMD) and education status. To evaluate factors associated with time-to-testing, a Cox proportional-hazards (CP) model was used. Of 779 tests undertaken, 336 (43.1%) were identified with a BRCA variant. A total of 537 (68.9%) were female and in 83.4% (387/464) of probands, predictive testing was received by relatives. Analysis identified inequalities since decreased testing was found when the proband was unaffected by cancer (OR 0.14, 95% CI 0.06–0.33). Median time-to-testing was 390 days (range, 0–7090 days) and the CP model also identified inequalities in the hazard ratio (HR) for testing for people aged >40 was higher than for aged <40 (HR 1.41, 95% CI 1.20–1.67) and BRCA2 testing was higher than for BRCA1 testing (HR 1.39, 95% CI 1.18–1.64). Reduced testing was found when probands were unaffected by cancer and time-to-testing was found to vary by age and BRCA1/2 test. Given limited study sample size, further research is recommended to examine inequalities in predictive BRCA testing.Subject terms: Cancer genomics, Cancer genetics     

Truncus arteriosus: successful surgical correction without the use of a valved conduit

A new operation for the restoration of continuity between the right ventricle and pulmonary circulation in truncus arteriosus in infancy without the use of a tube graft is described. This was achieved by anastomosing the inferior margin of the detached confluent branch pulmonary arteries to the apex of a vertical infundibular ventriculotomy to form the posterior wall of the reconstructed right ventricular outflow tract. A patch of pericardium was used to form the anterior wall and complete the primary cardiac repair.     

A CORRELATIVE STUDY BY ELECTRON AND LIGHT MICROSCOPY OF THE DEVELOPMENT OF TYPE 5 ADENOVIRUS : II. LIGHT MICROSCOPY

The evolution of the intranuclear lesion produced by type 5 adenovirus in HEp-2 and HeLa cells is described as seen in the light microscope and the bodies formed in the course of the infection characterized histochemically. Some 12 hours after infection acidophilic protein bodies, without appreciable nucleic acid, first appear in the nucleus and coalesce into a network. Within or in association with this material, DNA-containing masses (viral aggregates) are formed which rapidly increase in amount and then coalesce. At the same time, a protein is produced, histochemically different from that of the acidophilic or basophilic structures mentioned, within the infected nucleus, which constitutes a matrix within which regular cytstals of a protein, (presumably non-viral) materialize. These structural and histochemical features are correlated with details which have been observed in parallel studies with the electron microscope.     

Left ventricular function in adolescents and adults with restrictive ventricular septal defect and moderate left-to-right shunting

BACKGROUND: The long-term haemodynamic effects of a restrictive ventricular septal defect permitting moderate left-to-right shunting are not known. PATIENTS AND METHODS: Echocardiographic measurements of left heart dimensions and function were compared between a group of 9 older children and adults (median age 21 years, range 12-24.5 years) having restrictive ventricular septal defects (median Qp/Qs 1.7, range 1.4-2.1) and a group of 10 age matched controls. RESULTS: Left ventricular mass indexed to body surface area was significantly greater in subjects than in controls (102+/-29 vs. 75+/-13 g/m2, p=0.02), although there was no significant difference in the ratio of mass to volume. There were no significant differences between indexes of left ventricular systolic function. Ratios of peak early to late diastolic ventricular filling were lower in those with septal defects (1.5+/-0.3 vs. 1.8+/-0.3, p=0.03), but there were no differences in other indexes of diastolic function. CONCLUSIONS: Resting left ventricular function does not appear to have deteriorated by early adult life in patients with restrictive ventricular septal defects and moderate volume loading. This would support a continued conservative approach to management in these patients.     

Correlating novice nurses' perceptions of nursing orientation and first-year support with direct preceptor interventions

Can preceptors correlate novices' experiences of the transition into nursing with interventions for support? A medical specialty preceptor committee representing more than 300 nurses at a large academic medical center conducted educational sessions for 46 inpatient nurses who had successfully completed orientation, but were still in the first year of practice. The novice forum used literature themes to guide exploration of the novices' perceptions. In the two novice forum sessions, the new nurses were invited to reflect on their experiences using a Turning Point Query(?). The questions posed addressed the themes in the literature concerning the transition into professional practice. After noting and discussing the group responses, each preceptor committee representative held a discussion with two novices about their struggles and successes. The preceptors, after learning about novices' needs in this way, planned and directed forums for preceptor development of their peers. Concepts and teaching activities addressed the novices' identified concerns, which targeted greater need for feedback, affirmation, and debriefing, as well as reflective discussions on practice. This group thus correlated novices' perceptions with preceptor development activities.     

Late aortic homograft valve endocarditis caused by Cardiobacterium hominis: a case report and review of the literature

An unusual case of Cardiobacterium hominis endocarditis involving an aortic homograft valve is presented. Although the patient was young (a 17 year old man) and showed few of the characteristic features of the disease, the report does illustrate a number of the problems associated with this illness and highlights the need for the careful assessment of apparent culture negative endocarditis. The organism itself is susceptible to most antibiotics but further treatment, including surgery, may be necessary. Patients must therefore be examined repeatedly and assessed for haemodynamic deterioration, valve destruction or embolic phenomena. Homograft valve replacement may offer some benefits in the setting of aortic valve endocarditis and is therefore an attractive option in this situation.


Keywords: Cardiobacterium hominis; endocarditis; valve replacement