Epithelioid angiosarcoma of the bone: a series of 10 cases

The clinical and pathologic features of 10 epithelioid angiosarcomas of bone were analyzed. There were eight males and two females who ranged in age from 26 to 83 years (mean 62 years). Four tumors were solitary and six were multifocal. In two consultation cases, the submitted diagnosis was metastatic carcinoma. Microscopically, the tumor cells were arranged in solid and infiltrative sheets, and in most cases vascular channels or cystically dilated spaces were present. The neoplastic cells had abundant eosinophilic cytoplasm and large nuclei with open chromatin and prominent eosinophilic nucleoli. Intratumoral hemorrhage, neutrophilic infiltrates, and intracytoplasmic lumina were frequently present. All 10 tumors stained positive for one or more endothelial markers, with CD31 being the most sensitive marker. Seven cases stained positive for cytokeratin. Ultrastructural examination in three tumors confirmed their endothelial differentiation. In the absence of obvious vascular differentiation, abundant intratumoral hemorrhage and intratumoral neutrophils are useful ancillary morphologic features that may suggest a vascular origin. Six patients are dead of disease, one is alive with metastasis, and two patients are currently disease free. Epithelioid angiosarcoma of bone should be included in the differential diagnosis of epithelioid neoplasms of bone, and endothelial markers should be a part of their immunohistochemical analysis to avoid the misdiagnosis of a metastatic carcinoma because of the significant differences in the treatment and clinical outcomes of these entities.     

Ancistrotanzanine A, the first 5,3'-coupled naphthylisoquinoline alkaloid, and two further, 5,8'-linked related compounds from the newly described species Ancistrocladus tanzaniensis

The first phytochemical investigation of the recently discovered East African liana Ancistrocladus tanzaniensis is described, resulting in the isolation and structural elucidation of two new naphthylisoquinoline alkaloids, ancistrotanzanines A (5) and B (6), and the known compound ancistrotectoriline A (7). Ancistrotazanine A (5) represents a hitherto unprecedented 5,3'-coupling type between the naphthalene and isoquinoline portions, while 6 and 7 are 5,8'-coupled. The structures of the compounds were determined by spectroscopic, chemical, and chiroptical methods. Compounds 5 and 6 showed good activities against the pathogens of leishmaniasis and Chagas' disease, Leishmania donovani and Trypanosoma cruzi, while 5-7 displayed moderately potent antiplasmodial activities against Plasmodium falciparum parasites.     

R-wave changes in fatal air embolism during bone cementation

Holter monitoring during cementation of a hip prosthesis showed sudden R-wave loss. At post mortem, demonstration of a large intracardiac air embolus may explain the ECG changes.     

Platelet transfusions in infants with necrotizing enterocolitis do not lower mortality but may increase morbidity.

OBJECTIVE: Necrotizing enterocolitis (NEC), a serious multisystemic inflammatory disease most commonly seen in premature neonates, is often associated with thrombocytopenia. Infants with severe forms of NEC commonly have platelet counts of less than 50,000/mm(3), occasionally less than 10,000/mm(3). Despite an absence of data to support the practice, platelet transfusions are commonly used to maintain a certain arbitrary platelet count in an effort to prevent bleeding. As platelet transfusions contain a variety of bioactive factors including pro-inflammatory cytokines, we hypothesized that a higher number and volume of platelet transfusions would not be associated with an improvement in mortality or morbidity. STUDY DESIGN: A retrospective cohort analysis was conducted of the medical records of all infants between 1997 and 2001 with Bell's Stage 2 or 3 NEC associated with platelet counts of <100,000/mm(3). The medical records were evaluated for the following variables: platelet counts, number and volume of platelet transfusions, symptoms of bleeding, and hospital course. Mortality and development of short bowel syndrome and/or cholestasis were correlated to the total number and volume (total ml and ml/kg) of platelet transfusions. Differences between the outcome groups were compared using the independent t-test, Fisher's exact test and Mann-Whitney tests. RESULTS: A total of 46 infants met the study criteria (gestational age 28+/-4 weeks and birth weight 1166+/-756 g, mean+/-SD). There were a total of 406 platelet transfusions administered to the study population. Of these, 151 (37.2%) were given in the presence of active bleeding, with 62% of these resulting in the cessation of bleeding within 24 hours. Other listed indications for platelet transfusions were hypovolemia and severe thrombocytopenia. On analysis of the entire cohort, there was no statistical improvement in either mortality or morbidity (short bowel syndrome and cholestasis) with greater number and/or volume of platelet transfusions. Furthermore, we found that infants who developed short bowel syndrome and/or cholestasis had been given a significantly higher number and volume of platelet transfusions when compared to those who did not have these adverse outcomes [median (minimum - maximum) - number of transfusions : 9 (0 to 33) vs 1.5 (0 to 20), p=0.010; volume of transfusions (ml/kg): 121.5 (0 to 476.6) vs 33.2 (0 to 224.3), p=0.013]. CONCLUSION: This retrospective analysis suggests that greater number and volume of platelet transfusions in infants with necrotizing enterocolitis are associated with greater morbidity in the form of short bowel syndrome and/or cholestasis without the benefit of lower mortality.     

Interrelation of peptidergic innervation with mast cells and ED1-positive cells in rat thymus.

The peptidergic innervation of rat thymus has been investigated by immunohistochemical methods, focusing on the spatial interrelationship of peptidergic nerve fibers with mast cells and macrophages in the rat. An antiserum directed against the protein gene product 9.5 (PGP 9.5) regarded as a pan-neuronal marker revealed a rich innervation, especially in the subcapsular cortex, in interlobular septa, and of the vasculature in the cortex and the corticomedullary boundary. A minor proportion of PGP 9.5-immunoreactive (ir) fibers supplied the thymic parenchyma. The main component of peptidergic innervation consisted of fibers costaining for tachykinins (TKs) and calcitonin gene-related peptide (CGRP), but considerable amounts of neuropeptide Y (NPY)/tyrosine hydroxylase (TH)-positive fibers and vasoactive intestinal polypeptide/peptide histidine isoleucine-positive fibers also were present. There were sparse Leu-enkephalin and galanin immunoreactivities in thymic nerve fibers, while neurotensin was absent from nerve fibers. Close associations of TK/CGRP-ir and NPY-ir fibers with mast cells were frequently detected in the connective tissue areas of the thymus, often adjacent to the vasculature. TK/CGRP-ir fibers and some rare NPY-ir fibers were found adjacent to EDl-positive macrophages and less frequently to mast cells. TK/CGRP-ir and NPY-ir fibers were mainly detected in relation to the vasculature of the cortex and the corticomedullary boundary, but also were found in capsular and subcapsular regions of the thymic cortex. The possible importance of the close spatial relationship between the various peptide-containing nerve fibers and mast cells and ED1-positive macrophages in neuroimmune integration is discussed.     

水合氯醛和苯磺酸阿曲库铵对大鼠坐骨神经复合肌肉动作电位的影响

目的:研究水合氯醛和苯磺酸阿曲库铵对大鼠坐骨神经复合肌肉动作电位（compound muscle action potential,CMAP）的影响。方法:成年SD大鼠20只,随机分为2组（n=10）:水合氯醛组（C组）和水合氯醛复合苯磺酸阿曲库铵组（CA组）。2组腹腔注射7%水合氯醛350 mg·kg^-1麻醉,给予水合氯醛后8 min时CA组腹腔注射苯磺酸阿曲库铵2.5μg·kg^-1。于给予水合氯醛8 min时刺激坐骨神经,记录其所支配的腓肠肌的CMAP。刺激强度为0.50 v、0.55 v、0.60 v,波宽0.05 ms,频率10 Hz,每隔5 min重复上述刺激。结果:与8 min时比较,0.50 v,0.55 v,0.60 v强度下C组CMAP的峰峰值及潜伏期均无明显变化（P_均>0.05）;CA组与8 min时比较,0.50,0.55及0.60 v强度下23～43 min时的CMAP峰峰值降低（P<0.05或0.01）,0.50 v强度下38 min的CMAP潜伏期延长（P<0.05）,0.55 v,0.60 v强度下,23～43 min的CMAP潜伏期延长（P<0.05或0.01）。结论:水合氯醛对大鼠坐骨神经CMAP无明显影响;而复合肌松药苯磺酸阿曲库铵后对CMAP有一过性的抑制作用。     

Role of Sentinel Lymph Node Biopsy in the Staging of Synovial, Epithelioid, and Clear Cell Sarcomas

Background  Soft tissue sarcomas generally have a ≤5% risk of lymph node metastasis, but synovial, epithelioid, and clear cell subtypes reportedly have a much higher risk. The utility of sentinel lymph node biopsy (SLNB) for patients with these sarcoma subtypes is unknown. Methods  29 patients with nonmetastatic synovial, epithelioid, and clear cell sarcomas who underwent SLNB were examined. Results  Median age was 35 years (range 11–73 years), and 69% were male. Tumors were located in the lower extremity in 17 patients and the upper extremity in 12. The histological subtypes were synovial sarcoma in 16 patients, epithelioid sarcoma in 10, and clear cell sarcoma in 3. All patients had a staging chest computed tomography (CT) scan, none of which were suspicious, and 20 patients had staging positron emission tomography (PET) scans (16 negative, 3 indeterminate, and 1 suspicious). All patients had resection of their primary tumor. At least one sentinel node was found in 28 patients (97%), and the median number of sentinel nodes identified was 2 (range 1–4). One patient had a positive sentinel node on routine hematoxylin and eosin (H&E) staining and developed lung metastases. Two patients had positive sentinel nodes following immunohistochemical staining, and both remain disease free despite not undergoing completion lymphadenectomy. One patient developed a lymph node metastasis after a negative SLNB. Conclusion  For patients with these sarcoma subtypes without radiological evidence of nodal or distant metastases, the incidence of occult lymph node metastasis is relatively low. Determining utility of SLNB may require a multicenter trial.