The prognostic value of intraepithelial and stromal CD3‐, CD117‐ and CD138‐positive cells in non‐small cell lung carcinoma

Al‐Shibli K, Al‐Saad S, Andersen S, Donnem T, Bremnes RM, Busund L‐T. The prognostic value of intraepithelial and stromal CD3‐, CD117‐ and CD138‐positive cells in non‐small cell lung carcinoma. APMIS 2010; 118: 371–82. The major value of prognostic markers in potentially curable non‐small cell lung carcinoma (NSCLC) should be to guide therapy after surgical treatment. Although tumor‐infiltrating T lymphocytes and plasma cells have been documented in NSCLC, a clear association with clinical outcome, especially for the stromal component, has not been well established. The aim of this study was to elucidate the prognostic significance of these cells/markers in the epithelial and stromal compartments of NSCLC. Tissue microarrays from 335 resected, stage I‐IIIA, NSCLC were constructed by duplicate cores from viable neoplastic epithelial and stromal areas. Immunohistochemistry was used to evaluate the infiltration of CD3⁺, CD117⁺ as well as CD138⁺ cells in epithelial and stromal areas. In univariate analyses, increasing numbers of stromal CD3⁺ (p = 0.001) and epithelial CD3⁺ cells (p = 0.004) correlated significantly with an improved disease‐specific survival. No such relation was noted with CD3⁺ or CD117⁺ cells. In the multivariate analysis, stromal CD3⁺ cells was an independent prognostic factor for disease‐specific survival (HR 1.925, CI 1.21–3.04, p = 0.005). Increased presence of the pan T‐cell marker, CD3, which is an independent factor, correlates with improved clinical outcome in NSCLC. This prognostic impact of T cells is clearer in the tumor stroma. Neither plasma cells nor mast cells were prognostic indicators in our cohort.     

An oral practical examination in emergency clinical surgery

A body of students were asked about their views regarding an oral practical examination in clinical surgery that had been in practice for over 12 years. This is an examination with the planned objective to test problem-solving abilities and professional attitudes in emergency surgery. Verbal emergency simulation aided by appropriate pathological specimens, surgical instruments and X-rays are put forward by the examiners, and the candidate is asked to respond. One hundred and ninety-four students returned their questionnaire out of a total of 196 students (99% response rate). Candidates who were satisfied with their answers in the examination numbered 127 (65%), while 67 candidates were dissatisfied (35%). Reasons for dissatisfaction were cited as difficult and complex emergency simulation questions, expressed by 44 candidates (23%), and anxiety generated by confrontation of the examiners, expressed by 23 candidates (12%). One hundred and thirteen students (58%) thought a change in the format of the examination was not needed, while 47 students (24%) suggested a change mostly towards standardization of the examination. Emergency clinical surgery is an important area of the surgical curriculum that needs to be assessed properly. A more standardized version of this oral practical examination could perhaps provide a useful tool of assessment.     

Immunophenotyping of normal lymphocytes

Summary. We report the data of direct and indirect immunofluorescence labelling of peripheral blood mononuclear cells obtained from 40 normal controls and nine patients having blood tests for non-haematological disorders (PNHD controls) using flow cytometric analysis. Polyclonal and monoclonal antibodies were used to define the expression of cell surface antigen of T cells, their subsets, B cells, natural killer cells (NK) and myeloid cells. Normal values of absolute number and percentages of each of the populations of mononuclear cells were established and were sufficiently reproducible to be of clinical use. The percentages of positive values of T cells, T-cell subsets, and B cells in ten normal controls when mononuclear cells were used, were comparable to those using whole blood lysis, APAAP immuno-alkaline phosphatase, and E and M rosettes. The results obtained were similar in both the normal and PNHD controls. In most instances the percentage recovery of identified T, B and NK cells was complete. Currently we are using the results as reference values for lymphoid sub-populations in normal controls.     

New Procedure of Treatment for Combined Systemic Venous and Pulmonary Venous Obstruction Following the Mustard Operation for Transposition of the Great Arteries

Three patients aged 4.6, and 9 years were discovered at cardiac catheterization to have combined pulmonary venous and systemic venous obstruction following the Mustard operation for transposition of the great arteries. Relief of systemic venous baffle obstruction may unmask pulmonary venous obstruction. Full evaluation of the pulmonary venous confluence is recommended in any patient with systemic baffle obstruction.     

Artificial Hair Fiber Restoration in the Treatment of Scalp Scars

BACKGROUND: There is presently no treatment for scalp scars that is fully satisfactory. The modalities of treatment currently in use are surgery, hair transplantation, and micropigmentation. Scalp implantation with artificial hair fibers is used by some physicians as an adjunctive treatment. OBJECTIVE: The objective was to assess the utility of artificial hair fibers to treat scalp scars. METHODS: Data were collected by the principal author from 10 hair restoration practitioners who tested polyamide hair fiber (Biofibre CE 0373/TGA by Medicap Ltd., Carpi (MO), Italy) implantation for scalp scars. RESULTS: Artificial hair fiber implantation occurred between June 1996 and December 2000, and observations continued until December 2004. Data from 54 scars from 44 patients treated showed: (1) no complications in 49 scars (90.7%); (2) mild adverse outcomes in 4 scars (7.4%)-temporary superficial inflammation-infection that subsided following topical cortisone and local/systemic antibiotic treatment; and (3) moderately adverse outcomes in 1 scar (1.9%)-significant inflammation and generalized infection requiring removal of artificial implant to alleviate. Occasional minor skin reactions, sebum plugs, and hyperseborrhea were successfully controlled and well accepted by patients. Fiber fall rate was 20% on average per annum. CONCLUSION: Data show that polyamide hair fiber restoration can be considered an adjunctive treatment for scalp scars in selected cases.     

Acquired Intercostal Arteriovenous Fistulas

Acquired intercostal arteriovenous fistulas are recognized complications of traumatic injuries. In this article, transesophageal Doppler echocardiographic findings in a patient with posttraumatic acquired intercostal arteriovenous fistulas are presented. The findings have been confirmed by angiography. The demonstration of intercostal arteriovenous fistulas by transesophageal Doppler echocardiography has not been reported before.