Ductal Carcinoma In Situ with Microinvasion on Core Biopsy: Evaluating Tumor Upstaging Rate,Lymph Node Metastasis Rate,and Associated Predictive Variables

Annals of Surgical Oncology - The role of sentinel lymph node biopsy (SLNB) when ductal carcinoma in situ with microinvasion (DCISM) is identified on core biopsy is unclear. Our aim was to assess...     

LONG‐TERM FOLLOW UP OF PATIENTS WITH SMALL GASTROINTESTINAL STROMAL TUMORS IN THE STOMACH USING ENDOSCOPIC ULTRASONOGRAPHY‐GUIDED FINE‐NEEDLE ASPIRATION BIOPSY

Background: Gastrointestinal stromal tumors (GIST) are one of the most common mesenchymal tumors of the gastrointestinal tract. GIST are defined by positive immunohistochemical staining for KIT or CD34 and thus are generally diagnosed after surgery. Because small GIST are rarely diagnosed before surgery, the clinical course of these small tumors is not clear. The aim of the present study was to follow changes in size and configuration of small GIST that were pathologically confirmed using endoscopic ultrasonography‐guided fine‐needle aspiration biopsy (EUS‐FNAB). Methods: Between July 1997 and December 2003, 16 tumors in 16 patients (10 men and 6 women) with an immunohistochemical diagnosis of GIST were regularly followed in our hospital. The median patient age when EUS‐FNAB was performed was 62 years (range 26–82 years) and the median follow‐up period was 4.9 years (range 0.5–9.6 years). Results: Fourteen tumors showed no remarkable changes in size and shape during follow up compared with the initial diagnosis. Two tumors enlarged: one tumor approximately doubled its diameter in 8 years and the other tumor increased from 1.8 cm at diagnosis to up to 10 cm after only 2 years. Doubling time of the latter tumor was calculated as 3.1 months. Conclusions: We conclude that EUS‐FNAB might be a good modality for final diagnosis of GIST without surgery, and that GIST without rapid growth on follow up can be endoscopically followed.     

Lithium for irritability in Post-Traumatic stress disorder

Irritability is often a problem for patients with Post-Traumatic Stress Disorder (PTSD). We describe two cases that illustrate the use of lithium in the treatment of veterans with PTSD who complained of serious problems with irritability or angry outbursts. These cases are discussed in the context of evidence that lithium may be useful in other patients with disorders of impulse control. The evidence linking disorders of anger and impulse control to a dysregulation in neurotransmitter regulation, particularly in serotonergic pathways, supports a psychopharmacologic approach to treatment. These findings should lead to further study of the role of lithium in the treatment of this symptom complex in patients with PTSD.     

Effect of electrodesiccation on pain intensity associated with chronic heloma durum

Forty chronic heloma durum (HD) were treated by electrodesiccation. The mean age of the subjects was 55 years (range 40–72). Effectiveness of treatment was assessed by measuring pain associated with the corn. The subject's tolerance to pain was determined using a 10 cm visual analogue scale. Six weeks postoperatively the mean pain scores were 72.9% lower (P < 0.01) than preoperative scores. Twelve months postoperatively the mean pain scores were 57.6% lower (P < 0.01) than the preoperative scores. Electrodesiccation was found to be successful in reducing the pain experienced from chronic digital and plantar heloma durum.     

Platelet-associated IgG, IgM, and C3 in paediatric infectious disease

Elevated amounts of platelet-associated serum proteins (PASP) can be detected in idiopathic thrombocytopenic purpura (ITP) and are considered to be of patho-aetiological importance especially in the case of acute ITP, that commonly follows acute febrile illnesses. Using a micro-enzyme-linked immunoassay we examined PASP (IgG, IgM, and C3) in 120 paediatric patients with acute fever caused by viral (n = 45), bacterial (n = 48), or non-detectable agents (n = 27) and compared those values to the levels of PASP of an own paediatric control group (n = 21). Two of the patients presented mild temporary thrombocytopenia without clinical signs in the course of their infectious disease. While having normal platelet counts, the majority of our patients (69.2%) however, showed increased levels of PASP (IgG, IgM, C3; single or combined). Significant differences of PASP levels by discrimination of viral and bacterial diseases could not be demonstrated. Elevated platelet-associated complement was of special interest, because - in the absence of low platelet counts due to platelet-specific antibodies - it must be regarded as an indicator for immune complexes (IC) binding to thrombocyte surface IgG Fc-receptors. Thus we suggest that platelets play a considerable role in the elimination of circulating IC.     

Non-secretion of ABO blood group antigens as a host susceptibility factor in the spondyloarthropathies

Gram negative bacteria precipitate reactive arthritis and may be concerned in the pathogenesis of ankylosing spondylitis and other spondyloarthropathies. Susceptibility to many infectious agents is associated with ABO blood group or secretor state, or both. The distribution of the ABO blood group or secretor state, or both, was therefore determined in 87 patients with ankylosing spondylitis and 32 with other forms of spondyloarthropathy. The prevalence of non-secretors was significantly increased in the total patient group (54/114; 47%) and in the subgroup with ankylosing spondylitis (41/84; 49%) compared with local controls (89/334; 27%) (p less than 0.001). Other subgroups of patients showed a similarly increased prevalence of non-secretion (33-47%). The distribution of ABO blood groups did not differ between patients and controls. The association between non-secretor state and ankylosing spondylitis strengthens the hypothesis that ankylosing spondylitis is a form of reactive arthritis. It also suggests several pathogenic mechanisms which may be relevant to the initial hostparasite interaction in ankylosing spondylitis.