Clinicopathologic and genetic profile of intracranial marginal zone lymphoma: a primary low-grade CNS lymphoma that mimics meningioma.

PURPOSE: Although rare overall, marginal zone B-cell lymphoma (MZBCL) is the most common primary low-grade CNS lymphoma reported in the literature. The aim of this study is to elucidate the biology and genetic features of this unusual tumor. PATIENTS AND METHODS: Fifteen CNS MZBCLs were studied clinically, pathologically, and genetically, including fluorescent in situ hybridization analyses with commercially available MALT1 and IgH break-apart and centromere 3, 7, 12, and 18 probes. RESULTS: CNS MZBCLs preferentially affect middle-aged women (female-to-male ratio, 4:1), with 93% presenting as dural-based masses mimicking meningioma. Ten patients with 1 to 7.6 years of follow-up after diagnosis showed no evidence of disease after radiation and/or chemotherapy. Like MZBCLs outside of the CNS, they consisted of CD20+, CD3- small B lymphocytes with varying degrees of plasmacytic differentiation and predominantly kappa light-chain restriction (78%). Lymphoid follicles with follicular colonization were seen in three patients and deposition of amyloid was noted in samples from two patients, one of which was tumefactive. Neither Bcl-6 protein nor Epstein-Barr virus-encoded RNA was expressed. Trisomy 3 was detected in six of 12 patients, with no rearrangements of MALT1 or IgH and no trisomies of 7, 12, or 18 detected. CONCLUSION: Our data suggest that intracranial MZBCL is an indolent primary CNS lymphoma that typically presents as a meningioma-like dural-based mass. Trisomy 3, but not MALT1 or IgH translocation, is a common genetic abnormality that may contribute to the pathogenesis of this CNS lymphoma.     

Edward Zigler's legacy in the study of persons with intellectual disability: the developmental approach and the advent of a more rigorous and compassionate science

Edward Zigler transformed the science and humanity of the work with persons with intellectual disability. The developmental approach is Ed's great contribution to the field of intellectual disability as it both led to more conceptually compelling and methodologically rigorous science and provided an alternative to the Zeitgeist of segregation, defect, and pathology that had prevailed for decades. In an entirely unique way, the developmental approach allowed a seamless integration of increasingly precise science with concern for the “whole child” and their family. Thus, Ed's legacy led to a discipline in which scholarship and compassion prevail hand in hand as the integrity of science and of the person are mutually informative and interdependent.     

Combined endovascular and open repair of a penetrating innominate artery and tracheal injury

Endovascular therapy affords the opportunity to decrease surgical morbidity and improve operative planning in complex penetrating injuries of the chest. In this case report we describe a hemodynamically stable patient with a single gunshot wound to the base of the neck (zone I), with combined vascular and tracheal injuries. We present a novel approach to the repair of this type of injury using combined endovascular and open techniques.     

Perceptual processing among high-functioning persons with autism

Two tasks were used to assess the processing of whole versus parts of objects in a group of high-functioning children and adolescents with autism (N = 11) and a comparison group of typically developing peers (N = 11) matched for chronological age and IQ. In the first task, only the children with autism showed a global advantage, and the two groups showed similar interference between levels. In the second task, the children with autism, despite longer RTs, showed similar performance to the comparison group with regard to the effect of goodness on visual parsing. Contrary to expectations based on the central coherence and hierarchisation deficit theories, these findings indicate intact holistic processing among persons with autism. The implications of these findings are discussed in relation to apparently discrepant evidence from other studies.     

"Making all the difference in the world": how physicians can help HIV-seropositive patients become more involved in their healthcare

Physicians who treat HIV-seropositive patients can and should help them become more involved in their healthcare. This qualitative study investigated HIV-seropositive persons' perspectives regarding when and how physicians could have a pronounced effect on their involvement. Sixty-four HIV-seropositive patients, diverse in gender, ethnicity, and risk factors, were purposefully selected from three San Francisco Bay Area healthcare delivery settings. A combined interview-guide approach with a standardized open-ended interview was used to elicit participants' healthcare and physician relationship experiences. Data analysis revealed the themes that (1) involvement led to improved health outcomes and quality of life, (2) three life circumstances served as "opportune moments" for persons becoming more involved with their healthcare (a diagnosis of HIV/AIDS, the onset of symptoms, and beginning drug treatment intervention), and (3) participants became more involved when their physicians used a relationship-centered approach to healthcare. The results of the study suggest that physicians should be aware of opportune moments to intervene with their HIV-seropositive patients and of the helpful effect a personal, caring, relationship-centered approach can have on these individuals' involvement in their care. The recognition of opportune moments also may have implications for treating other chronic illnesses.     

Tolerability and patient acceptance of sodium phosphate tablets compared with 4-L PEG solution in colon cleansing: combined results of 2 identically designed, randomized, controlled, parallel group, multicenter phase 3 trials

GOALS: Evaluate patient tolerance and acceptance of a sodium phosphate (NaP) tablet purgative compared with a 4-L polyethylene glycol (PEG) solution. BACKGROUND: Characteristics and side effects of bowel purgatives deter patients from undergoing screening colonoscopy. Published data demonstrated comparable bowel cleansing with NaP tablets and a 4-L PEG solution in 2 phase for 3 studies. This report presents data on patient tolerability and acceptance. STUDY: Two identically designed, randomized, investigator-blinded, and multicenter trials were performed. Tolerability and patient acceptance were based on purgative regimen compliance, incidence of gastrointestinal adverse events, and patient responses to questionnaires. RESULTS: Eight hundred forty-five patients were assessed (420 and 425 in the tablet and PEG solution groups, respectively). Patient compliance with the tablet regimen was greater: 94% of patients took all the tablets compared with 57% completing the PEG solution regimen (P<0.0001). Nausea, vomiting, and bloating occurred significantly less often in patients taking NaP tablets (P<0.0001). Among patients taking tablets, 88.4% rated them "easy" or "slightly difficult" to take, compared with 60.6% of patients taking the PEG solution. The preparation's taste was rated "barely tolerable" or "not tolerable" by 1% of patients treated with NaP tablets and 23.6% treated with PEG solution. Drinking the required volume of clear liquid for the tablet or PEG preparation was rated "easy" or "slightly difficult" by 92.2% and 66.9% of patients, respectively. Almost all (90.7%) patients taking the tablets indicated they would take the same preparation in the future, compared with 67.1% of patients taking the PEG solution (P<0.0001 for each comparison). CONCLUSIONS: Tolerability and patient acceptance of a NaP tablet purgative were superior to 4-L PEG solution.