Growth rate of primary left atrial myxoma

We describe the growth of a primary left atrial myxoma overa period of approximately 27 months, review the literature onthe growth rate of primary myxoma and discuss the value of echocardiographycompared to CT scan and MRI in the diagnosis of intracardiactumuors.     

The prognostic value of pretreatment 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography scan in women with cervical cancer

There is substantial risk that prognosis determined with routine clinical staging for cervical cancer may be inaccurate. This is primarily due to understaging due to the lack of detection of nodal disease. This is particularly true for para-aortic nodal metastases. Treatment based on such staging may also be inadequate for the same reason. Positron emission tomography (PET) has been demonstrated to be useful in the staging of cervical cancer and superior to either computed tomography or magnetic resonance imaging in the detection of nodal disease. Our objective was to determine the prognostic value of pretreatment 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) PET scan in women with cervical cancer. We reviewed the records of 56 women with cervical cancer who underwent FDG PET scan prior to treatment. The primary outcome was the effect of abnormal FDG uptake consistent with metastatic nodal disease on 20-month disease-free survival. The pretreatment PET scan demonstrated abnormal FDG uptake in the pelvic nodes alone in 14 (25%) women, in pelvic and para-aortic nodes in 10 (17.9%), and in neither pelvic nor para-aortic nodes in 32 (57.1%). Women with positive pelvic nodes by PET as well as women with positive para-aortic nodes had significantly poorer 20-month disease-free survival compared to women with negative nodes (P= 0.0003 and P= 0.0017, respectively). We conclude that pretreatment FDG PET scan revealing abnormal FDG uptake consistent with nodal disease is a robust predictor of disease recurrence and may alter the therapeutic management of some patients.     

Undifferentiated carcinoma of the renal pelvis with osteoclast‐like giant cells: a report of two cases

McCash SI, Unger P, Dillon R, Xiao G‐Q. Undifferentiated carcinoma of the renal pelvis with osteoclast‐like giant cells: a report of two cases. APMIS 2010; 118: 407–12. Undifferentiated carcinoma with osteoclast‐like giant cells arising in the urothelium of the bladder or upper urinary tract is an extremely rare entity. The majority of cases found in the renal pelvis and bladder are associated with either an in situ urothelial malignancy or a conventional high‐grade urothelial carcinoma. These malignancies tend to behave poorly with a grim prognosis and course. We report two additional cases of undifferentiated carcinoma with osteoclast‐like giant cells of the renal pelvis in two patients disease free 42 and 18 months after surgical treatment, respectively.     

CARCINOEMBRYONIC ANTIGEN IN RHEUMATIC DISEASES

In an earlier study, the mean plasma carcinoembryonic antigen(CEA) level of patients with seropositive rheumatoid arthritis(RA) was found to be significantly higher than that of normal,control subjects. Levels of CEA in patients with seronegativeRA and ankylosing spondylitis, however, did not differ fromnormal. In this study it was shown that the mean CEA level of 16 patientswith Sjogren's syndrome was also significantly higher than normal(P—0.001), whereas in a group of 23 children with Still'sdisease the mean level fell within the normal adult range. Despitethe apparent association between rheumatoid factor and raisedplasma CEA, no correlation was found between titre of rheumatoidfactor and CEA levels. Gel filtration studies indicated that the CEA in rheumatoidarthritis was of a similar molecular weight to that found incancer of the colon and that there was minimal contributionby the known cross-reacting antigen CCEA2. The mean CEA level in rheumatoid synovial fluids was found tobe significantly higher than in osteoarthrotic fluids. A preliminarystudy has also shown that CEA can be extracted from rheumatoidsynovial membranes but was not detected in a normal synovium,further indicating that the source of this antigen in RA maybe the inflamed synovium. ^*Paper presented at a combined meeting of the British Associationfor Rheumatology and Rehabilitation, the Heberden Society, theRheumatology and Rehabilitation Section of the Royal Societyof Medicine, and the Swiss Society for Rheumatology, Bristol,June 1974.     

MORBIDITY IN MINOR GYNAECOLOGICAL SURGERY: A COMPARISON OF HALOTHANE, ENFLURANE AND ISOFLURANE

A comparison was made between halothane, enflurane and isofluranewith regard to their suitability for minor gynaecological proceduresin patients who would be leaving the hospital within 24 h ofthe anaesthetic. Seventy-five healthy patients were randomlyallotted to one of three groups which received one of theteanaesthetics. In respect of patient acceptance and postoperativemorbidity there were no significant differences between halothaneand enflurane, but after isoflurane there was a significantlygreater frequency of minor sequelae (headache, nausea, dizzinessand coughing) and its pungent odour made it unacceptable tosome patients.