Circulating tumor cells in breast cancer: A tool whose time has come of age

Circulating tumor cells (CTCs) are isolated tumor cells disseminated from the site of disease in metastatic and/or primary cancers, including breast cancer, that can be identified and measured in the peripheral blood of patients. As recent technical advances have rendered it easier to reproducibly and repeatedly sample this population of cells with a high degree of accuracy, these cells represent an attractive surrogate marker of the site of disease.     

Tumefactive foreign body giant cell reaction following high‐pressure paint injection injury: A case report and review of literature

High‐pressure paint injection injury is an uncommon but well‐described injury. The histologic features of long‐term paint injection injury with retained material are less recognized. A 46‐year‐old male presented clinically as “recurrent giant cell tumor of tendon sheath.” The right index finger demonstrated fusiform enlargement by a pigmented mass with diffuse infiltration into the soft tissue of the hand. Histologically the tumor showed multiple giant cells in a fibrotic stroma extending into the dermis. There were multiple types of foreign material including diffuse brown black pigment, weakly optically polarizing foreign material and white inclusions with a “train track” appearance. The cells were positive for CD68 and negative for S100 antigen. Further investigation revealed that the patient had a history of high‐pressure paint injection injury to his digit 6 years prior. Foreign material injected under high pressure into tissues may result in a pseudo‐neoplastic foreign body granulomatous reaction that can mimic giant cell tumor of tendon sheath. Our case demonstrates that this reaction can be florid and can have slow growth over years. A high index of suspicion, a good clinical history and careful examination can distinguish these 2 entities.     

Endocrine disruptors and spontaneous premature labor: a case control study

Background  

Premature labor is a poorly understood condition. Estrogen is thought to play a key role and therefore the labor process may be affected by endocrine disruptors. We sought to determine whether or not an environmental toxicant, DDE, or dietary derived endocrine disruptors, daidzein and genistein, are associated with spontaneous preterm labor.     

Identification of Aedes aegypti and its respective life stages by real-time polymerase chain reaction

An Aedes aegypti-specific, fluorogenic probe hydrolysis (Taq-Man), polymerase chain reaction assay was developed for real-time screening using a field-deployable thermocycler. Laboratory-based testing of A. aegypti, A. aegypti (Trinidad strain), Culex pipiens, Culex quinquefasciatus, Anopheles stephensi, and Ochlerotatus taeniorhynchus individual adult mosquitoes and mixed pools (n = 10) demonstrated 100% concordance in both in vitro sensitivity (six of six samples) and specificity (10 of 10 samples). A single adult A. aegypti was identified in a pool of 100 non-A. aegypti mosquitoes. The limit of detection of A. aegypti egg pools was five individual eggs. Field testing was conducted in central Honduras. An A. aegypti and Culex spp. panel of individual and mixed pools (n = 30) of adult mosquitoes, pupae, and larvae demonstrated 100% concordance in sensitivity (22 of 22 samples) and 97% concordance in specificity (29 of 30 samples), with one false-positive result. Field testing of an A. aegypti and Culex spp. blind panel (n = 16) consisting of individual and mixed pools of adult mosquitoes, pupae, and larvae demonstrated 90% concordance in sensitivity (nine of 10 samples) and 88% concordance in specificity (14 of 16 samples).     

Chronic diseases management in the Jamaican setting: HOPE worldwide Jamaica's experience

The prevalence of hypertension and diabetes in Jamaica is very high. Hypertension is present in 3 out of 10 Jamaicans over the age of 30 years while the prevalence of diabetes mellitus varies between 13% and 18% for Jamaicans over 15 years. HOPE worldwide Jamaica is a 7-year-old private voluntary organization that collaborates with the government of Jamaica to provide a mobile medical service to poor rural communities. The records between January 1999 and December 1999 of 1091 chronic disease patients aged > 30 years were reviewed. The average recorded age of the patients was 64 years and 82% among them were females. 60% had hypertension, 16% had diabetes and 24% had both diabetes and hypertension. There were 2390 visits for hypertension, with an average of 2 visits per patient. 34% of patients had a blood pressure of < or = 140/90 mmHg while 43% had a blood pressure < 160/95 mmHg. Compliance was defined as daily consistency in taking prescribed medication. 44% of the patients with hypertension were non-compliant at the time of their visit. Antihypertensive treatment included thiazide diuretics (65%), reserpine (50%), angiotensin converting enzyme (ACE) inhibitors (30%) and alpha-methyldopa (5%). There were 1122 visits for diabetes, with an average of 2 visits per patient. Among the diabetic patients 23% were controlled to a fasting blood glucose (FBG) level of less than 6.7 mmol/l and 38% to below 8 mmol/l. 30% of the diabetic patients were non-compliant at the time of their visit. The most frequently used oral hypoglycaemic agents were metformin (78%), glyburide (43%) and chlorpropamide (30%). 14% of the diabetic patients were on treatment with insulin: insulin 70/30 (12%) and lente insulin (2%). Electrocardiograms (ECGs) were done in the previous two years on 267 patients (29%), among whom 38% had evidence of left ventricular hypertrophy and 16% of ischaemic heart disease. The level of blood pressure and blood glucose control was inadequate despite the provision of regular monitoring, surveillance and improved access to medication. It is perceived that poor socioeconomic conditions, lack of education, cultural beliefs and some other factors continue to militate against improved compliance and control. HOPE worldwide Jamaica is currently implementing programs to improve patient education, especially in compliance, to provide access to more effective medication with convenient once-daily dosage regimens, and to develop support groups among chronic disease patients in order to improve compliance and control.     

Determination of cancer risk associated with germ line BRCA1 missense variants by functional analysis

Germ line inactivating mutations in BRCA1 confer susceptibility for breast and ovarian cancer. However, the relevance of the many missense changes in the gene for which the effect on protein function is unknown remains unclear. Determination of which variants are causally associated with cancer is important for assessment of individual risk. We used a functional assay that measures the transactivation activity of BRCA1 in combination with analysis of protein modeling based on the structure of BRCA1 BRCT domains. In addition, the information generated was interpreted in light of genetic data. We determined the predicted cancer association of 22 BRCA1 variants and verified that the common polymorphism S1613G has no effect on BRCA1 function, even when combined with other rare variants. We estimated the specificity and sensitivity of the assay, and by meta-analysis of 47 variants, we show that variants with <45% of wild-type activity can be classified as deleterious whereas variants with >50% can be classified as neutral. In conclusion, we did functional and structure-based analyses on a large series of BRCA1 missense variants and defined a tentative threshold activity for the classification missense variants. By interpreting the validated functional data in light of additional clinical and structural evidence, we conclude that it is possible to classify all missense variants in the BRCA1 COOH-terminal region. These results bring functional assays for BRCA1 closer to clinical applicability.     

Trans-obturator surgery for stress urinary incontinence: 1-year follow-up of a cohort of 52 women

This study was a 1-year follow-up of a cohort of 52 women who underwent trans-obturator tape (TOT) procedures using Obtape. Follow-up information was available for 45/52 (87%) women. The rate of erosions was 8/52 (15%). Among 34 women examined, 26% experienced tenderness on palpation of operative site, and 72% were objectively cured on pad test. Forty women completed questionnaires (median Incontinence Impact Questionnaire-7, 0; median Urogenital Distress Inventory-6, 17) and of those, 93% would recommend TOT to a friend. We found a high rate of erosions among our cohort. Our high rate of erosions may be a result of our review of the majority of the cohort, and it is likely related to the specific device used (Obtape). The majority of women were satisfied with the outcome. Before introducing new procedures into widespread clinical practice, it is important to rigorously investigate their outcomes.