bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic prospecting of the Roman military camp at Septimer Pass (Switzerland)
Authors: Fassbinder Jörg W.E. , Sternberg Rob , Zanier Werner , Ebner Doris , Rageth Jürg
Published: November 2014

The Roman military encampment at the Septimer Pass (near Bivio, Switzerland) was located in 2003 using metal detectors. Dating between 15 BCE and 16 CE, the camp was designed for controlling the Pass, and to enable the movement of Roman troops between Italy and the northern province of Raetia. The 2-ha sized site was delineated by topography, aerial photographs, visible fortification walls and ditches, and the locations of finds. Subsequent trench excavations by the Bavarian Academy of Science were limited to 150 m2. Although these excavations provided a better understanding of the construction of the fortification walls, they gave no idea about the overall layout of tents or other buildings. For this study, magnetometry with a cesium-magnetometer in a duo-sensor configuration was used to survey an area of 160x120 m at a sampling interval of 25x50 cm. Some magnetic anomalies suggest geologic lineaments and modern cultural sources. Other anomalies support visual evidence of fortifications, suggest the outline of wooden barracks or contubernia used for military housing, and possibly the locations of watchtowers, pits and fireplaces. The magnetically clean zones between these anomalies correlate with the occurrence of tent nails that were found and cleared by the earlier metal detectorists, suggesting that these areas were primarily used for tents.
The masonries of the Roman bridge of Sant’Antioco (Sardinia, Italy)
Authors: Giannattasio Caterina , Grillo Silvana Maria
Published: November 2014

The bridge of Sant’Antioco is an architectural specialty dating back most probably to Roman origin, interested by many other interventions during the following centuries. It represents a piece of art of a unique road net in its kind, for its function in connecting not only the opposite banks of a river but also a small island with the dry land. Additionally, its architectural design does not have any analogies in other episodes. It has been studied following an interdisciplinary approach, with the aim of combining the historical, architectural and constructive knowledge with methods used in geologic and geochemical investigations, intending to elucidate the various phases that this architectural monument underwent within the course of the centuries. Specifically, the ultimate goal of the present research is to gain a more profound comprehension of this architecture, which is essential to define a correct and qualified restoration and conservation process.
Evaluation of urbanization influences on urban temperature of Nairobi City, Kenya
Authors: Ongoma Victor , Muthama John Nzioka , Gitau Wilson
Published: November 2014

Developing countries are becoming more urbanized leading to modification on climate over the cities. Proper urban atmospheric planning and management are thus fundamental for cities’ sustainability. Urban weather and climate therefore needs continuous monitoring to offer accurate, reliable and timely update of any significant changes. This study examined the long term modification of temperature by urbanization utilizing decadal population data, monthly maximum and minimum temperature and land surface albedo for forty years. The data were subjected to homogeneity test using Short-Cut Bartlett test method that showed both maximum and minimum temperature increasing, though insignificant. Urbanization is evidenced by the reducing land surface albedo and increasing population. The study revealed the influence of urbanization on urban climate. The increase in temperatures is harmful to human comfort. Practical approaches, such as increasing the urban forest cover and a proper planning of the cities, have been suggested to help prevent further modification of weather and urban climate by urbanization. The findings of this work are thus important for multi-sectoral use in the Kenyan cities.
A dynamic model for solar radiation in the Tyrrhenian Basin of Central Mediterranean area
Authors: Naccarato Alessia
Published: November 2014

Studying the level of solar radiation is important for problems related to both environmental pollution and alternative energy development. In this work a space-time model for solar radiation in the Tyrrhenian basin is presented. Three main features of the model must be stressed because of their importance in modelling space-time variability of a phenomenon. The first and most important one is that relations between solar radiation in different sites are an outcome of the model’s estimation procedure. With this approach spatial weights are not bound to be symmetrical and proportional to distance between locations or to be constant over time. The second one is the presence of a simultaneous effect among locations as the solar radiation in one of them is a function of what simultaneously happens in all the other ones. The third main feature of the model is represented by constrained estimation on the basis of a priori knowledge about the phenomenon that allows to cope the problem of the increased number of parameters.
Biphenotypic Acute Leukemia with t(15;17) Lacking Promyelocytic-Retinoid Acid Receptor α Rearrangement
Authors: Saito Makoto , Izumiyama Koh , Mori Akio , Irie Tatsuro , Tanaka Masanori , Morioka Masanobu , Musashi Manabu
Published: November 2014

Biphenotypic acute leukemias (BAL) account for less than 4% of all cases of acute leukemia. Philadelphia chromosome and 11q23 rearrangement are the most frequently found cytogenetic abnormalities. Since t(15;17) is almost always associated with acute promyelocytic leukemia, t(15;17) in BAL cases is extremely uncommon. We report here a rare and instructive case of BAL with t(15;17) and the successful treatment approach adopted. A 55-year old woman was referred to our hospital for an examination of elevated white blood cell (WBC) counts with blasts (WBC 13.4 × 109/L; 76% blasts). The blasts with acute lymphoblastic leukemia (ALL-L2, FAB) morphology coexpressed B-lymphoid and myeloid lineages, and a cytogenetic study revealed 4q21 abnormalities and t(15;17). However, promyelocytic-retinoid acid receptor α rearrangement was not detected by fluorescence in situ hybridization on interphase nuclei. Our patient was treated with chemotherapy for ALL and gemtuzumab ozogamicin without all-trans-retinoic acid, and has remained in hematologic first complete remission for more than 3.7 years.
Serum Thrombopoietin and cMpl Expression in Thrombocytopenia of Different Etiologies
Authors: Vianello Fabrizio , Vettore Silvia , Tezza Fabiana , Toni Luca , Scandellari Raffaella , Sambado Luisa , Treleani Martina , Fabris Fabrizio
Published: November 2014

The relationship between thrombopoietin (TPO) and its receptor cMpl in thrombocytopenic conditions has not been entirely clarified. To elucidate this interplay may expand the spectrum of indications of TPO mimetics. In this study we have explored the relationship between TPO and cMpl in platelets and megakaryocytes of 43 patients with thrombocytopenia due to idiopathic thrombocytopenic purpura (ITP), bone marrow hypoplasia, myelodysplastic syndromes (MDS), and familial thrombocytopenia. Data were compared to cMpl and TPO in patients with a normal platelet count and in patients with thrombocytosis due to essential thrombocythemia (ET). All but familial patients showed higher TPO compared to controls. All thrombocytopenic states were invariably associated with increased expression of platelet cMPL compared to healthy controls. ET patients showed normal TPO and a trend toward a reduced cMpl expression. Immunofluorescence of bone marrow sections from patients with ITP and MDS failed to show a peculiar pattern compared to controls. Multiple mechanisms regulate TPO and cMpl in thrombocytopenic conditions.
Glucose-6-Phosphate Dehydrogenase Deficiency Presented with Convulsion: A Rare Case
Authors: Merdin Alparslan , Avci Fatma , Guzelay Nihal
Published: November 2014

Red blood cells carry oxygen in the body and Glucose-6-Phosphate Dehydrogenase protects these cells from oxidative chemicals. If there is a lack of Glucose-6-Phosphate Dehydrogenase, red blood cells can go acute hemolysis. Convulsion is a rare presentation for acute hemolysis due to Glucose-6-Phosphate Dehydrogenase deficiency. Herein, we report a case report of a Glucose-6-Phosphate Dehydrogenase deficiency diagnosed patient after presentation with convulsion. A 70 year-old woman patient had been hospitalized because of convulsion and fatigue. She has not had similar symptoms before. She had ingested fava beans in the last two days. Her hypophyseal and brain magnetic resonance imaging were normal. Blood transfusion was performed and the patient recovered.
Intracranial Hemorrhage in Patient Treated with Rivaroxaban
Authors: Molina Michelle , Hillard Virany , Fekete Robert
Published: November 2014

Rivaroxaban is an oral factor Xa inhibitor used for stroke prevention in atrial fibrillation. There are currently no evidence-based guidelines for the treatment of hemorrhagic side effects of factor Xa inhibitors. We report a case of a thalamic hemorrhage in an 84 year-old right-handed female on rivaroxaban for treatment of atrial fibrillation. The patient had fallen down steps and became unresponsive. She was found to have diffuse scattered acute subarachnoid hemorrhage as well as intraventricular hemorrhage. Neurosurgical intervention was not required in this case, but controversy over decision making to pursue pro-coagulant therapy in the setting of worsening hemorrhage requiring emergent surgery is discussed.
Hemophagocytic Lymphohistiocytosis and Pelger-Huët Anomaly Associated with Colchicine Intoxication
Authors: Malbora Baris , Polat Emine , Akyuz Sare Gulfem
Published: November 2014

Colchicine is frequently used in the treatment of familial Mediterranean fever (FMF). First symptoms of colchicine intoxication are gastrointestinal disturbances, such as abdominal cramps, diarrhea, pancytopenia and so on. Herein, we report a female FMF patient with pancytopenia and hemophagocytic lymphohitiocytosis (HLH), following colchicine intoxication for committing suicide. To our knowledge, this is the first reported case of a patient with HLH associated with colchicine intoxication.
Intensive Serial Biomarker Profiling for the Prediction of Neutropenic Fever in Patients with Hematologic Malignancies Undergoing Chemotherapy: A Pilot Study
Authors: Chan Steven M. , Chadwick John , Young Daniel L. , Holmes Elizabeth , Gotlib Jason
Published: November 2014

Neutropenic fever (NF) is a life-threatening complication of myelosuppressive chemotherapy in patients with hematologic malignancies and triggers the administration of broad-spectrum antimicrobials. The ability to accurately predict NF would permit initiation of antimicrobials earlier in the course of infection with the goal of decreasing morbid complications and progression to septic shock and death. Changes in the blood level of inflammatory biomarkers may precede the occurrence of NF. To identify potential biomarkers for the prediction of NF, we performed serial meas- urements of nine biomarkers [C-reactive protein (CRP), protein C, interleukin (IL)-6, IL-8, IL-10, IL-1β, tumor necrosis factor-α, monocyte chemotactic protein-1, and intercellular adhesion molecule-1] using a multiplex ELISA array platform every 6-8 hours in patients undergoing myelosuppressive chemotherapy for hematologic malignancies. We found that the blood levels of IL-6 and CRP increased significantly 24 to 48 hours prior to the onset of fever. In addition, we showed that frequent biomarker monitoring is feasible using a bedside micro sample test device. The results of this pilot study suggest that serial monitoring of IL-6 and CRP levels using a bedside device may be useful in the prediction of NF. Prospective studies involving a larger cohort of patients to validate this observation are warranted. This trial is registered at ClinicalTrials.gov (NCT01144793).
Lactobacillus endocarditis with prosthetic material: a case report on non-surgical management with corresponding literature review
Authors: Botros Mena , Mukundan Deepa
Published: November 2014

Lactobacilli are rod shaped gram positive bacteria that naturally colonize the human gastrointestinal and genitourinary tracts and occasionally cause disease in humans. Lactobacillus infections are found in patients who are immunocompromized or have severe comorbidities. We report Lactobacillus endocarditis in a 17-year-old adolescent girl with cardiac prosthetic material following surgical correction for complex cyanotic congenital heart disease. Accurate identification of the organism can be delayed. Despite in vivo susceptibility to vancomycin, our patient clinically failed vancomycin therapy but ultimately responded to a six-week course of penicillin, in addition to a 4-week course of clindamycin and gentamicin. She recovered without the need for surgical intervention and has been symptom free for one year. Upon review of the literature, we found that Lactobacillus endocarditis has not been reported in a pediatric patient with complex cyanotic congenital heart disease.
Disseminated cutaneous herpes zoster in an immunocompetent elderly patient
Authors: Gomez Eric , Chernev Ivan
Published: November 2014

Herpes zoster is a clinical syndrome which usually presents with a localized, vesicular rash in a dermatomal distribution. Cutaneous dissemination rarely occurs in immunocompetent patients, therefore little is known about the baseline demographic, clinical characteristics, management and outcome of these patients. Herein, we report a case of disseminated cutaneous herpes zoster in an immunocompetent patient along with a review and analysis of 28 cases previously reported in the literature.
CTLA-4 expressed by human dendritic cells modulates thei cytokine secretion and induction of T cell proliferation
Authors: Laurent S. , Carrega P. , Saverino D. , Piccioli P. , Camoriamo M. , Morabito A. , Dozin B. , Fontana V. , Simone R. , Mortara L. , Mingari M.C. , Ferlazzo G. , Pistillo M.P.
Published: November 2014

CTLA-4 is the major nefative regulator of T cell response. We have analyzed the expression of CTLA-4 in human monocytes and monocyte-derived DCs and the effects of its engagement on cytokine production and T cell stimulatory activity by mature DCs (mDCs). We found the CTLA-4 was highly expressed on freshly isolated monocytes, then down-modulated on the immature DCs (iDCs) and upregulated on mDCs. Treatment of mDCS with an agonistic anti-CTLA-4 m Ab enhanced secretion of IL-10 but reduced secretion of IL-8 and IL-12, as well as autologous CD4* T-cell proliferation in response to simulation with PPD recall antigenloaded-DCs. Neutralization of IL-10 with an anti-IL-10 antibody partially restored the ability of anti-CTLA-4-treated mDCs to stimulate T cell proliferation in response to PPD. Our data provide the first evidence that CTLA-4 receptor is expressed by human mDCs and exerts immune modulatory effects in these cells.
Decreased mental health care utilization following a psychosocial intervention in caregivers of hematopoietic stem cell transplant patients
Authors: Ouseph Rita , Croy Calvin , Natvig Crystal , Simoneau Teresa , Laudenslager Mark L.
Published: November 2014

Caregivers are known to experience increased morbidity when compared to non-caregivers. Does an intervention targeting caregiver distress affect their health care utilization? One hundred forty-eight caregivers of allogeneic hematopoietic stem cell transplant patients were randomized to treatment as usual (TAU) or a psychoeducation, paced respiration, and relaxation (PEPRR) intervention. Assessments of caregivers’ service utilization were collected at baseline and 1, 3, and 6 months post-transplant. During the first 30 days after patient transplant, caregiver medical and mental health professional service use decreased while support group attendance peaked. Mixed model regressions showed a significant decrease in mental health service use by the PEPRR group (P=0.001). At six months caregivers in TAU had predicted marginal probabilities of mental health services utilization over 10 times as high as caregivers in PEPRR (18.1% vs 1.5%). Groups failed to differ in medical service (P=0.861) or support group (P=0.067) use. We can conclude that participation in PEPRR compared to TAU was associated with reduced mental health service utilization. Caregiver psychosocial support services are critical to improve caregiver outcomes.
Thyrotoxicosis followed by hypothyroidism in a patient on lithium
Authors: Kar Nilamadhab , Hullumane Surabhi R. , Williams Carol
Published: November 2014

While hypothyroidism is common in lithium-treated patients, thyrotoxicosis is rarely reported. We present a female patient on lithium for maintenance therapy of bipolar affective disorder, who developed thyrotoxicosis for few months which was followed by hypothyroidism which continued. There was no further thyrotoxicosis episode during a five year follow up period. While she was treated for thyroid dysfunction, lithium was continued. There was no clinical impact on the maintenance of the bipolar affective disorder during the follow up period; she was maintained well in the community.
Another perspective on fasciculations: when is it not caused by the classic form of amyotrophic lateral sclerosis or progressive spinal atrophy?
Authors: Leite Marco Antonio Araujo , Orsini Marco , De Freitas Marcos R.G. , Pereira João Santos , Gobbi Fábio Henrique Porto , Bastos Victor Hugo , De Castro Machado Dionis , Machado Sergio , Arrias-Carrion Oscar , De Souza Jano Alves , Oliveira Acary Bulle
Published: November 2014

Fasciculations are visible, fine and fast, sometimes vermicular contractions of fine muscle fibers that occur spontaneously and intermittently. The aim of this article is to discuss the main causes for fasciculations and their pathophysiology in different sites of the central/peripheral injury and in particular to disprove that the presence of this finding in the neurological examination is indicative of amyotrophic lateral sclerosis. Undoubtedly, most fasciculations have a distal origin in the motor nerve both in normal subjects and in patients with motor neuron disease. Most of them spread to other dendritic spines often producing an antidromic impulse in the main axon. The clinical and neurophysiological diagnosis must be thorough. It may often take long to record fasciculations with electroneuromyography. In other cases, temporal monitoring is necessary before the diagnosis. The treatment, which may be adequate in some cases, is not always necessary
Severe orthostatic hypotension due to unilateral carotid artery dissection
Authors: Ishii Nobuyuki , Mochizuki Hitoshi , Taniguchi Akitoshi , Shiomi Kazutaka , Nakazato Masamitsu
Published: November 2014

A 46-year-old woman was admitted to our hospital with mild right-sided hemiparesis and orthostatic hypotension. Magnetic resonance angiography of the neck showed stenosis of the left distal carotid sinus surrounded by intraluminal hyperintensities on both T1-weighted and T2-weighted images, representing a periluminal hematoma secondary to carotid artery dissection. The dissection hyperextended the carotid artery wall and stimulated baroreceptors in the carotid sinus. The stimulated baroreceptors induced carotid sinus hypersensitivity, which may have been related to her orthostatic hypotension. Post-stroke orthostatic hypotension should prompt consideration of carotid artery dissection.
West Nile virus encephalitis induced opsoclonus-myoclonus syndrome
Authors: Cooper Chad J. , Said Sarmad
Published: November 2014

West Nile virus (WNV) is an arthropod borne neurotropic single stranded RNA flavivirus with <1% developing presenting with neurological disease. Immunocompromised and elderly patients are more prone to developing WNV meningitis or encephalitis. Definitive diagnosis of WNV meningoencephalitis is a combination of clinical suspicion and cerebrospinal fluid (CSF) serology. Forty-eight year old Caucasian female presented with a sudden onset of altered mental status after being found unresponsive. She was confused with intermittent bouts of alertness/lethargy and unintelligible responses to questioning. Her medical problems included endometrial cancer that was in remission after undergoing a total abdominal hysterectomy with bilateral salpingectomy and postoperative chemotherapy with paclitaxel and carboplatin. Pertinent physical examination revealed muscle strength that was significantly decreased, nuchal rigidity and +2 pitting edema of both lower extremities. Computed tomography and magnetic resonance imaging of the brain were negative for any intracranial pathology. CSF analysis was consistent with aseptic meningitis with all CSF serology being negative except for positive WNV antibody. A few days after being admitted she developed involuntary random movements of her eyes and generalized jerking movements (myoclonus). This was determined to be opsoclonus myoclonus syndrome (OMS) induced by the WNV meningoencephalitis. She then received five consecutive days of plasmapheresis with a significant improvement in her neurological status. Opsoclonusmyoclonus syndrome (OMS) is a rare neurological disorder associated with chaotic multidirectional eye movements, myoclonus and less frequently cerebellar ataxia. OMS affects as few as 1 in 10,000,000 people per year. The pathogenesis is not fully understood with the majority of cases of opsoclonus-myoclonus syndrome being idiopathic. According to current medical literature there have only been two previous case reports of opsoclonus myoclonus syndrome associated with WNV encephalitis.
Moyamoya in Hispanics: not only in Japanese
Authors: Said Sarmad , Cooper Chad J. , Alkhateeb Haider , Galvis Juan M. , Hernandez German T. , Salameh Hasan J.
Published: November 2014

Moyamoya disease was first described in 1957 as hypoplasia of the bilateral internal carotid arteries, the characteristic appearance of the associated network of abnormally dilated collateral vessels on angiography was later likened to something hazy, like a puff of cigarette smoke, which, in Japanese, is moyamoya. This paper describes two cases of moyamoya presentations, including moyamoya disease and moyamoya syndrome. Moyamoya may rarely occur in North American Hispanic patients. The presentation can vary significantly and ranges bwtween fulminant outcome and prolonged survival. Awareness about moyamoya and its different presentations may be beneficial for the patients and can improve the outcome.
Unihemispheric burst suppression
Authors: Mader Jr. Edward C. , Villemarette-Pittman Nicole R. , Rogers Cornel T. , Torres-Delgado Frank , Olejniczak Piotr W. , England John D.
Published: November 2014

Burst suppression (BS) consists of bursts of high-voltage slow and sharp wave activity alternating with periods of background suppression in the electroencephalogram (EEG). When induced by deep anesthesia or encephalopathy, BS is bihemispheric and is often viewed as a non-epileptic phenomenon. In contrast, unihemispheric BS is rare and its clinical significance is poorly understood. We describe here two cases of unihemispheric BS. The first patient is a 56-year-old woman with a left temporoparietal tumor who presented in convulsive status epilepticus. EEG showed left hemispheric BS after clinical seizure termination with lorazepam and propofol. The second patient is a 39-year-old woman with multiple medical problems and a vague history of seizures. After abdominal surgery, she experienced a convulsive seizure prompting treatment with propofol. Her EEG also showed left hemispheric BS. In both cases, increasing the propofol infusion rate resulted in disappearance of unihemispheric BS and clinical improvement. The prevailing view that typical bihemispheric BS is non-epileptic should not be extrapolated automatically to unihemispheric BS. The fact that unihemispheric BS was associated with clinical seizure and resolved with propofol suggests that, in both cases, an epileptic mechanism was responsible for unihemispheric BS.
Hormonal Response and Root Architecture in Arabidopsis thaliana Subjected to Heavy Metals
Authors: Vitti Antonella , Nuzzaci Maria , Scopa Antonio , Tataranni Giuseppe , Tamburrino Imma , Sofo Adriano
Published: November 2014

In this work, specific concentrations of cadmium, copper and zinc in double combination, were supplied for 12 days to growing seedlings of the model species Arabidopsis thaliana. Metal accumulation was measured in roots and shoots. Microscopic analyses revealed that root morphology was affected by metals, and that the root and shoot levels of indole-3-acetic acid, trans-zeatin riboside and dihydrozeatin riboside varied accordingly. Minor modifications in gibberellic acid levels occurred in the Zinc treatments, whereas abscisic acid level did not change after the exposition to metals. Reverse transcription polymerase chain reaction analysis of some genes involved in auxin and cytokinin synthesis (AtAAO, AtNIT and AtIPT) revealed that their expression were not affected by metal treatments. The root morphological alterations that resulted in an increased surface area, due to the formation of root hairs and lateral roots, could be signs of the response to metal stress in terms of a functionally-addressed reorientation of root growth. The root system plasticity observed could be important for better understanding the manner in which the root architecture is shaped by environmental and hormonal stimuli.
Metabolic Response of Adenocalymma peregrinum during Regeneration of the Aerial Parts
Authors: dos Santos Vanessa Samudio , Marques Maria Rita , Gouvea Dayana Rubio , Lopes Norberto Peporine , de Paiva Neto Vespasiano Borges , Carollo Carlos Alexandre
Published: November 2014

Adenocalymma peregrinum, popularly known as ciganinha, is an aggressive pasture invader. This species has a vegetative propagation mechanism that includes aerial latent buds and subterranean stalks activated by cuts and other lesions. In the present study, we evaluated the levels of cytokinins and secondary metabolites in A. peregrinum during regeneration of the aerial part. Plants used in this experiment were established in the field and were cut at intervals of five days until the 25th day. The regeneration of the cut plants started on the 10th day after the first cut. Among observed compounds, only kinetin, allantoin and the iridoide 6-β-hydroxyipolamiide were detected at adequate levels for comparative evaluation. The maximum levels of these compounds coincided with the beginning of regeneration in these plants, indicating the involvement of these compounds in the regeneration process.
Double layer anisotropy beneath the New Madrid seismic zone and adjacent areas: insights from teleseismic shear wave splitting
Authors: Moidaki Moikwathai Dax
Published: November 2014

A total of 93 well-defined PKS, 54 SKKS, and 126 SKS shear-wave splitting parameters are determined at 25 broadband seismic stations in an approximately 1000 by 1000 km2 area centered at the New Madrid seismic zone (NMSZ) in order to test the existence of two anisotropic layers and to map the direction and strength of mantle fabrics. The individual splitting parameters suggest a significant and systematic spatial and azimuthal variation in the splitting parameters. The azimuthal variations at most stations can be explained as the results of present SW ward asthenospheric flow and NNE trending lithospheric fabrics formed during past orogenic events. In the NMSZ, rift-parallel fast directions (potentially related to a long-rift flow) and rift-orthogonal fast directions from small-scale mantle convection are not observed. In addition, reduction in splitting times as a result of vertical asthenospheric flow is not observed.
Near-field tsunami early warning and emergency planning in the Mediterranean Sea
Authors: Papadopoulos Gerassimos A. , Fokaefs Anna
Published: November 2014

The new European project Near-field Tsunami Early Warning and Emergency Planning in the Mediterranean Sea (NEARTOWARN) faces the need to develop operational tsunami early warning systems in near-field (local) conditions where the travel time of the first tsunami wave is very short, that is less than 30 min, which is a typical case in the North East Atlantic and the Mediterranean Sea region but also elsewhere around the globe. The operational condition that should be fulfilled is that the time of tsunami detection, plus the time of warning transmitting, plus the time of evacuation should not exceed the travel time of the first tsunami wave from its source to the closest evacuation zone. To this goal the time to detect of the causative earthquake should be compressed at the very minimum. In this context the core of the proposed system is a network of seismic early warning devices, which activate and send alert in a few seconds after the generation of a near-field earthquake, when a seismic ground motion exceeding a prescribed threshold is detected. Then civil protection mobilizes to manage the earthquake crisis but also to detect and manage a possible tsunami through a geographical risk management system. For the tsunami detection the system is supported by tide-gauges of radar type, a database of presimulated tsunami scenarios, and a local tsunami decision matrix. The island of Rhodes in the eastern termination of the Hellenic Arc and Trench has been selected for a pilot and operational development of the local tsunami warning system given that the island is a highly popular tourist destination, historically it was hit by large tsunamigenic earthquakes and was recently the master test-site for the pan-European FP6 tsunami research project Tsunami Risk ANd Strategies For the European Region (TRANSFER).
Atypical Choroid Plexus Papilloma Treated with Single Agent Bevacizumab
Authors: Kamar Francois G. , Kairouz Victor F. , Nasser Selim M. , Faddoul Sami G. , Saikali Ibrahim C.
Published: November 2014

Choroid plexus papillomas (CPPs) are usually not malignant and occur in less than 1% of brain tumors in patients of all ages. They represent 3% of childhood intracranial neoplasms with a predilection in younger ages. Papillomas have an indolent course and carry a good long-term outcome if gross total surgical resection is achieved. However malignant evolution may occur, with a 10-30% incidence. Chemotherapy has been used with varied degrees of success. Most series are very small, some are only limited to case reports and cannot lead to guidelines or therapeutic recommendations. We are reporting the first case of recurrent CPP treated with 5 mg/kg of bevacizumab administered once every two weeks. Complete patient evaluations with follow-up contrast-enhanced magnetic resonance imaging (MRI) scans were obtained after the initial two treatments and every 8 weeks thereafter. Only after two treatments, the MRI scans showed radiological stabilization of the tumor, and the patient achieved an excellent clinical response with significant resolution of all skin lesions.
Renal Cell Carcinoma with Rhabdoid and Sarcomatoid Features Presented as a Metastatic Thigh Mass with an Unusual Immunohistochemical Profile
Authors: Abdou Asmaa Gaber , Kandil Mona , Elshakhs Soliman , El-Dien Marwa Serag , Abdallah Rania
Published: November 2014

Renal cell carcinoma (RCC) may metastasize anywhere in the body and sometimes the primary tumor is missing and necessitates extensive investigations to detect. In this report, we describe a case of RCC metastasizing to the thigh in a 70 year old male with a highly pleomorphic morphology suggesting a high grade sarcoma that showed unequivocal positivity for desmin directing the diagnosis for pleomorphic rhabdomyosarcoma. After completion of 33 cycles of radiotherapy, the patient developed large intraabdominal mass that showed conventional areas of RCC with immunoreactivity for CD10, CK, EMA, carbonic anhydrase IX and vimentin. The tumor cells in other areas resembled that of thigh mass which raised suspicions whether the two masses represented the same tumor or not. Surprisingly, the tumor cells of thigh mass showed diffuse positivity for CD10 and focal expression for CK, EMA and carbonic anhydrase IX. Extensive investigations failed to detect any primary renal lesions. The present case demonstrated that RCC can metastasize to virtually any body site and can have significant morphologic overlap with other non-renal neoplasms. Absence of primary origin of RCC according to radiological and operative data should not hinder the diagnosis of metastatic RCC. RCC with sarcomatoid and rhabdoid features carries aggressive behavior manifested by great metastatic potential and short survival time.
Primary Leiomyosarcoma of Peritoneal Cavity
Authors: Bharti Jyotsna Naresh , Dey Biswajit , Desai Parth , Gupta Richa , Khurana Nita , Gandhi Gauri
Published: November 2014

Leiomyosarcomas of soft tissue are the rare tumors and the retroperitoneum is the most common site involved. We report a case of primary leiomyosarcoma of the peritoneal cavity which clinically presented with suprapubic, freely mobile, nontender mass which measured 10×10 cm in size. Contrast enhanced computed tomography revealed well defined heterogenous hypodense solid cystic mass. The mass was surgically excised out in its entirety. The histopathological examination revealed spindle cells arranged in alternating fascicles having pleomorphic nuclei, indistinct margin and eosinophilic cytoplasm with foci of haemorrhage, necrosis and 5-6 mitosis/HPF. The spindle cells were immunoreactive for smooth muscle actin, desmin and negative for S-100, CD-34 and c-kit. Histopathology and immunohistochemistry were helpful in making the final confirmatory diagnosis. Leiomyosarcomas are aggressive tumors, with poor prognosis and often difficult to treat. The survival rates are lowest among all soft tissue sarcomas.
Proton Beam Therapy for a Patient with a Giant Thymic Carcinoid Tumor and Severe Superior Vena Cava Syndrome
Authors: Sugawara Kaori , Mizumoto Masashi , Numajiri Haruko , Ohno Toshiki , Ohnishi Kayoko , Ishikawa Hitoshi , Okumura Toshiyuki , Sakurai Hideyuki
Published: November 2014

Surgical resection is the first choice for treatment of a thymic carcinoid tumor and radiotherapy is often performed as adjuvant therapy. Here, we report a case of an unresectable and chemoresistant thymic carcinoid tumor that was treated successfully using standalone proton beam therapy (PBT). The patient was a 66-year-old woman in whom surgical resection of the tumor was impossible because of cardiac invasion. Therefore, chemotherapy was administered. However, the tumor grew to 15 cm in diameter and she developed severe superior vena cava (SVC) syndrome. She was referred to our hospital and received PBT at a dose of 74 GyE in 37 fractions. PBT was conducted without severe early toxicities. After PBT, the tumor mildly shrunk to 13 cm in diameter and SVC syndrome almost disappeared. Subsequently, the tumor has continued to decrease in size slowly over the last 2 years and late toxicities have not been observed. Our experience with this case suggests that PBT may be effective for an unresectable thymic carcinoid tumor.
A Case Series of Transformation of Teratoma to Primitive Neuroectodermal Tumor: Evolving Management of a Rare Malignancy
Authors: Dunne Richard F. , Sahasrabudhe Deepak M. , Messing Edward M. , Jean-Gilles Jerome , Fung Chunkit
Published: November 2014

Primitive neuroectodermal tumor (PNET) is a pathologic diagnosis that encompasses several different tumor types, including central nervous system tumors and Ewing's sarcomas. Teratoma, a common element of germ cell tumor (GCT), has the ability to transform to malignant PNET in a small number of patients. Making a definitive diagnosis of PNET is difficult given its deviation from elements of GCT and its non-specific pathologic findings. Establishing the diagnosis is crucial as PNETs respond poorly to standard platinum-based chemotherapy used for treatment of GCT. Primary treatment for PNET is surgical, though this is often not feasible in many patients due to extensive disease at diagnosis. As an alternative, chemotherapy regimens traditionally used for Ewing's sarcoma, such as vincristine, doxorubicin and cyclophosphamide alternating with ifosfamide and etoposide, have shown limited efficacy in the neoadjuvant, adjuvant, and palliative settings. Future research should delineate the genetic underpinnings of PNET and develop therapeutic options accordingly.
Intrameningioma Metastasis of Breast Carcinoma
Authors: Sayegh Eli T. , Henderson Grant A. , Burch Ezra A. , Reis Gerald F. , Cha Soonmee , Oh Taemin , Bloch Orin , Parsa Andrew T.
Published: November 2014

Tumor-to-tumor metastasis of breast carcinoma to meningioma is a rare phenomenon. It is likely underdiagnosed given the relatively high prevalence and comorbidity of these two primary tumor types, the lack of standardized methodologies for its diagnosis, and the tendency to obfuscate this lesion with simple meningioma or cerebral metastasis of breast carcinoma. Careful histopathologic study of the resected meningioma is the cornerstone of diagnosis of these lesions, although certain conventional radiological features along with specialized modalities may clue the diagnosis. Vigilance for this lesion is appropriate in selected patients with known breast cancer or meningioma, as the two are often coexistent in the same patient, permitting tumor-to-tumor metastasis. Detection of this rare disease process may alter the treatment plan and prognosis. Here, we report a case of breast carcinoma-to-meningioma metastasis in a patient who developed subacute neurological decline while undergoing long-term treatment of her primary, late-stage breast cancer.
Dedifferentiated Giant-Cell Tumor of Bone with an Undifferentiated round Cell Mesenchymal Component
Authors: Estrada-Villaseñor Eréndira G. , Cortés-González Socorro , Linares-González Luis Miguel , González-Guzmán Roberto , Rico-Martínez Genaro
Published: November 2014

The dedifferentiated giant-cell tumor of the bone is a very rare variant of the giant-cell tumor (GCT). We report the clinical, radiographic and histological findings of a dedifferentiated GCT in which the dedifferentiated component consisted of small round cells. We also comment on previously reported cases of dedifferentiated GCT, discuss the clinical implications of this dual histology, and analyze the information published about the coexistence of similar genetic abnormalities in GCT and small round cell tumors of the bone.
Clear Cell Hidradenoma of Breast Mimicking Atypical Breast Lesion: A Diagnostic Pitfall in Breast Cytology
Authors: Sehgal Shelly , Goyal Prashant , Ghosh Soumyesh , Mittal Deepti , Kumar Awanindra , Singh Sompal
Published: November 2014

Clear cell hidradenoma (CCH) is an uncommon skin adnexal tumor arising from eccrine glands. Although several kind of skin adnexal tumors arise in the breast tissue, CCH of the breast is an extremely rare entity. Failure to identify its cytomorphologic features and rarity of this tumor may lead to misdiagnosis on fine needle aspiration cytology. Hereby we report a case of 30-year-old female who presented with painless lump in left breast since 10 months. Fine needle aspiration cytology of lump yielded fluid material. On May-Grunwald-Giemsa stained smears, a possibility of atypical breast lesion was considered and patient was advised a biopsy examination. Final diagnosis of CCH was made on histopathologic examination. Awareness of cytomorphologic features of breast CCH will prevent misdiagnosis as malignant or atypical breast lesions and will allow for correct management of the patients.
Cutaneous Lymphadenoma: A Rare Case and Brief Review of a Diagnostic Pitfall
Authors: Yu Ryan , Salama Samih , Alowami Salem
Published: November 2014

We report a case of cutaneous lymphadenoma on the posterior left ear of a 67-year-old woman. Although it is benign, recognition of cutaneous lymphadenoma is important as it presents a diagnostic pitfall to the unsuspecting dermatologist and general surgical pathologist, who may readily misdiagnose the lesion because it is not only very rare, but also clinically and histologically resembles the far more common and locally destructive basal cell carcinoma.
Metastatic Angiosarcoma and Kasabach-Merritt Syndrome
Authors: Massarweh Suleiman , Munis Aun , Karabakhtsian Rouzan , Romond Edward , Moss Jessica
Published: November 2014

Angiosarcomas are exceedingly rare tumors that are often difficult to diagnose. Exceptionally unusual is the presentation of these tumors with Kasabach-Merritt Syndrome, a curious form of intratumoral coagulation that can be impossible to distinguish from intravascular coagulation, which is more common. Instant recognition of this clinical association can help making a prompt diagnosis and timely initiation of therapy.
Diffuse Intestinal Submucosal Lipomatosis with Incidental Epidermal Inclusion Cyst of Caecum Clinically Masquerading as Carcinoma Caecum
Authors: Thakur Brijesh , Kishore Sanjeev , Bhardwaj Aparna , Kudesia Sandip
Published: November 2014

Symptomatic diffuse submucosal intestinal lipomatosis is a rare entity. Also few cases of epidermal inclusion cyst of caecum have been reported in literature. Here, we are presenting a rare case of intestinal submucosal lipomatosis with coincidence of epidermal inclusion cyst of caecum and presumptively diagnosed as carcinoma of ileocaecal region during surgery in a 55 years old male. Both are rare entity considering the location even they should be kept as a differential diagnosis in unusual cases of intestinal perforations with inconclusive radiological findings or clinical uncertainity.
Spinal Drop Metastasis in Myxopapillary Ependymoma: A Case Report and a Review of Treatment Options
Authors: Bates James E. , Peterson Carl R. , Yeaney Gabrielle A. , Walter Kevin A. , Lundquist Thomas , Rosenzweig Douglas , Milano Michael T.
Published: November 2014

Myxopapillary ependymoma (MPE) is a World Health Organization grade I ependymoma that is quite rare and generally thought to be benign. Possible drop metastasis from MPE has been reported three times in the literature; in each case there were cotemporaneous additional MPE lesions. We report the case of a man who had a piecemeal gross total resection of a MPE at L1-L3 followed by adjuvant external beam radiotherapy (EBRT) who presented sixteen months later with a lesion in the thecal sac consistent with drop metastasis. A subtotal resection and adjuvant EBRT were performed. The patient has been disease-free in follow-up 27 months from the second surgery. A review of the literature regarding the treatment for MPE showed that gross total resection is optimal initial management. Several retrospective studies supported the role of adjuvant radiotherapy in enhancing local control and progression-free survival. Chemotherapy has a minimal role in the management of MPE.
Bilateral Sertoli-Leydig Cell Tumor in a Primigravida: A Rare Case
Authors: Tyagi Ruchita , Agrawal Parimal , Nijhawan Raje , Prasad GRV
Published: November 2014

We present a unique case of incidentally discovered bilateral Sertoli Leydig cell tumour in a primigravida who displayed no features of virilization. The apha fetoprotein levels were elevated. Magnetic resonance imaging was suggestive of ovarian tumors, possibly germ cell tumor. Bilateral salpingo-oophorectomy was performed and histopathology showed features of Sertoli Leydig cell tumor with intermediate to poor differentiation. Immunohistochemistry was positive for calretinin and inhibin, while cytokeratin was negative. Four courses of bleomycin-, etoposide- and cisplatin-based chemotherapy regimen was started, but the patient aborted while receiving the second cycle of chemotherapy. She received the remaining two cycles of chemotherapy and is now on close follow up with monitoring of serum inhibin levels to detect any tumor recurrence. Bilateral Sertloli Leydig cell tumor has not been reported previously in a pregnant female. The aim of this article is to describe the clinical, radiological and pathological features and management of this rare entity.
History of the Rare Cancer Network and past Research
Authors: Mirimanoff René-Olivier , Ozsahin Mahmut , Thariat Juliette , Ozyar Enis , Schick Ulrike , Pehlivan Berrin , Krengli Marco , Pellanda Alessandra Franzetti , Vees Hansjörg , Cai Ling , Scandolaro Luciano , Belkacemi Yazid , Villà Salvador , Igdem Sefik , Lutsyk Myroslav , Miller Robert C.
Published: November 2014

Approximately, twenty years ago, the Rare Cancer Network (RCN) was formed in Lausanne, Switzerland, to support the study of rare malignancies. The RCN has grown over the years and now includes 130 investigators from twenty-four nations on six continents. The network held its first international symposium in Nice, France, on March 21-22, 2014. The proceedings of that meeting are presented in two companion papers. This manuscript reviews the history of the growth of the RCN and contains the abstracts of fourteen oral presentations made at the meeting of prior RCN studies. From 1993 to 2014, 74 RCN studies have been initiated, of which 54 were completed, 10 are in progress or under analysis, and 9 were stopped due to poor accrual. Forty-four peer reviewed publications have been written on behalf of the RCN.
Multicentric Castleman's Disease and Kaposi's Sarcoma in a HIV-Positive Patient on Highly Active Antiretroviral Therapy
Authors: Ortega Lauro , Cooper Chad J. , Otoukesh Salman , Mojtahedzadeh Mona , Didia Claudia S. , Torabi Alireza , Nahleh Zeina
Published: November 2014

Castleman's disease is a group of rare lymphoproliferative disorders. The plasmablastic multicentric Castleman's disease is frequently discovered in HIV-infected individuals in association with Kaposi sarcoma (HHV-8). Thirty-five year old male presented to our care with the main compliant of severe back pain for one week. His past medical problems include acquired immune deficiency syndrome diagnosed 12 years prior and Kaposi sarcoma, currently on highly active antiretroviral therapy (HAART). Radiographic imaging revealed hepatomegaly and diffuse lymphadenopathy. The HIV viral load was <20 polymerase chain reaction copies/mL, absolute CD4 count was 453 cells/mcL (490-1740 cells/mcL) and CD8 count was 4142 cells/mcL (180-1170 cells/ mcL). Excisional biopsy of the left supraclavicular lymph node was performed with pathological findings of HHV8+ Kaposi sarcoma in the background of multicentric Castleman's disease (plasmacytic variant). No evidence of transformation into large B-cell or plasmablastic lymphoma was noted. He was discharged on HAART and follow up to receive chemotherapy with cyclophosphamide, adriamycin, vincristine plus prednisone was started and rituximab plus prophylaxis for pneumocystis carinii. Multicentric Castleman's disease has become more relevant in recent years due to its association with HIV and HHV-8 (Kaposi sarcoma) and its potential to progress into plasmablastic B-cell lymphoma. The progression of MCD to B-cell lymphoma is a concern, especially in patients with HIV infection because it precludes the worst outcome and a high mortality, despite treatment. The most intriguing part of this case is that MCD occurred in a HIV-positive on HAART. This case signals a warning that a high suspicion for MCD can be justified even in those HIV-positive patients on HAART because the possibly of progression to plasmablastic B-cell lymphoma.
A Technical Tip in Microlipofilling
Authors: Bernardi Claudio , Giordani Colpo Paula
Published: November 2014

Lipofilling has become a very important tool in plastic surgery today, since the first experience of autologous fat graft described more than one hundred years ago. Technical developments have led to a more delicate procedure called microlipofilling, in which thin cannulas or needles are used. A frequently discussed technical difficulty is how to inject with a small cannula the fat collected with a larger one. The authors describe their personal maneuver to resolve the above mentioned problem.